WO2015125933A1 - 加齢黄斑変性に伴う地図状萎縮の処置のための医薬組成物 - Google Patents
加齢黄斑変性に伴う地図状萎縮の処置のための医薬組成物 Download PDFInfo
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- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/557—Eicosanoids, e.g. leukotrienes or prostaglandins
- A61K31/5575—Eicosanoids, e.g. leukotrienes or prostaglandins having a cyclopentane, e.g. prostaglandin E2, prostaglandin F2-alpha
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- 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
- A61K9/0012—Galenical forms characterised by the site of application
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P27/00—Drugs for disorders of the senses
- A61P27/02—Ophthalmic agents
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- 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 pharmaceutical composition for the treatment of geographic atrophy associated with age-related macular degeneration.
- Age-related macular degeneration is a disease that causes damage to the macular at the center of the retina with age. The macular is the part most involved in vision, and AMD is the fourth leading cause of blindness in Japan.
- AMD is the fourth leading cause of blindness in Japan.
- Exudative AMD is a pathological condition in which choroidal neovascularization occurs under the macular retina, and causes changes in vision, central dark spots, and a high degree of visual acuity.
- PDT photodynamic therapy
- IVR vascular endothelial growth factor inhibitor
- a combination therapy is currently being performed.
- Non-Patent Document 9 GA is often discussed in connection with dry AMD, but is also a symptom associated with wet age-related macular degeneration. There is a need for a method for effectively treating GA regardless of the exudation type or the dry type.
- Prostaglandins are members of organic carboxylic acid taxa that are found in human or other mammalian tissues or organs and exhibit a wide range of physiological activities.
- Naturally occurring PGs naturally occurring PGs generally have a prostanoic acid skeleton as shown in formula (A): .
- Natural PGs are classified into PGAs, PGBs, PGCs, PGDs, PGEs, PGFs, PGGs, PGHs, PGIs and PGJs according to the structure of the five-membered ring part. It is classified into the following three types according to the number and position of unsaturated bonds. Subscript 1: 13,14-Unsaturated-15-OH Subscript 2: 5,6- and 13,14-diunsaturated-15-OH Subscript 3: 5,6-, 13,14- and 17,18-triunsaturated-15-OH.
- PGFs are classified into ⁇ type (hydroxy group is ⁇ configuration) and ⁇ type (hydroxy group is ⁇ configuration) depending on the 9-position hydroxy group.
- 15-keto-PGs ie, PGs having an oxo group at the 15 position instead of the hydroxy group
- 13,14-dihydro-15-keto-PGs ie, the 13 and 14 positions
- Single bond between is known as a substance that is naturally produced by the action of enzymes during the in vivo metabolism of natural PG and exhibits a therapeutic effect.
- 15-keto-prostaglandin compounds are known to be useful in the treatment of ocular hypertension and glaucoma (US Pat. Nos. 5,001,153 and 5,151,444, these references are incorporated herein by reference). Incorporated in the description).
- This application aims at providing the therapeutic method of the map-like atrophy accompanying age-related macular degeneration in mammals including a human, and the pharmaceutical for the said treatment.
- the present invention provides a pharmaceutical composition for treating geographic atrophy associated with age-related macular degeneration, comprising a 15-keto prostaglandin compound.
- the present invention provides a method for treating geographic atrophy associated with age-related macular degeneration, comprising administering to a subject an effective amount of a 15-keto prostaglandin compound.
- the present invention further provides the use of a 15-keto prostaglandin compound for the manufacture of a medicament for treating geographic atrophy associated with age-related macular degeneration.
- the GA associated with AMD can be effectively treated with the pharmaceutical composition of the present invention.
- the pharmaceutical composition of the present invention can suppress a decrease in visual acuity caused by GA accompanying AMD.
- 15-keto-prostaglandin compound refers to each configuration of the 5-membered ring, the number of double bonds, Any derivative or analog of a compound with an oxo group instead of a hydroxy group at the 15-position of the prostanoic acid skeleton, including substituted derivatives, whether present or absent, or other modifications in the ⁇ or ⁇ chain Can be included.
- Formula (A) shows a basic skeleton of C-20 carbon atoms, but the 15-keto-PG compounds in the present invention are not limited to those having the same number of carbon atoms.
- the number of the carbon atom constituting the basic skeleton of the PG compound starts with a carboxylic acid (numbered 1), and 2 to 7 toward the carbon atom on the ⁇ chain toward the 5-membered ring is 8 ⁇ 12 are attached to 5-membered ring carbon atoms, and 13-20 are attached to carbon atoms on the ⁇ chain.
- PGD, PGE and PGF each represent a PG compound having a hydroxy group at the 9-position and / or the 11-position, but in the present specification and claims, a hydroxy group at the 9-position and / or the 11-position. Including those having a substituent other than. Such compounds are referred to as 9-dehydroxy-9-substituted-PG compounds or 11-dehydroxy-11-substituted-PG compounds. PG compounds having hydrogen instead of hydroxy groups are simply named 9- or 11-deoxy-PG compounds.
- the 15-keto-prostaglandin compound nomenclature is based on the prostanoic acid skeleton.
- the abbreviation “PG” may be used. Therefore, a PG compound in which two ⁇ -chain carbon atoms are extended, that is, a PG compound having nine ⁇ -chain carbon atoms is 2-decarboxy-2- (2-carboxyethyl) -15-keto- Named PG compound.
- a PG compound having 11 carbon atoms in the ⁇ chain is named 2-decarboxy-2- (4-carboxybutyl) -15-keto-PG compound.
- PG compound in which two ⁇ chain carbon atoms are extended that is, a PG compound having 10 ⁇ chain carbon atoms is named 15-keto-20-ethyl-PG compound.
