WO2013063263A1 - Compositions pharmaceutiques pour le traitement de la douleur - Google Patents

Compositions pharmaceutiques pour le traitement de la douleur Download PDF

Info

Publication number
WO2013063263A1
WO2013063263A1 PCT/US2012/061922 US2012061922W WO2013063263A1 WO 2013063263 A1 WO2013063263 A1 WO 2013063263A1 US 2012061922 W US2012061922 W US 2012061922W WO 2013063263 A1 WO2013063263 A1 WO 2013063263A1
Authority
WO
WIPO (PCT)
Prior art keywords
pain
pharmaceutical composition
agomelatine
formula
treatment
Prior art date
Application number
PCT/US2012/061922
Other languages
English (en)
Inventor
Ramesh Sesha
Original Assignee
Lycus Llc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Lycus Llc filed Critical Lycus Llc
Publication of WO2013063263A1 publication Critical patent/WO2013063263A1/fr

Links

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
    • A61K9/20—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
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/13—Amines
    • A61K31/135—Amines having aromatic rings, e.g. ketamine, nortriptyline
    • A61K31/137—Arylalkylamines, e.g. amphetamine, epinephrine, salbutamol, ephedrine or methadone
    • 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
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/164—Amides, e.g. hydroxamic acids of a carboxylic acid with an aminoalcohol, e.g. ceramides
    • 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
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • 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
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
    • 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
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • A61K31/197—Carboxylic acids, e.g. valproic acid having an amino group the amino and the carboxyl groups being attached to the same acyclic carbon chain, e.g. gamma-aminobutyric acid [GABA], beta-alanine, epsilon-aminocaproic acid or pantothenic acid
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • 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
    • A61K9/2027—Organic macromolecular compounds obtained by reactions only involving carbon-to-carbon unsaturated bonds, e.g. polyvinyl pyrrolidone, poly(meth)acrylates
    • 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
    • A61K9/2004—Excipients; Inactive ingredients
    • A61K9/2022—Organic macromolecular compounds
    • A61K9/205—Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A61K9/2059—Starch, including chemically or physically modified derivatives; Amylose; Amylopectin; Dextrin
    • 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
    • A61K9/2072—Pills, tablets, discs, rods characterised by shape, structure or size; Tablets with holes, special break lines or identification marks; Partially coated tablets; Disintegrating flat shaped forms
    • A61K9/2086—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat
    • A61K9/209—Layered tablets, e.g. bilayer tablets; Tablets of the type inert core-active coat containing drug in at least two layers or in the core and in at least one outer layer

