WO2014128882A1 - Agent thérapeutique pour la dépression anxieuse - Google Patents

Agent thérapeutique pour la dépression anxieuse Download PDF

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Publication number
WO2014128882A1
WO2014128882A1 PCT/JP2013/054344 JP2013054344W WO2014128882A1 WO 2014128882 A1 WO2014128882 A1 WO 2014128882A1 JP 2013054344 W JP2013054344 W JP 2013054344W WO 2014128882 A1 WO2014128882 A1 WO 2014128882A1
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depression
action
anxiety
receptor
disorder
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PCT/JP2013/054344
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English (en)
Japanese (ja)
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久宣 貝谷
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医療法人 和楽会
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Priority to PCT/JP2013/054344 priority Critical patent/WO2014128882A1/fr
Priority to JP2015501155A priority patent/JPWO2014128882A1/ja
Publication of WO2014128882A1 publication Critical patent/WO2014128882A1/fr

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    • 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
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/22—Anxiolytics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/24—Antidepressants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the present invention relates to a medicament for the treatment of depression with invasive cognitive emotion, so-called anxiety depression, which has an anti-noradrenaline action, an anti-dopamine action, an anti-serotonin receptor 2 action and a serotonin 1A receptor partial agonist action. .
  • AD Atypical Depression
  • PTSD Posttraumatic Stress Disorder
  • Atypical depression is also called a new type of depression and is a type of depression that has been called "neurotic depression”. Depression often seen in women, also called ⁇ weather shop depression '', although it continues to be depressed more, but if there are good things and fun events, the previous malfunctions like a lie quickly and well Become. However, it does not last long and is characterized by returning to a depressed mood. Furthermore, it is a disease that shows the opposite characteristics of conventional "depression", such as running overeating, gaining weight, and sleeping as much as possible.
  • Post-traumatic stress disorder is a disease that causes a variety of stress disorders caused by shocking wounds on the heart that occur after an event that can be fatal or severe.
  • diagnostic criteria for atypical depression include mood responsiveness, hypersomnia, overeating (weight gain), lead-like paralysis, and rejection hypersensitivity.
  • rejection hypersensitivity is a core symptom of AD and mood responsiveness is It has been a necessary condition.
  • rejection hypersensitivity appears in avoidable personality disorder and social anxiety disorder (SAD). This rejection hypersensitivity is also known to appear in phobia, panic disorder and self-loving personality through stress in human relationships. There is a hypothesis that atypical depression is triggered by this rejection hypersensitivity, particularly interpersonal hypersensitivity (see Non-Patent Document 1).
  • Non-patent Document 1 On the other hand, from the observation of depression accompanied by panic disorder (PD) and social anxiety disorder (SAD), anxiety-depressive mixed symptoms (intrusive cognitive emotion) as independent disease, that is, anxiety / depressive seizure (Depressive- anxious paroxysmal (DAP) is presumed (Non-patent Document 1).
  • This anxiety / depressive attack is considered to be an important target symptom that develops from anxiety disorder to mood disorder, and is known to appear in social anxiety disorder, panic disorder, and atypical depression that tend to occur together.
  • the present inventor proposes that anxiety / depressive attacks are important symptoms that have been overlooked in the above mental disorders (non-patented). Reference 2).
  • Non-patent Document 1 The present inventor has submitted a hypothesis of occurrence of atypical depression based on the above background and clinical experience.
  • anxiety disorders phobia, panic disorder, social anxiety disorder
  • “Atypical depression” develops and symptoms including “anxiety / depressive attack” appear (see FIG. 1).
  • the present inventor has set a hypothesis that the three major signs of atypical depression are rejection hypersensitivity, PTSD symptoms (flashback), and anxiety / depressive seizures based on the above background and further clinical experience. . Furthermore, based on this hypothesis, the present inventor has previously focused clinically on the fact that a compound that suppresses the three major signs of atypical depression, particularly perospirone, has an effect on atypical depression and PTSD symptoms. It was found in his own clinical experience that the above-mentioned diseases having anxiety / depressive seizures (intrusive cognitive emotions) were not found in his own clinical experience, and the present invention was completed.