- 15-keto-20-ethyl-PG compound 15-keto-20-ethyl-PG compound.
- the 15-keto-PG used in the present invention can include any PG derivative or analog as long as it has an oxo group instead of a hydroxy group at the 15-position.
- a 15-keto-PG type 1 compound having a double bond at positions 13-14 a 15-keto-PG type 2 compound having two double bonds at positions 13-14 and 5-6, 5- 15-keto-PG type 3 compound with 3 double bonds at 6, 13-14 and 17-18 position, 13,14-dihydro-15-keto- with double bond at 13-14 position as single bond PG compound is mentioned.
- Representative examples of compounds used in the present invention include 15-keto-PG type 1, 15-keto-PG type 2, 15-keto-PG type 3, 13,14-dihydro-15-keto-PG type 1. 13,14-dihydro-15-keto-PG type 2, 13,14-dihydro-15-keto-PG type 3 and derivatives or analogues thereof.
- Examples of analogs (including substituted derivatives) or derivatives are 15-keto-PG compounds in which the carboxy group at the ⁇ -chain end is esterified; compounds with extended ⁇ -chains; physiologically acceptable salts thereof; A compound having a double bond in the 2-3 position, or a triple bond in the 5-6 position, a compound having a substituent in the 3, 5, 6, 16, 17, 18, 19 and / or 20 position; And / or a compound having a lower alkyl or hydroxy (lower) alkyl group at the 11-position instead of a hydroxy group.
- preferred substituents at the 3, 17, 18 and / or 19 positions include alkyl having 1-4 carbon atoms, especially methyl and ethyl.
- Preferred substituents at the 16 position include lower alkyl such as methyl and ethyl, hydroxy, halogen atoms such as chlorine and fluorine, and aryloxy such as trifluoromethylphenoxy.
- Preferred substituents at the 17 position include lower alkyl such as methyl and ethyl, hydroxy, halogen atoms such as chlorine and fluorine, aryloxy such as trifluoromethylphenoxy and the like.
- Preferred substituents at the 20 position include saturated or unsaturated lower alkyl, such as C1-4 alkyl, lower alkoxy, such as C1-4 alkoxy, and lower alkoxyalkyl, such as C1-4 alkoxy-C1-4 alkyl. .
- Preferred substituents at the 5-position include halogen atoms such as chlorine and fluorine.
- Preferred substituents at the 6-position include oxo groups that form carbonyl groups.
- the configuration of PGs having hydroxy, lower alkyl or hydroxy (lower) alkyl substituents at the 9- and 11-positions can be ⁇ , ⁇ or a mixture thereof.
- the analog may be a compound having a shorter ⁇ chain than natural PGs and having an alkoxy, cycloalkyl, cycloalkyloxy, phenoxy or phenyl group at the end of the ⁇ chain.
- Particularly preferred compounds include 13,14-dihydro-15-keto-PG compounds having a single bond at positions 13-14; compounds with extended ⁇ -chains.
- Preferred compounds for use in the present invention are represented by formula (I): Wherein L, M and N are hydrogen, hydroxy, halogen, lower alkyl, hydroxy (lower) alkyl, or oxo, wherein the 5-membered ring may have at least one double bond ;
- A is —CH 3 , —CH 2 OH, —COCH 2 OH, —COOH or functional derivatives thereof;
- B is —CH 2 —CH 2 —, —CH ⁇ CH— or —C ⁇ C—;
- R 1 is a divalent saturated or unsaturated low or intermediate aliphatic hydrocarbon group which is unsubstituted or substituted by a halogen, lower alkyl, hydroxy, oxo, aryl or heterocyclic group, and an aliphatic carbon At least one carbon atom in hydrogen is optionally substituted by oxygen, nitrogen or sulfur; and Ra is unsubstituted or halogen, oxo, hydroxy, lower alkyl
- a particularly preferred group of compounds is represented by formula (II):
- L and M are a hydrogen atom, hydroxy, halogen, lower alkyl, hydroxy (lower) alkyl, lower alkanoyloxy or oxo, and the 5-membered ring may have at least one double bond
- A is —CH 3 , —CH 2 OH, —COCH 2 OH, —COOH or functional derivatives thereof
- B is —CH 2 —CH 2 —, —CH ⁇ CH— or —C ⁇ C—
- X 1 and X 2 are hydrogen, lower alkyl, or halogen
- R 1 is a divalent saturated or unsaturated low or intermediate aliphatic hydrocarbon group which is unsubstituted or substituted by a halogen, lower alkyl, hydroxy, oxo, aryl or heterocyclic group, and an aliphatic carbon
- At least one carbon atom in the hydrogen is optionally substituted by oxygen, nitrogen or sulfur
- the term “unsaturated” in the definition for R 1 and Ra is at least one or more, present in isolation, in isolation or in succession, between the main chain and / or side chain carbon atoms. It is intended to include further double and / or triple bonds. According to normal nomenclature, the unsaturated bond between two consecutive positions is represented by displaying a low number of two positions, and the unsaturated bond between the two distal positions Represented by displaying.
- low or medium aliphatic hydrocarbon means 1 to 14 carbon atoms (preferably 1 to 3 carbon atoms in the side chain), preferably 1 to 10, in particular 1 to 8 carbon atoms.
- a linear or branched hydrocarbon group having a carbon atom is meant.
- halogen atom includes fluorine, chlorine, bromine and iodine.
- lower alkyl refers to a straight or branched chain saturated hydrocarbon group containing from 1 to 6 carbon atoms, eg, methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl. , Pentyl and hexyl.
- lower alkylene means a straight or branched, divalent saturated hydrocarbon group containing from 1 to 6 carbon atoms, for example, methylene, ethylene, propylene, isopropylene, butylene. , Isobutylene, t-butylene, pentylene and hexylene.