Definitions

  • the present invention provides pharmaceutical compositions, useful treating pain and pain related disorders.
  • the invention further provides, methods for treating pain and pain related disorders using a therapeutically effective amount of the compounds and pharmaceutical compositions disclosed herein.
  • pain types include chronic pain, e.g., nociceptive, neuropathic, psychogenic pain, and mixed nociceptive and neuropathic pain.
  • Examples of these types of pain include, but are not limited to, diabetic neuropathy, neurogenic pain, central pain, somatic pain, visceral and cancer pain, inflammatory pain, inflammatory bowel disease (IBD) pain, multiple sclerosis pain, post-operative pain, chronic low back pain, sciatica, cervical and lumbar pain, tension headaches, cluster headaches, chronic daily headaches, herpes neuralgia and post-herpetic neuralgia, facial and oral neuralgias and myofascial pain syndromes, phantom limb pain, stump pain and paraplegic pain, dental pain, opioid resistant pain, post-surgical pain including cardiac surgery and mastectomy, pain of labor and delivery, post-partum pain, post-stroke pain, angina pain, genitourinary tract pain including pelvic pain and cystitis and vulvar vestibulitis and orchialgia, irritable bowel syndrome, premenstrual syndrome pain, pain resulting from burns or chemical injury or sunburn, and bone injury pain.
  • IBD inflammatory
  • Fibromyalgia is a chronic pain illness. Symptoms of the disease include muscle aches, pain and stiffness of joints and muscles, soft tissue tenderness, general fatigue, and sleep disturbances. Common sites of this widespread pain include: neck, shoulders, back, pelvic girdle, and hands. The disease and its progression can affect any part of the body. The difficulty with fibromyalgia and pain levels the patient experiences can change over time. Sometime a patient will feel better and sometime a patient can feel worse since the pain waxes and wanes over time.
  • fibromyalgia particularly ones that are suitable for long-term use
  • drugs that have been used include, for example, alpha2delta agonists, such as pregabalin, gabapentin, or opioids such as tramadol, tapentadol, and tricyclic antidepressants such as nortriptytline.
  • alpha2delta agonists such as pregabalin, gabapentin, or opioids such as tramadol, tapentadol
  • tricyclic antidepressants such as nortriptytline.
  • IBD Irritable bowel disease
  • IBD is typically characterized by cramping, abdominal pain, bloating, constipation, and diarrhea. IBD may cause a great deal of discomfort and distress, but it is not believed to cause permanently harm to the intestines or lead to a serious disease, such as cancer. Many patients can control their symptoms with diet, stress management, and prescribed medications. For some patients, however, IBD can be disabling. They may be unable to work, attend social events, or even travel short distances. As many as 20 percent of the adult population, or one in five Americans, have symptoms of IBD, making it one of the most common disorders diagnosed by doctors.
  • Lotronex irritable bowel disease
  • FDA U.S. Food and Drug Administration
  • Neuropathic pain is caused by a primary lesion or dysfunction in the nervous system.
  • Neuropathic pains are divided into peripheral neuropathic pain due to lesion of the peripheral nervous system and central pain following lesions of the central nervous system.
  • Neuropathic pain commonly is described as hot burning, throbbing, shooting, lancinating, stabbing, sharp, cramping, gnawing, aching, heavy, tender, splitting, tiring, exhausting, sickening, fearful, punishing, Har, icy cold, tingling, pins and needles, intense and itch like.
  • Medical descriptors are allodynia (pain due to a stimulus which does not normally provoke pain), hyperalgesia (an increased response to a stimulus which is normally painful), hyperaesthesia (increased sensitivity to stimulation, excluding the special senses), dysaesthesia (an unpleasant abnormal sensation, whether spontaneous or evoked), hyperpathia (a painful syndrome characterized by an abnormally painful reaction to astimulus, especially a repetitive stimulus, as well as an increased threshold) and neuralgia (pain in the distribution of a nerve or nerves not necessarily of paroxysmal quality).
  • Neuropathic pain may be associated with mood changes, sleep disturbance, fatigue and may have an impact on physical and social functioning. The prevalence of neuropathic pain is estimated to be about 1%.
  • the treatment options for neuropathic pain include alpha2deltaagonists such as pregabalin, gabapentin, opioids such as morphine, dextromethorphan, and tapentadol etc.
  • Compounds of formula I for example Agomelatine, A, a melatonergic agonist (MTi and MT 2 receptors) and 5-HT 2 c antagonist are known for their antidepressant like properties.
  • Agomelatine and similar compounds were disclosed in U.S. Patent No. 5, 194,614 and U.S. Patent No. 5,224,442.
  • the patents disclose several compounds of naphthalene structure including agomelatine, their pharmaceutical compositions and methods for treating a living animal afflicted with treatable disorder of the melatoninergic system.
  • Agomelatine has been reported to re-synchronize circadian rhythms, based on animal models of delayed sleep phase syndrome and other circadian rhythm disruptions.
  • agomelatine has been reported to provide positive phase shifting properties; it induces a phase advance of sleep, body temperature decline and melatonin onset. Thus, it has been marketed for the treatment of major depressive disorders and reported to have a reduced level of sexual side effects, as well as discontinuation effects, compared to other antidepressants.
  • Agomelatine can also have beneficial effects on sleep associated with a number of disorders.
  • Agomelatine has no reported abuse potential as measured in healthy volunteer studies. The clinical studies on pain disorders indicate that non-response to antiepileptic drugs is substantial, up to 30%. Another critical factor in antiepileptic treatment is compliance, which has a rather profound effect on the patient's motivation to continue pharmacotherapy with antiepileptic drugs.
  • Peroxisome Pro liferator- Activated Receptors belongs to a large family of nuclear receptors that have been reported to affect a wide range of disorders such as cancer, obesity, diabetes, inflammation, neurodegeneration and depressive disorders.
  • proliferator-activated receptors include, alpha, beta and gamma subtype receptors.
  • PPAR-alpha and PPAR-gamma are the molecular targets of a number of marketed drugs.
  • hypolipidemic fibrates activate PPAR-alpha
  • PPAR-gamma activate PPAR-gamma
  • the synthetic chemical perfluorooctanoic acid activates PPAR-alpha while the synthetic perfluorononanoic acid activates both PPAR-alpha and PPAR-gamma.
  • PPAR-alpha regulates the expression of genes involved in fatty acid beta-oxidation and is a major regulator of energy homeostasis. More recent research has demonstrated antiinflammatory and anti-thrombotic actions of PPAR-alpha agonists in the inflammation, depression, vessel wall as well. Thus, PPAR-alpha agonists decrease the progression of inflammation by modulating glial/mast cells and by their anti-inflammatory actions on the level of the vascular wall. There are reports that agonists of the nuclear receptor PPAR-alpha
  • PPAR- alpha modulator suppress pain behaviors induced in mice by chemical tissue injury, nerve damage, or inflammation.
  • PPAR- alpha modulator there is not a single PPAR- alpha modulator been approved for treating pain and pain related disorder.
  • Another major class of drugs that are used to treat chronic and acute pain include opioids.
  • Opioid or opioid agonists class of drugs include morphine, the archetypical opioid, and various others such as, for example, codeine, dihydrocodeine, hydrocodone, hydromorphone, levorphanol, meperidine, buprenorphine, fentanyl, fentanyl derivatives, dipipanone, heroin, tapentadol tramadol, etorphine, dihydroetorphine, butorphanol, methadone, diamorphine, oxycodone, oxymorphone, pethidine and propoxyphene, etc.
  • Opioid agonists chemically interact with areas or binding sites of the central nervous system related to the perception of pain, to movement, mood and behavior, and to the regulation of neuroendocrinological functions. Opioid agonists exhibit pharmacological properties that provide a range of therapeutic uses for patients in addition to analgesic use. Opioid agonists have been prescribed for effective use as hypnotics, sedatives, anti-diarrheal, anti-spasmodic, and anti-tussives.
  • opioid agonists have also been associated with a number of undesirable side effects; constipation, respiratory depression, nausea, vomiting, dizziness, orthostatic hypotension, drowsiness, urinary retention, itch, dry mouth, headache, miosis, changes in mood and mental clouding resulting without resulting loss of consciousness in patients, and, due to the addictive properties, has been subjected to illegal diversion for abuse by addicts.
  • Widely used opioid agonists include Morphine, Oxycodone, Tramadol and recently approved Tapentadol. Morphine has a high potential for addiction; tolerance and both physical and psychological dependence develop rapidly. It has side effects such constipation, addiction, tolerance and is prone for high abuse. Another widely used opioid agonist is Oxycodone, whose most commonly reported effects include constipation, fatigue, dizziness, nausea,
  • Tramadol is a centrally acting synthetic opioid analgesic. It is chemically ( ⁇ ) cis-2-[(dimethylamino) methyl]- 1 -(3- methoxyphenyl) cyclo-hexanol hydrochloride.
  • Tramadol has certain commonly reported side effects include nausea, constipation, dizziness, headache, drowsiness, and vomiting. Less commonly reported side effects include itching, sweating, dry mouth, diarrhea, rash, visual disturbances, and vertigo. It is desirable to prevent these side effects by prescribing lower doses of tramadol without compromising the extent of pain relief.
  • Tapentadol, 3-(3-Dimethylamino-l-ethyl-2- methyl-propyl)-phenol is a centrally acting analgesic with a dual mode of action: mu-opioid receptor agonism and noradrenaline reuptake inhibition. Its dual mode of action provides analgesia at similar levels of more potent narcotic analgesics such as hydrocodone, oxycodone, and morphine with a more tolerable side effect profile.
  • compositions comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; c) an opioid; or d) NSAID useful for preventing or treating pain and pain related disorders, in a patient need of such treatment.
  • PPAR peroxisome proliferator-activated receptors
  • a composition comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; c) an opioid; or d) NSAID; that provides surprisingly useful clinical benefits is disclosed herein.
  • the instant invention provides a composition having one or more of the disclosed compounds that provides clinical benefits when used to treat patients with pain and pain related disorders.
  • compositions comprising a therapeutically effective amount of a na hthalene compound having formula I:
  • R 1 is substituted or unsubstituted (Ci-C6)alkyl
  • R 2 is hydrogen or substituted or unsubstituted (Ci-C 6 )alkyl
  • R 3 is hydrogen, substituted or unsubstituted (Ci-C 6 )alkyl, or substituted or unsubstituted (C3-Cio)cycloalkyl, substituted or unsubstituted (C 6 -Cio)aryl, substituted or unsubstituted (C7-Ci6)arylalkyl, substituted or unsubstituted (Cs-C ⁇ heteroaryl, substituted or unsubstituted (C6-C2i)heteroarylalkyl, substituted or unsubstituted heterocyclic group or substituted or unsubstituted (C6-Ci5)heterocycloalkyl group;
  • substituents for the alkyl, aryl, cycloalkyl, or heterocyclic groups include (Ci-C 6 )alkyl, fluoro, chloro, or bromo; and a therapeutically effective amount of a second active agent, wherein the second active agent is;
  • PPAR peroxisome proliferator-activated receptors
  • compositions are useful for treating useful for treating pain or pain related disorders.
  • the invention provides pharmaceutical compositions comprising naphthalene compounds having formula I-A,
  • R 1 is methyl, ethyl, n-propyl, or 1-methylethyl (isopropyl)
  • R 3 is methyl, ethyl, n-propyl, 1-methylethyl (isopropyl), n-butyl, isobutyl, n-pentyl, t-butyl (1,1- dimethylethyl), or phenyl, or pharmaceutically acceptable salts, isomers, or polymorphs thereof
  • second agent wherein second agent is a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; c) an opioid or d) NSAID; useful for pain and pain related disorders.
  • PPAR peroxisome proliferator-activated receptors
  • the invention provides pharmaceutical compositions comprising naphthalene compounds having formula I-A, wherein R 1 is methyl and R 3 is methyl, ethyl, isopropyl, isobutyl or phenyl.
  • the invention provides a method for preventing or treating pain or pain related disorders in a mammal, comprising administering to said mammal a pharmaceutical composition comprising therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier.
