Classifications

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  • 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
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  • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
  • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
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  • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
  • A61K31/4196—1,2,4-Triazoles
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  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
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  • 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
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  • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
  • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
• • A—HUMAN NECESSITIES
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  • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
  • A61K31/566—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol having an oxo group in position 17, e.g. estrone
• • A—HUMAN NECESSITIES
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  • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
  • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
  • A61K31/7048—Compounds having saccharide radicals and heterocyclic rings having oxygen as a ring hetero atom, e.g. leucoglucosan, hesperidin, erythromycin, nystatin, digitoxin or digoxin
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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  • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
• • A—HUMAN NECESSITIES
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  • 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
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  • A61K9/48—Preparations in capsules, e.g. of gelatin, of chocolate
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/04—Drugs for disorders of the alimentary tract or the digestive system for ulcers, gastritis or reflux esophagitis, e.g. antacids, inhibitors of acid secretion, mucosal protectants
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
  • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
  • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
  • G01N33/68—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving proteins, peptides or amino acids
  • G01N33/6872—Intracellular protein regulatory factors and their receptors, e.g. including ion channels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00
• • G—PHYSICS
  • G01—MEASURING; TESTING
  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/06—Gastro-intestinal diseases
  • G01N2800/065—Bowel diseases, e.g. Crohn, ulcerative colitis, IBS
• • G—PHYSICS
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  • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
  • G01N2800/00—Detection or diagnosis of diseases
  • G01N2800/52—Predicting or monitoring the response to treatment, e.g. for selection of therapy based on assay results in personalised medicine; Prognosis

Definitions

• sphingosine 1 -phosphate subtype 1 SIPi or SIPI
• the sphingosine-l-phosphate (SIP) receptors 1-5 constitute a family of G protein-coupled receptors with a seven-transmembrane domain. These receptors, referred to as SIPi to SIPs (formerly termed endothelial differentiation gene (EDG) receptor-1, -5, -3, -6, and -8, respectively; Chun et a!.. Pharmacological Reviews, 54:265-269, 2002), are activated via binding by sphingosine-l-phosphate, winch is produced by tire sphingosine kinase-catalyzed phosphorylation of sphingosine.
• SIPi to SIPs (formerly termed endothelial differentiation gene (EDG) receptor-1, -5, -3, -6, and -8, respectively; Chun et a!.. Pharmacological Reviews, 54:265-269, 2002)
• SIPs, Sll and S IP5 receptors activate Gi but not Gq
• SIP 2 and SIP 3 receptors activate both Gi and Gq.
• the SIP 3 receptor, but not the SIPs receptor, responds to an agonist with an increase in intracellular calcium .
• agonists useful in the treatment of SI Pi receptor-associated disorders the compound ⁇ R)-2 -(7-(4-cyclopentyl-3-(trifluoromethyl)benzyloxy)-l, 2,3,4- tetrahydrocyclopenta[0]indo! ⁇ 3-yl)acetic acid (Compound 1, APD334) , or a pharmaceutically acceptable salt, solvate, or hydrate thereof,
• Compound 1 is an investigational drug candidate intended for the treatment of sphingosine 1- phosphate subtype 1 (SlPi) receptor-associated disorders.
• SI Pi agonists cause side effects, and particularly cardiovascular related adverse events, that require that doctors titrate patients slowly to a maintenance dose. This titration period can take weeks or even a month. The complexity and length of the titration regimen may result in prematurely discontinuing therapy by patients prior to reaching the maintenance dose or to doctors preferring other therapeutic options.
• a method of treating an individual with a sphingosine 1 -phosphate subtype 1 (S J P i) receptor-associated disorder comprising: administering to the individual in need thereof a pharmaceutical dosage form comprising a therapeutically effective amount of (i?)-2-(7-(4-cyclopentyl-3- (trifluorometiiyl)benzyloxy)-l,2,3,4-tetrahydrocyclopenta[6]indol-3-yl)acetic acid (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof, wherein the pharmaceutical dosage form has a mean fed/fasted ratio of the area under the plasma concentration versus time curve of from about 0.8 to about 1.25 and a mean fed/fasted ratio of the maximum plasma concentration (Cmax) from about 0.8 to about 1.25.
• SI Pi sphingosine 1 -phosphate subtype 1
• Compound 1 chosen from (R) ⁇ 2-(7 -(4 -cyclopentyl-3
• Pgp P -glycoprotein
• BCRP breast cancer resistance protein
• OATPIBI
• Figure 1 shows the mean plasma concentration-time profiles for the tablet formulation of Compound 1 administered under fed versus fasted conditions.
• COMPOUND 1 As used herein,“Compound 1” means (R)-2-(7-(4-cyclopentyl-3- (trifluoromethyl)benzyloxy)-l,2,3,4-tetrahydrocyclopenta[Z>]indol-3-yl)acetic acid including crystalline forms thereof. As a non-limiting example, Compound 1 may be present as an anhydrous, non-solvated crystalline form as described in WO 2010/011316 (incorporated by reference herein in its entirety).
• an L-arginine salt of Compound 1 may be present as an anhydrous, non- solvated crystalline form as described in WO 2010/011316 and WO 2011/094008 (each of winch is incorporated by reference herein in its entirety').
• a calcium salt of Compound 1 may be present as a crystalline form as described in WO 2010/011316 (incorporated by reference herein m its entirety).
• ADMINISTERING means to provide a compound or other therapy, remedy, or treatment such that an individual internalizes a compound.
• CO-ADMINISTER As used herein, "co-administer” and “co-administration” and variants thereof mean the administration of at least two drugs to a patient either subsequently, simultaneously, or consequently proximate in time to one another (e.g., within the same day, or week or period of 30 days, or sufficiently proximate that each of the at least two drugs can be simultaneously detected in the blood plasma).
• two or more active agents can be co-formulated as part of the same composition or administered as separate formulations. This also may be referred to herein as
• PRESCRIBING means to order, authorize, or recommend the use of a drag or other therapy, remedy, or treatment.
• a health care practitioner can orally advise, recommend, or authorize the use of a compound, dosage regimen or other treatment to an individual.
• the health care practitioner may or may not provide a prescription for the compound, dosage regimen, or treatment. Further, the health care practitioner may or may not provide the
• a health care practitioner can advise the individual where to obtain the compound without providing the compound.
• a health care practitioner can provide a prescription for the compound, dosage regimen, or treatment to the individual.
• a health care practitioner can give a written or oral prescription to an individual.
• a prescription can be written on paper or on electronic media such as a computer file, for example, on a hand held computer device.
• a health care practitioner can transform a piece of paper or electronic media with a prescription for a compound, dosage regimen, or treatment.
• a prescription can be called in (oral), faxed in (written), or submitted electronically via the internet to a pharmacy or a dispensary.
• a sample of the compound or treatment can be given to the individual.
• a prescription can include, for example, an individual’s name and/or identifying information such as date of birth .
• a prescription can include: the medication name, medication strength, dose, frequency of administration, route of administration, number or amount to be dispensed, number of refills, physician name, physician signature, and the like.
• a prescription can include a DBA number and/or state number.
• a healthcare practitioner can include, for example, a physician, nurse, nurse practitioner, or other related heal th care professional who can prescribe or administer compounds (drags) for the treatment of a sphingosine 1-phosphate subtype 1 (S IPi) receptor-associated disorder.
• a healthcare practitioner can include anyone who can recommend, prescribe, administer, or prevent an individual from receiving a compound or drag including, for example, an insurance provider.
• the term“prevent,” “preventing”, or“prevention” such as prevention of a sphingosine 1 -phosphate subtype 1 (SI P receptor- associated disorder or the occurrence or onset of one or more symptoms associated with the particular disorder and does not necessarily mean the complete prevention of the disorder.
• the term‘prevent,”“preventing” and“prevention” means the administration of therapy on a prophylactic or preventative basis to an individual who may ultimately manifest at least one symptom of a disease or condition but who has not yet done so. Such individuals can be identified on the basis of risk factors that are known to correlate with tire subsequent occurrence of the disease. Alternatively, prevention therapy can be administered without prior identification of a risk factor, as a prophylactic measure . Delaying the onset of at least one symptom can also be considered prevention or prophylaxis.
• the tenn“treat,”“treating”, or “treatment” means the administration of therapy to an individual who already manifests at least one symptom of a disease or condition or who has pre viously manifested at least one symptom of a disease or condition.
• “treating” can include alleviating, abating or ameliorating a disease or condition symptoms, preventing additional symptoms, ameliorating the underlying metabolic causes of symptoms, inhibiting the disease or condition, e.g., arresting the development of the disease or condition, relieving die disease or condition, causing regression of the disease or condition, relieving a condition caused by the disease or condition, or stopping the symptoms of the disease or condition.
• the tenn“treating” in reference to a disorder means a reduction in severity of one or more symptoms associated with that particular disorder. Therefore, treating a disorder does not necessarily mean a reduction in severity' of ail symptoms associated with a disorder and does not necessarily mean a complete reduction m the severity of one or more symptoms associated with a disorder.
• TOLERATE A s used herein, an individual is said to“tolerate” a dose of a compound if administration of that dose to that individual does not result in an unacceptable adverse event or an unacceptable combination of adverse events.
• tolerance is a subjective measure and that what may be tolerable to one individual may not be tolerable to a different individual . For example, one individual may not be able to tolerate headache, whereas a second individual may find headache tolerable but is not able to tolerate vomiting, whereas for a third individual, either headache alone or vomiting alone is tolerable, but the indi vidual is not able to tolerate the combination of headache and vomiting, even if the severity of each is less than when experienced alone.
• an“adverse event” is an untoward medical occurrence that is associated with treatment with Compound 1 or a pharmaceutically acceptable salt, solvate, or hydrate thereof.
• an adverse event is selected from: leukopenia, constipation, diarrhea, nausea, abdominal pain, neutropenia, vomiting, back pain, and menstrual disorder.
• an adverse event is heart block, for example, a first-degree atrioventricular heart block.
• an adverse event is an acute heart rate reduction.
• an adverse event is an abnormal pulmonary' ⁇ function test finding, such as an FEY 1 below 80%, FVC.
• an adverse event is an abnormal liver function test, such as an elevated ALT & AST>2X ULN.
• an adverse event is macular edema.
• INDIVIDUAL As used herein,“individual” means any animal, including mammals, preferably mice, rats, other rodents, rabbits, dogs, cats, swine, cattle, sheep, horses, or primates and most preferably humans. In some embodiments, a human individual is referred to a“patient.”
• acute heart rate reduction means a heart rate decrease from normal sinus rhythm of, for example, 10 or more beats per minute (bpm), such as less than about 5 bpm, e.g., less than about 4 bpm or less than about 3 bpm or less than 2 bpm, that is maximal within a few hours, for example 1-3 hours, after drug administration, and thereafter the heart rate returns towards the pre-dose value.
• bpm beats per minute
• NORMAL SINUS RHYTHM As used herein,“normal sinus rhythm” means the sinus rhythm of the individual when not undergoing treatment. The evaluation of normal sinus rhythm is within the ability of a physician. A normal sinus rhythm will generally give rise to a heart rate in the range from 60-100 bpm.
• DOSE As used herein,“dose” means a quantity of Compound 1, or a pharmaceutically acceptable salt, solvate, or hydrate thereof, given to the individual for treating or preventing the disease or disorder at one specific time
• standard dose means the dose of Compound 1, or a pharmaceutically acceptable salt, solvate, or hydrate thereof, that is given to the individual for treating or preventing the disease or disorder.