  • the medicament according to the present invention is as follows. That is, [1] A medicament for the treatment of depression having an invasive cognitive emotion, which has an anti-noradrenaline action, an anti-dopamine action, an anti-serotonin receptor 2 action and a serotonin 1A receptor partial agonist action. [2] The medicament according to [1], wherein the depression having an invasive cognitive emotion is either atypical depression or post-traumatic stress disorder. [3] The medicament according to [1] or [2], wherein the depression having an intrusive cognitive emotion is atypical depression.
  • the depression having an invasive cognitive emotion is a depression having an invasive cognitive emotion accompanied by panic disorder or social anxiety disorder.
  • Any one of [1] to [5], wherein the medicament for treating depression having an invasive cognitive emotion contains at least one compound selected from the group consisting of perospirone and lurasidone as an active ingredient.
  • the pharmaceutical according to Item [7]
  • the medicament according to any one of [1] to [6], wherein the medicament for treating depression having an invasive cognitive emotion contains perospirone as an active ingredient.
  • Depression with invasive cognitive emotion of a composition comprising a compound or a pharmaceutically acceptable salt thereof, which has an anti-noradrenaline action, an anti-dopamine action, an anti-serotonin receptor 2 action and a serotonin 1A receptor partial agonist action Use as a therapeutic drug.
  • a pharmaceutical comprising a specific compound for treating depression having an invasive cognitive emotion, particularly perospirone or a pharmaceutically acceptable salt thereof.
  • the medicament according to the present invention has an anti-noradrenaline action, an anti-dopamine action, an anti-serotonin receptor 2 action and a serotonin 1A receptor partial agonist action, and has depression with invasive cognitive emotion, so-called anxiety depression, for treatment Or a pharmaceutically acceptable salt thereof.
  • depression with invasive cognitive emotion is defined as depression having anxiety / depressive attacks as clinical symptoms, and is also referred to as anxiety depression.
  • typical disease Atypical depression) Depression (AD) (also called “new depression”) and posttraumatic stress disorder Disorder: PTSD) is included. These depressions are known to frequently accompany panic disorder or social anxiety disorder.
  • the present inventor has proposed the hypothesis that the three major signs of atypical depression are rejection hypersensitivity, PTSD symptoms (especially flashback), and anxiety / depressive seizures based on the above circumstances and further own clinical experience.
  • anxiety disorders phobia, panic disorder, social anxiety disorder
  • atypical “atypical depression” develops and symptoms including “anxiety / depressive attack” appear (see FIG. 1).
  • the blocking agent for rejection hypersensitivity is a dopamine receptor 2 blocking agent (hereinafter also referred to as “D2 blocking agent”), and the blocking agent for PTSD symptoms is also referred to as a serotonin receptor blocking agent (hereinafter referred to as “5HT blocking agent”). ),
  • D2 blocking agent dopamine receptor 2 blocking agent
  • 5HT blocking agent serotonin receptor blocking agent
  • a dopamine blocker and a noradrenaline blocker, and the anxiety / depressive seizure blocker is a dopamine blocker and a noradrenaline blocker (hereinafter also referred to as “NA blocker”), as indicated below.
  • NA blocker noradrenaline blocker
  • the D2 blocker is a drug that blocks dopamine (hereinafter also referred to as “DA”) 2 receptor, and it is known that there are two classes of D2 receptor, D2S and D2L.
  • the 5HT blocker is a serotonin receptor blocker, and is classified into 11 types including 5HT1 to 5HT7.
  • the NA blocker is an adrenergic receptor blocker, and two classes of ⁇ and ⁇ types are known.
  • Ponusamy et al. (2005) reported that systemic administration of D2 blockers promotes conditioned fear extinction learning (Ponnusamy R, Nissim HA, Barad M. Systemic blockade of D2-like dopamine receptors facilitates extinction Learn Mem. 2005 Jul-Aug; 12 (4): 399-406.).
  • atypical depression and PTSD can be regarded as a fear-conditioned state for trauma and minitrauma.
  • risperidone was used for supplementary use, although the number of cases was small and the basic symptoms of PTSD were not targeted (Baker DG, Nievergelt). CM, Risbrough VB. Post-traumatic stress disorder: emerging Concept of pharmacotherapy. Expert Opin Emerg Drugs. 2009 Jun; 14 (2): 251-72).