  • the mammal is a human.
  • the present invention provides a method for the prevention or treatment of pain or pain related disorders, wherein the method comprises administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof, to a patient in need thereof.
  • the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof, to a patient in need thereof.
  • PPAR peroxisome proliferator-activated receptors
  • Non-limiting examples of pain that can be prevented or treated include neuropathic pain, neurogenic pain, central pain, somatic pain, visceral and cancer pain, inflammatory pain, post-operative pain, chronic low back pain, sciatica, cervical and lumbar pain, tension headaches, cluster headaches, chronic daily headaches, herpes neuralgia and post-herpetic neuralgia, facial and oral neuralgias and myofascial pain syndromes, phantom limb pain, stump pain and paraplegic pain, dental pain, opioid resistant pain, post-surgical pain including cardiac surgery and mastectomy, pain of labor and delivery, post-partum pain, post-stroke pain, angina pain, genitourinary tract pain including pelvic pain, cystitis, vulvar vestibulitis, orchialgia, irritable bowel syndrome, pre -menstrual syndrome pain, pain resulting from burns, e.g., sunburn, or chemical injury, bone injury pain, and the like.
  • the pain can be from neuropathic pain
  • the invention provides both a compound of formula I, and an antiepileptic agent (or pharmaceutically acceptable salts thereof) in a pharmaceutical
  • the pain can be from any cause, e.g., neuropathic pain, fibromyalgia, diabetic and peripheral neuropathic pain, rheumatoid arthritis, irritable bowel syndrome, osteoarthritis, and the like.
  • the invention provides both a compound of formula I, and a peroxisome proliferator-activated receptors (PPAR) agonist; (or pharmaceutically acceptable salts thereof) in a pharmaceutical composition for treating epilepsy or painful conditions.
  • the pain can be from any cause, e.g., neuropathic pain, fibromyalgia, diabetic and peripheral neuropathic pain, rheumatoid arthritis, irritable bowel syndrome, osteoarthritis, and the like.
  • the invention provides both a compound of formula I, and an opioid; (or pharmaceutically acceptable salts thereof) in a pharmaceutical composition for treating epilepsy or painful conditions.
  • the pain can be from any cause, e.g., neuropathic pain, fibromyalgia, diabetic and peripheral neuropathic pain, rheumatoid arthritis, irritable bowel syndrome, osteoarthritis, and the like.
  • the invention provides a pharmaceutical composition having a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of an antiepileptic administered in suboptimal dosages.
  • the compound of formula I, and the antiepileptic are administered in amounts and for a sufficient time to provide a synergistic effect.
  • the invention provides the use of a pharmaceutical composition comprising a therapeutically effective amount of a first drug and a therapeutically effective amount of a second drug, where the first drug is a compound of formula I, and the second drug is an antiepileptic, for the manufacture of a medicament for the treatment of epilepsy.
  • the invention provides a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof, useful for treatment of pain and pain related disorders.
  • PPAR peroxisome proliferator-activated receptors
  • opioid or pharmaceutically acceptable salts, isomers, or polymorphs thereof, useful for treatment of pain and pain related disorders.
  • a preferred indication is fibromyalgia.
  • the preferred indication is neuropathic pain. In another aspect, the preferred indication is irritable bowel syndrome.
  • the invention provides a pharmaceutical composition
  • a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;, or pharmaceutically acceptable salts thereof, for use in medical treatment (for example, treatment of pain, e.g., fibromyalgia).
  • PPAR peroxisome proliferator-activated receptors
  • the invention provides a method for management of pain, pain related disorders, or treatment of epilepsy, comprising administering to a subject in need thereof, a pharmaceutical composition comprising a first agent (drug), a second active agent, and optionally a pharmaceutically acceptable carrier, wherein the first agent (drug) is a compound of formula I, and the second agent is an antiepileptic (or pharmaceutically acceptable salts thereof).
  • a pharmaceutical composition comprising a first agent (drug), a second active agent, and optionally a pharmaceutically acceptable carrier, wherein the first agent (drug) is a compound of formula I, and the second agent is an antiepileptic (or pharmaceutically acceptable salts thereof).
  • the present invention provides a method for the treatment of pain and pain related diseases, wherein the method comprises administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;, to a patient in need thereof.
  • the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;
  • the present invention provides a method, for the treatment of the treatment of epilepsy, wherein the method comprises administration of therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of an antiepileptic, to a patient in need thereof.
  • the invention provides a method for management of pain comorbid with epilepsy.
  • the invention provides a method for the manufacture of a medicament for the treatment of chronic pain in which the active agent is a pharmacologically acceptable salt of a compound of formula I, and an antiepileptic drug wherein the antiepileptic drug is pregabalin, gabapentin, topiramate, baclofen, or gabapentin enacarbil, for treating pain.
  • the compound of formula I is agomelatine and the antiepileptic is pregabalin.
  • the invention provides a method for the use of a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of palmitoylethanolamide, or pharmaceutically acceptable salts thereof for the preparation of a medicament for treatment of pain and pain related disorders in a mammalian species (for example, a human).
  • the invention provides a preferred combination of a low dose of agomelatine and palmitoylethanolamide (PEA).
  • PDA palmitoylethanolamide
  • the combination of a therapeutically effective amount agomelatine and a therapeutically effective amount of palmitoylethanolamide (PEA) provides surprisingly useful clinical benefits over the single drugs are disclosed herein.
  • the invention provides a composition dosage form wherein the form is a bilayer composition, where one layer includes comprising a therapeutically effective amount of agomelatine, and one layer comprises a therapeutically effective amount of palmitoylethanolamide (PEA).
  • the form is a bilayer composition, where one layer includes comprising a therapeutically effective amount of agomelatine, and one layer comprises a therapeutically effective amount of palmitoylethanolamide (PEA).
  • PDA palmitoylethanolamide
  • the invention provides a method for the use of a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of an opioid, or pharmaceutically acceptable salts thereof for the preparation of a medicament for treatment of pain and pain related disorders in a mammalian species (for example, a human).
  • the present invention provides a method for the prevention or treatment of pain or a pain related disorder, wherein the disorder is fibromyalgia, comprising administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, to a patient in need thereof.
  • PPAR peroxisome proliferator-activated receptors
  • the present invention provides a method for the prevention or treatment of pain or a pain related disorder, wherein the disorder is neuropathic pain, comprising administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, to a patient in need thereof.
  • PPAR peroxisome proliferator-activated receptors
  • the present invention provides a method for the prevention or treatment of pain or a pain related disorder, wherein the disorder is cancer related pain, comprising administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, to a patient in need thereof.
  • PPAR peroxisome proliferator-activated receptors
  • the present invention provides a method for the prevention or treatment of pain or a pain related disorder, wherein the disorder is arthritis, comprising administration of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier.
  • the arthritis is rheumatoid arthritis or osteoarthritis.
  • the invention provides a pharmaceutical composition
  • a pharmaceutical composition comprising a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, for treating pain and pain related disorders.
  • the pharmaceutical composition is suitable for administration by oral, intravenous, intraarterial, intraperitoneal, intradermal, buccal, transdermal, intrathekal
  • intramuscular intramuscular, intranasal, transmucosal, subcutaneous, or rectal routes.
  • the invention provides a method for the use of a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, for the preparation of a medicament for the prevention or treatment of pain or pain related disorders.
  • the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, for the preparation of a medicament for the prevention or treatment of pain or pain related disorders.
  • PPAR peroxisome proliferator-activated receptors
  • the invention provides a compound having formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;; or pharmaceutically acceptable salts, isomers, or polymorphs thereof and optionally a pharmaceutically acceptable carrier, for use in a method for the prevention or treatment of pain or pain related disorders in a mammal, and wherein the medicament optionally comprises a solid or liquid carrier, comprising administering to said mammal an effective amount of a said compound or said pharmaceutically acceptable salt or ester thereof.
  • the mammal is a human.
  • the present invention provides the use of a pharmaceutical composition, as disclosed herein, for the prevention or treatment of pain and pain related disorders.
  • the invention provides a titration-dosing regimen for the administration of a compound of formula I, and an antiepileptic, a peroxisome proliferator- activated receptors (PPAR) agonist, or an opioid to patients.
  • the titration-dosing regimen provides a significant reduction in the occurrence of adverse effects from the introduction of an active agent in a slow release dosing, thus increasing patient compliance and medication tolerability.
  • the second agent is an antiepileptic, where is the antiepileptic drug is aminobutyric acid, baclofen, beclamide, barbexaclone, brivaracetam, clonazepam,
  • the second agent is an opioid, where is the opioid drug is alfentanil, allylprodine, alphaprodine, anileridine, asimadoline, benzylmorphine, bezitramide,
  • ethylmethylthiambutene ethylmorphine, etonitazene, faxeladol, fentanyl, heroin, hydrocodone, hydromorphone, hydroxypethidine, isomethadone, ketobemidone, levorphanol,
  • piritramide propheptazine, promedol, properidine, propoxyphene, sufentanil, tilidine, tapentadol, axamadol, and, tramadol, pharmaceutically acceptable salts thereof and mixtures thereof.
  • the second agent is a peroxisome proliferator-activated receptors (PPAR) agonist
  • PPAR peroxisome proliferator-activated receptors
  • PPAR peroxisome proliferator-activated receptors
  • Figure 1 is an illustration of the weekly change in the mean pain score comparing the agomelatine and palmitoylethanolamide (PEA) combination treated patients.
  • Figure 2 is an illustration of the weekly trend in change in mean sleep quality score comparing the agomelatine and palmitoylethanolamide (PEA) combination treated patients.
  • Figure 3 is an illustration of the change in the mean pain score comparing the agomelatine and pregabalin combination with agomelatine, pregabalin and a placebo.
  • Figures 4 and 5 are illustrations of the percent of patients with or without
  • Figure 6 is an illustration of the weekly trend in change in mean sleep quality score comparing the agomelatine and pregabalin combination with agomelatine, pregabalin and a placebo.
  • Figure 7 is an illustration of mean pain scores plotted against time for the neuropathic pain study.
  • Figure 8 is an illustration of mean pain scores plotted against time for the neuropathic pain study using three different combinations
  • composition that comprises "an” element means one element or more than one element.
  • Analgesic means to include any drug used to relieve pain including paracetamol (acetaminophen), the non-steroidal anti-inflammatory drugs (NSAIDs) for example, the salicylates, narcotic drugs for example, morphine, synthetic drugs with narcotic properties for example, tramadol, tapentadol, asimadoline, antiepileptics (e.g., pregabalin, gabapentin) and various others other classes of drugs not normally considered analgesics are used to treat neuropathic pain syndromes; for example, tricyclic antidepressants and
  • a disease or disorder is "alleviated” if the severity of a symptom of the disease or disorder, the frequency with which such a symptom is experienced by a patient, or both, is reduced.