• administration of the standard dose achieves a target reduction in peripheral blood lymphocyte counts, e.g., a reduction baseline of at least 35%, such as at least 40%, such as at least 45%, such as at least 50%, such as at least 55%, such as at least 60%, such as at least 65%, such as at least 70%.
• administration of the standard dose achieves a reduction in baseline of about 35% to about 70%, such as about 40% to about 65%, such as about 50% to about 65%.
• administration of the standard dose achieves target peripheral blood lymphocyte counts, e.g., less than 1000 lymphocytes per microliter, such as 400-800 lymphocytes per microliter.
• the target dose may vary depending on the nature and severity of the disease to be treated.
• THERAPEUTICALLY EFFECTIVE AMOUNT As used herein, "therapeutically effective amount" of an agent, compound, drug, composition or combination is an amount which is nontoxic and effective for producing some desired therapeutic effect upon administration to a subject or patient (e.g., a human subject or patient).
• the precise therapeutically effective amount for a subject may depend upon, e.g., the subject’s size and health, the nature and extent of the condition, the therapeutics or combination of therapeutics selected for administration, and other variables known to those of skill in the art.
• the effecti ve amount for a given situation is determined by routine experimentation and is within the judgment of the clinician.
• the therapeutically effective amount is the standard dose.
• fasted individual means an individual who has not eaten any food, i.e., has fasted for at least 6-8 hours, such as about 8 hours, before the administration of Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof, and who does not eat any food and continues to fast for at least 1 hour after the administration of Compound 1 , or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• the individual may also refrain from ingesting certain non-food substances during the fasting period. For example, in certain embodiments tire individual does not ingest any supplements and/or drugs during the fasting period.
• the individual does not ingest any high calorie liquids during the fasting period. In certain embodiments, the individual does not ingest any liquids other than water during the fasting period. In certain embodiments, the individual may ingest small amounts of low-calorie beverages, such as tea, coffee, or diluted juices.
• the 6-point Mayo score is based on stool frequency and rectal bleeding PROs collected daily using electronic patient diaries and excludes the findings on endoscopy and the physician’s global assessment.
• the 3-point Mayo score is based on stool frequency, rectal bleeding, and findings on endoscopy and has a total score ranging from 0 to 9.
• the 2- point Mayo score is based on rectal bleeding and findings on endoscopy and has a total score ranging from 0 to 6.
• the physician’s global assessment acknowledges the three other criteria findings of the MCS, the individual’s daily record of abdominal discomfort and general sense of well-being, and other observations, such as physical findings and the individual’s performance.
• MILDLY TO MODERATELY ACTIVE ULCERATIVE COLITIS means ulcerative colitis characterized by a 4-component MCS of 4 to 10
• ulcerative colitis characterized by a 3-component MCS of 4 to 9 including an endoscopic subscore of > 2 and a rectal bleeding score of > 1.
• the 3-component MCS uses 3 of the 4 components of the complete MCS (endoscopic findings, rectal bleeding, and stool frequency).
• CLINICAL REMISSION As used herein,“clinical remission” with respect to ulcerative colitis means a 3-component Mayo Clinic score as follows: an endoscopy score (using flexible
• proctosigmoidoscopy of 0 or 1
• rectal bleeding score of 0
• stool frequency score of 0 or 1 with a decrease of > 1 point from baseline subscore.
• CLINICAL RESPONSE As used herein,“clinical response” with respect to ulcerative colitis means a reduction in the 3-component Mayo Clinic score of > 2 points and a decrease of > 30% from baseline with an accompanying decrease in rectal bleeding subscore of > 1 or absolute rectal bleeding score of 0 or 1.
• ENDOSCOPIC IMPROVEMENT As used herein,“endoscopic improvement” with respect to ulcerative colitis means ulcerative colitis characterized by a Mayo endoscopic subscore (using findings of flexible proctosigmoidoscopy) of ⁇ 1 point.
• IMPROVEMENT IN RECTAL BLEEDING As used herein,“improvement in rectal bleeding” with respect to ulcerative colitis means a change from baseline ⁇ 0.
• HISTOLOGIC HEALING / HISTOLOGIC IMPROVEMENT As used herein,“histologic healing,”“histological healing,”“histologic improvement,” or“histological improvement” with respect to ulcerative colitis means a score of ⁇ 3.1 on the Geboes Index.
• HISTOLOGIC REMISSION As used herein,“histologic remission” or“histological remission” with respect to ulcerative colitis means a score of ⁇ 2.0 on the Geboes Index.
• MUCOSAL HEALING As used herein,“mucosal healing” is both endoscopic improvement and histological remission.
• IMPROVEMENT IN STOOL FREQUENCY As used herein,“improvement in stool frequency” with respect to ulcerative colitis means a change from baseline ⁇ 0.
• 5-AMINOSALICYLATES As used herein,“5-aminosalicylates”, means a class of drags that include, for example, CANASA® (mesalamine), COLAZAL® (balsalazide disodium), ASACOL®
• IMMUNOSUPPRESSIVES means a class of drugs that include, for example, AZASAN® (azathioprine), IMURAN® (azathioprine), GENGRAF® (cyclosporine), NEORAL® (cyclosporine), and SANDIMMUNE® (cyclosporine).
• GLUCOCORTICOSTEROIDS As used herein,“glucocorticosteroids”, means a class of drugs that include, for example, UCER1S® (budesonide); DELTASONE® (prednisone), MEDROL®
• TNFa ANTAGONISTS means a class of drugs that include, for example, SIMPONI® (golirnumab), REMICADE® (infliximab), HUMIRA® (adalimumab), and CIMZIA® (certolizumab pegol).
• INTEGRIN RECEPTOR ANTAGONISTS means a class of drugs that include, for example, ENTYYTO® (vedolizumab).
• PHARMACEUTICAL COMPOSITION means a composition comprising at least one active ingredient, such as Compound I: including but not limited to, salts, solvates, and hydrates of Compound 1 , whereby the composition is amenable to investigation for a specified, efficacious outcome in a mammal (for example, without limitation, a human).
• active ingredient such as Compound I: including but not limited to, salts, solvates, and hydrates of Compound 1
• a mammal for example, without limitation, a human
• an agonist means a moiety ' that interacts with and activates a G-protein- coupled receptor, such as the SIP ⁇ , receptor, such as can thereby initiate a physiological or pharmacological response characteristic of that receptor.
• a G-protein- coupled receptor such as the SIP ⁇
• an agonist activates an intracellular response upon binding to the receptor or enhances GTP binding to a membrane hi certain embodiments, an agonist of the invention is an S IPi receptor agonist that is capable of facilitating sustained S IPi receptor internalization (see e.g. , Matloubian et ai. Nature, 427, 355, 2004).
• ANTAGONIST means a moiety that competitively binds to the receptor at the same site as an agonist (for example, the endogenous ligand), but which does not activate the intracellular response initiated by the active form of the receptor and can thereby inhibit the intracellular responses by an agonist or partial agonist.
• An antagonist does not diminish the baseline intracellular response in the absence of an agonist or partial agonist.
• inverse agonist means a moiety that binds to tire endogenous fonn of the receptor or to the constitutively activated form of the receptor and which inhibits the baseline intracellular response initiated by the active form of the receptor below the normal base level of activity which is observed in the absence of an agonist or partial agonist, or decreases GTP binding to a membrane.
• the baseline intracellular response is inhibited in the presence of the inverse agonist by at least 30%. In some embodiments, the baseline intracellular response is inhibited in die presence of the inverse agonist by at least 50%.
• the baseline intracellular response is inhibited in the presence of the inverse agonist by at least 75%, as compared with the baseline response in the absence of the inverse agonist.
• HYDRATE As used herein,“hydrate” means a compound of the invention or a salt thereof, that further includes a stoichiometric or non-stoichiometric amount of water bound by non-covalent intermolecular forces.
• SAFETY POPULATION As used herein,“safety population” means all randomized subjects who received study medication.
• solvent means a compound of the invention or a salt, thereof, that further includes a stoichiometric or non-stoichiometric amount of a solvent bound by non-covalent intermolecular forces.
• Preferred solvents are volatile, non-toxic, and/or acceptable for administration to humans in trace amounts.
• the compounds according to the invention may optionally exist as pharmaceutically acceptable salts including pharmaceutically acceptable acid addition salts prepared from pharmaceutically acceptable non-toxic acids including inorganic and organic acids.
• Representative acids include, but are not limited to, acetic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethenesulfonic, dichloroacetic, formic, fumaric, gluconic, glutamic, hippunc, hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic, methanesulfonic, mucic, nitric, oxalic, pamoic, pantothenic, phosphoric, succinic, sulfiric, tartaric, oxalic, -toluenesul tonic and the like, such as those pharmaceutically acceptable salts listed by Berge et al, Journal of Pharmaceutical Sciences , 66: 1-19 (1977), incorporated herein by reference in its entirety.
• the acid addition salts may be obtained as the direct products of compound synthesis.
• the free base may be dissolved in a suitable solvent containing the appropriate acid and the salt isolated by evaporating the solvent or otherwise separating the salt and solvent.
• Tire compounds of this invention may form solvates with standard low molecular weight solvents using methods known to the skilled artisan.
• “pharmaceutically acceptable solvates and hydrates” or the phrase“pharmaceutically acceptable solvate or hydrate” is used when referring to Compound Ithat are salts, it embraces pharmaceutically acceptable solvates and/or hydrates of such salts.
• the dosage forms described herein may comprise, as the active component, either Compound 1 or a pharmaceutically acceptable salt or as a solvate or hydrate thereof.
• various hydrates and solvates of Compound 1 and their salts will find use as intermediates in the manufacture of pharmaceutical compositions. Typical procedures for making and identifying suitable hydrates and solvates, outside those mentioned herein, are well known to those m the art; see for example, pages 202-209 of K.J. Guillory,“Generation of Polymorphs, Hydrates, Solvates, and Amorphous Solids,’ in: Polymorphism in Pharmaceutical Solids, ed. Harry G. England, Vol.
• one aspect of the present disclosure pertains to methods of prescribing and/or administering hydrates and solvates of Compound 1 and/or its pharmaceutical acceptable salts, that can be isolated and characterized by methods known in the art, such as,
• TGA themiogravimetnc analysis
• TGA-mass spectroscopy TGA-Infrared spectroscopy
• XRPD powder X-ray diffraction
• Karl Fisher titration high resolution X-ray diffraction, and the like.
• the present disclosure includes all isotopes of atoms occurring in the present compounds, salts, solvates, and hydrates.
• Isotopes include those atoms having the same atomic number but different mass numbers.
• One aspect of the present invention includes every combination of one or more atoms in the present compounds, salts, solvates, and hydrates that is replaced with an atom having the same atomic number but a different mass number.
• One such example is the replacement of an atom that is the most naturally abundant isotope, such as ⁇ or !2 C, found in one the present compounds, salts, solvates, and hydrates, with a different atom that is not the most naturally abundant isotope, such as 2 H or ⁇ (replacing 3 ⁇ 4), or U C, 13 C, or i4 C (replacing !2 C).
• a replacement When such a replacement has taken place, it is commonly referred to as being isotopically labeled.
• Isotopic -labeling of the present compounds, salts, solvates, and hydrates can be accomplished using any one of a variety of different synthetic methods know to those of ordinary skill in the art and they are readily credited with understanding the synthetic methods and available reagents needed to conduct such isotopic -labeling.
