Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K38/00—Medicinal preparations containing peptides
  • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
  • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
  • A61K38/22—Hormones
  • A61K38/2278—Vasoactive intestinal peptide [VIP]; Related peptides (e.g. Exendin)
• • 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
  • A61K31/13—Amines
  • A61K31/155—Amidines (), e.g. guanidine (H2N—C(=NH)—NH2), isourea (N=C(OH)—NH2), isothiourea (—N=C(SH)—NH2)
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/04—Anorexiants; Antiobesity agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P3/00—Drugs for disorders of the metabolism
  • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
  • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
• • 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

• Subject of the present invention is a pharmaceutical combination for use in the treatment of a diabetes type 2 patient, said combination comprising (a) desPro 36 Exendin-4(1-39)-Lys 6 -NH 2 (AVE0010, lixisenatide) or/and a pharmaceutically acceptable salt thereof, and (b) metformin or/and a pharmaceutically acceptable salt thereof, wherein the compound (a) is administered once daily before an evening meal.
• Yet another aspect is a method for treatment of diabetes type 2 patients, said method comprising administering desPro 36 Exendin-4(1-39)-Lys 6 -NH 2 or/and a pharmaceutically acceptable salt thereof, in combination with metformin to a subject in need thereof, wherein compound (a) is administered once daily before an evening meal.
• diabetes type 2 In contrast to diabetes type 1 , there is not generally a lack of insulin in diabetes type 2 but in many cases, particularly in progressive cases, the treatment with insulin is regarded as the most suitable therapy, if required in combination with orally administered anti-diabetic drugs.
• BMI body mass index
• Metformin is a biguanide hypoglycemic agent used in the treatment of non- insulin-dependent diabetes mellitus (diabetes mellitus type 2) not responding to dietary modification. Metformin improves glycemic control by improving insulin sensitivity and decreasing intestinal absorption of glucose. Metformin is usually administered orally. However, control diabetes mellitus type 2 in obese patients by metformin may be insufficient. Thus, in these patients, additional measures for controlling diabetes mellitus type 2 may be required.
• the compound desPro 36 Exendin-4(1 -39)-Lys 6 -NH 2 (AVE0010, lixisenatide) is a derivative of Exendin-4.
• AVE0010 is disclosed as SEQ ID NO:93 in WO 01/04156:
• SEQ ID NO: 2 Exendin-4 (39 AS)
• Exendins are a group of peptides which can lower blood glucose concentration.
• the Exendin analogue AVE0010 is characterised by C- terminal truncation of the native Exendin-4 sequence.
• AVE0010 comprises six C-terminal lysine residues not present in Exendin-4.
• AVE0010 includes pharmaceutically acceptable salts thereof.
• pharmaceutically acceptable salts of AVE0010 A preferred pharmaceutically acceptable salt of AVE0010 employed in the present invention is acetate.
• FPG Fasting plasma glucose
• a first aspect of the present invention is a pharmaceutical combination for use in the treatment of a diabetes type 2 patient, said combination comprising
• administration before an evening meal in particular refers to administration in a range from about 4 h, from about 3h, from about 2h, from about 1h 30 min to about 15 min, to about 30 min, or to about 40 min before the evening meal, or about 1 hour before the evening meal.
• a further aspect of the present invention is a pharmaceutical combination for use in the treatment of a diabetes type 2 patient, said combination comprising
• administration before a morning meal in particular refers to administration in a range from about 4 h, from about 3h, from about 2h, from about 1 h 30 min to about 15 min, to about 30 min, or to about 40 min before the morning meal, or about 1 hour before the morning meal.
• desPro Exendin-4(1 -39)-Lysg-NH 2 or/and a pharmaceutically acceptable salt may be administered in an add-on therapy to administration of metformin.
• the subject to be treated by the medicament of the present invention may be an adult subject.
• the subject may have an age of at least 18 years of may have an age in the range of 18 to 80 years, of 18 to 50 years, or 40 to 80 years, or 50 to 60 years.
• the subject may be younger than 50 years.
• the analysis included measurements obtained up to 3 days after the last dose of the double-blind investigational product injection on or before Visit 12 (Week 24), or Day 169 if Visit 12 (Week 24) is not available.
• the analysis included measurements obtained up to 3 days after the last dose of the double-blind investigational product injection on or before Visit 12 (Week 24), or Day 169 if Visit 12 (Week 24) is not available.