  • a "disorder" in an animal is a state of health in which the animal is able to maintain homeostasis, but in which the animal's state of health is less favorable than it would be in the absence of the disorder. Left untreated, a disorder does not necessarily cause a further decrease in the animal's state of health.
  • immediate agent used interchangeably, and as used herein are defined to include at least one form of a compound of formula I, antiepileptic drug; palmitoylethanolamide (PEA); or opioid; chosen from their respective salts, their respective optically active enantiomers, racemic mixtures thereof, isomers, polymorphs, prodrugs, active metabolites, pharmaceutically acceptable salts thereof, such as, for example, acid addition or base addition salts of the disclosed compounds salts, optically active
  • agomelatine as used herein is defined to mean at least one form of agomelatine chosen from agomelatine salts, polymorphs, prodrugs, active metabolites, pharmaceutically acceptable salts thereof, such as for example, acid addition or base addition salts of agomelatine.
  • antiepileptic includes compounds that reduce or prevent seizures.
  • antiepileptics also encompass all the modulators of voltage gated calcium channels, their pharmaceutically equivalent salts, isomers, polymorphs, hydrates, complexes, clatharates and the like.
  • Non-limiting examples include, but are not limited to, aminobutyric acid, baclofen, beclamide, barbexaclone, brivaracetam, clonazepam, carbamazepine, ethotoin, ethadione, ethosuximide, eslicarbazepine, felbamate, fosphenytoin, gabapentin, gabapentin enacarbil, lamotrigine, levetiracetam, lacosamide, mephenytoin, methylphenobarbital, metharbital, mesuximide, oxcarbazepine, phenytoin, phenobarbital, primidone, paramethadione,
  • Preferred antiepileptic drugs include pregabalin, gabapentin, gabapentin enacarbil, topiramate, baclofen or pharmaceutically acceptable salts thereof, and the like.
  • Preferred examples of the antiepileptic drugs include gabapentin, gabapentin enacarbil, pregabalin and pharmaceutically acceptable salts thereof.
  • the preferred combination is agomelatine and pregabalin.
  • Non-steroidal anti-inflammatory drug or "NSAID” as used herein means any non-steroidal anti-inflammatory drug.
  • Non-limiting examples include Celecoxib,
  • Diclofenac Diflunisal, Etodolac, Fenoprofen, Flurbirofen, Ibuprofen, Indomethacin, Ketoprofen, Ketorolac, Mefenamic acid, Meloxicam, Nabumetone, Naproxen, Oxaprozin, Piroxicam, Sulindac and Tolmetin and their pharmaceutically equivalent salts.
  • opioid or opioids include but are not limited to, alfentanil, allylprodine, alphaprodine, anileridine, benzyl-morphine, bezitramide, buprenorphine, butorphanol, clonitazene, codeine, cyclazocine, desomorphine, dextromethorphan,
  • peroxisome proliferator-activated receptors (PPAR) agonist used used here mean a modulator of peroxisome proliferator-activated receptors (PPAR).
  • the exemplary peroxisome proliferator-activated receptors (PPAR) agonists are palmitoylethanolamide, anandamide, stearoyl ethanolamine, Oleoylethanolamine, fenofibrate, bezafibrate, ciprofibrate, clofibrate, gemfibrozil, and ureido-fibrate-5 (UF-5).
  • band range is defined as the difference in in vitro dissolution measurements of the controlled release formulations when comparing the dissolution profile (curve) obtained by the formulation upon completion of the manufacturing of the coated product (prior to storage) and the dissolution profile obtained after the coated product is exposed to accelerated storage conditions, expressed as the change in percent of the active agent released from the coated product at any dissolution time point along the dissolution curves.
  • co-administration means administration of the two drugs (agents) together ⁇ e.g., simultaneously as a mixture) or administration can be sequential.
  • the sequential administration of the agomelatine can be prior to or after administration of the second analgesic agent, within minutes of each other or up to about 48 hours after the administration of the other agent.
  • the administration of the agomelatine will be within about 24 hours of administration of the second analgesic agent and more preferably within about 12 hours of administration of the second analgesic agent.
  • an effective amount means an amount sufficient to produce a selected effect.
  • an effective amount of a compound of formula I, and an optional second agent are amounts that is sufficient in order to relieve the pain symptoms of the patient to be controlled when compared with no treatment.
  • terapéuticaally effective amount means an amount that elicits a biological response in a mammal, including the effect from a suboptimal amount.
  • suboptimal dosage or suboptimal amount means a dosage, which is below the optimal dosage for that compound when used in single-compound therapy.
  • additive effect means the effect resulting from the sum of the effects obtained from the individual compounds.
  • the term "synergistic effect” as used herein means an effect from two drugs (active agents), which is greater than the additive effect that results from the sum of the effects of the two individual agents.
  • treatment of a disease means the management and care of a patient having developed the disease, condition or disorder.
  • the purpose of treatment is to combat the disease, condition or disorder.
  • Treatment includes the administration of the active compounds to eliminate or control the disease, condition or disorder as well as to alleviate the symptoms or complications associated with the disease, condition or disorder.
  • prevention of a disease is defined as the management and care of an individual at risk of developing the disease prior to the clinical onset of the disease.
  • the purpose of prevention is to combat the development of the disease, condition or disorder, and includes the administration of the active compounds to prevent or delay the onset of the symptoms or complications and to prevent or delay the development of related diseases, conditions or disorders.
  • epilepsy or "epileptic disorders” are used interchangeably and as used herein, means disorders that result from the surges in electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy can simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions. The condition may be co-morbid with other psychiatric conditions such as pain, depression, anxiety, and the like.
  • pain and pain related disorder includes all types of pain, e.g., chronic pain such as nociceptive, neuropathic, psychogenic pain, and mixed category pain (nociceptive and neuropathic components).
  • pain or pain related disorder include in particular, but are not limited to, diabetic neuropathy, neurogenic pain, central pain, somatic pain, visceral and cancer pain, inflammatory pain, inflammatory bowel disease (IBD) pain, postoperative pain, chronic low back pain, sciatica, cervical and lumbar pain, tension headaches, cluster headaches, chronic daily headaches, herpes neuralgia and post-herpetic neuralgia, facial and oral neuralgias and myofascial pain syndromes, phantom limb pain, stump pain and paraplegic pain, dental pain, opioid resistant pain, post-surgical pain including cardiac surgery and mastectomy, pain of labor and delivery, post-partum pain, post-stroke pain, angina pain, genitourinary tract pain including pelvic pain and cystitis and vulvar vestibulitis and orchialgia, irritable bowel syndrome, pre-menstrual syndrome pain, pain resulting from burns or chemical injury or sunburn, and bone injury pain.
  • IBD inflammatory bowel disease
  • pain which can be treated includes but is not limited to inflammatory pain, neuropathic pain, acute pain, chronic pain, visceral pain, migraine pain, cancer pain and the like.
  • Non-limiting examples of chronic pain, to be treated by the disclosed compositions is
  • nociceptive pain Preferred indications of nociceptive pain are inflammatory and post-operative pain. In another aspect, it is preferred that the chronic pain to be treated is neuropathic pain. Preferred indications of neuropathic pain are neurogenic pain and facial and oral neuralgias.
  • slow-release or “controlled release” are used interchangeably and as used herein, applies to any release from a formulation that is other than an immediate release, wherein the release of the active ingredient is slow in nature. This includes various terms used interchangeably in the pharmaceutical context such as, extended release, delayed release, sustained release, controlled release, timed release, specific release and targeted release, and the like.
  • extended release material in an inner solid particulate phase or an outer solid continuous phase refers to one or more hydrophilic polymers and/or one or more hydrophobic polymers and/or one or more other type hydrophobic materials, such as, for example, one or more waxes, fatty alcohols and/or fatty acid esters.
  • the "extended release material" present in the inner solid particulate phase may be the same as or different from the “extended release material” present in the outer solid continuous phase.
  • hydrophilic polymers include, but are not limited, to hydroxypropylmethylcellulose, hydroxypropylcellulose, sodium, carboxymethylcellulose, carboxymethylcellulose calcium, ammonium alginate, sodium alginate, potassium alginate, calcium alginate, propylene glycol alginate, alginic acid, polyvinyl alcohol, povidone, carbomer, potassium pectate, potassium pectinate, and the like.
  • hydrophobic polymers include, but are not limited, to ethyl cellulose, hydroxyethylcellulose, ammonio methacrylate copolymer (EudragitTM RL or EudragitTM RS), methacrylic acid copolymers (EudragitTM L or EudragitTM S), methacrylic acid- acrylic acid ethyl ester copolymer (EudragitTM L 100-5), methacrylic acid esters neutral copolymer (EudragitTM NE 30D), dimethylaminoethylmethacrylate-methacrylic acid esters copolymer (EudragitTM E 100), vinyl methyl ether/malefic anhydride copolymers, their salts and esters (GantrezTM), and the like.
  • hydrophobic materials which may be employed in the inner solid particulate phase and/or outer solid continuous phase include, but are not limited, to waxes such as beeswax, carnauba wax, microcrystalline wax, and ozokerite; fatty alcohols such as cetostearyl alcohol, stearyl alcohol; cetyl alcohol myristyl alcohol etc; and fatty acid esters such as glyceryl monostearate, glycerol monooleate, acetylated monoglycerides, tristearin, tripalmitin, cetyl esters wax, glyceryl palmitostearate, glyceryl behenate, hydrogenated castor oil, and the like.
  • waxes such as beeswax, carnauba wax, microcrystalline wax, and ozokerite
  • fatty alcohols such as cetostearyl alcohol, stearyl alcohol; cetyl alcohol myristyl alcohol etc
  • fatty acid esters such as glyceryl monostea
  • the term "candidate for sustained release” as used herein, encompasses all the characteristics of a drug which make it a candidate for formulating it into an extended release fashion like a short elimination half life and consequent dosing of more than once a day, a single dose product given in an extended fashion to achieve better clinical results and avoid side effects associated with an immediate release etc.
  • binding agent refers to any conventionally known pharmaceutically acceptable binder such as polyvinyl pyrrolidone, hydroxypropyl cellulose, hydroxyethyl cellulose, hydroxypropyl methylcellulose, ethylcellulose, polymethacrylate, polyvinyl alcohol, waxes and the like. Mixtures of the aforementioned binding agents may also be used.
  • the preferred binding agents include water-soluble materials such as, for example, polyvinyl pyrrolidone having a weight average molecular weight of 25,000 to 3,000,000.
  • the binding agent may comprise approximately about 0 to about 40% of the total weight of the core and preferably about 3% to about 15% of the total weight of the core. In one embodiment, the use of a binding agent in the core is optional.
  • pharmaceutically acceptable derivative means various pharmaceutical equivalent isomers, enantiomers, complexes, salts, hydrates, polymorphs, esters, and the like, e.g., of agomelatine.
  • salts refers to salts that retain the biological effectiveness and properties of the disclosed compounds and which are not biologically or otherwise undesirable.
  • the disclosed compounds are capable of forming acid or base salts by virtue of the presence of amino or carboxyl groups or groups similar thereto.
  • the preparation of the salts and suitable acids or bases is known in the art.
  • combination therapy means a therapy where two or more active ingredients are administered separately or are administered in the form of a
  • compositions for the treatment and/or prophylaxis of a disease are included in the composition.
  • the term "monotherapy” as used herein, means a therapy that uses only one active ingredient for treatment and/or prophylaxis of a disease or disorder.