• isotopes of hydrogen include 2 H (deuterium) and 3 H (tritium).
• Isotopes of carbon include U C, ]3 C, and ]4 C.
• Isotopes of nitrogen include i3 N and ! , N.
• Isotopes of oxygen include !:, 0, l7 Q, and !S 0
• An isotope of fluorine includes I8 F.
• An isotope of sulfur includes 35 S.
• An isotope of chlorine includes 36 C1.
• Isotopes of bromine include 75 Br, /6 Br, / ; Br, and 82 Br.
• Isotopes of iodine include S23 1, 124 I, u' l, and l S I.
• compositions such as, those prepared during synthesis, preformulation, and the like, and pharmaceutical compositions, such as, those prepared with the intent of using in a mammal for the treatment of one or more of the disorders described herein, comprising one or more of the present compounds, salts, solvates, and hydrates, wherein the naturally occurring distribution of the isotopes in the composition is perturbed.
• compositions and pharmaceutical compositions comprising the compounds, salts, solvates, and hydrates, as described herein wherein the salt is enriched at one or more positions with an isotope other than the most naturally abundant isotope.
• Compounds of the present invention can be converted to“prodrugs.”
• the tenn“prodrags” means compounds that have been modified with specific chemical groups known in the art and that when administered into an individual undergo biotransformation to give the parent compound.
• Prodrugs can thus be viewed as compounds of the invention containing one or more specialized non-toxic protective groups used in a transient manner to alter or to eliminate a property of the compound.
• the “prodrug” approach is utilized to facilitate oral absorption.
• T. Higuchi and V. Stella Prodrugs as Novel Delivery Systems Yol. 14 of the A.C.S. Symposium Series; and in Bioreversible Carriers in Drug Design, ed. Edward B. Roche, American Pharmaceutical Association and Pergamon Press, 1987, both of which are hereby incorporated by reference in their entirety.
• AUC refers to the area under the curve, or the integral, of the plasma concentration of an active pharmaceutical ingredient or metabolite over time following a dosing event.
• AUCo- t is the integral under the plasma concentration curve from time 0 (dosing) to time "t" .
• AUCo- co! is the AUC from time 0 (dosing) to time infinity. Unless otherwise stated, AUC refers to AUCo- ⁇ .
• Cmax (or C max ) is a pharmacokinetic parameter denoting the maximum observed blood plasma concentration following delivery of an active pharmaceutical ingredient. Cmax occurs at the time of maximum plasma concentration, t max .
• t max is a pharmacokinetic parameter denoting the time to maximum blood plasma concentration following delivery of an active pharmaceutical ingredient
• ti, 3 ⁇ 4 is a pharmacokinetic parameter denoting the apparent plasma terminal phase half-life, i.e., the time, after absorption and distribution of a drug is complete, for the plasma concentration to fall by half.
• a substance having a narrow therapeutic index means a substance falling within any definition of narrow therapeutic index as promulgated by the U.S. Food and Drug Administration or any successor agency thereof, for example, a substance having a less than 2-fold difference in median lethal dose (LD50) and median effective dose (ED50) values or having a less than 2-fold difference in the minimum toxic concentration and minimum effective concentration in the blood; and for which safe and effective use of the substance requires careful titration and patient monitoring.
• LD50 median lethal dose
• ED50 median effective dose
• a substance is a "substrate” of enzyme activity when it can be chemically transformed by action of the enzyme on the substance.
• Enzyme activity refers broadly to the specific activity of the enzyme (i.e., the rate at which the enzyme transforms a substrate per mg or mole of enzyme) as well as the metabolic effect of such transformations dims
• a substance is an "inhibitor” of enzyme activity when the specific activity or the metabolic effect of the specific activity of the enzyme can be decreased by the presence of the substance, without reference to the precise mechanism of such decrease.
• a substance can be an inhibitor of enzyme activity by competitive, non-competitive, allosteric or other type of enzyme inhibition, by decreasing expression of the enzyme, or other direct or indirect mechanisms.
• a substance is an "inducer" of enzyme activity when the specific activity or the metabolic effect of the specific activity of the enzyme can be increased by the presence of the substance, without reference to the precise mechanism of such increase.
• a substance can be an inducer of enzyme activity by increasing reaction rate, by increasing expression of the enzyme, by allosteric activation or other direct or indirect mechanisms. Any of these effects on enzyme activity can occur at a given concentration of active agent in a single sample, donor, or patient without regard to clinical significance.
• a substance can be a substrate, inhibitor, or inducer of an enzyme activity.
• the substance can be an inhibitor of enzyme activity by one mechanism and an inducer of enzyme activity by another mechanism.
• the fimction (substrate, inhibitor, or inducer) of the substance with respect to activity of an enzyme can depend on environmental conditions. Lists of inhibitors, inducers and substrates for CYP3A4 can be found, for instance, at
• composition of mater unless specifically stated otherwise or the context requires otherwise, reference to a single step, composition of mater, group of steps, or group of composi tions of mater shall be taken to encompass one and a plurality (i.e. one or more) of those steps, compositions of matter, groups of steps, or groups of compositions of matter.
• compositions, and methods are clearly within the scope of the invention(s), as described herein.
• kits for co-admini storing Compound 1 with another drug are also provided herein. Also provided herein me methods of reducing the dosage of Compound 1 when co-administered with another drug. Also provided herein are methods of reducing the dosage of another drug when co-administered with Compound 1. Also provided herein are methods of discontinuing the administration of Compound 1 when an individual is administered another drug. Also provided herein are methods of discontinuing the administration of another drug when an individual is administered Compound 1. Also provided herein are methods of continuing the administration of Compound 1 when an individual is administered another drug. Also provided herein are methods of continuing the administration of another drug when an indi vidual is administered Compound 1. Also provided herein are methods of monitoring an individual who is co administered Compound 1 and another drug.
• a method of treating an individual with a sphingosine 1 -phosphate subtype 1 (S lP i) receptor-associated disorder comprising: administering to the individual in need thereof a pharmaceutical dosage form comprising a therapeutically effective amount of (i?)-2-(7-(4-cyclopentyl-3- (trifluoromethyl)benzyloxy)-l,2,3,4-tetrahydrocyclopenta[6]indol-3-yl)acetic acid (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof wherein the pharmaceutical dosage form has a mean fed/fasted ratio of the area under the plasma concentration versus time curve of from about 0.8 to about 1.25 and a mean fed/fasted ratio of the maximum plasma concentration (Cmax) from about 0.8 to about 1.25.
• the method further comprises informing the patient or a medical care worker that administration of the S IPi modulator to a patient who is also being administered a CYP2C8 inhibitor, CYP2C9 inhibitor, UDP-glucuronosyltransferase (UGT) enzyme IJGTI AI inhibitor, or UDP- glucuronosyltransferase (UGT) enzyme UGT1A6 inhibitor results in higher exposure of the SI Pi modulator than administration of the S IPi modulator to a patient who is not being administered a CYP2C8 inhibitor, CYP2C9 inhibitor, UDP-glucuronosyltransferase (UGT) enzyme UGT!A! inhibitor, or UDP- glucuronosyltransferase (UGT) enzyme UGT! A6 inhibitor.
• the method further comprises informing the patient or a medical care worker that administration of the S lPi modulator to a patient who is also being administered a CYP2C8 inhibitor, CYP2C9 inhibitor, UDP-glucuronosyltransferase (UGT) enzyme UGT!A!
• UDP- glucuronosyltransferase (UGT) enzyme UGT1A6 inhibitor may result in increased risk of one or more exposure-related adverse reactions than administration of the S IPi modulator to a patient who is not being administered a CYP2C8 inhibitor, CYP2C9 inhibitor, UDP-glucuronosyitransferase (UGT) enzyme UGT1A1 inhibitor, or UDP-glucuronosyltransferase (UGT) enzyme UGT1A6 inhibitor.
• the patient is also being administered a CYP2C8 inhibitor. In some embodiments, the patient is also being administered a CYP2C9 inhibitor. In some embodiments, the patient is also being administered a UDP-glucuronosyltransferase (UGT) enzyme UGT1A1 inhibitor. In some embodiments, the patient is also being administered a UDP-glucuronosyltransferase (UGT) enzyme UGT1A6 inhibitor
• the CYP2C8 inhibitor is gemfibrozil, ritonavir, clopidogrel, iopinavir, deferasirox, lapatinib, trimethoprim, thiazolidinediones, montelukast, quercetin, candesartan cilexetil (cyclohexylcarbonate ester prodrug of candesartan), zafirlukast, clotrimazole, felodipine, mometasone furoate, salmeterol, raloxifene, fenofihrate, ritonavir, levothyroxine, tamoxifen, loratadine, oxybutynin, medroxyprogesterone, simvastatin, ketoconazole, ethinyl estradiol, spironolactone, lovastatin, nifedipine, or irbes
• the CYP2C9 inhibitor is amiodarone, disulfram, doxifluridine, efavirenz, fluconazole, imatinib, lefluonomide, metronidazole, miconazole, phenytoin, sulfamethoxazole, sulfapenazone, sildenafil, zafirlukast, valdecoxib, diclofenac, voriconazole, tamoxifen, iosartan, warfarin, etodolac, mefenamic acid, meloxicam, suprofen, irbesartan, ibuprofen, fluvastatin, sertraline, fluvoxamine, pantoprazole, rosiglitazone, lansoprazole, ritonavir, nicardipine, aprepitant, delavirdine, desloratadine, g
• the CYP2C9 inhibitor is ticlopidine, omeprazole, paroxetine, valsartan, bortezomib, valproic acid, nevirapine, azelastine, lornoxicam, fenofibrate, isomazid, phenylbutazone, probenecid, sulfaphenazole, tcniposide, etravirine, sulfadiazine, sulfinpyrazone, sulfisoxazole,
• trimethoprim leflunomide, nilotinib, pyrimethamine, sorafenib, capecitabine, fluorouracil, sitaxentan, tranylcypromine, aminophenazone, clopidogrel, verapamil, etoricoxib, propofol, ketoprofen, seratrodast, sulfamoxole, amlodipme, amodiaquine, anastrozole, atovaquone, chloramphenicol, cyclosporine, cimetidine, clotrimazole cocaine, colchicine, cholecalciferol, cyclizine, dexfenfluramine,
• dextropropoxyphene dicoumarol, diltiazem, disulfiram, epinephrine, eprosartan, ethanol, felodipine, flecainide, histamine, indinavir, Iopinavir, loratadine, medroxyprogesterone acetate, methazolamide, moclobemide, modaf il, nelfmavir, nifedipine, nilutamide, mlvadipine, olanzapine, phentemune, pioglitazone, praniukast, pravastatin, promethazine, propafenone, quinidine, rutin, saquinavir, selegiline, sulfadimethoxine, sulfamethizole, sulfanilamide, suifapyridine, tegaserod, methimazole, thioridazine,
• the UDP-glucuronosyltransferase (UGT) enzyme UGT1A1 inhibitor is adenine, propofol, indomethacin, nilotinib, pazopanib, regorafenib, flunitrazepam, erlotinib, sorafenib, enasidenib, pibrentasvir, glecaprevir, rucaparib, ertuglif!ozin, or fostamatinib.
• the UDP-glucuronosyltransferase (UGT) enzyme UGT1A6 inhibitor is troglitazone.