- lower alkoxy refers to a group of lower alkyl-O—, wherein lower alkyl is as defined above.
- hydroxy (lower) alkyl is defined above, which is substituted by at least one hydroxy group such as hydroxymethyl, 1-hydroxyethyl, 2-hydroxyethyl and 1-methyl-1-hydroxyethyl. Means lower alkyl.
- lower alkanoyloxy refers to a group represented by the formula RCO—O—, wherein RCO— is an acyl group formed by oxidation of a lower alkyl group as defined above, eg, acetyl. .
- cyclo (lower) alkyl refers to a cyclic group formed by cyclization of a lower alkyl group containing 3 or more carbon atoms, such as cyclopropyl, cyclobutyl, Includes cyclopentyl and cyclohexyl.
- cyclo (lower) alkyloxy refers to the group cyclo (lower) alkyl-O—, wherein cyclo (lower) alkyl is as defined above.
- aryl may include unsubstituted or substituted aromatic hydrocarbon rings (preferably monocyclic groups) such as phenyl, tolyl, xylyl.
- substituents are halogen atoms and halo (lower) alkyl, where halogen atoms and lower alkyl are as defined above.
- aryloxy refers to a group represented by the formula ArO—, where Ar is aryl as defined above.
- heterocyclic group refers to optionally substituted carbon atoms and 1 to 4, preferably 1 to 3, of one or two heteroatoms selected from nitrogen, oxygen and sulfur atoms. It may contain 5 to 14, preferably 5 to 10 membered, monocyclic to tricyclic, preferably monocyclic heterocyclic groups.
- heterocyclic groups are furyl, thienyl, pyrrolyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, imidazolyl, pyrazolyl, furazanyl, pyranyl, pyridyl, pyridazinyl, pyrimidyl, pyrazinyl, 2-pyrrolinyl, pyrrolidinyl, 2-imidazolinyl, imidazolidinyl, 2 -Pyrazolinyl, pyrazolidinyl, piperidino, piperazinyl, morpholino, indolyl, benzothienyl, quinolyl, isoquinolyl, purinyl, quinazolinyl, carbazolyl, acridinyl, phenanthridinyl, benzimidazolyl, benzimidazolinyl, benzothiazolyl, phenothiazo
- heterocyclic oxy group means a group represented by the formula HcO—, where Hc is a heterocyclic group as described above.
- the term “functional derivative” of A includes salts (preferably pharmaceutically acceptable salts), ethers, esters and amides.
- Suitable “pharmaceutically acceptable salts” include conventional non-toxic salts such as alkali metal salts (sodium salts, potassium salts, etc.), alkaline earth metal salts (calcium salts, magnesium salts, etc.), ammonium salts, etc.
- an amine salt eg, methylamine salt, dimethylamine salt, cyclohexylamine salt, benzylamine salt, piperidine salt, ethylenediamine salt, ethanolamine salt, diethanolamine salt, triethanolamine salt, tris ( Hydroxymethylamino) ethane salts, monomethyl-monoethanolamine salts, procaine salts, caffeine salts, etc.), basic amino acid salts (eg arginine salts, lysine salts, etc.), and salts with organic bases such as tetraalkylammonium salts. .
- These salts can be prepared, for example, from the corresponding acids and bases by conventional reactions, or by salt exchange.
- ethers include alkyl ethers, eg, lower alkyl ethers such as methyl ether, ethyl ether, propyl ether, isopropyl ether, butyl ether, isobutyl ether, t-butyl ether, pentyl ether and 1-cyclopropylethyl ether; and octyl ether Middle or higher alkyl ethers such as diethyl hexyl ether, lauryl ether, and cetyl ether; unsaturated ethers such as oleyl ether and linolenyl ether; lower alkenyl ethers such as vinyl ether and allyl ether; lower alkynyl such as ethynyl ether and propynyl ether Ethers; hydroxy (lower) alkyl ethers such as hydroxyethyl ether and hydroxyisopropyl ether; methoxymethyl ether And
- esters include aliphatic esters such as lower alkyl esters such as methyl ester, ethyl ester, propyl ester, isopropyl ester, butyl ester, isobutyl ester, t-butyl ester, pentyl ester, 1-cyclopropylethyl ester; Lower alkenyl esters such as vinyl esters and allyl esters; Lower alkynyl esters such as ethynyl esters and propynyl esters; Hydroxy (lower) alkyl esters such as hydroxyethyl esters; Lower alkoxy (lower) such as methoxymethyl esters and 1-methoxyethyl esters Alkyl esters; and, for example, phenyl esters, tolyl esters, t-butyl phenyl esters, salicyl esters, 3,4-dimethoxyphenyl esters, benzamido esters Optionally substituted ary al
- the amide of A means a group represented by the formula -CONR'R '', wherein R 'and R' 'are hydrogen, lower alkyl, aryl, alkyl or arylsulfonyl, lower alkenyl and lower alkynyl, respectively.
- R 'and R' ' are hydrogen, lower alkyl, aryl, alkyl or arylsulfonyl, lower alkenyl and lower alkynyl, respectively.
- lower alkylamides such as methylamide, ethylamide, dimethylamide and diethylamide
- arylamides such as anilide and toluidide
- alkyl or arylsulfonylamides such as methylsulfonylamide, ethylsulfonylamide and tolylsulfonylamide, and the like.
- L and M include a combination of both being hydroxy, a 5-membered ring structure referred to as PGF type; a combination of L being hydroxy and M being oxo, 5-membered referred to as PGE type It has a ring structure and a 5-membered ring structure called 11-deoxy-PG type, which is a combination of L being oxo and M being hydrogen.
- A is -COOH, pharmaceutically acceptable salts, esters or amides thereof.