  • Sleep Disorder means any disorder that affects, or disrupts, sleep. They include any disorder affecting five stages (Stage 1 non-rapid eye movement (NREM) sleep, Stage 2 non-rapid eye movement (NREM) sleep, Stage 3 non-rapid eye movement (NREM) sleep, Stage 4 non-rapid eye movement (NREM) sleep and Rapid Eye Movement (REM) sleep) of sleep.
  • NREM non-rapid eye movement
  • NREM non-rapid eye movement
  • REM Rapid Eye Movement
  • compositions comprising a therapeutically effective amount of a compound of formula I, and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator- activated receptors (PPAR) agonist; or c) an opioid; or a pharmaceutically equivalent salt, isomer, or polymorph thereof, for treating pain and pain related disorders.
  • the disclosed compositions can be formulated for any route of administration (e.g., the formulations described herein) and can be administered in a single dose or multiple doses to a subject in need thereof.
  • the active ingredients for the disclosed method, a compound of formula I, and second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid; are preferably used in the free amphoteric form.
  • Pharmaceutically acceptable salts that retain the biological effectiveness and properties of the compounds of formula I, and second active agent that are not biologically or otherwise undesirable, can also be used and can show superior bioavailability.
  • compositions are intended for parenteral, intranasal, topical, oral, buccal, or local administration, such as by a transdermal means, for prophylactic and/or therapeutic treatment. Commonly, the pharmaceutical compositions are administered
  • parenterally e.g., by intravenous, intramuscular, or subcutaneous injection
  • oral ingestion or by topical application at areas affected by pain and pain related disorders.
  • compositions can be mixed with solid, powdered ingredients, such as lactose, microcrystalline cellulose, maltodextrin, saccharose, sorbitol, mannitol, starch, amylopectin, cellulose derivatives, gelatin, or another suitable ingredient, as well as with disintegrating agents and lubricating agents such as magnesium stearate, calcium stearate, sodium stearyl fumarate and polyethylene glycol waxes.
  • disintegrating agents and lubricating agents such as magnesium stearate, calcium stearate, sodium stearyl fumarate and polyethylene glycol waxes.
  • the compound of formula I can be an acid addition salt.
  • Acids commonly employed to form acid addition salts are inorganic acids, such as for example, hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, and the like, and organic acids such as p-toluenesulfonic, methanesulfonic acid, oxalic acid, p-bromophenylsulfonic acid, carbonic acid, succinic acid, citric acid, benzoic acid, acetic acid, and the like.
  • salts examples include the sulfate, pyrosulfate, bisulfate, sulfite, bisulfite, phosphate, monohydrogenphosphate, dihydrogenphosphate, metaphosphate, pyrophosphate, chloride, bromide, iodide, acetate, propionate, decanoate, caprylate, acrylate, formate, isobutylate, caproate, heptanoate, propiolate, oxalate, malonate, succinate, suberate, sebacate, fumarate, maleate, butyne-l ,4-dioate, hexyne-l ,6-dioate, benzoate, chlorobenzoate,
  • the compound of formula I can be a base addition salt.
  • Base addition salts include those derived from inorganic bases, such as for example, ammonium or alkali or alkaline earth metal hydroxides, carbonates, bicarbonates, and the like.
  • bases useful in preparing the salts of this invention thus include sodium hydroxide, potassium hydroxide, ammonium hydroxide, potassium carbonate, sodium carbonate, sodium bicarbonate, potassium bicarbonate, calcium hydroxide, calcium carbonate, and the like.
  • Soft gelatin capsules can be prepared by mixing the active agent and vegetable oil, fat, or other suitable vehicle.
  • Hard gelatin capsules can contain granules of the active agent, alone or in combination with solid powdered ingredients such as lactose, saccharose, sorbitol, mannitol, potato starch, corn starch, amylopectin, cellulose derivatives or gelatin.
  • Liquid preparations for oral administration can be prepared in the form of syrups or suspensions, e.g., solutions or suspensions containing about 0.2-20 wt % of the active agent and the remainder consisting of sugar or sugar alcohols and a mixture of ethanol, water, glycerol, propylene glycol and polyethylene glycol. If desired, such liquid preparations can contain coloring agents, flavoring agents, saccharin and carboxymethyl cellulose or other thickening agents. Liquid preparations for oral administration can also be prepared in the form of a dry powder to be reconstituted with a suitable solvent prior to use.
  • the present invention provides methods for prevention or treatment of pain and pain related disorders in a patient, by administering a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;.
  • a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula I and a therapeutically effective amount of a second active agent, wherein the second active agent is; a) an antiepileptic drug; b) a peroxisome proliferator-activated receptors (PPAR) agonist; or c) an opioid;.
  • PPAR peroxisome proliferator-activated receptors
  • Non- limiting examples of pain or pain related disorders that can be treated using the disclosed compositions include: lack of sleep, difficulty in falling asleep, sleep awakenings, disturbed sleep, pain, tingling, numbness, tremors, loss of balance, weakness in one or more limbs, fatigue, muscle spasms, that are associated with pain.
  • a physician can measure the symptoms of pain or pain related disorders, and their resolution during treatment, during a physical examination.
  • compositions and methods of this invention can also further include the addition of one or more therapeutic agents with a compound of formula I treatment as discussed below.
  • a patient can be administered a dosage form comprising a compound of formula I and optionally an additional therapeutic agents such as, analgesics, antiepileptic, opioids, NSAIDS, to prevent or treat pain or a pain related disorder.
  • analgesics such as, analgesics, antiepileptic, opioids, NSAIDS, to prevent or treat pain or a pain related disorder.
  • the second active agents can be administered at the same time or at a different time than the administration of a compound of formula I, and will depend upon the nature of the disease being treated as well as the agent itself.
  • the additional agent is an anti-epileptic
  • a twice-daily dose is sufficient and it can be administered at the same time or at a different time than a compound of formula I.
  • administration of any of the aforementioned additional agents at the same time is preferred.
  • the combination compositions can allow a decrease in the dosage of active agents, such as, the compound of formula I (e.g., agomelatine), or antiepileptic, to a patient and can improved patient compliance.
  • active agents such as, the compound of formula I (e.g., agomelatine), or antiepileptic
  • the disclosed compositions for management of pain and pain related disorders, comprise from about 0.1 mg to about 1500 mg of a compound of formula I (agomelatine), from about 0.1 mg to about 1500 mg of an antiepileptic and optionally a pharmaceutically acceptable carrier.
  • the disclosed pharmaceutical composition comprises from 1 to about 500 mg of a compound of formula I (agomelatine) and from about 5 to about 1000 mg of an antiepileptic. More preferably, the disclosed pharmaceutical
  • composition comprises from 5 to about 100 mg of a compound of formula I (agomelatine) and from about 10 to about 600 mg of an antiepileptic. Most preferably, the disclosed
  • composition comprises from about 10 to about 50 mg of a compound of formula I (agomelatine) and from about 250 to about 350 mg of pregabalin.
  • one active agent is in a controlled release form and one active agent in an immediate release form, extended (controlled) release form or delayed release form, with an optional pharmaceutically acceptable carrier.
  • the disclosed method comprises administering to a subject in need of relief from pain and pain related disorders, a pharmaceutical composition comprising from about 0.1 mg to about 1500 mg of a compound of formula I (agomelatine), from about 0.1 mg to about 1500 mg of an antiepileptic and optionally a pharmaceutically acceptable carrier.
  • a pharmaceutical composition comprises from about 1 mg to about 500 mg of a compound of formula I (agomelatine) and from about 5 to about 1000 mg of an antiepileptic. More preferably, the disclosed pharmaceutical composition comprises from about 5 mg to about 100 mg of a compound of formula I (agomelatine) and from about 10 to about 600 mg of an antiepileptic.
  • the disclosed pharmaceutical composition comprises from 10 to about 50 mg of a compound of formula I (agomelatine) and from about 250 to about 350 mg of pregabalin.
  • the disclosed method comprises administering to a subject in need of relief from pain and pain related disorders, a pharmaceutical composition comprising from about 0.1 mg to about 1500 mg of a compound of formula I (agomelatine), from about 0.1 mg to about 1500 mg of an antiepileptic and optionally a pharmaceutically acceptable carrier.
  • a pharmaceutical composition comprises from about 1 mg to about 500 mg of a compound of formula I (agomelatine) and from about 5 to about 1000 mg of an antiepileptic. More preferably, the disclosed pharmaceutical composition comprises from about 5 mg to about 100 mg of a compound of formula I (agomelatine) and from about 10 to about 600 mg of an antiepileptic.
  • the disclosed pharmaceutical composition comprises from 10 to about 50 mg of a compound of formula I (agomelatine) and from about 250 to about 350 mg of gabapentin.
  • the dosage of an opioid that can be administered to a patient is from about 0.1 mg to about 1,500 mg per dose one or more times per week, from about 0.1 mg to about 750 mg per dose one or more times per week, from about 0.1 mg to about 350 mg per dose one or more times per week.
  • the dosage of tapentadol that can be administered to a patient is from about 0.1 mg to about 500 mg per dose one or more times per week, from about 0.1 mg to about 250 mg per dose one or more times per week, from about 0.1 mg to about 100 mg per dose one or more times per week.
  • the dosage of morphine that can be administered to a patient is from about 0.1 mg to about 250 mg per dose one or more times per week, from about 0.1 mg to about 100 mg per dose one or more times per week, from about 0.1 mg to about 50 mg per dose one or more times per week.
  • the dosage of oxycodone that can be administered to a patient is from about 0.1 mg to about 250 mg per dose one or more times per week, from about 0.1 mg to about 100 mg per dose one or more times per week, from about 0.1 mg to about 50 mg per dose one or more times per week.
  • the amount of agomelatine in the disclosed compositions is in the range of from about 0.1 mg to about 500 mg, preferably from about 1 mg to about 100 mg and most preferably from about 5 mg to about 50 mg, per dosage unit.
  • the amount of palmitoylethanolamide (PEA) in the disclosed compositions is in the range of from about from about 0.1 to about 1500 mg, more preferably, from about 5 to about 1000 mg of an palmitoylethanolamide (PEA), and most preferably, from about 10 to about 600 mg, per dosage unit, still most preferably from about 50 to about 600mg of palmitoylethanolamide (PEA).
  • the disclosed compositions can allow a decrease in the dosage of active agents, such as, agomelatine or palmitoylethanolamide (PEA), to a patient, which can promote better patient compliance.
  • active agents such as, agomelatine or palmitoylethanolamide (PEA)
  • the disclosed compositions comprise from about 0.1 mg to about 500 mg of agomelatine, from about 0.1 mg to about 1500 mg of palmitoylethanolamide (PEA) and optionally a pharmaceutically acceptable carrier, for management of pain, depression, and pain related disorders.
  • the disclosed pharmaceutical composition comprises from 1 to about 100 mg of agomelatine and from about 5 to about 1000 mg of palmitoylethanolamide (PEA).
  • the disclosed pharmaceutical composition comprises from 5 to about 50 mg of agomelatine and from about 10 to about 600 mg of palmitoylethanolamide (PEA). Most preferably, the disclosed pharmaceutical composition comprises from 10 to about 20 mg of agomelatine and from about 250 to about 300 mg of palmitoylethanolamide (PEA).
  • one active agent is in a controlled release form and one active agent in an immediate release form, extended (controlled) release form or delayed release form, with an optional pharmaceutically acceptable carrier.
  • the amount of NSAID administered to the patient is from about 0.1 mg to about 1,500 mg per dose one or more times per week, from about 0.1 mg to about 800 mg per dose one or more times per week, from about 0.1 mg to about 400 mg per dose one or more times per week, from about 0.1 mg to about 200 mg per dose one or more times per week, from about 0.1 mg to about 100 mg per dose one or more times per week, from about 0.1 mg to about 50 mg per dose one or more times per week, or from about 0.1 mg to about 25 mg per dose one or more times per week.