• the UGT substrate is diclofenac.
• SIPi sphingosine 1 -phosphate subtype 1
• Compound 1 chosen from (i?)-2-(7 ⁇ (4 ⁇ cyc!opentyl-3
• SI Pi sphingosine 1 -phosphate subtype 1 receptor modulator chosen from R
• the method further comprises monitoring the patient for signs and symptoms of toxicity and clinical response associated with the substrate of the membrane transporter.
• the method further comprises reducing the amount of the substrate of the membrane transporter administered to the patient based on the patient’s ability to tolerate one or more exposure -related adverse reactions related to the substrate of the membrane transporter.
• the method further comprises informing the patient or a medical care worker that co-administration of the SIPi receptor modulator and the substrate of a membrane transporter may result in increased exposure of the substrate of the membrane transporter. In some embodiments, the method further comprises informing the patient or a medical care worker that co-administration of the S lPi receptor modulator and the substrate of the membrane transporter may result in increased risk of one or more exposure-related adverse reactions associated with the substrate of the membrane transporter.
• monitoring for signs and symptoms of toxicity and clinical response comprises monitoring the serum concentration of the substrate of the membrane transporter.
• monitoring for signs and symptom s of toxicity and clinical response comprises determining whether the patient experiences one or more exposure-related adverse reaction associated with serum concentration of the substrate of the membrane transporter.
• monitoring for signs and symptoms of toxicity and clinical response comprises monitoring efficacy of the substrate of the membrane transporter.
• the membrane transporter is P-glycoprotein (Pgp). In some embodiments, the membrane transporter is BCRP (breast cancer resistance protein). In some embodiments, the membrane transporter is QATP1BI.
• the membrane transporter is P-glycoprotein.
• the substrate of the membrane transporter is chosen from digoxin, loperamide, berberine, irinotecan, doxorubicin, vinblastine, paclitaxel, and fexofenadine.
• the membrane transporter is BCRP.
• the substrate of the membrane transporter is chosen from mitoxantrone, methotrexate, topotecan, imatinib, irinotecan, statins, sulphate conjugates, and porphyrins.
• the membrane transporter is OATP1B1.
• the substrate of the membrane transporter is chosen from bromosulphophthalein, oestrone-3 -sulphate, oestradiol-l7 -glucuronide, statins, repagiimde, valsartan, olmesartan, bilirubin glucuronide, bilirubin, and bile acids.
• the substrate of the membrane transporter is rifampin.
• the membrane transporter is OATPIB3. In some embodiments, the substrate of the membrane transporter is rifampin.
• the dosage form is administered under fasted conditions. In some embodiments, the dosage form is administered under fed conditions.
• the method is non-gender specific.
• the individual is also being administered one or more agents independently- chosen from oral corticosteroids and aminosalicylates.
• the individual is not being administered one or more agents independently chosen from natalizumab, efalizumab, and rituximab.
• the administration of Compound 1 is not initiated if the individual is being administered one or more agents independently- chosen from natahzumab, efalizumab, and rituximab.
• the administration of Compound 1 is discontinued if the individual is being administered one or more agents independently chosen from natahzumab, efalizumab, and rituximab.
• the dose of Compound 1 is reduced if the individual is being administered one or more agents independently chosen from natalizumab, efalizumab, and rituximab.
• the individual has not been administered a biologic agent.
• the individual has not been administered two or more biologic agents.
• the individual has not been administered three or more biologic agents.
• the individual is not being administered a biologic agent.
• the individual is not being administered two or more biologic agents.
• the individual is not being administered three or more biologic agents.
• the standard dose is administered without titration: and the individual does not experience a severe related adverse event.
• the therapeutically effective amount is equivalent to about 0 5 to about 5.0 mg of Compound 1 if the individual does not have an active infection. In some embodiments, Compound 1 is not administered to the individual 1 if the individual has an active infection. In some embodiments, the active infection is a serious active infection. In some embodiments, the method further comprises monitoring the individual for an active infection. In some embodiments, the method further comprises discontinuing administration if the individual develops an active infection.
• the method further comprises monitoring for adverse events during the admini stration of Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof, and optionally, interrupting or terminating the administration of Compound I, or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• the treatment further comprises monitoring heart rate during the administration, monitoring pulmonary ' function during the administration, or monitoring liver function during the administration.
• the treatment further comprises monitoring heart rate during the administration.
• the treatment further comprises monitoring pulmonary function during the administration.
• the treatment further comprises monitoring liver function during the administration.
• the method reduces the incidence and severity of adverse events resulting from the treatment of the sphingosine 1 -phosphate subtype 1 (S lPi) receptor-associated disorder.
• the adverse event is a serious adverse event.
• the serious adverse event is selected from leukopenia, constipation, diarrhea, nausea, abdominal pam, neutropenia, vomiting, back pain, and menstrual disorder. In some embodiments, the method results in no serious adverse events.
• the standard dose is administered without substantially inducing an acute heart rate reduction or heart block in the individual.
• Compound 1 is administered without causing a reduction of more than 6 bpm in heart rate.
• Compound 1 is administered without a first-dose effect on heart rate as seen with other SIP receptor modulators. In some embodiments. Compound 1 is administered without a first- dose effect on AV conduction as seen with other SIP receptor modulators.
• the individual was pre viously administered at least one agent selected from: a TNF antagonist, an integrin antagonist, and an immunosuppressive agent.
• the individual had an inadequate response with, lost response to, or was intolerant to the at least one agent.
• the individual had demonstrated, over the previous 3-month period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5- aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists. In some embodiments, the individual had demonstrated, over the previous 6-month period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists.
• the individual had demonstrated, over the previous 9-month period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists. In some embodiments, the individual had demonstrated, over the previous 1-year period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5 -aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists.
• the individual had demonstrated, over the previous 2-year period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists. In some embodiments, the individual had demonstrated, over the previous 3-year period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists.
• the individual had demonstrated, over the previous 4-year period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists. In some embodiments, the individual had demonstrated, over the previous 5 -year period, an inadequate response to, loss of response to, or intolerance of at least one agent selected from oral 5-aminosalicylates, corticosteroids, immunosuppressives, TNFa antagonists, and integrin antagonists. In some embodiments, the standard dose is administered without titration.
• the individual has fasted prior to being administered the standard dose
• treating comprises inducing and/or maintaining clinical response; improving endoscopic appearance of the mucosa; and/or inducing and/or maintaining clinical remission.
• treating comprises inducing and/or maintaining histologic improvement.
• treating comprises inducing and/or maintaining histologic remission.
• treating comprises inducing and/or maintaining mucosal healing.
• the individual prior to the administering the individual has a 3-component Mayo Clinic Score of at least 6.
• the method results in an improvement of the individual’s 3 -component Mayo Clinic Score. In some embodiments, the method results in an improvement of the individual’s 2- component Mayo Clinic Score. In some embodiments, the method results in an improvement of the individual’s Total Mayo Clinic Score.
• the treatment results in endoscopic improvement, e.g., improving endoscopic appearance of the mucosa.
• the treatment results in inducing clinical remission.
• the treatment results in maintaining clinical remission.
• the treatment results in inducing and maintaining clinical remission.
• the treatment results in inducing clinical response.
• the treatment results in maintaining clinical response.
• the treatment results in inducing and maintaining clinical response.
• the treatment reduces a lymphocyte count in the individual by at least 40%. In some embodiments, the treatment reduces a lymphocyte count in the individual by at least 45%, 50%, 55%, 60%, or 65%. In some embodiments of the method of treatment of inflammatory bowel disease, e.g., ulcerative colitis, such as moderately to severely active ulcerative colitis, the treatment results in corticosteroid-free remission.
• inflammatory bowel disease e.g., ulcerative colitis, such as moderately to severely active ulcerative colitis
• the treatment results in endoscopic remission.
• the treatment results in an improvement in rectal bleeding.
• the treatment results in histologic healing.
• the treatment results in an improvement in stool frequency.
• the treatment further comprises monitoring the level of level of fecal calprotectin.
• the treatment further comprises monitoring the level of level of c-reactive protein (CRP).
• CRP c-reactive protein
• treating is reducing a sign and/or symptom of ulcerative colitis. In some embodiments, treating is reducing a sign of ulcerative colitis. In some embodiments, treating is reducing a symptom of ulcerative colitis. In some embodiments, treating is reducing a sign and/or symptom of Crohn’s disease. In some embodiments, treating is reducing a sign of Crohn’s disease. In some embodiments, treating is reducing a symptom of Crohn’s disease.
• treating is inducing and/or maintaining clinical remission. In some embodiments, treating is inducing and maintaining clinical remission. In some embodiments, treating is inducing and/or maintaining clinical remission and/or clinical response. In some embodiments, treating is inducing and maintaining clinical remission and clinical response. In some embodiments, treating is inducing clinical remission and/or clinical response. In some embodiments, treating is maintaining clinical remission and/or clinical response. In some embodiments, treating is inducing clinical remission and clinical response. In some embodiments, treating is maintaining clinical remission and clinical response. In some embodiments, treating is inducing and/or maintaining clinical remission and/or mucosal healing.
• treating is inducing and maintaining clinical remission and mucosal healing. In some embodiments, treating is inducing and maintaining mucosal healing. In some embodiments, treating is inducing and maintaining clinical remission. In some embodiments, treating is inducing ciinical remission. In some embodiments, treating is inducing mucosal healing. In some embodiments, treating is maintaining clinical remission. In some embodiments, treating is maintaining mucosal healing. In some embodiments, treating is achieving and/or sustaining clinical remission in induction responders. In some embodiments, treating is achieving and sustaining clinical remission in induction responders. In some embodiments, treating is achieving clinical remission in induction responders.
• treating is sustaining clinical remission in induction responders. In some embodiments, treating is inducing and/or maintaining clinical response. In some embodiments, treating is inducing and maintaining clinical response. In some embodiments, treating is inducing clinical response. In some embodiments, treating is maintaining clinical response hi some embodiments, treating is inducing endoscopic improvement i some embodiments, treating is maintaining endoscopic improvement. In some embodiments, treating is achieved endoscopic improvement. In some embodiments, treating is improving endoscopic remission. In some embodiments, treating is maintaining endoscopic remission. In some embodiments, treating is inducing histologic healing. In some embodiments, treating is maintaining histologic healing. In some embodiments, treating is improving stool frequency. In some embodiments, treating is maintaining improvement in stool frequency.
• treating is improving endoscopic appearance of the mucosa. In some embodiments, treating is maintaining endoscopic improvement of the mucosa. In some embodiments, treating is improving endoscopic appearance of the mucosa during induction hi some embodiments, treating eliminates the need for corticosteroid rise. In some embodiments, treating allows for reduced corticosteroid use. In some embodiments, treating allows for the use of a lower dose of a corticosteroid. In some embodiments, treating is achieving corticosteroid-free remission. In some embodiments, treating is sustaining corticosteroid-free remission. In some embodiments, treating is improving rectal bleeding. In some embodiments, treating is maintaining improvement in rectal bleeding in some embodiments, treating is improving endoscopic subscore. In some embodiments, treating is maintaining improvement in endoscopic subscore.