• Treatment with lixisenatide also improved post-prandial glycemic control as shown by the results for 2-hour Post-Prandial Glucose (PPG) and for glucose excursion in the morning injection arms (meal test was not performed in the evening injection arms).
• 2-hour PPG was significantly decreased from baseline to Week 24 in the lixisenatide arm, compared to the placebo arm with a LS mean difference of -4.51 mmol/L (p- value O.0001).
• PPG 2-hour post-prandial plasma glucose
• FPG Fasting plasma glucose
• FPI Fasting plasma insulin
• the approximate minimum double-blind study duration per patient was 79 weeks (up to 2 weeks screening + 1 week run-in + 24 weeks main double-blind treatment + variable extension + 3 days follow-up).
• a 4-week follow-up was performed in patients from the morning injection arms only.
• Patients who completed the 24- week main double-blind period underwent a variable double-blind extension period, which ended for all patients approximately at the scheduled date of week 76 visit (V25) for the last randomized patient.
• the standardized meal challenge test was performed in patients in the morning injection arms only.
• the safety analysis was based on the reported TEAEs and other safety information including symptomatic hypoglycemia and severe symptomatic hypoglycemia, local tolerability at injection site, allergic events (as adjudicated by ARAC), suspected pancreatitis, increased calcitonin, vital signs, 12-lead ECG and laboratory tests.
• CAC Cardiovascular events Adjudication Committee
• sample size/power calculations were performed based on the primary efficacy variable, absolute change from baseline to week 24 in HbAi c .
• a total of 680 patients (255 in each lixisenatide morning or evening injection arm and 85 in each placebo morning or evening injection arm) provided a power of 97% (or 87%) to detect a difference of 0.5% (or 0.4%) in the absolute change in HbA ]c from baseline to Week 24 between lixisenatide and placebo.
• This calculation assumed a common standard deviation of 1.3% with a 2sided test at the 5% significance level.
• the sample size calculations were based upon the 2 sample t test and made using nQuery® Advisor 5.0. Standard deviation was estimated in a conservative manner from previously conducted diabetes studies (based on published data of similarly designed study and on internal data, not published), taking into account early dropout.
• the modified intent-to-treat (mlTT) population consisted of all randomized patients who received at least one dose of double-blind investigational product (IP), and had both a baseline assessment and at least one post-baseline assessment of efficacy variables.
• the safety population was defined as all randomized patients who took at least one dose of the double-blind IP.
• the primary efficacy variable (change in HbA from baseline to Week 24) was analyzed using an analysis of covariance (ANCOVA) model with treatment arms (morning injection lixisenatide and placebo arms, evening injection lixisenatide and placebo arms), randomization strata of screening HbAi c ( ⁇ 8.0, >8.0%), randomization strata of screening BMI ( ⁇ 30, >30 kg/m 2 ) values, and country as fixed effects and using the baseline HbAi c values as a covariate. Differences between each lixisenatide arm and the placebo combined group and its two-sided 95% confidence intervals as well as p-value were estimated within the framework of ANCOVA.
• ANCOVA covariance
• the morning and evening injection placebo arms were included as separate treatments, but combined as one group when presenting results and making comparisons using appropriate contrast (e.g., [0.5, - 0.5, 1, 0] in the order of placebo morning injection, placebo evening injection, lixisenatide morning injection and lixisenatide evening injection when comparing the lixisenatide morning injection arm with the placebo combined group).
• appropriate contrast e.g., [0.5, - 0.5, 1, 0] in the order of placebo morning injection, placebo evening injection, lixisenatide morning injection and lixisenatide evening injection when comparing the lixisenatide morning injection arm with the placebo combined group.
• a stepwise testing procedure was applied in order to ensure type I error control. First, morning injection lixisenatide arm was compared to the combined placebo group (primary objective). If the test was statistically significant, the evening injection lixisenatide arm would be compared to the combined placebo group (secondary objective).
• the primary analysis of the primary efficacy variable was performed based on the mlTT population and the measurements obtained during the main 24-week double-blind on-treatment period for efficacy variables.