  • compositions can be prepared by methods known in the art. Such methods are well known in the art for example in "Remington's Pharmaceutical Sciences", A.R. Gennaro (ed.), 17th edition, Mack Publishing Company, Easton, Pa. (1985), in particular in part 8, chapters 76 to 93.
  • One or both of the active agents can be present in the disclosed pharmaceutical formulations at least partially in controlled-release form.
  • any controlled release/ immediate release combination of the agents can also be present in the disclosed pharmaceutical formulation.
  • one or both of the components can be released from the disclosed formulations with a delay, e.g., if administered orally, rectally or percutaneously.
  • Such formulations are particularly useful for "once-daily” or “twice-daily” preparations, which only have to be taken once a day, or twice a day, respectively.
  • Suitable controlled-release materials are well known to those skilled in the art.
  • compositions can be prepared in various forms such as, for example, granules, spheroids, pellets, multiparticulates, capsules, patches tablets, sachets, controlled release suspensions, or in any other suitable dosage form incorporating such granules, spheroids, pellets or multiparticulates.
  • the compositions can be, for example, a tablet formed from granules, spheroids, pellets, multiparticulates and the like or the granules, spheroids, pellets, multiparticulates can be in pellets
  • the disclosed solid pharmaceutical compositions can be tablets, for example, the components of the pharmaceutical composition can be granulated with a pharmaceutical carrier, for example, conventional tablet ingredients such as corn starch, lactose, saccharose, sorbitol, talcum, magnesium stearate, dicalcium phosphate or pharmaceutically acceptable gums, and pharmaceutical diluents, for example, water, in order to form a solid composition which can be divided into unit dosage forms such as tablets, or capsules, and the like.
  • the disclosed tablets or capsules prepared can be coated suitably to provide an osmotic delivery system.
  • osmotically driven release systems are, for example, disclosed in U.S. patent no. 4,765,989, U.S. patent no. 4,783,337 and U.S. patent no. 4,612,008.
  • compositions can be in dosage forms, e.g., coated tablets wherein the coating includes at least one water-insoluble, water permeable film-forming polymer, at least one plasticizer and at least one water-soluble polymer, and the second active agent.
  • the coating can have at least one water-insoluble, water-permeable film-forming polymer varies from about 20% to about 90% of the coating dry weight, the proportion of the at least one plasticizer varies from about 5% to about 30% of the coating dry weight, and the proportion of the at least one water-soluble polymer varies from about 10% to about 75% of the coat dry weight.
  • One or more of active ingredients in the disclosed compositions can also be incorporated in a matrix.
  • matrices are provided in U.S. patent no. 5,330,761, U.S. Patent No. 5,399,362, U.S. Patent No. 5,472,711 and U.S. Patent No. 5,455,046.
  • the matrix can be any type known to a person skilled the art, that affords slow release active agent over at least about a twelve-hour period and preferably that affords in-vitro dissolution rates and in vivo absorption rates of an agomelatine or secondary agent within the therapeutically effective ranges.
  • the disclosed composition can preferably use a slow release matrix.
  • normal release matrices having a coating that provides for slow release of the active agents can be used.
  • the slow release matrices that can be employed in the disclosed compositions can also contain other pharmaceutically acceptable ingredients which are conventional in the pharmaceutical art such as diluents, lubricants, binders, granulating aids, colorants, flavorants, surfactants, pH adjusters, anti-adherents and glidants, e.g., dibutyl sebacate, ammonium hydroxide, oleic acid and colloidal silica. Any known diluent e.g., microcrystalline cellulose, lactose and dicalcium phosphate can be used to prepare this composition.
  • lubricants are, e.g., magnesium stearate and sodium stearyl fumarate.
  • Non-limiting examples of binding agents are, e.g., hydroxypropyl methylcellulose, polyvidone and methyl- cellulose.
  • Suitable disintegrating agents include starch, sodium starch glycolate, crospovidone, croscarmellose sodium and the like.
  • the composition comprising a compound of formula I, and the second agent, wherein one of the active agents is in slow release form can comprise a normal release matrix having a slow release coating.
  • the combination comprises film-coated spheroids containing the active ingredient and a spheronising agent.
  • the spheronising agent can be any suitable pharmaceutically acceptable material that can be combined with the active ingredient to form spheroids.
  • the amount of the disclosed pharmaceutical composition to be administered to the patient can vary as is well known to those skilled in the art. Factors such as, for example, the weight of the patient, the route of administration, or the severity of the illness can affect the exact amount administered. Suitable methods of delivering the disclosed composition include, but are not limited to oral, intravenous, intraarterial, intraperitoneal, intradermal, transdermal, intrathekal (intrathecal), intramuscular, intranasal, transmucosal, subcutaneous, or rectal administration.
  • compositions comprising agomelatine are for illustrating the invention related to compositions comprising agomelatine and no intended to limit the scope of the invention.
  • the experimental examples disclose the preparation and use of a composition comprising a combination of agomelatine and an immunomodulatory DMARD, antiepileptic, opioid, NSAID and
  • corticosteroid agent for treating a disorder and are intended to be a way of illustrating but not limiting the invention.
  • Example: 1 Formulation having Agomelatine and Palmitoylethanolamide
  • Palmitoylethanolamide was sifted through a #140 mesh (US) sieve (less than 105 ⁇ ) and ensure that there are no lumps in the powder.
  • agomelatine and microcrystalline cellulose were charged in a suitable blender (Turbula mixer, twin shell blender or bin blender) after sifting the excipients through #40 mesh (US) sieve. The contents were mixed thoroughly for 5 minutes.
  • Povidone K 30 was sifted through #80 mesh US sieve and dissolved in 80% of purified water at 30°C. The contents were stirred at slow speed. The Povidine reaction mixture was heated with 20% purified water to 60°C. Polysorbate 80 was added to Povidone solution and stirred slowly till the solution becomes clear by gentle mixing.
  • the granulating fluid prepared above was added to palmitoylethanolamide and agomelatine and other excipients.
  • the contents were granulated in a Rapid mixer granulator (RMG) by running the mixer and chopper at slow speed.
  • the granules were checked to ensure there are no lumps.
  • the granules were dried at 60°C till the moisture content of the granules is less than 2% and passed through a suitable mill (Fitz or Multi mill) with a #30 mesh (US) sieve.
  • the contents were transferred to a blender, and sodium CMC was added. Colloidal Silica was passed through sieve no. #80 and was mixed with granules for 5 minutes.
  • the tablets were prepared by compressing the granules in a rotary tablet machine with appropriate tooling and a compression weight of 234 mg.
  • Example 2 Case Study A (PT #3342 DP) agomelatine and PEA
  • Diagnosis The diagnosis of DPNP was made based on the physical examination of the patient, which revealed no other pronounced abnormalities, coupled with her description of bilateral burning pain and dysesthesia in her feet, abnormal skin appearance, and diminished pulses.
  • Treatment Over a two-week period, the patient was treated with gabapentin (from 100 mg to 600 mg/day) at bedtime. The gabapentin dose was reduced to 300 mg/day and duloxetine (30 mg/day) was added. The patient was told to take duloxetine in the morning. She was able to successfully increase the dose to the target dosage of 60 mg/d after 1 week, with her daytime pain level decreasing from 8/10 to 6/10.
  • the palmitoylethanolamide (PEA) dose increased to 600 mg/day and reduced agomelatine to 12.5 mg/day. Once stabilized with PEA and agomelatine, her pain intensity during the day was 2/10 with intensity during the night of 3/10. With these final changes, she was able to resume her favorite sports.
  • PEA palmitoylethanolamide
  • Treatment Method The patients were asked to discontinue the pregabalin and a washout period maintained. During the wash out period, each of the patents underwent physiotherapy as rescue treatment. After one week of washout period, subjects received 12.5 mg agomelatine and 300 mg tablets of PEA (BID) and were titrated. Patients were instructed to maintain their normal daily routine and not to alter exercise regimens. The pain was measured using the 11 -point NRS with respect the single primary endpoint was mean pain score from patients' daily pain diaries. Each day on awakening, patients rated their pain during the previous 24 hours. The patients were treated for a period of six weeks after wash out period. The pain and sleep quality scores were recorded and followed up every week. There after the patients were followed up once every month for three more visits.
  • Baseline characteristics The baseline pain scores for patient 1, patient 2, and patient 3 were 7.45, 7.7, and 7.23 respectively. Similarly the baseline sleep quality scores for patient 1, patient 2, and patient 3 were 6.85, 6.99, and 7.07 respectively.
  • HPMC (2910 - 15 cps viscosity grade) 20.16 20.16
  • Titanium dioxide (micronized) 6.72 6.72
  • Step I Granulation of the modified release layer
  • Pregabalin and 50% of the ethyl cellulose were passed through sieve no. #40 and agglomerates were removed.
  • the materials were mixed in a blender (Turbula mixer, twin shell V blender or bin blender) for 10-15 minutes.
  • the Hydrogenated castor oil was melted, at 90°C, in a jacketed rapid mixer granulator (RMG) and the pregabalin-ethyl cellulose blend was added and granulated.
  • the granulated materials were mixed continuously with gradual cooling to room temperature.
  • the resulting granules were sized through a 1.5 mm screen to break the agglomerates.
  • the screened granules were transferred to a blender and mixed with the remaining quantity of Ethyl cellulose for 5 minutes in a V shaped blender.
  • Step II Wet granulation of the immediate release layer.
  • the granules were dried at 60°C until the moisture content of the granules is less than 2% and passed through a suitable mill (Fitz or Multi mill) with a 1.5 mm sieve.
  • the granules were transferred to a blender, to which Sodium Starch Glycolate, Stearic acid and Magnesium stearate (passed through sieve no. #60) were added, and mixed thoroughly for 5 minutes. Silicon dioxide (passed through sieve no #80) was added to the granules and thoroughly mixed for 5 minutes.
  • the particle size distribution of the granules is controlled for the fine fraction to be not more than 25 to 30% so that there are no flow issues. (Fines are defined as particles sized ⁇ 140 ⁇ (100 mesh US standard).)
  • Step III Compression on a bilayer press
  • the tablets were compressed using a bilayer press and compression tooling.
  • the immediate release material prepared in step II (agomelatine layer) was loaded into one hopper of the bilayer press, and the modified release material prepared in step I (pregabalin layer) was loaded into the second hopper of the bilayer press.
  • a suitable container was charged with 80 ml of purified water and heated to about 60°C - 70°C.
  • HPMC 20.16 g was added into the heated water, with gentle stirring. After the polymer is wetted, 80 ml of cold water was added immediately. The dispersion was stirred until it becomes homogenous.
  • Polyethylene 8000, 6.72 g was dissolved in 100 ml of water and added to the HPMC dispersion. This was followed by addition of PEG400, 6.72 g, and stirring for an additional five minutes.
  • the pigment, micronized titanium dioxide, 6.72 g was added to this polymer solution, with constant stirring. The dispersion was homogenized to achieve particle size reduction of the pigment.
  • the volume was increased by addition 336 mL of cold water.
  • the core tablets were loaded onto a coating pan.
  • the coating dispersion was applied to provide a weight gain of about 2.5 to 4.0% w/w.
  • the coating dispersion was agitated during the coating process.
  • the coating is a non-active material and is provided only for the purpose of providing a protective layer and for ease of swallowing.
  • Procedure The procedure used to determine and compare the effect of the disclosed compositions, for which there is a good correlation with human efficacy for the treatment of pain, is the procedure for the measurement of allodynia according to the Chung Model