• ulcerative colitis has been diagnosed using a 2-component Mayo Clinic Score. For example, in some embodiments, ulcerative colitis has been diagnosed using a score ranging from 0 to 9 for rectal bleeding and endoscopic findings. In some embodiments, ulcerative colitis has been diagnosed using a 3-component Mayo Clinic Score. For example, in some embodiments, ulcerative colitis has been diagnosed using a score ranging from 0 to 9 for stool frequency, rectal bleeding, and endoscopic findings. In some embodiments, ulcerative colitis has been diagnosed using a Total Mayo Score. For example, in some embodiments, ulcerative colitis has been diagnosed using a score ranging from 0 to 12 for stool frequency, rectal bleeding, endoscopic findings, and Physicians Global Assessment.
• improvement in ulcerative colitis is measured using a 2-component Mayo Clinic Score. In some embodiments, improvement in ulcerative colitis is measured using a 3 -component Mayo Clinic Score. In some embodiments, improvement in ulcerative colitis is measured using a Total Mayo Score. In some embodiments, improvement in ulcerative colitis is measured by clinical remission in some embodiments, improvement in ulcerative colitis is measured by lymphocyte reduction. In some embodiments, improvement in ulcerative colitis is measured by endoscopic improvement. In some embodiments, improvement in ulcerative colitis is measured by 6-point Mayo Score. For example, in some embodiments, improvement in ulcerative colitis is measured by stool frequency and rectal bleeding. In some embodiments, improvement in ulcerative colitis is statistically significant.
• Compound 1 is not recommended in an individual with active, severe infection. In some embodiments, Compound 1 is not recommended in an individual with an active infection. In some embodiments, Compound 1 is not recommended in an individual with a severe infection. In some embodim nts, Compound 1 is not recommended in an individual with an active, severe infection until the infection is controlled. In some embodiments, Compound 1 is not recommended in an individual with an active infection until the infection is controlled. In some embodiments, Compound 1 is not recommended in an individual with a severe infection until the infection is controlled. In some embodiments, administration of Compound 1 is not started during an active infection. In some embodiments, an individual is monitored for infection. In some embodiments, administration of
• Compound 1 is stopped if an individual develops an infection. In some embodiments, administration of Compound 1 is stopped if infection becomes serious. In some embodiments, administration of Compound 1 is discontinued if an individual develops an infection. In some embodiments, Compound 1 is not administered to an individual with an infection. In some embodiments, Compound 1 is not administered during an active infection. In some embodiments, administration of Compound 1 is not started during active infection; an individual is monitored if an infection develops during administration; and
• an infection is mild. In some embodiments, an infection is moderate. In some embodiments, an infection is severe. In some embodiments, an infection is serious. In some embodiments, an infection is a serious adverse event. In some embodiments, an infection is a respiratory infection.
• Compound 1 is administered without causing a severe adverse event. In some embodiments, Compound 1 is administered without causing a severe adverse event related to heart rate. In some embodiments, Compound 1 is administered without causing a severe adverse event related to heart rate change. In some embodiments. Compound 1 is administered without causing a severe adverse event related to elevated heart rate hr some embodiments, Compound I is administered without causing a severe adverse event related to bradycardia. In some embodiments, Compound 1 is administered without causing a severe adverse event related to AV block. In some embodiments, Compound 1 is administered without causing a severe adverse event related to AV conduction. In some embodiments, Compound 1 is administered without causing bradycardia.
• Compound 1 is administered without causing AV block. In some embodiments, Compound 1 is administered without causing more than mild decrease heart rate on first day of treatment (for example, >10 bpm). In some embodiments, Compound 1 is administered without a first-dose effect seen with other SIP receptor modulators. In some embodiments. Compound 1 is administered without a first-dose cardiovascular effect seen with other SIP receptor modulators. In some embodiments, Compound 1 is administered without symptomatic changes in heart rate. In some embodiments, Compound 1 is administered without symptomatic changes in heart rhythm. In some embodiments, Compound 1 is administered without requiring titration to avoid first-dose effect seen with other SIP receptor modulators.
• Compound 1 is administered without increasing a liver function test (LFT). In some embodiments, Compound 1 is administered without causing an elevated LFT. In some embodiments. Compound 1 is administered without increasing ALT. In some embodiments, Compound 1 is administered without increasing AST. In some embodiments. Compound 1 is administered without increasing ALT >3X ULN. In some embodiments. Compound 1 is administered without increasing ALT >2.5X ULN. In some embodiments, Compound I is administered without increasing ALT >2X ULN. hr some embodiments. Compound 1 is administered without increasing ALT >1.5X ULN. In some embodiments, Compound 1 is administered without increasing AST >3X ULN.
• LFT liver function test
• Compound 1 is administered without increasing AST >2.5X ULN. In some embodiments, Compound 1 is administered without increasing AST >2X ULN. In some embodiments, Compound 1 is administered without increasing AST >!.5X ULN. In some embodiments, Compound 1 is administered without increasing bilirubin. In some embodiments, Compound 1 is administered without increasing bilirubin >3X ULN. In some embodiments, Compound 1 is administere without increasing bilirubin >2.5X ULN. In some embodiments, Compound 1 is administered without increasing bilirubin >2X ULN. In some embodiments, Compound 1 is administered without increasing bilirubin >1 5X ULN .
• Compound 1 is administered without increasing gamma-glutamyl transferase (GGT). In some embodiments. Compound 1 is administered without increasing GGT >3X ULN. In some embodiments, Compound 1 is administered without increasing GGT >2.5X ULN. In some embodiments, Compound 1 is administered without increasing GGT >2X ULN. In some embodiments, Compound 1 is administered without increasing GGT >!.5X ULN.
• GGT gamma-glutamyl transferase
• Compound 1 is administered without causing an abnonnality in a pulmonary function test. In some embodiments, Compound 1 is administered without causing macular edema.
• the individual has had an inadequate response with, lost response to, been intolerant to, or demonstrated dependence on another agent for the treatment of an inflammatory bowel disease. In some embodiments, the individual has had an inadequate response with the other agent for the treatment of an inflammatory bowel disease. In some embodiments, the individual has lost response to another agent for the treatment of an inflammatory bowel disease. In some embodiments, the individual was intolerant to another agent for the treatment of an inflammatory bowel disease. In some embodiments, the individual requires continuous steroid therapy. In some embodiments, the other agent is at least one agent selected from; a tumor necrosis tumor necrosis factor (TNF) antagonist, a corticosteroid, an integrin antagonist, and immunosuppressive agent, and an aminosalicylate.
• TNF tumor necrosis tumor necrosis factor
• the individual has had an inadequate response with, lost response to, or been intolerant to a conventional therapy. In some embodiments, the individual has had an inadequate response to conventional therapy. In some embodiments, the individual has lost response to conventional therapy. In some embodiments, the individual has been intolerant to conventional therapy. In some embodiments, the conventional therapy is selected from: at least one agent selected from: a tumor necrosis tumor necrosis factor (TNF) antagonist, a corticosteroid, an integrin antagonist, and immunosuppressive agent, and an aminosalicylate.
• TNF tumor necrosis tumor necrosis factor
• the individual was previously administered a corticosteroid and/or an aminosalicylate. In some embodiments, the individual was previously administered a tumor necrosis tumor necrosis factor (TNF) antagonist, an integrin antagonist, and/or an immunosuppressive agent.
• TNF tumor necrosis tumor necrosis factor
• the corticosteroid is an oral corticosteroid.
• the TNF antagonist is a TNF-a blocker.
• the aminosalicylate is a 5-aminosaiicylate.
• the integrin antagonist is referred to as an integrin receptor antagonist.
• the TNF antagonist is referred to as a TNF blocker.
• the TNF blocker is referred to as a TNF blocker.
• immunosuppressive agent is referred to as an immunomodulator.
• prior conventional therapy is referred to as prior treatment.
• the indi vidual is not administered a therapeutic dose of a thiopurine .
• the individual is not administered a therapeutic dose of azathioprine.
• the individual is not administered a therapeutic dose of 6-mercaptopurine.
• the individual is not administered a therapeutic dose of thioguanine (also referred to as tioguamne or 6-thioguanine).
• the inhibitor is a moderate inhibitor. In some embodiments, the inhibitor is a strong inhibitor. In some embodiments, the inducer is a moderate inducer. In some embodiments, the inducer is a strong inducer.
• caution is used when Compound 1 is co-administered with a CYP substrate. In some embodiments, caution is used when Compound 1 is co-administered with a UGT substrate. In some embodiments, caution is used when Compound 1 is co-administered with an OAT substrate. In some embodiments, caution is used when Compound 1 is co-administered with strong inhibitors. In some embodiments, the strong inhibitor is a strong CYP inhibitor. In some embodiments, the strong inhibitor is a CYP2C8. In some embodiments, caution is used when Compound 1 is co-administered with moderate inhibitors. In some embodiments, the moderate inhibitor is a moderate CYP inhibitor.
• the moderate inhibitor is a CYP2C9 inhibitor. In some embodiments, caution is used when Compound 1 is co-administered with strong inducers. In some embodiments, the strong inhibitor is a strong CYP inducer. In some embodiments, caution is used when Compound 1 is co-administered with moderate inducers. In some embodiments, the moderate inducer is a moderate CYP inhibitor. In some embodiments, the moderate inducer is a CYP2C8 inducer. In some embodiments, the moderate inducer is a CYP2C9 inducer.
• the dose of Compound 1 is limited when used with a CYP substrate. In some embodiments, the dose of Compound 1 is limited when used a UGT substrate. In some
• the dose of Compound 1 is limited when used with an OAT substrate. In some embodiments, the dose of Compound 1 is limited when used with an OAT substrate.
• the dose of Compound 1 is limited when used with strong inhibitors. In some embodiments, the dose of Compound 1 is limited to, or is limited to about, does not exceed, or does not exceed about,
• Compound 1 is administered at the lowest dose when used with a strong inhibitor hi some embodiments, the dose of Compound 1 is limited when used with moderate inhibitors. In some embodiments, Compound 1 is administered at the lowest dose when used with a moderate inhibitor. In some embodiments, the lowest dose is the lowest efficacious dose. In some embodiments, the lowest dose is the lowest marketed dose. In some embodiments, the lowest dose is the lowest marketed dose in the United States.
• the lowest dose of Compound 1 is, or is about, 0.25, 0.3, 0.4, 0.5, 0.6, 0.7. 0.75, 0 8, 0 9, 1.0., 1 .1., 1 2, 1 3, 1 4, 1 5, 1 6, 1 7, 1 75, 1.8, 1 9, or 2.0 mg.
• the dose of a co-administered compound is limited when used with Compound 1.
• the co-administered compound is a CYP substrate.
• the co-administered compound is a UGT substrate.
• the dose of a co administered compound is an OAT substrate.
• the co-administered compound is a strong inducer.
• the co-adrninistered compound is a strong inhibitor.
• the co-administered compound is a moderate inducer.
• the co administered compound is a moderate inhibitor.
• the co-administered compound is administered at the lowest dose.
• the lowest dose is the lowest efficacious dose.
• the lowest dose is the lowest marketed dose.
• the lowest dose is the lowest marketed dose in the United States.
• Compound 1 is not used with a CYP substrate. In some embodiments, Compound 1 is not used with a UGT substrate. I some embodiments. Compound 1 is not used with an OAT substrate. In some embodiments. Compound 1 is not used with strong inducers. In some embodiments, Compound 1 is not used with moderate inducers. In some embodiments. Compound 1 is not used with strong inhibitors hi some embodiments, Compound I is not used with moderate inhibitors. In some embodiments, concomitant use of Compound 1 is not recommended with a CYP substrate. In some embodiments, concomitant use of Compound I is not recommended with a UGT substrate. In some embodiments, concomitant use of Compound 1 is not recommended with an OAT substrate.