  • Risperidone, quetiapine, and aripiprazole which have been reported to have limited effects on PTSD, are all blockers of D2 and 5HT1A receptors, although to varying degrees. Therefore, it was considered that the basic symptom of PTSD may be suppressed by the serotonin receptor 1A partial agonistic action by an antagonist of 5HT1A receptor.
  • Meyer et al. (2003) also reported that increased 5-HT2 receptors were observed in depression (Meyer JH, McMain S, Kennedy SH, Korman L, Brown GM, DaSilva JN, et al. Dysfunctional Attitudes and 5-HT2 Receptors During Depression and Self-Harm. Am J Psychiatry 2003; 160: 90-99).
  • 5-HT2 receptors may be associated with depressive symptoms such as in PTSD and AD.
  • a drug having both anti-dopaminergic action, 5-HT receptor action (particularly anti-serotonin receptor 2 action and serotonin 1A receptor partial agonist action), and anti-noradrenaline action has the above-mentioned atypical depression. The possibility of suppressing the three major signs was considered.
  • Perospirone has been used as a therapeutic agent for schizophrenia and has a strong affinity for the D2 receptor, and has the effect of increasing free dopamine (DA) in the prefrontal cortex in addition to its direct effect on the receptor.
  • DA free dopamine
  • perospirone has been reported to increase DA in the prefrontal cortex approximately 2-fold (Mitsuaki Murasaki et al., Clinical Psychopharmacology, Vol. 11, No. 5, 845-854, 2008). .
  • perospirone has a strong affinity for the 5HT2 receptor and the 5HT1 receptor.
  • Drevets et al. (2008) report a decrease in 5-HT1 receptors in depression (Drevets et al .; Nucl Med Biol. 2007 Oct; 34 (7): 865-77).
  • Nash et al. (2008) also reported a decrease in 5-HT1 receptors in panic disorders.
  • Lanzenberger et al. (2007) reported a decrease in 5-HT1 receptors in social anxiety disorder (Lanzenberger RR et al .; Biol Psychiatry. 2007 May 1; 61 (9): 1081-9). From these points, it is considered that the 5HT receptor 1A partial antagonism of perospirone has a therapeutic effect on these mental disorders.
  • perospirone is antagonistic to D2 receptor, 5HT2 receptor, 5HT1A receptor and ⁇ 1 receptor, compared to risperidone, quetiapine, aripyrazole, olanzapine, etc., which are conventional drugs for various mental disorders As a result, it turned out to be all good.
  • compounds that can suppress the three major symptoms of atypical depression include serotonin-dopamine antagonists such as lurasidone (Ishiobashi et al., The Journal of Pharmacology and Experimantal Therapeutics, Vol. 334, No. 1, 2010).
  • serotonin-dopamine antagonists such as lurasidone (Ishiobashi et al., The Journal of Pharmacology and Experimantal Therapeutics, Vol. 334, No. 1, 2010).
  • the general names of these compounds are as follows:
  • Perospirone cis-N- [4- [4- (1,2-benzisothiazol-3-yl) -1-piperazinyl] butyl] cyclohexane-1,2-dicarboxamide and lurasidone: (3aR, 4S, 7R, 7aS) -2- ⁇ (1R, 2R) -2- [4- (1,2-benzisothiazol-3-yl) piperazin-1-ylmethyl] cyclohexylmethyl ⁇ hexahydro-4,7-methano-2H -Isoindole-1,3-dione.
  • perospirone the chemical structural formula of perospirone hydrochloride dihydrate contained in 4 mg of commercially available Luran (registered trademark) tablets and the like is shown.
  • Luran registered trademark
  • lurasidone lurasidone hydrochloride contained in Latuda tablets is shown.
  • the perospirone hydrochloride dihydrate and lurasidone hydrochloride can be produced by a known production method.
  • a preparation containing a tablet containing at least one of these compounds as an active ingredient can also be produced by a known method.
  • perospirone is disclosed by Ono et al. (2001) (Sumitomo Chemical 2001-I, pp. 38-45).
  • perospirone among the above compounds was applied to depression with invasive cognitive emotion.
  • the effects were examined at the Nagoya Mental Clinic (1-16 Sakaimachi, Nakamura-ku, Nagoya, Imon Nagoya Building 6F) and Akasaka Clinic (3-9-18 Akasaka, Minato-ku, Tokyo BIC Akasaka Building 6F).
  • CGI-I Clinical global impression-improvement scale
  • the evaluation results showed improvement in all patients with prominent improvement 59%, moderate improvement 34%, and mild improvement 6%. Therefore, it was found that the perospirone preparation according to the present invention is highly effective in cases with anxiety / depressive attacks.
  • perospirone was able to eliminate anxiety / depressive seizures and improve depression through disappearance of anxiety / depressive seizures.
  • Many patients who have anxiety / depressive seizures such as atypical depression (new type of depression) and PTSD are useful for treatment of diseases in these patients.
  • the medicament according to the present invention further includes a psychiatric drug such as an anticholinergic antiparkinsonian or a benzodiazepine minor tranquilizer, or can be used in combination with these psychiatric drugs.