• the main 24week double-blind on-treatment period for efficacy variables except those from the standardized meal test was defined as the time from the first dose of the double-blind IP up to 3 days (except for FPG, FPI, and ⁇ by central laboratory, which was up to 1 day) after the last dose of the double-blind IP injection on or before Visit 12/Week 24 visit (or Day 169 if Visit 12/Week 24 visit was missing), or up to the introduction of the rescue therapy, whichever the earhest.
• the main 24week double-blind on-treatment period for efficacy variables from the meal challenge test including PPG and glucose excursion was defined as the time from the first dose of the double-blind EP up to the date of the last dose of the double-blind IP injection on or before Visit 12/Week 24 visit (or Day 169 if Visit 12 Week 24 visit was missing), or up to the introduction of the rescue therapy, whichever the earliest.
• the LOCF procedure was used by taking the last available post-baseline on-treatment HbA measurement (before the initiation of the new
• the safety analyses were primarily based on the on-treatment period of the whole study.
• the on- treatment period of the whole study was defined as the time from the first dose of double-blind IP up to 3 days after the last dose of IP administration during the whole study period regardless of rescue status.
• the 3-day interval was chosen based on the half-life of the IP (approximately 5 times the half-life).
• Table 1 provides the number of patients included in each analysis population.
• Randomized population 85 ( 100%) 85 ( 100%) 170 (100%) 255 (100%) 255 ( 100%) 510 (100%) 680 (100%)
• Safety population 85 170 255 255 510 680
• Table 2 provides the summary of patient disposition for each treatment group.
• 169 (24.9%) patients prematurely discontinued the study treatment with a higher percentage in the lixisenatide evening injection arm (27.5%) and a lower percentage in the lixisenatide morning injection arm (22.4%) compared to the combined placebo group (24.7%).
• the main reason for treatment discontinuation was "adverse events" (10.2% for evening injection and 8.2% for morning injection versus 3.5% for combined placebo) followed by "other reasons” (8.6% for each lixisenatide arm versus 1 1.2% for combined placebo).
• HLGT Gastrointestinal neoplasms malignant and 0 0 0 1 (0.4%) 0 1 (0.2%) unspecified
• HLGT Miscellaneous and site unspecified 1 (1 .2%) 0 1 (0.6%) 0 0 0 neoplasms malignant and unspecified
• HLT Prostatic neoplasms malignant 0 1 (0.4%) 1 (0.2%)
• HLT Disturbances in initiating and 0 0 0 0 1 (0.4%) 1 (0.2%) maintaining sleep
• HLT Inguinal hernias 0 0 0 1 (0.4%) 1 (0.4%) 2 (0.4%)
• HLT Benign neoplasms gastrointestinal 0 0 0 0 1 (0.4%) 1 (0.2%) (excl oral cavity)
• HLGT Peritoneal and retroperitoneal conditions 0 0 0 0 1 (0.4%) 1 (0.2%)
• HLT Angioedemas 0 1 (0.4%) 1 (0.2%)
• HLT Spinal fractures and dislocations 0 0 0 1 (0.4%) 1 (0.4%) 2 (0.4%)
• n (%) number and percentage of patients with at least one serious TEAE.
• HLT Thrombocytopenias 0 0 0 0 1 (0.4%) 1 (0.2%)
• HLT Rosaceas 0 0 0 1 (0.4%) 0 1 (0.2%)
• HLGT Hepatobiliary investigations 0 0 0 0 1 (0.4%) 1 (0.2%) m

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• 2012
  • 2012-05-10 US US13/468,422 patent/US20130040878A1/en not_active Abandoned
  • 2012-05-11 AR ARP120101668A patent/AR086356A1/es unknown
  • 2012-05-11 KR KR1020137033311A patent/KR20140041553A/ko not_active Ceased
  • 2012-05-11 EP EP12720196.0A patent/EP2709652A1/en not_active Withdrawn
  • 2012-05-11 MX MX2013013198A patent/MX356728B/es active IP Right Grant
  • 2012-05-11 WO PCT/EP2012/058779 patent/WO2012156312A1/en not_active Ceased
  • 2012-05-11 RU RU2017129878A patent/RU2017129878A/ru not_active Application Discontinuation
  • 2012-05-11 BR BR112013029256A patent/BR112013029256A8/pt not_active Application Discontinuation
  • 2012-05-11 CA CA2835336A patent/CA2835336A1/en not_active Abandoned
  • 2012-05-11 CN CN201280034724.7A patent/CN103648519A/zh active Pending
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