• concomitant use of Compound 1 is not recommended with strong inducers. In some embodiments, concomitant use of Compound 1 is not recommended with moderate inducers. In some embodiments, concomitant use of Compound 1 is not recommended with strong inhibitors. In some embodiments, concomitant use of Compound 1 is not recommended with moderate inhibitors. In some embodiments, concomitant use of Compound 1 is not recommended with a CYP2C8 inhibitor. In some embodiments, concomitant use of Compound 1 is not recommended with a CYP2C8 inducer. In some embodiments, concomitant use of Compound 1 is not recommended with a CYP2C9 inhibitor. In some embodiments, concomitant use of Compound 1 is not recommended with a CYP2C8 inducer.
• Some embodiments provide a method of safely treating an individual with ( R)-2 ⁇ (7-(4-cyclopenty! ⁇ 3-(trifluoromethyl)benzyloxy)-l,2,3,4-tetrahydrocyclopenta[6]indol-3-yl)acetic acid (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• Some embodiments provide a method of safely administering (i?)-2-(7-(4-cyclopentyl-3- (trifluoromethyl)benzyloxy)-l,2,3,4-tetrahydrocyclopenta[Z>]indol-3-yl)acetic acid (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof.
• Some embodiments provide a method of administering a daily dose of Compound 1 when an individual is concomitantly receiving a CYP substrate, OAT substrate, or UGT substrate.
• the daily dose of Compound 1 is nor more than, or no more than about, 0.25, 0.3, 0 4, 0.5, 0.6, 0.7. 0.75, 0.8, 0.9, 1.0., 1.1., 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.75, 1.8, 1.9, 2.0, 2.1, 2.2, 2.25, 2.3, 2.4, 2.5, 2.6, 2.7, 2.75, 2.8, 2.9, or 3.0 mg.
• the daily dose of Compound 1 is less than, or less than about, 0.25, 0.3, 0.4, 0.5, 0.6, 0.7. 0.75, 0.8, 0.9, 1.0., 1.1., 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.75, 1.8, 1.9, 2.0, 2.1, 2.2, 2.25, 2.3, 2.4, 2.5, 2.6, 2.7, 2.75, 2.8, 2.9, or 3.0 mg.
• the CYP substrate is a CYP2C8 substrate.
• the CYP substrate is a CYP2C9 substrate.
• the UGT substrate is a UGT1A1 substrate.
• the UGT substrate is a UGT1A4 substrate.
• the UGT substrate is a UGT1A6 substrate.
• the UGT substrate is a UGT1A7 substrate.
• the OAT substrate is an OATP1BI substrate.
• the OAT substrate is an OATP1B3 substrate.
• the OAT substrate is an OAT1 substrate.
• the OAT substrate is an OAT3 substrate.
• the CYP2C8 inhibitor, CYP2C9 inhibitor, CYP2C8 inducer, or CYP2C9 inducer is fluconazole.
• the CYP2C8 inhibitor, CYP2C9 inhibitor, CYP2C8 inducer, or CYP2C9 ducer is gemfibrozil
• the CYP2C8 inhibitor, CYP2C9 inhibitor, CYP2C8 inducer, or CYP2C9 inducer is rifampin.
• the substrate of OATP1B1 is rifampin.
• the substrate of OATP1B3 is rifampin.
• the co-administered compound is a CYP2C8 inhibitor.
• the co-administered compound is a CYP2C8 inducer.
• the co-administered compound is a CYP2C9 inhibitor.
• the co-administered compound is a CYP2C9 inducer.
• the co-administered compound is fluconazole.
• the co-administered compound is gemfibrozil.
• the co-administered compound is rifampin.
• less than the amount that would be administered to a patient who is not also being administered a CYP substrate, OAT substrate, UGT substrate, CYP2C8 inhibitor, CYP2C9 inhibitor, CYP2C8 inducer, CYP2C9 inducer, UGT1A1 inhibitor, or UGT1A6 inhibitor is about, at least, or at least about, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23,24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 , 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 778, 79, 80, 81 , 82, 83,
• CYP substrate OAT substrate, UGT substrate, CYP2C8 inhibitor, CYP2C9 inhibitor
• CYP2C8 inducer
• CYP2C9 inducer
• UGT1A1 inhibitor or UGT1A6 inhibitor.
• less than the amount that would be administered to a patient who is not also being administered a CYP substrate, OAT substrate, UGT substrate, CYP2C8 inhibitor, CYP2C9 inhibitor, CYP2C8 inducer, CYP2C9 inducer, UGT1A1 inhibitor, or UGT1A6 inhibitor is about, at least, or at least about, 0.1, 0.2, 0.25, 0.3, 0.4, 0.5, 0.6, 0.7, 0.75, 0.8, 0.9, 1.0, 1.1, 1.2, 1.25, 1.3, 1.4, 1.5, 1.6, 1.7, 1.75, 1.8, 1.9, or 2.0 mg less than the amount that would be administered to a patient who is not also being administered a CYP substrate, OAT substrate, UGT substrate, CYP2C8 inhibitor, CYP2C9 inhibitor,
• CYP2C8 inducer
• CYP2C9 inducer
• UGT1A1 inhibitor or UGT1A6 inhibitor.
• Some embodiments provide a method of safely administering a sphingosine 1 -phosphate subtype 1 (SIP ) receptor modulator chosen from (i?)-2-(7-(4-cyclopentyl-3-(trifluoromethyl)benzyloxy)-l,2,3,4- tetrahydrocyclopenta[6]indol-3-yl)acetic acid (Compound 1), or a pharmaceutically acceptable salt, hydrate, or solvate thereof, to a patient in need thereof wherein the patient is also being administered a cytochrome P450 (CYP) inhibitor, CYP inducer, organic anion transporter (OAT) substrate, UDP- glucuronosyltransferase (UGT) enzyme inhibitor, or UDP-glucuronosy!transferase (UGT) enzyme inhibitor, comprising administering to the patient a daily dose of less than 2 mg of the SIP modulator.
• SIP sphingosine 1 -phosphate subtype 1
• the daily dose of the SIP ⁇ , modulator is selected from: 1.0, 1.25, 1.5, and 1.75 mg of the SI Pi modulator.
• lymphopenia also referred to as peripheral lymphocyte lowering (PLL); Hale et ai, Bioorg. Med. Chem. Lett. , 14:3351-3355, 2004. This is attended by clinically useful immunosuppression by virtue of sequestering T- and B-cells in secondary lymphoid tissue (lymph nodes and Peycr’s patches) and thus apart from sites of inflammation and organ grafts (Rosen et ai, Immunol. Rev. , 195: 160-177,
• lymphocyte sequestration for example in lymph nodes, is thought to be a consequence of concurrent agonist-driven functional antagonism of the S 1 Pi receptor on T-cells (whereby the ability of SIP to mobilize T-cell egress from lymph nodes is reduced) and persistent agonism of the SIPi receptor on lymph node endothelium (such that barrier function opposing transmigration of lymphocytes is increased) (Matloubian et al, Nature, 427:355-360, 2004; Baumruker et al. Expert Opin. Investig. Drugs, 16:283-289, 2007).
• agonism of the S IP receptor alone is sufficient to achieve lymphocyte sequestration (Sauna et al. , J. Biol. Chem. , 279: 13839-13848, 2004) and that this occurs without impairment of immune responses to systemic infection (Brinkmann et ai, Transplantation, 72:764-769, 2001; Brinkmann et ai., Transplant: Proa, 33:530-531, 2001)
• That agonism of endothelial SIPi receptors has a broader role in promoting vascular integrity is supported by work implicating the SIPi receptor in capillary integrity in mouse skin and lung (Sauna et al, Nat. Chem. Biol, 2:434-441, 2006).
• Vascular integrity can be compromised by inflammatory processes, for example as may derive from sepsis, major trauma and surgery so as to lead to acute lung injury or respiratory distress syndrome (Johan Groeneveld, Vascul. Pharmacol , 39:247-256, 2003).
• An exemplary SIP receptor agonist having agonist activity on the SlPi receptor is FTY720 (fmgoiimod), an immunosuppressive agent that has undergone clinical trials (Martini et al, Expert Opin Investig. Drugs, 16:505-518, 2007) and was recently approved by the FDA for the treatment of individuals with relapsing forms of multiple sclerosis (MS) to reduce the frequency of clinical exacerbations and to delay the accumulation of physical disability.
• FTY720 acts as a prodrug which is phosphorylated in vivo; the phosphorylated derivative is an agonist for S IPi, SIP3, S IP4 and SIP5 receptors (but not the Sllti receptor) (Chiba, Pharmacology & Therapeutic , 108:308-319, 2005). FTY720 has been shown to rapidly 7 and reversibly induce lymphopenia; Hale et al. , Bioorg. Med. Chem. Lett., 14:3351-3355, 2004).
• FTY720 elicited an adverse event (i.e., transient asymptomatic bradycardia) which may be due to its agonism of the S1P 3 receptor (Budde et al., J Am. Soc. Nephrol , 13: 1073-1083, 2002; Sauna et al , J. Biol. Chern., 279: 13839-13848, 2004; Ogawa et al, BBRC, 361 :621-628, 2007).
• an adverse event i.e., transient asymptomatic bradycardia
• FTY720 has been reported to have therapeutic efficacy in at least: a rat model for autoimmune myocarditis and a mouse model for acute viral myocarditis (Kiyabayashi etal., J. Cardiovasc. Pharmacol. , 35:410-416, 2000; Miyamoto et al., J. Am. Coll. Cardiol, 37: 1713-1718, 2001 ); mouse models for inflammator bowel disease including colitis (Mizushima et al , Inflamm. Bowel Dis. , 10: 182-192, 2004; Deguchi etal. Oncology Reports, 16:699-703, 2006; Fuji! et al., Am. J. Physiol Gastrointest.
• mice model for asthma suggested to be primarily through the SI P receptor on the basis of work using the SlPi receptor agonist SEW2871 (idzko et al. , J Clin. Invest., 116:2935- 2944, 2006); a mouse model for airway inflammation and induction of bronchial hyperresponsiveness (Sawicka et al, J. Immunol, 171 ;6206-6214, 2003); a mouse model for atopic dermatitis (Kohno etal, Biol Pharm. Bull, 27: 1392-1396, 2004); a mouse model for ischemia-reperfusion injury (Kaudel et al. Transplant.
• KRP-203 an SIP receptor agonist having agonist activity on the SlPi receptor, has been reported to have therapeutic efficacy in a rat model for autoimmune myocarditis (Ogawa et al , BBRC, 361:621-628, 2007).
• S 1 Pi receptor agonist SEW2871 it has been shown that agonism of endothelial SIP receptors prevents proinf!ammatory monocyte/endothelial interactions in type I diabetic vascular endothelium (Whetzel et al, Circ.
• FTY720 has been reported to have therapeutic efficacy in experimental autoimmune encephalomyelitis (EAE) in rats and mice, a model for human multiple sclerosis (Brinkmann et al. , J. Biol. Chem . , 277:21453-21457, 2002; Fujino et al., J Pharmacol Exp. Ther. , 305: 70-77, 2003; Webb et al. , J. Neuroimmunol, 153: 108-121, 2004; Rausch et al, J Magn. Reson Imaging, 20: 16-24, 2004; Kataoka et al , Cellular & Molecular Immunology , 2:439-448, 2005; Brinkmann et al.