- a preferred example of B is —CH 2 —CH 2 — which provides a structure referred to as the 13,14-dihydrotype.
- X 1 and X 2 are hydrogen or halogen, preferably at least one of them is halogen, more preferably both are halogen atoms, especially fluorine atoms, which is 16,16-difluoro Provides a structure called type.
- R 1 is a hydrocarbon containing 1 to 10 carbon atoms, preferably 6 to 10 carbon atoms. Furthermore, at least one carbon atom in the aliphatic hydrocarbon is optionally replaced by oxygen, nitrogen or sulfur.
- Ra is a hydrocarbon containing 1 to 10 carbon atoms, more preferably 1 to 8 carbon atoms. Ra may have 1 or 2 side chains with 1 carbon atom.
- the configuration of the ring and ⁇ and / or ⁇ chain may be the same as or different from the configuration of natural PGs.
- the present invention also includes mixtures of compounds having a natural type configuration and compounds of a non-natural type configuration.
- Examples of representative compounds of the present invention are 13,14-dihydro-15-keto-20-ethyl PGF compounds, and derivatives or analogs thereof.
- An example of the most preferred compound of the present invention is 13,14-dihydro-15-keto-20-ethyl F 2 ⁇ isopropyl ester (hereinafter also referred to as “isopropyl unoprostone”).
- X 1 and X 2 are halogen atoms, particularly fluorine atoms, it has been confirmed that the compounds include bicyclic compounds as tautomers.
- the ratio of both tautomers varies depending on the remaining structure of the molecule or the type of substituent present. In some cases, one isomer may be predominantly present compared to the other. However, it should be understood that the present invention includes both isomers.
- the 15-keto-PG compounds used in the present invention include bicyclic compounds and analogs or derivatives thereof.
- Bicyclic compounds are represented by formula (III): [Wherein A is —CH 3 , or —CH 2 OH, —COCH 2 OH, —COOH, or a functional derivative thereof; X 1 ′ and X 2 ′ are hydrogen, lower alkyl, or halogen; Y is And Here, R 4 ′ and R 5 ′ are hydrogen, hydroxy, halogen, lower alkyl, lower alkoxy or hydroxy (lower) alkyl, and R 4 ′ and R 5 ′ are not simultaneously hydroxy and lower alkoxy.
- R 1 is a divalent saturated or unsaturated low or intermediate aliphatic hydrocarbon group which is unsubstituted or substituted by a halogen, alkyl, hydroxy, oxo, aryl or heterocyclic group, and an aliphatic hydrocarbon At least one carbon atom therein is optionally substituted by oxygen, nitrogen or sulfur;
- R 2 ′ is unsubstituted or halogen, oxo, hydroxy, lower alkyl, lower alkoxy, lower alkanoyloxy, cyclo (lower) alkyl, cyclo (lower) alkyloxy, aryl, aryloxy, heterocyclic group or heterocyclic oxy
- a saturated or unsaturated, low or intermediate aliphatic hydrocarbon residue substituted by a group; lower alkoxy; lower alkanoyloxy; cyclo (lower) alkyl; cyclo (lower) alkyloxy; aryl; aryloxy; A heterocyclic oxy group;
- the compounds used in the present invention may be represented by a keto-type formula or name, with or without the presence of isomers, but such structures or names are not intended to exclude hemiacetal-type compounds. Note that there is no.
- any isomer for example, individual tautomers, mixtures thereof, or optical isomers, mixtures, racemic mixtures, and other stereoisomers are used for the same purpose. Is possible.
- the present invention provides a pharmaceutical composition for the treatment of geographic atrophy (GA) associated with age-related macular degeneration (AMD) and a method for treating GA associated with AMD.
- GA geographic atrophy
- AMD age-related macular degeneration
- the subject of the present invention is mammals including humans.
- treatment refers to any disease or symptom management means such as prevention, treatment, symptom reduction, symptom attenuation, progression inhibition, and the like.
- AMD includes AMD in general regardless of dry type or exudation type unless otherwise specified.
- GA associated with AMD includes GA found in patients suffering from AMD and GA found after treatment of AMD. For example, GA observed after exudative lesions disappear by treatment of wet AMD is also included in GA accompanying AMD.
- the subjects that can be treated with the pharmaceutical composition of the present invention include subjects diagnosed with GA and subjects predicted to develop GA.
- a subject who is predicted to develop GA may be treated with the pharmaceutical composition of the present invention in parallel with the usual treatment of AMD.
- the pharmaceutical composition of the present invention may be administered in parallel with normal treatment such as IVR or PDT regardless of the presence or absence of GA findings.
- the pharmaceutical composition of the present invention may be administered regardless of the presence or absence of GA findings.
- the pharmaceutical composition can be applied systemically or locally.
- the compound is administered orally, intravenous injection (including infusion), topical ocular administration (e.g., periocular fistula (e.g., under Tenon), subconjunctiva, intraocular, intravitreal, intraanterior, subretinal, superior choroid) For example, and after eyeball administration).
- intravenous injection including infusion
- topical ocular administration e.g., periocular fistula (e.g., under Tenon)
- subconjunctiva e.g., intraocular, intravitreal, intraanterior, subretinal, superior choroid
- eyeball administration e.g., eyeball administration.
- the dosage may vary depending on the animal strain, age, weight, symptoms to be treated, desired therapeutic effect, administration route, treatment period, and the like. Satisfactory effects can be obtained by systemic or continuous administration of 0.00001 to 500 mg / kg, more preferably 0.0001 to 100 mg / kg daily, 1 to 4 times daily.
- the compound is preferably formulated as a pharmaceutical composition suitable for administration by conventional methods.
- the composition may be suitable for oral administration, topical ophthalmic administration, injection or perfusion, as well as external medicine.