  • a psychiatric drug such as an anticholinergic antiparkinsonian or a benzodiazepine minor tranquilizer
  • akathisia which is a side effect of the spirone compound, can be reduced.
  • Tasmoline (registered trademark) tablets (generic name: biperiden hydrochloride) and tremin (registered trademark) tablets (generic name: trihexyphenidyl hydrochloride)
  • Tasmoline (registered trademark) tablets (generic name: biperidene hydrochloride) are preferable.
  • the benzodiazepine-based minor tranquilizer include Wipacs (registered trademark) tablets (generic name: lorazepam), Solanax (registered trademark) tablets (generic name: alprazolam), among others, Waipacs (registered trademark) from the viewpoint of immediate effect. ) Tablets (generic name: lorazepam) are preferred.
  • the medicament according to the present invention further contains components such as excipients, binders and lubricants in addition to the above compound, the anticholinergic antiparkinson agent and / or the benzodiazepine minor tranquilizer to be blended. It can be set as a pharmaceutical composition.
  • the medicament according to the present invention may contain 4 mg to 60 mg of the above compound as a daily dose.
  • biperidene hydrochloride can contain 3 mg to 6 mg daily and lorazepam can contain 1.5 mg to 3 mg daily.
  • Such a pharmaceutical composition can take various administration routes such as oral preparations, transdermal preparations, and external preparations.
  • the pharmaceutical composition can take various dosage forms such as tablets, capsules, injections, etc., but tablets are preferred from the viewpoint of patient QOL.
  • the use as a medicament according to the present invention is a use of a medicament containing the above compound or a pharmaceutically acceptable salt thereof for the treatment of depression having an invasive cognitive emotion.
  • Case 1 Patient SC, 56 years old, housewife (chief complaint) has a strong feeling of fatigue, cannot do housework at all, self-care is almost impossible, and somehow lives with the assistance of her husband. (Patient history) 3-4 years old: Insect / fear of injection, hand-washing compulsion, but friendly and friendly. Before and after entering elementary school; I heard my father's grandmother who was hostile to her mother telling her uncle to his uncle. I thought that the mother who was bullied by her grandmother seemed sorry for her childhood. He often suffered physical violence during his school days from his father. Elementary school 2nd-5th graders were often abused and bullied. Anxiety / depressive seizures occurred for the first time while traveling abroad with a husband 16 years ago (40 years old).
  • Diagnosis Diagnosis: History of specific phobia, social anxiety disorder, agoraphobia, atypical depression failure type, anxiety / depressive attack 1-3 / month, CGI-S: 7.
  • Three tablets of Luran (4 mg), three tablets of Tasmoline (1 mg), and three tablets of Wipac (0.5 mg) were administered at a minute of 3 after each meal. Eleven days after the first visit, there were no anxiety / depressive attacks. Visit without sunglasses. Bathing three times a week. I went to the beauty salon where I did laundry. I didn't feel like getting up. Awakened because the sleep-inducing agent that had been prescribed until then disappeared. Akathisia appeared.
  • CGI-S 5. Luran (4 mg) 3 tablets ⁇ 4 tablets, tasmorine 3 mg ⁇ 6 mg, Wipacs tablets 1.5 mg ⁇ 3 mg.
  • Levotomin tablet 10 mg, Halcyon tablet 0.25 mg, and Rohypnol tablet 2 mg were added. 18 days after the first visit, a telephone revisit was carried out, and due to dizziness, Lulan 4 tablets ⁇ 3 tablets, and levotomin was discontinued. 21 days after the first visit, there was one anxiety / depressive attack, but it disappeared immediately. Daily function decreased slightly due to side effects.
  • CGI-S: 4. (Diagnosis 10 weeks after the first visit) Psychological examination and CGI-S revealed that the symptoms were greatly improved. CGI-S improved from 7 to 4, and CGI-1 improved greatly. The psychological test and CGI-S after 10 weeks are shown in
  • Panic attacks are not prominent at present, but there are several anxiety / depressive attacks every day, and the desire for wrist cuts is constant. I have collected my wrist cut photos for the past year. If you look at the blood in the photo, you can put up with the wrist cut.
  • Psychological examination Square fear scale; 65/100 (altitude), social anxiety disorder scale; 131 (highest degree), Leibovitz social anxiety disorder scale; 94 (highest degree), University of Tokyo egogram; wall flower ( Panic), panic disorder questionnaire; recent panic attacks 15 symptoms, anticipation anxiety moderate. Diagnosis of social anxiety disorder, panic disorder, unspecified depression disorder, avoidance and addiction personality disorder.