• EAE experimental autoimmune encephalomyelitis
• FTY720 has been found to have therapeutic efficacy for multiple sclerosis in clinical trials. In Phase 11 clinical trials for relapsing-remitting multiple sclerosis, FTY720 was found to reduce the number of lesions detected by magnetic resonance imaging (MRI) and clinical disease activity in individuals with multiple sclerosis (Kappos et al , N Engl. J. Med. , 355: 1124- 1140, 2006; Martini et al, Expert Opin.
• MRI magnetic resonance imaging
• FTY720 has also been reported to have anti-viral activity. Specific data has been presented in the lymphocytic choriomeningitis virus (LCMV) mouse model, wherein the mice were infected with either the Armstrong or the clone 13 strain of LCMV (Premenko-Lanier et al. Nature, 454, 894, 2008).
• LCMV lymphocytic choriomeningitis virus
• FTY720 has been reported to impair migration of dendritic cells infected with Francisella tularensis to the mediastinal lymph node, thereby reducing the bacterial colonization of it.
• Francisella tularensis is associated with tularemia, ulcerogiandular infection, respiratory infection and a typhotdai disease (E. Bar-Haim et al , PLoS Pathogens, 4(11): e 100021 1 , published 21 November 2008;
• Agonism of tire SIPi receptor has been implicated in enhancement of survival of oligodendrocyte progenitor cells. Survival of oligodendrocyte progenitor cells is a required component of the remyelination process. Remyelination of multiple sclerosis lesions is considered to promote recovery from clinical relapses (Miron et aI., Ahh. Neurol. , 63:61-71, 2008; Coelho et al., J. Pharmacol. Exp. Ther., 323:626-635, 2007; Dev et al. , Pharmacology and Therapeutics, 117:77-93, 2008).
• PDGF platelet-derived growth factor
• Agonism of the SIPi receptor has also been reported to mediate migration of neural stem cells toward injured areas of the central nervous system (CNS), including in a rat model of spinal cord injury (Kimura etal.. Stem Cells, 25: 1 15-124, 2007).
• Agonism of the SIPi receptor has been implicated in the inhibition of keratinocyte proliferation (Sauer etal., J. Biol. Ghent., 279:38471-38479, 2004), consistent with reports that SIP inhibits keratinocyte proliferation (Kim et al, Cell Signal 16:89-95, 2004).
• the hyperproliferation of keratinoeytes at the entrance to the hair follicle, which can then become blocked, and an associated inflammation are significant pathogenetic factors of acne (Koreck et al., Dermatology, 206:96-105, 2003; Webster, Cutis, 76(2
• FTY720 has been reported to have therapeutic efficacy in inhibiting pathologic angiogenesis, such as that as may occur in tumor development. Inhibition of angiogenesis by FTY720 is thought to involve agonism of the SI Pi receptor (Oo et al., J. Biol. Chem., 282;9082-9089, 2007; Schmid et al., J. Cell Biochem., 101:259-270, 2007). FTY720 has been reported to have therapeutic efficacy for inhibiting primary and metastatic tumor growth in a mouse model of melanoma (LaMontagne et al. , Cancer Res. , 66:221 -231, 2006) FTY720 has been reported to have therapeutic efficacy in a mouse model for metastatic hepatocellular carcinoma (Lee et al, Clin. Cancer Res., 11:84588466, 2005).
• Cyclosporin A and FK506 are drugs used to prevent rejection of transplanted organs. Although they are effective in delaying or suppressing transplant rejection, classical immunosuppressants such as cyclosporin A and FK506 are known to cause several undesirable side effects including nephrotoxicity, neurotoxicity, b-cell toxicity and gastrointestinal discomfort. There is an unmet need in organ transplantation for an immunosuppressant without these side effects which is effective as a monotherapy or in combination with a classical immunosuppressant for inhibiting migration of, e.g., alloantigen-reactive T-ceils to the grafted tissue, thereby prolonging graft survival.
• classical immunosuppressants such as cyclosporin A and FK506 are known to cause several undesirable side effects including nephrotoxicity, neurotoxicity, b-cell toxicity and gastrointestinal discomfort.
• FTY720 has been shown to have therapeutic efficacy in transplant rejection both as a monotherapy and in synergistic combination with a classical immunosuppressant, including cyclosporin A, FK506, and RAD (an mTOR inhibitor). It has been shown that, unlike the classical immunosuppressants cyclosporin A, FK506 and RAD, FTY72Q has efficacy for prolonging graft survival without inducing general
• FTY720 has been reported to have therapeutic efficacy for prolonging allograft survival in a rat cardiac allograft model (Suzuki et at , Transpl. Immunol. , 4:252-255, 1996). FTY720 has been reported to act synergistically with cyclosporin A to prolong rat skin allograft survival (Yanagawa et al. , J Immunol , 160:5493-5499, 1998), to act
• KRP-203 an SIP receptor agonist has been reported to have therapeutic efficacy for prolonging allograft survival in a rat skin allograft model and both as monotherapy and in synergistic combination with cyclosporin A in a rat cardiac allograft model (Shimizu et at , Circulation, 1 1 1 : 222-229, 2005). KRP-203 also has been reported to have therapeutic efficacy in combination with mycophenolate mofetil (MMF; a prodrug for which the active metabolite is
• FTY720 has been reported to act synergistically with cyclosporin A to prolong small bowel allograft survival (Sakagawa et al , Transpl. Immunol , 13: 161-168, 2004).
• FTY72G has been reported to have therapeutic efficacy in a mouse islet graft model (Fu et al , Transplantation, 73: 1425-1430, 2002; Liu et al , Microsurgery , 27:300-304; 2007) and in a study using human islet cells to evidence no detrimental effects on human islet function (Truong et al. , American Journal of Transplantation, 7:2031-2038, 2007).
• FTY720 has been reported to reduce the nociceptive behavior in the spared nerve injury ' model for neuropathic pain which does not depend on prostaglandin synthesis (O. Costu et at, Journal of Cellular and Molecular Medicine 12(3), 995-1004, 2008).
• the present invention encompasses compounds which are agonists of the SlPs receptor having selectivity over the SIP 3 receptor.
• Sanna et al. reported that sustained bradycardia was induced by nonselective SIP receptor immunosuppressive agonists in wild-type mice but was abolished in SIP 3 -/- mice whereas an SlPi- selective agonist did not produce bradycardia.
• SIP 3 receptor, and not the SIP ⁇ , receptor was responsible for bradycardia (Sanna et al., J. Biol. Chem., 279: 13839-13848, 2004).
• an SIPi receptor agonist selective over at least the SIP3 receptor has advantages over current therapies by virtue of an enhanced therapeutic window, allowing better tolerability with higher dosing and thus improving efficacy as therapy.
• the present invention encompasses Compound 1 (and pharmaceutically acceptable salts, hydrates, and solvates thereof) which is an agonist of the SIPi receptor and has exhibited no or substantially no bradycardia in male Sprague-Dawley® rats (see WQ2010/011316, Example 9).
• a phase 1 study with Compound 1 was conducted with single dosing at 0.1 mg, 0.35 mg, 1 mg, 3 mg, and 5 mg.
• Compound 1 was administered as the L-arginine salt.
• Lower doses of 0.1 mg through 3 mg were well tolerated by subjects with only minor adverse events reported, the most common of which were headache and contact dermatitis.
• a dose -dependent reduction heart rate - was seen in all doses >0.35 mg, however, no adverse events related to bradycardia were reported at doses lower than the 5 mg dose.
• Dose limiting adverse events were observed at the dose of 5 mg, with 3 (50%) subjects experiencing 4 AEs of bradycardia with first or second degree atrioventricular (AY) block, which resulted in discontinuation of dose escalation.
• the maximum tolerated dose in the study was 3 mg. There were no deaths or serious adverse events in the study.
• peripheral blood lymphocyte counts were reduced by 2-4 hours after dosing, reaching a nadir by hour 8 which persisted for 24 hours with recover ) 7 to baseline over the next 4 days. PBL counts were reduced by -40% and -55% at tire 3 mg and 5 rng dose levels.
• SIP receptor agonists are useful to treat or prevent conditions where suppression of the immune system or agonism of the SI Pi receptor is in order, such as diseases and disorders mediated by
• lymphocytes transplant rejection, autoimmune diseases and disorders, inflammatory diseases and disorders, and conditions that have an underlying defect in vascular integrity or that relate to angiogenesis such as may be pathologic.
• the present invention encompasses compounds which are agonists of the SIPi receptor having good overall physical properties and biological activities and having an effectiveness that is substantially at least that of prior compounds with activity at the SIP receptor
• S IP receptor agonists are useful for treating or preventing conditions where suppression of the immune system or agonism of the SIPi receptor is in order, such as diseases and disorders mediated by lymphocytes, transplant rejection, autoimmune diseases and disorders, inflammatory diseases and disorders (e.g., acute and chronic inflammatory conditions), cancer, and conditions that have an underlying defect in vascular integrity or that are associated with angiogenesis such as may be pathologic (e.g., as may occur in inflammation, tumor development and atherosclerosis).
• diseases and disorders mediated by lymphocytes such as may be pathologic (e.g., as may occur in inflammation, tumor development and atherosclerosis).
• Such conditions where suppression of the immune system or agonism of the SlPi receptor is in order include diseases and disorders mediated by lymphocytes; conditions that have an underlying defect in vascular integrity; autoimmune diseases and disorders;
• inflammatory diseases and disorders e.g., acute and chronic inflammatory conditions); acute or chronic rejection of cells; tissue or solid organ grafts; arthritis, including psoriatic arthritis, and rheumatoid arthritis; diabetes, including type ⁇ diabetes; demyelinating disease, including multiple sclerosis; ischemia- reperfusion injury ' , including renal and cardiac ischemia-reperfusion injury'; inflammatory ' skin disease, including psoriasis, atopic dermatitis, and acne; hyperproliferative skin disease, including acne;
• erythematosus erythematosus
• asthma uveitis
• myocarditis allergy
• atherosclerosis brain inflammation, including Alzheimer's disease, and brain inflammatory reaction following traumatic brain injury'; ankylosing spondylitis
• central nervous system disease including spinal cord injury', or cerebral infarction
• pathologic angiogenesis including as may occur m primary and metastatic tumor growth
• rheumatoid arthritis including as may occur m primary and metastatic tumor growth.
• SIPi receptor agonists are useful for treating microbial infections, and viral infections or diseases.
• the sphingosine 1-phosphate subtype 1 (SIP i) receptor-associated disorder is selected from: a disease or disorder mediated by lymphocytes, an autoimmune disease or disorder, an inflammatory disease or disorder, ankylosing spondylitis, biliary ' cirrhosis, cancer, psoriasis, psoriatic arthritis, rheumatoid arthritis, Crohn’s disease, transplant rejection, multiple sclerosis, systemic lupus erythematosus, inflammatory bowel disease, ulcerative colitis, type I diabetes, hypertensive nephropathy, glomerulosclerosis, myocardial ischemia-reperfusion injury and acne.
• the SI Pi receptor-associated disorder is a disease or disorder mediated by lymphocytes.
• the SIPi receptor-associated disorder is an autoimmune disease or disorder.
• the SIPs receptor-associated disorder is an inflammatory disease or disorder.
• the SiPi receptor-associated disorder is ankylosing spondylitis.