  • the dosing materials were all prepared in the vehicle, a suspension of 0.9% NaCl in distilled water; drug weights were calculated as the free base.
  • the agomelatine solution was prepared first, and the appropriate volume of this solution was added to an amount of the pregabalin to give the final dosing suspension.
  • Drug weights were calculated as the free base, and the ratios used were based on the respective ED 50 values. The necessary doses for each ratio were prepared separately and dosed orally in a volume of 10 mL/kg per rat.
  • Animal dosing The Chung Model rats were all dosed orally with the composition comprising a combination of agomelatine and pregabalin (calculated as the base) or the composition of each agent separately dissolved in distilled water or dissolved in a suspension of 0.9% NaCl in distilled water. The dosing volume was 5 mL/kg. After the tests and baseline measurements, the rats were incubated with various doses of agomelatine alone, pregabalin drug alone, combined doses of agomelatine and pregabalin or vehicle such as distilled water or a suspension of 0.9%> NaCl in distilled water by the intravenous (i.v.) route (application volume 5 ml/kg).
  • i.v. intravenous route
  • Animals were randomly assigned to groups of 10 for each test dose and vehicle (0.9 % NaCl solution) and tactile withdrawal thresholds were tested 0.5 hours before administration and on several time points (0.5, 1 and 3 hours) after intravenous administration. Ipsilateral and contralateral hind paws were tested.
  • ANOVA analysis of variance
  • Agomelatine 0.1, 3.16 and 5 mg/kg
  • pregabalin 0.1, 3.16 and 10 mg/kg i.v.
  • Agomelatine and an antiepileptic (pregabalin) composition show a potency difference, which amounts to a factor 2.5 based on the ED50 values 30 minutes after administration.
  • Combinations in a fixed ratio of 1 : 2.5 were tested in doses of 0.01 mg/kg + 0.25 mg/kg; 0.03 mg/kg + 0.75 mg/kg, 0.09 mg/kg + 2.5 mg/kg i.v. Agomelatine + pregabalin, respectively. The results are illustrated in Table 4.
  • the experimental ED50 value (95 % confidence interval) of the combination is below the theoretical additive ED50 value (95 % confidence interval) of the combination and is statistically significant (p ⁇ 0.001) as compared to the additive value.
  • agomelatine and pregabalin is synergistic.
  • the 3 to 30-day screening phase was followed by a 1 -week, single blind, placebo lead-in baseline phase begun at visit 2. Subjects were provided a placebo for 1 week to obtain an evaluation of the baseline variables, including safety measures. At visit 3, the patients were randomized to 1 of 4 treatment groups: 1) pregabalin, 2) agomelatine, 3) a combination of agomelatine and pregabalin, or 4) placebo, in a 1 : 1 : 1 : 1 ratio. Assignment to treatment groups was determined by a computer-generated random sequence using an interactive voice response system. The treatment phase was a double blind for 12 weeks. The patients were evaluated Weeks 1 , 2, 5, 9, 13 (termination), and 13 (follow up).
  • Sample Size A total of about 98 patients were enrolled from 132 screened. The design ensured that drugs were administered to at least 15 patients in each of four clinical arms so that at least 10-12 patients completed treatments in each arm.
  • NRS 1 1 -point numeric rating scale
  • FIQ-Total Scores administered at the termination visit, was used as additional primary endpoints to evaluate the efficacy of pregabalin for meeting the management of FM, and [00186] The Patient Global Impression of Improvement (PGI-Improvement) scale, ranging from 1 (very much better) to 7 (very much worse).
  • Baseline characteristics Demographic and baseline characteristics of the randomized subjects were similar across treatment groups. Most patients were female (90%>), and between 18 and 64 years of age (80%), with a mean age of 58.5 years (range 33 to 82). The majority of women were postmenopausal (65%). The pain scores were similar at the baseline for all groups. Most patients in the study had been symptomatic with FM for more than 6 years, with a mean duration of 7.5 years.
  • Fibromyalgia Impact Questionnaire (total, 0-100; items 0-10)
  • the PGIC measures are listed in Table 8 and Figure 4. Overall, the percentage of patients reporting at least minimal improvement in PGIC at endpoint 58% for agomelatine, 65% for pregabalin and 72% for combination, compared with 47% in the placebo group.
  • the FIQ-Total Score at endpoint was the third outcome used to assess efficacy. All patients improved from baseline, greater improvement was observed in patients using agomelatine, pregabalin, and the combination groups.
  • the Medical Outcomes Study Scale is adopted from the methodology as disclosed in "Evaluation of the reliability and validity of the Medical Outcomes Study sleep scale in patients with painful diabetic peripheral neuropathy during an international clinical trial", Muriel Viala- Danten et al, Health and Quality of Life Outcomes 2008, 6: 113 doi: 10.1186/1477-7525-6-113, was used as an additional measure of efficacy.
  • the MOS-Sleep is a 12-point measurement developed using patients with chronic illness; it is divided into 6 dimensions evaluating "sleep disturbance,” “snoring,” “sleep awakening short of breath or with headache,” “sleep adequacy,” “somnolence,” and “quantity of sleep/optimal sleep”.
  • a sleep problems index summarizing information across 9 items of the MOS-Sleep scored as outlined below.
  • Patient History The study recruited a 30-year-old male patient who had a long history of suffering from primary generalized epilepsy. The patient's history revealed he had no personality disorder, schizophrenia, schizoaffective, bipolar- or an organic mental disorder. His generalized tonic-clonic seizures began 7 years ago. The patient had a complete neurologic workup, with some of the tests repeated several times. He normally experiences 1-2 seizures per week.
  • the subject had been treated, over the previous five years, with a variety of antiepileptic drugs including lamotrigine (Lamictal), carbamazepine (Tegretol), topiramate (Topamax), oxcarbazepine (Trileptal), zonisamide (Zonegran) and gabapentin (Neurontin).
  • lamotrigine Lamictal
  • carbamazepine Tegretol
  • topiramate Topicamax
  • oxcarbazepine Terileptal
  • zonisamide Zaonegran
  • gabapentin Neurorontin
  • the agomelatine dosage was reduced to 12.5 mg and pregabalin was retained at 50 mg (BID). The patient was monitored for additional eight weeks.
  • Study Design This was a two-center, interventional, randomized, parallel assignment, double blind design to study the efficacy and safety of the combination compared to concurrent controls with Placebo, Agomelatine alone and Pregabalin alone in patients with Neuropathic Pain associated with Diabetic Peripheral Neuropathy (DPN).
  • DPN Diabetic Peripheral Neuropathy
  • Sample Size The screening was completed on 94 patients. A total of 63 patients in four clinical arms were enrolled and randomized to achieve at least ten patients in each arm at two centers. 45 patients completed the full treatment.
  • Inclusion Criteria The following inclusion criteria were used for patient selection for this study. Prior to randomization, subjects eligible for enrollment in the study must meet all of the following criteria:
  • a female subject is eligible to enter and participate in the study if she:
  • Type 1 or Type 2 diabetes mellitus including:
  • Stable glycemic control for three months prior to randomization may be changed after randomization to maintain glycemic control
  • Insulin ⁇ 25% change of their routine insulin dose to maintain glycemic
  • Oral anti-diabetic agents ⁇ 50% change of their routine oral dose to maintain glycemic control.
  • HbAlc glycosylated hemoglobin
  • Subjects with HbAlc concentration of 9 to 11% maybe eligible if, in the opinion of the investigator, attempts have been made by the subject to improve diabetic control but these attempts have failed.
  • DPN Distal symmetric chronic sensorimotor painful polyneuropathy
  • Symptoms including:
  • a history of pain for at least 24 months and no greater than five years attributed to DPN (Note this requirement refers to duration of pain, not the duration of polyneuropathy) .
  • the Baseline score is the calculated mean of the daily scores during the 7 days prior to randomization. (The subject must record at least four assessments of the 24-hour average daily pain intensity score during the seven-day Baseline Period. The investigators have the discretion to recruit patients with a baseline score of up to 3.5 as exceptions.) 9. The subject must be able to provide written informed consent prior to participation in the study. The contents and process of obtaining informed consent will be in accordance with all applicable regulatory requirements.
  • Exclusion Criteria The following criteria were used for excluding patients during patient selection for this study. Subjects meeting any of the following criteria must be excluded from the study:
  • the patient has other chronic pain conditions not associated with distal symmetric chronic sensorimotor painful polyneuropathy. However, the subject will not be excluded if:
  • the pain condition is located at a different region of the body; b.
  • the pain intensity of this condition is not greater than the pain intensity of the distal symmetric chronic sensorimotor painful polyneuropathy; or c.
  • the subject can assess their DPN independently of their other pain
  • neuropathy or lower extremity pain which may include, but not be limited to:
  • osteoarthritis of the ankle or foot gout, bursitis, or fasciitis;
  • peripheral neuropathy caused by: alcoholism, malignancy, human immunodeficiency virus (HIV), syphilis, drug abuse, peripheral ischemia, B-12 deficiency, hypothyroidism, liver disease, chemotherapy or radiation therapy;
  • HIV human immunodeficiency virus
  • syphilis drug abuse, peripheral ischemia, B-12 deficiency, hypothyroidism, liver disease, chemotherapy or radiation therapy;
  • Focal neuropathy in the lower extremities including nerve entrapment or local trauma;
  • Focal or multifocal diabetic neuropathies including:
  • Non-drug therapies or procedures i.e. nerve blocks, trans cutaneous
  • ETS electrical nerve stimulation
  • Hepatic impairment defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2x upper limit of normal (ULN) or alkaline phosphatase or bilirubin > 1.5x ULN;
  • HsAg Hepatitis C Core Antigen Antibody
  • Hep C antibody Hepatitis C Core Antigen Antibody
  • QTc Corrected QT (QTc) interval >450 msec (based on single or average QTc value of triplicate electrocardiograms (ECGs) obtained over a brief recording period);
  • the first two weeks were for screening and to establish a baseline period.
  • the baseline score and first drug administration were at To and continued every day for ten weeks.
  • the pain scores were recorded by the patients daily in their daily pain dairies.
  • the weekly pain scores were assessed on T 0 (week 2) thru T 10 (week 12).
  • the primary efficacy measure was the mean Numeric Rating Scale from daily pain diaries (11 -point numeric rating scale).
  • the secondary efficacy measures included weekly NRS and proportion of responders (patients achieving >20% reduction in the mean Numeric Rating Scale compared those from comparator drugs.
  • AEs Adverse events
  • vital signs were monitored during the study.
  • Safety evaluations also included laboratory measurements, physical examinations, and neurological exams, including Screening:
  • the patients were trained to mark on the scale that correlated what they think was best representation of intensity of pain.
  • To use the Numeric Rating Scale the patient was asked to choose the number between 0 (no pain) and 10 (worst possible pain) that best describes the intensity of pain felt by them.
  • Pregabalin CR Pregabalin CR
  • pregabalin as BID 25 mg Agomelatine and 125 mg Pregabalin BID
  • the study was conducted as per above protocol except for dosage and mode of Pregabalin administration. The results are shown in Figure 8.
  • a total of 28 patients were screened to achieve targeted patient size of about 5 patients in each of the four arms- agomelatine, tapentadol, placebo and the combination of tapentadol and agomelatine.
  • Week 0-2 Baseline; Week 0-2, Intermediate: Week 6-12 and Final: Week 18 or Last Visit.
  • Example 10 Pharmacological Example of Agomelatine and NSAID (Naproxen)
  • the patients were selected from screening 26 patients and were randomly assigned to three groups- Agomelatine, Naproxen and Combination groups.
  • the patients were administered for one week either agomelatine 25 mg, naproxen 250 mg or a combination of 25 mg agomelatine and 250 mg of naproxen. Placebo capsules were administered to mask the drugs. Patients were trained record the pain scores on 11- point Numeric Rating Scale (NRS) in their pain dairies. Data are expressed as means ⁇ SD.
  • NRS Numeric Rating Scale