- composition of the present invention may further contain a physiologically acceptable additive.
- additives include components used in combination with the compounds of the present invention, for example, excipients, diluents, extenders, solvents, lubricants, adjuvants, binders, disintegrants, coatings, encapsulation.
- Agent ointment base, suppository base, aerosol, emulsifier, dispersant, suspension, thickener, tonicity agent, buffer, soothing agent, preservative, antioxidant, flavoring agent, aroma
- coloring agents, functional substances for example, cyclodextrins, biodegradable polymers, etc.
- stabilizers are well known in the art, and may be appropriately selected from those described in general books on pharmaceutics.
- the amount of the above defined compounds in the composition of the present invention may vary depending on the formulation of the composition and is generally 0.000001-10.0%, more preferably 0.00001-5.0%, most preferably 0.0001-1%. obtain.
- solid compositions for oral administration include tablets, troches, sublingual tablets, capsules, pills, powders, granules and the like.
- a solid composition may be prepared by mixing one or more active ingredients with at least one inert diluent.
- the composition may further include additives other than inert diluents, such as lubricants, disintegrants and stabilizers. Tablets and pills may be coated with enteric or gastroenteric films as desired.
- compositions may be covered by two or more layers. They can be absorbed into sustained-release materials or microencapsulated. Further, the present composition may be encapsulated using an easily decomposable substance such as gelatin. They may be further dissolved in a suitable solvent such as fatty acid or its mono-, di- or triglycerides to form soft capsules. If immediate effect is required, sublingual tablets may be used.
- liquid compositions for oral administration include emulsions, solutions, suspensions, syrups and elixirs. Such compositions may further comprise conventionally used inert diluents such as purified water or ethyl alcohol. This composition may contain additives other than the inert diluent, for example, adjuvants such as wetting agents and suspending agents, sweeteners, flavoring agents, fragrances and preservatives.
- inert diluents such as purified water or ethyl alcohol.
- This composition may contain additives other than the inert diluent, for example, adjuvants such as wetting agents and suspending agents, sweeteners, flavoring agents, fragrances and preservatives.
- composition of the present invention may be in the form of a spraying composition containing one or more active ingredients, which can be prepared according to known methods.
- Examples of the injectable composition of the present invention for parenteral administration include sterilized aqueous or non-aqueous solutions, suspensions and emulsions.
- diluent for the aqueous solution or suspension examples include distilled water for injection, physiological saline, and Ringer's solution.
- Non-aqueous diluents for solutions and suspensions can include, for example, propylene glycol, polyethylene glycol, vegetable oils (such as olive oil), alcohols (such as ethanol), and polysorbates.
- the composition may further contain additives such as preservatives, wetting agents, emulsifying agents, and dispersing agents. They may be sterilized, for example, by filtration through a bacteria-retaining filter, by incorporating a sterilizing agent, or by gas or radioisotope irradiation sterilization.
- the injectable composition can also be provided as a sterile powder composition that is dissolved in a sterile solvent for injection before use.
- the present compound may be prepared as an ophthalmic composition such as an ophthalmic solution or an eye ointment.
- the dosage form may include all ophthalmic formulations for topical ophthalmic administration used in the ophthalmic field.
- Ophthalmic solutions may be prepared by dissolving the active ingredient in a sterile aqueous solution, such as saline and buffer solutions. Ophthalmic solutions may be provided as a powder composition that is dissolved prior to use or by combining powder compositions that are dissolved prior to use. Eye ointments are prepared by mixing the active ingredient with a base. The formulations are prepared according to conventional methods.
- osmotic pressure regulators include sodium chloride, potassium chloride, calcium chloride, sodium hydrogen carbonate, sodium carbonate, magnesium sulfate, sodium hydrogen phosphate, sodium dihydrogen phosphate, dipotassium hydrogen phosphate, boric acid, borax, water
- osmotic pressure regulators include sodium chloride, potassium chloride, calcium chloride, sodium hydrogen carbonate, sodium carbonate, magnesium sulfate, sodium hydrogen phosphate, sodium dihydrogen phosphate, dipotassium hydrogen phosphate, boric acid, borax, water
- sodium oxide, hydrochloric acid, mannitol, isosorbitol, propylene glycol, glucose and glycerin but are not limited thereto as long as they are usually used in the ophthalmic field.
- additives usually used in the ophthalmic field may be added to the composition of the present invention as desired.
- Such additives include, for example, buffers (e.g. boric acid, sodium monohydrogen phosphate and sodium dihydrogen phosphate), preservatives (e.g.
- benzalkonium chloride benzethonium chloride and chlorobutanol
- thickeners for example, sugars such as lactose and mannitol, maltose; such as hyaluronic acid or salts thereof such as sodium hyaluronate and potassium hyaluronate; such as mucopolysaccharides such as chondroitin sulfate; eg sodium polyacrylate, carboxyvinyl polymer And cross-linked polyacrylic acid), both of which are incorporated herein by reference.
- the composition may contain a commonly used eye ointment base.
- ophthalmic ointment bases include, but are not limited to, oily bases such as petrolatum, liquid paraffin, polyethylene, selenium 50, plastibase, macrogol or combinations thereof; an oily phase emulsified with a surfactant and aqueous Emulsifying bases having a phase; and water-soluble bases such as hydroxypropylmethylcellulose, carboxypropylmethylcellulose, and polyethylene glycol.
- the ophthalmic composition is substantially free of benzalkonium chloride.
- the term “the ophthalmic composition is substantially free of benzalkonium chloride” means that the composition does not contain benzalkonium chloride or is capable of the composition. It means containing as little benzalkonium chloride.