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Abstract

L'invention concerne un médicament qui comprend un composé, ou un sel pharmaceutiquement acceptable de celui-ci, pour le traitement de la dépression accompagnée par une émotion cognitive intrusive, à savoir une dépression anxieuse, ledit composé ayant un effet anti-noradrénaline, un effet anti-dopamine, un effet anti-récepteur 2 de la sérotonine et un effet agoniste partiel du récepteur 1A de la sérotonine. Selon la présente invention, l'invention concerne un médicament qui comprend un composé spirone, en particulier la pérospirone, ou un sel pharmaceutiquement acceptable de celui-ci, pour le traitement de la dépression accompagnée par une émotion cognitive intrusive, plus particulièrement pour le traitement de la dépression par la prévention d'un paroxysme anxieux dépressif pour améliorer la dépression.
PCT/JP2013/054344 2013-02-21 2013-02-21 Agent thérapeutique pour la dépression anxieuse WO2014128882A1 (fr)

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PCT/JP2013/054344 WO2014128882A1 (fr) 2013-02-21 2013-02-21 Agent thérapeutique pour la dépression anxieuse
JP2015501155A JPWO2014128882A1 (ja) 2013-02-21 2013-02-21 不安うつ病の治療薬

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11977085B1 (en) 2023-09-05 2024-05-07 Elan Ehrlich Date rape drug detection device and method of using same

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US11977085B1 (en) 2023-09-05 2024-05-07 Elan Ehrlich Date rape drug detection device and method of using same

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