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Epidemiology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Molecular Biology (AREA)
  • Biophysics (AREA)
  • Engineering & Computer Science (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Emergency Medicine (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

L'invention porte sur une composition pharmaceutique comprenant une quantité thérapeutiquement efficace d'un composé de formule (I) et une quantité thérapeutiquement efficace d'un second principe actif, le second principe actif étant : a) un médicament antiépileptique ; b) un agoniste des récepteurs activés par les proliférateurs de peroxysomes (PPAR) ; c) un opioïde ; ou d) un AINS ou des sels pharmaceutiquement acceptables, isomères ou polymorphes de ceux-ci et éventuellement un véhicule pharmaceutiquement acceptable, utile pour la prévention ou le traitement de la douleur et de troubles liés à la douleur. Les compositions pharmaceutiques sont utiles dans un procédé pour le traitement de la douleur et de troubles liés à la douleur, par administration des compositions à un patient qui en a besoin.
PCT/US2012/061922 2011-10-25 2012-10-25 Compositions pharmaceutiques pour le traitement de la douleur WO2013063263A1 (fr)

Applications Claiming Priority (8)

Application Number Priority Date Filing Date Title
US201161551376P 2011-10-25 2011-10-25
US61/551,376 2011-10-25
US201261619405P 2012-04-02 2012-04-02
US61/619,405 2012-04-02
US201261660765P 2012-06-17 2012-06-17
US61/660,765 2012-06-17
US201261665296P 2012-06-27 2012-06-27
US61/665,296 2012-06-27

Publications (1)

Publication Number Publication Date
WO2013063263A1 true WO2013063263A1 (fr) 2013-05-02

Family

ID=48168493

Family Applications (2)

Application Number Title Priority Date Filing Date
PCT/US2012/061955 WO2013063289A1 (fr) 2011-10-25 2012-10-25 Compositions pharmaceutiques pour traiter la douleur
PCT/US2012/061922 WO2013063263A1 (fr) 2011-10-25 2012-10-25 Compositions pharmaceutiques pour le traitement de la douleur

Family Applications Before (1)

Application Number Title Priority Date Filing Date
PCT/US2012/061955 WO2013063289A1 (fr) 2011-10-25 2012-10-25 Compositions pharmaceutiques pour traiter la douleur

Country Status (1)

Country Link
WO (2) WO2013063289A1 (fr)

Cited By (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2014013497A1 (fr) * 2012-07-20 2014-01-23 Yissum Research Development Company Of The Hebrew University Of Jerusalem Ltd. Dérivés d'acides gras destinés à être utilisés dans un procédé de traitement de la dépression et d'états associés
US20140199369A1 (en) * 2013-01-17 2014-07-17 Industrial Technology Research Institute Pharmaceutical composition
US9155734B2 (en) 2012-03-07 2015-10-13 Mallinckrodt Llc Stability of hydromorphone hydrochloride solutions
WO2015189778A1 (fr) * 2014-06-10 2015-12-17 Laboratorio Chimico Internazionale S.P.A. Adsorbats et compositions d'agomélatine en solution
US9428448B2 (en) 2008-03-04 2016-08-30 Yissum Research Development Company Of The Hebrew University Of Jerusalem Ltd. Compounds and methods of treating obesity
WO2016146453A1 (fr) 2015-03-16 2016-09-22 Vanderbilt Science Holding Ltd Composition servant au traitement de la douleur neuropathique
CN108653739A (zh) * 2018-06-19 2018-10-16 广州脉缔欣谱医药科技有限公司 可降低Gabapentinoid致肥胖副作用的镇痛抗癫痫组合物及其制备方法
US10653737B1 (en) 2019-01-02 2020-05-19 Celagenex Research (India) Pvt. Ltd. Synergistic nutritional compositions for pain management
WO2022159086A1 (fr) * 2021-01-20 2022-07-28 Rush University Medical Center Traitement amélioré pour la leucodsytrophie à cellules globoïdes ou la maladie de krabbe

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5194614A (en) * 1990-02-27 1993-03-16 Adir Et Compagnie Compounds having a naphthalene structure
US20110159048A1 (en) * 2009-12-22 2011-06-30 Pondera Biotechnologies, LLC Methods and compositions for treating distress dysfunction and enhancing safety and efficacy of specific medications

Family Cites Families (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050203130A1 (en) * 2003-12-02 2005-09-15 Erik Buntinx Use of D4 and 5-HT2A antagonists, inverse agonists or partial agonists
US7645905B2 (en) * 2005-08-03 2010-01-12 Les Laboratoires Servier Crystalline form IV of agomelatine, a process for its preparation and pharmaceutical compositions containing it
US7635721B2 (en) * 2005-08-03 2009-12-22 Les Laboratoires Servier Crystalline form III of agomelatine, a process for its preparation and pharmaceutical compositions containing it
KR20090024140A (ko) * 2006-05-22 2009-03-06 반다 파마슈티칼즈, 인코퍼레이티드. 우울증 질환에 대한 치료

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5194614A (en) * 1990-02-27 1993-03-16 Adir Et Compagnie Compounds having a naphthalene structure
US5225442A (en) * 1990-02-27 1993-07-06 Adir Et Compagnie Compounds having a naphthalene structure
US20110159048A1 (en) * 2009-12-22 2011-06-30 Pondera Biotechnologies, LLC Methods and compositions for treating distress dysfunction and enhancing safety and efficacy of specific medications

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9428448B2 (en) 2008-03-04 2016-08-30 Yissum Research Development Company Of The Hebrew University Of Jerusalem Ltd. Compounds and methods of treating obesity
US9155734B2 (en) 2012-03-07 2015-10-13 Mallinckrodt Llc Stability of hydromorphone hydrochloride solutions
US10905685B2 (en) 2012-03-07 2021-02-02 Piramal Critical Care, Inc. Intrathecal hydromorphone solutions having improved stability
WO2014013497A1 (fr) * 2012-07-20 2014-01-23 Yissum Research Development Company Of The Hebrew University Of Jerusalem Ltd. Dérivés d'acides gras destinés à être utilisés dans un procédé de traitement de la dépression et d'états associés
US20140199369A1 (en) * 2013-01-17 2014-07-17 Industrial Technology Research Institute Pharmaceutical composition
US9408917B2 (en) * 2013-01-17 2016-08-09 Industrial Technology Research Institute Pharmaceutical composition
WO2015189778A1 (fr) * 2014-06-10 2015-12-17 Laboratorio Chimico Internazionale S.P.A. Adsorbats et compositions d'agomélatine en solution
WO2016146453A1 (fr) 2015-03-16 2016-09-22 Vanderbilt Science Holding Ltd Composition servant au traitement de la douleur neuropathique
CN108653739A (zh) * 2018-06-19 2018-10-16 广州脉缔欣谱医药科技有限公司 可降低Gabapentinoid致肥胖副作用的镇痛抗癫痫组合物及其制备方法
US10653737B1 (en) 2019-01-02 2020-05-19 Celagenex Research (India) Pvt. Ltd. Synergistic nutritional compositions for pain management
WO2020141546A1 (fr) 2019-01-02 2020-07-09 Celagenex Research (India) Pvt. Ltd. Compositions nutritionnelles synergiques pour la gestion de la douleur
WO2022159086A1 (fr) * 2021-01-20 2022-07-28 Rush University Medical Center Traitement amélioré pour la leucodsytrophie à cellules globoïdes ou la maladie de krabbe

Also Published As

Publication number Publication date
WO2013063289A1 (fr) 2013-05-02

Similar Documents

Publication Publication Date Title
WO2013063263A1 (fr) Compositions pharmaceutiques pour le traitement de la douleur
JP6074003B2 (ja) パーキンソン病の治療におけるオピオイド作動薬とオピオイド拮抗薬との組合せ
CN104958282B (zh) 他喷他多组合物
AU2016203567B2 (en) Novel gastro- retentive dosage forms comprising a GABA Analog and an opioid
WO2008121496A1 (fr) Agonistes du récepteur opiacé kappa pour le traitement du syndrome du côlon irritable avec alternance ou à diarrhée prédominante
JP2007302657A (ja) 痙症の兆候および症候の緩和方法
US20210353559A1 (en) Composition and method for treating neurological disease
WO2015071380A1 (fr) Hydromorphone et naloxone utilisées pour le traitement de la douleur et du syndrome de dysfonctionnement intestinal dû aux opioïdes
US10500170B2 (en) Composition and method for treating neurological disease
US11833121B2 (en) Composition and method for treating neurological disease
TW200812579A (en) Treatment of pain
Waheed et al. Tramadol and its health implications
US20240066025A1 (en) Combination of dextromethorphan and bupropion for treating depression
US20230390216A1 (en) Bromhexine for the treatment of pain
WO2021016338A1 (fr) Procédés de traitement de troubles du sommeil associés à la douleur
JP2006327993A (ja) 鎮痛薬

Legal Events

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

Ref document number: 12844216

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 12844216

Country of ref document: EP

Kind code of ref document: A1