- the “ophthalmic composition substantially free of benzalkonium chloride” in the present invention may contain benzalkonium chloride at a concentration of 0.01% or less, preferably 0.005% or less, more preferably 0.003% or less. Good.
- the ophthalmic solution of the present invention may be formulated as a sterile unit dose type (daily or single unit dose type) preparation containing no preservative, for example, benzalkonium chloride.
- ophthalmic compositions have sustained release dosage forms such as gel formulations, liposome formulations, lipid microemulsion formulations, microsphere formulations, nanosphere formulations to provide the active compound continuously to the back of the eye. And implant formulations.
- the concentration and frequency of administration of the active ingredient of the eye drop used in the present invention are, for example, the compound used, the type of subject (for example, animal or human), age, weight, symptom to be treated, desired treatment It varies depending on the effect, administration method, administration dose and treatment period. Accordingly, a suitable concentration and number of administrations can be selected as desired.
- isopropyl unoprostone according to one embodiment of the present invention include 0.01 to 1.0%, preferably 0.05 to 0.5%, more preferably 0.12 to 0.36%, such as 0.12%, 0.15%, 0.18% or 0.3%.
- Formulations containing isopropyl unoprostone can usually be administered in 1 to 3 drops for a single dose and 1 to 10 doses per day for an adult.
- the pharmaceutical composition of the present invention may contain a single active ingredient or a combination of two or more active ingredients.
- the content of each may be appropriately increased or decreased in consideration of the therapeutic effect and safety.
- preparation of the present invention may suitably contain other pharmacologically effective ingredients as long as they do not contradict the purpose of the present invention.
- Subjects who meet the following two requirements: It suffers from wet AMD, and after the exudative lesion disappears by the following treatment, no recurrence is observed even after 6 months. Geographical atrophy is confirmed from the fundus autofluorescence.
- Age 50 to 85 years (average 74.7 ⁇ 8.1 years) 2) Sex: male 30 eyes, female 18 eyes The test started with 52 eyes, but 4 eyes dropped out, and the remaining 48 eyes (24 eyes in each group) were examined. 3) Disease type of wet AMD Typical AMD (t-AMD) 29 eyes Polypoidal choroidal vasculopathy (PCV) 10 eyes Retinal hemangiomatous proliferation (RAP) 9 eyes 4) Treatment history The following subjects treated as wet AMD Received treatment with either or a combination of both.
- Study drug dosage / dose, administration period / dose Test drug or placebo (vehicle) is administered to the subject eye in two drops every 5 minutes, 3 times a day, morning and evening, instillation Administration period: 54 Weeks
- the study drug group shall be “U group” and the placebo group shall be “P group”.
- FIG. 1 An example of a representative patient is shown.
- U group 74-year-old male, left eye, t-AMD, treatment history PTD 3 times, IVR 10 times
- FIG. 1 A fundus photograph (FIG. 1-A), a fundus autofluorescence image (FIG. 1-B) and an optical coherence tomography finding (FIG. 1-C) before starting treatment of the patient are shown.
- FIG. 2 shows the fundus autofluorescence images at 24 weeks and 54 weeks before the start of treatment (baseline), and images in which the GA portion is determined by processing of the fundus autofluorescence image with RegionFinder.
- the GA part is solid.
- the GA expansion rate at the 54th week was 118%.
- FIG. 3 A fundus photograph (FIG. 3-A), a fundus autofluorescence image (FIG. 3-B) and an optical coherence tomography finding (FIG. 3-C) before starting treatment of the patient are shown.
- FIG. 4 shows the fundus autofluorescence images at 24 weeks and 54 weeks before the start of treatment (baseline), and an image in which the GA portion is determined by processing of the fundus autofluorescence image with RegionFinder (FIG. 4).
- the GA part is solid.
- the GA expansion rate at the 54th week was 138%.
- GA area was an average of about 2.7 mm 2 in both the U group, P group (U group 2.71 ⁇ 2.03mm 2, P group 2.65 ⁇ 2.60mm 2). There was no statistically significant difference in GA area between the two groups throughout the measurement period. On the other hand, the change in GA area was p ⁇ 0.05 at the 4th week and p ⁇ 0.001 (t-test) at the 8th to 54th week, and a statistically significant difference was observed between the two groups. It was. GA variation of 54 week U group, mean respectively P group 0.44 ⁇ 0.39 mm 2, was 2.01 ⁇ 1.34 mm 2 (Fig. 5).
- the change with time of LogMAR visual acuity is shown in FIG.
- the visual acuity before starting treatment was 0.39 ⁇ 0.39 in the U group and 0.42 ⁇ 0.36 in the P group.
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Abstract
Description
下付1:13,14-不飽和-15-OH
下付2:5,6-および13,14-ジ不飽和-15-OH
下付3:5,6-、13,14-および17,18-トリ不飽和-15-OH。
Aは、-CH3、-CH2OH、-COCH2OH、-COOHまたはそれらの官能性誘導体であり;
Bは、-CH2-CH2-、-CH=CH-または-C≡C-であり;
R1は、非置換、またはハロゲン、低級アルキル、ヒドロキシ、オキソ、アリールまたは複素環基により置換された、二価の飽和または不飽和の低または中級の脂肪族炭化水素基であり、脂肪族炭化水素中の少なくとも1つの炭素原子は所望により酸素、窒素または硫黄により置換されており;そして
Raは、非置換、またはハロゲン、オキソ、ヒドロキシ、低級アルキル、低級アルコキシ、低級アルカノイルオキシ、シクロ(低級)アルキル、シクロ(低級)アルキルオキシ、アリール、アリールオキシ、複素環基または複素環オキシ基によって置換された、飽和または不飽和の低または中級の脂肪族炭化水素基;低級アルコキシ;低級アルカノイルオキシ;シクロ(低級)アルキル;シクロ(低級)アルキルオキシ;アリール;アリールオキシ;複素環基;複素環オキシ基である]。
Aは、-CH3、-CH2OH、-COCH2OH、-COOHまたはそれらの官能性誘導体であり;
Bは、-CH2-CH2-、-CH=CH-または-C≡C-であり;
X1およびX2は、水素、低級アルキル、またはハロゲンであり;
R1は、非置換、またはハロゲン、低級アルキル、ヒドロキシ、オキソ、アリールまたは複素環基により置換された、二価の飽和または不飽和の低または中級の脂肪族炭化水素基であり、脂肪族炭化水素中の少なくとも1つの炭素原子は所望により酸素、窒素または硫黄により置換されており;
R2は、単結合または低級アルキレンであり;そして
R3は、低級アルキル、低級アルコキシ、低級アルカノイルオキシ、シクロ(低級)アルキル、シクロ(低級)アルキルオキシ、アリール、アリールオキシ、複素環基または複素環オキシ基である]。
-CH2-CH2-CH2-CH2-CH2-CH2-、
-CH2-CH=CH-CH2-CH2-CH2-、
-CH2-CH2-CH2-CH2-CH=CH-、
-CH2-C≡C-CH2-CH2-CH2-、
-CH2-CH2-CH2-CH2-O-CH2-、
-CH2-CH=CH-CH2-O-CH2-、
-CH2-C≡C-CH2-O-CH2-、
-CH2-CH2-CH2-CH2-CH2-CH2-CH2-、
-CH2-CH=CH-CH2-CH2-CH2-CH2-、
-CH2-CH2-CH2-CH2-CH2-CH=CH-、
-CH2-C≡C-CH2-CH2-CH2-CH2-、
-CH2-CH2-CH2-CH2-CH2-CH(CH3)-CH2-、
-CH2-CH2-CH2-CH2-CH(CH3)-CH2-、
-CH2-CH2-CH2-CH2-CH2-CH2-CH2-CH2-、
-CH2-CH=CH-CH2-CH2-CH2-CH2-CH2-、
-CH2-CH2-CH2-CH2-CH2-CH2-CH=CH-、
-CH2-C≡C-CH2-CH2-CH2-CH2-CH2-、および
-CH2-CH2-CH2-CH2-CH2-CH2-CH(CH3)-CH2-。
X1'およびX2'は、水素、低級アルキル、またはハロゲンであり;
Yは
ここで、R4'およびR5'は、水素、ヒドロキシ、ハロゲン、低級アルキル、低級アルコキシまたはヒドロキシ(低級)アルキルであり、R4'およびR5'が同時にヒドロキシおよび低級アルコキシであることはなく、
R1は、非置換、またはハロゲン、アルキル、ヒドロキシ、オキソ、アリールまたは複素環基により置換された、二価の飽和または不飽和の低または中級の脂肪族炭化水素基であり、脂肪族炭化水素中の少なくとも1つの炭素原子は所望により酸素、窒素または硫黄により置換されており;
R2'は、非置換、またはハロゲン、オキソ、ヒドロキシ、低級アルキル、低級アルコキシ、低級アルカノイルオキシ、シクロ(低級)アルキル、シクロ(低級)アルキルオキシ、アリール、アリールオキシ、複素環基または複素環オキシ基により置換された、飽和または不飽和の低または中級の脂肪族炭化水素残基;低級アルコキシ;低級アルカノイルオキシ;シクロ(低級)アルキル;シクロ(低級)アルキルオキシ;アリール;アリールオキシ;複素環基;複素環オキシ基であり;
R3'は水素、低級アルキル、シクロ(低級)アルキル、アリールまたは複素環基である]。
滲出型AMDの治療後6か月以上再発をみとめずGAを有する48眼を対象とした前向き無作為プラセボ対照試験を行った。対象眼に0.15%イソプロピルウノプロストンを1日3回、1回に2滴点眼し、GA面積、GA変化量ならびにGA拡大率、logMAR視力の変化を治験開始前、4、8、12、24、36、54週目に測定した。対照群にはプラセボとしてイソプロピルウノプロストン点眼液のビヒクルを1日3回点眼した。
下記2要件を満たす患者を対象とした:
滲出型AMDに罹患、下記の治療により滲出性病変が消失した後、6か月以上経過しても再発をみとめない。
眼底自発蛍光所見より地図状萎縮が確認される。
2)性別:男性30眼、女性18眼
試験は52眼で開始したが4眼は脱落し、残りの48眼(各群24眼)にて検討した。
3)滲出型AMDの病型
典型AMD(t-AMD)29眼
ポリープ状脈絡膜血管症(PCV)10眼
網膜血管腫状増殖(RAP)9眼
4)治療歴
被験者は滲出型AMDの治療として下記いずれか、または両方の組み合わせによる治療を受けた。
ラニビズマブ硝子体内注射(IVR):ルセンティス(登録商標)硝子体内注射液2.3mg/0.23mlの硝子体内注射
光線力学的療法(PDT)
5)被験者への説明ならびに同意
治験施設における治験審査委員会の承認を受けた同意説明文書を患者に渡し、文書および口頭による十分な説明を行った上で、文書による同意を受けた。
一般名:イソプロピル ウノプロストン(isopropyl unoprostone)
含量:1mL中に1.5mg
製造元:株式会社アールテック・ウエノ
前向き無作為プラセボ対照試験
治験開始前後での比較。試験群とプラセボ群との比較。
群分け:交互法
試験薬またはプラセボ(ビヒクル)を試験対象眼に1回につき5分間隔で2滴点眼投与
1日3回、朝昼夕、点眼
投与期間:54週間
以下試験薬群は「U群」と、プラセボ群は「P群」とする。
治験開始前、4、8、12、24、36、54週目に下記を評価した
1)GA面積
眼底自発蛍光BluePeakTMブルーレーザを用いた共焦点走査型レーザ検眼鏡(cSLO)にて撮影した。自発蛍光が障害されて低蛍光を示す部位をGAの範囲と判断した。具体的には撮影したデジタル画像をハイデルベルグエンジニアリング社(ドイツ)のRegionFinderソフトウェア(バージョン2.4)にて補正、解析してGA範囲を特定し、その面積を得た。眼底自発蛍光画像の撮影ならびにその解析方法およびGA面積の決定方法は撮影機器ならびにソフトウエアのマニュアルに従った。
各測定時におけるGA面積、治験開始前と比較した変化量ならびに治験開始前と比較した拡大率を求めた。
2)視力
通常の視力検査を行い、logMar換算してlogMar視力を求めた。
3)その他
細隙灯顕微鏡検査を含む他覚的検査、眼圧測定、眼底検査、MAIA微小視野検査(中心10-2)、光干渉断層計(OCT)検査を併せて行った(結果表示せず)。
U群:74歳男性、左眼、t-AMD、治療歴PTD3回、IVR10回(図1)
患者の治療開始前の眼底写真(図1-A)、眼底自発蛍光像(図1-B)ならびに光干渉断層計所見(図1-C)を示す。図2に治療開始前(baseline)、24週および54週の眼底自発蛍光像と、この眼底自発蛍光像のRegionFinderによる処理によりGA部分を確定した画像を示す。GA部分はべた塗りしている。54週目におけるGA拡大率は118%であった。
P群:79歳女性、左眼、t-AMD、治療歴PTD1回、IVR18回(図3)
患者の治療開始前の眼底写真(図3-A)、眼底自発蛍光像(図3-B)ならびに光干渉断層計所見(図3-C)を示す。図4に治療開始前(baseline)、24週および54週の眼底自発蛍光像と、この眼底自発蛍光像のRegionFinderによる処理によりGA部分を確定した画像を示す(図4)。GA部分はべた塗りしている。54週目におけるGA拡大率は138%であった。
この結果より、イソプロピルウノプロストンの点眼によって、GAの拡大抑制が可能であることがわかった。
Claims (17)
- 15-ケトプロスタグランジン化合物を含有する、加齢黄斑変性に伴う地図状萎縮を処置するための医薬組成物。
- 15-ケト-プロスタグランジン化合物が、以下一般式(I)により示される化合物である、請求項1に記載した組成物。
[式中、L、MおよびNは、水素、ヒドロキシ、ハロゲン、低級アルキル、ヒドロキシ(低級)アルキル、またはオキソであり、ここで該5員環は、少なくとも1つの二重結合を有してもよく;
Aは、-CH3、-CH2OH、-COCH2OH、-COOHまたはそれらの官能性誘導体であり;
Bは、-CH2-CH2-、-CH=CH-または-C≡C-であり;
R1は、非置換、またはハロゲン、低級アルキル、ヒドロキシ、オキソ、アリールまたは複素環基により置換された、二価の飽和または不飽和の低または中級の脂肪族炭化水素基であり、脂肪族炭化水素中の少なくとも1つの炭素原子は所望により酸素、窒素または硫黄により置換されており;そして
Raは、非置換、またはハロゲン、オキソ、ヒドロキシ、低級アルキル、低級アルコキシ、低級アルカノイルオキシ、シクロ(低級)アルキル、シクロ(低級)アルキルオキシ、アリール、アリールオキシ、複素環基または複素環オキシ基によって置換された、飽和または不飽和の低または中級の脂肪族炭化水素基;低級アルコキシ;低級アルカノイルオキシ;シクロ(低級)アルキル;シクロ(低級)アルキルオキシ;アリール;アリールオキシ;複素環基;複素環オキシ基である]。 - 15-ケト-プロスタグランジン化合物が、13,14-ジヒドロ-15-ケト-プロスタグランジン化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、15-ケト-20-低級アルキル-プロスタグランジン化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、13,14-ジヒドロ-15-ケト-20-低級アルキル-プロスタグランジン化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、15-ケト-20-エチル-プロスタグランジンF化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、13,14-ジヒドロ-15-ケト-20-エチル-プロスタグランジンF化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、13,14-ジヒドロ-15-ケト-20-エチル-プロスタグランジンF2α化合物である、請求項1に記載した組成物。
- 15-ケト-プロスタグランジン化合物が、13,14-ジヒドロ-15-ケト-20-エチル-プロスタグランジンF2αイソプロピルエステルである、請求項1に記載した組成物。
- 加齢黄斑変性が、滲出型黄斑変性である、請求項1~9何れかに記載の組成物。
- 滲出型黄斑変性の治療により滲出性病変が消失した対象における地図状萎縮を処置するためのものである、請求項10に記載の組成物。
- 加齢黄斑変性が、ドライ型黄斑変性である、請求項1~9何れかに記載の組成物。
- 局所投与のための組成物として製剤される、請求項1~12のいずれかに記載の組成物。
- 眼局所投与のための眼科用組成物である、請求項13に記載した組成物。
- 点眼液として製剤される、請求項14に記載した組成物。
- 保存剤を含まない滅菌単位用量型点眼液として製剤される、請求項15に記載した組成物。
- 眼用組成物が、塩化ベンザルコニウムを実質的に含まない、請求項14または15に記載した組成物。
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EP15752724.3A EP3108887A1 (en) | 2014-02-21 | 2015-02-20 | Pharmaceutical composition for treating geographic atrophy associated with age-related macular degeneration |
US15/241,818 US20170042908A1 (en) | 2014-02-21 | 2016-08-19 | Method for treating geographic atrophy associated with age-related macular degeneration |
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