• the SI Pi receptor-associated disorder is biliary cirrhosis.
• the SI P ⁇ , receptor-associated disorder is primary biliary ' cholangitis.
• the SI Pi receptor-associated disorder is cancer.
• the SiP receptor-associated disorder is psoriasis.
• the SIPs receptor-associated disorder is erythema nodosum.
• the SIPs receptor-associated disorder is pyoderma gangrenosum.
• the SIP ⁇ receptor-associated disorder is psoriatic arthritis.
• the SlPi receptor-associated disorder is rheumatoid arthritis.
• the SiPi receptor-associated disorder is Crohn’s disease.
• the SI P ⁇ , receptor-associated disorder is transplant rejection .
• the SI Pi receptor-associated disorder is multiple sclerosis.
• the SIPs receptor-associated disorder is systemic lupus erythematosus.
• the SIPs receptor-associated disorder is inflammatory bowel disease (IBD).
• IBD inflammatory bowel disease
• the SIPs receptor-associated disorder is an active skin extra-intestinal manifestation of inflammatory ' ⁇ bowel disease. In some embodiments, the S IPs receptor-associated disorder is £in active skin extra-intestinal manifestation of ulcerative colitis. In some embodiments, the active skin extra-intestinal manifestation is psoriasis hi some embodiments, the active skin extra-intestinal manifestation is erythema nodosum. In some embodiments, the active skin extra-intestinal manifestation is pyoderma gangrenosum.
• the SIPs receptor-associated disorder is ulcerative colitis. In some embodiments, the SiPi receptor-associated disorder is moderately to severely active ulcerative colitis hi some embodiments, the SlPi receptor-associated disorder is moderately active ulcerative colitis. In some embodiments, the SI P receptor-associated disorder is severely active ulcerative colitis. In some embodiments, the SlPi receptor-associated disorder is mildly to moderately active ulcerative colitis. In some embodiments, the SlPi receptor-associated disorder is mildly active ulcerative colitis.
• the Sl Pi receptor-associated disorder is type I diabetes.
• the SI P ⁇ , receptor-associated disorder is hypertensive nephropathy.
• the SI Pi receptor-associated disorder is glomerulosclerosis. In some embodiments, the SI PI receptor-associated disorder is myocardial ischemia-reperfusion injury.
• the SIPi receptor-associated disorder is acne.
• the S!Ps receptor-associated disorder is autoimmune hepatitis.
• the standard dose is in an amount equivalent to 1 mg of Compound 1.
• the standard dose is in an amount equivalent to 2 mg of Compound 1
• the standard dose is in an amount equivalent to 3 mg of Compound 1.
• the standard dose of Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof is administered once daily to the individual.
• the Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof is administered orally.
• the Compound 1 or a pharmaceutically acceptable salt, hydrate, or solvate thereof, is formulated as a capsule or tablet suitable for oral administration.
• the Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof is selected from: Compound 1 ; a calcium salt of Compound 1 ; and an L-arginine salt of Compound 1.
• the Compound 1 , or a pharmaceutically acceptable salt, hydrate, or solvate thereof is an L-arginine salt of Compound 1
• the pharmaceutically acceptable salt, hydrate, or solvate thereof is an anhydrous, non-solvated crystalline form of an L-arginine salt of Compound 1.
• the Compound 1, or a pharmaceutically acceptable salt, hydrate, or solvate thereof is an anhydrous, non-solvated crystalline form of Compound 1.
• the individual also is administered a therapeutic dose of an oral 5 -ASA compound hi some embodiments, the individual also is administered a stable dose of an oral 5-ASA compound.
• the individual also is administered a therapeutic dose of an oral corticosteroid therapy. In some embodiments, the individual also is administered a stable dose of an oral corticosteroid therapy.
• the corticosteroid is prednisone, e.g., prednisone at a dose ⁇ 10 tng/day or 20 tng/day, or an equivalent steroid. In some embodiments, the corticosteroid is budesonide, e.g., at a dose ⁇ 9 mg/day, or an equivalent steroid.
• the individual also is administered a therapeutic dose of an
• the individual also is administered a therapeutic dose of a thiopurme. hi some embodiments, the individual also is administered a therapeutic dose of azathiopnne. In some embodiments, the individual also is administered a therapeutic dose of 6-mercaptopurine. In some embodiments, the individual also is administered a therapeutic dose of thioguanine (also referred to as tioguanine or 6-thioguanine). In some embodiments, the individual also is administered a therapeutic dose of a probiotic. In some embodiments, the individual also is administered a therapeutic dose of Culturelle. In some embodiments, the individual also is administered a therapeutic dose of Saccharomyces houlardii.
• the individual also is administered a therapeutic dose of an antidiarrheal . In some embodiments, the individual also is administered a therapeutic dose of loperamide. In some embodiments, the individual also is administered a therapeutic dose of diphenoxylate with atropine.
• Some embodiments of the present invention include a method of producing a pharmaceutical composition for“combination-therapy ” comprising admixing at least one compound according to any of the compound embodiments disclosed herein, together with at least one known pharmaceutical agent as described herein and a pharmaceutically acceptable carrier.
• compositions comprising a standard dose of Compound 1, or, a phannaceutically acceptable salt, a hydrate or solvate thereof and, optionally, one or more pharmaceutically acceptable carriers.
• pharmaceutical compositions comprising Compound 1, or, a pharmaceutically acceptable salt, a hydrate or solvate thereof, optionally, one or more pharmaceutically acceptable carriers.
• the carrier(s) must he“acceptable” in the sense of being compatible with the other ingredients of the formulation and not overly deleterious to the recipient thereof.
• Compound 1, or, a pharmaceutically acceptable salt, a hydrate or solvate thereof is administered as a raw or pure chemical, for example as a powder in capsule formulation.
• Compound 1, or, a pharmaceutically acceptable salt, a hydrate or solvate thereof is formulated as a pharmaceutical composition further comprising one or more pharmaceutically acceptable carriers.
• compositions may be prepared by any suitable method, typically by uniformly mixing the active compound(s) with liquids or finely divided solid carriers, or both, in the required proportions and then, if necessary, forming the resulting mixture into a desired shape.
• the pharmaceutical composition may be in the form of, for example, a tablet or capsule.
• the pharmaceutical composition is preferably made in the form of a dosage unit containing a particular amount of the active ingredient.
• dosage units are capsules, tablets, powders, granules or suspensions, with conventional additives such as lactose, mannitol, com starch or potato starch; with binders such as crystalline cellulose, cellulose derivatives, acacia, com starch or gelatins; with disintegrators such as com starch, potato starch or sodium carboxymethyl-cellulose; and with lubricants such as talc or magnesium stearate.
• Solid form preparations include powders, tablets, pills, capsules, cachets, suppositories, and dispersible granules.
• a solid carrier can be one or more substances which may also act as diluents, flavoring agents, solubilizers, lubricants, suspending agents, binders, preservatives, tablet disintegrating agents, or encapsulating materials.
• the carrier is a finely divided solid which is in a mixture with the finely divided active component.
• the active component is mixed with the carrier having the necessary binding capacity in suitable proportions and compacted to the desired shape and size.
• the pow'ders and tablets may contain varying percentage amounts of the active compound.
• a representative amount in a powder or tablet may be from 0.5 to about 90 percent of the active compound.
• Suitable carriers for powders and tablets include magnesium carbonate, magnesium stearate, talc, sugar, lactose, pectin, dextrin, starch, gelatin, tragacanth, methylcellulose, sodium carboxymethyl cellulose, a low' melting wax, cocoa butter, and the like.
• the term "‘preparation” includes the formulation of the active compound with encapsulating material as carrier providing a capsule in which the active component, with or without carriers, is surrounded by a carrier, which is thus in association with it.
• cachets and lozenges are included. Tablets, pow'ders, capsules, pills, cachets, and lozenges can be used as solid forms suitable for oral administration.
• the pharmaceutical preparations are preferably in unit dosage forms.
• the preparation is subdivided into unit doses containing appropriate quantities of the active component.
• the unit dosage form can be a packaged preparation, the package containing discrete quantities of preparation, such as packeted tablets or capsules.
• the unit dosage form can be a capsule or tablet itself, or it can be the appropriate number of any of these in packaged form.
• Formulations composed of immediate-release tablets containing an L-arginine salt of Compound 1 were prepared as shown in Table 2.
• Compound 1 was evaluated for potential inhibition of the cytochrome P450 (CYP) enzymes CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5 (using two different marker substrates) and UDP -glucuronosyltransferase (UGT) enzymes UGT1A 1, UGT1 A3, UGT1A4, UGT1 A6, UGT1 A9, UGT2B7 and UGT2B17 in human liver microsomes, with the aim of ascertaining the potential of Compound 1 to inhibit the metabolism of concomitantly administered drugs.
• CYP cytochrome P450
• CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP3A4/5 using two different marker substrates
• UDP -glucuronosyltransferase (UGT) enzymes UGT1A 1, U
• Compound 1 as a direct and metabolism-dependent inhibitor of CYP activity and as a direct inhibitor of UGT activity, human liver microsomes from a pool of 200 individuals were incubated with marker substrates in the presence or absence of Compound 1 at concentrations of 0, 1 or 10 mM.
• Compound 1 was preincubated with human liver microsomes for 30 minutes with an NADPH-regenerating system, prior to the incubation with the marker substrates.
• Known metabolism-dependent and/or direct inhibitors of CYP and UGT enzymes were included as positive controls, as applicable.
• Direct inhibition of CYP2C8 activity was 22% at 1 mM and -100% at 10 mM in the presence of Compound 1. Little or no direct inhibition of CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6 or CYP3A4/5 activities was observed in the presence of Compound 1 concentrations up to 10 mM. In addition, little or no evidence of metabolism-dependent inhibition of CYPs was seen.
• Treatment of cultured human hepatocytes with Compound 1 was found to have no induction potential on CYP1A2 mRNA. Additionally, no induction potential for CYP2B6 and CYP3A4 was seen, based on induction criteria being a > 2-fold increase in mRNA and > 20% of the mRNA increase seen with positive control.
• CYP2C8 and CYP2C9 were established to play major roles in conversion of Compound 1 to oxidative metabolites, and CYP2C8 also plays a major role in formation of a ketone metabolite.
• the overall conversion of Compound 1 to metabolites was negligible in HLMs and there eas little difference in the loss of Compound 1 seen in the presence and absence of direct-acting and metabolism -dependent selective CYP inhibitors.
• Direct inhibition of CYP2C8 activity was 22% at 1 mM and -100% at 10 mM in the presence of Compound 1. However, there was little or no direct inhibition observed for any other CYPs with Compound 1.
• Compound 1 was evaluated as a potential substrate and/or inhibitor of human ABC transporters P- gp, BCRP and BSEP or human SLC transporters OATP1B1, OATP1B3, GATE OAT3, OCTl, OCT2, MATE1 and MATE2-K.
• P-gp and BCRP are expressed on the apical membrane of a number of tissues.
• P- gp and BCRP are expressed in the luminal membrane of enterocytes, endothelial cells in the brain, the brush border membrane of renal proximal tubules and the canalicular membrane of hepatocytes where they limit the intestinal absorption, blood-brain barrier penetration and facilitate excretion into the bile and urine BSEP is mainly expressed in the canalicular membrane of hepatocytes where it facilitates excretion into the bile.
• OATP1 B1, OATP1B3 and OCTl are expressed on the sinusoidal membrane of hepatocytes and facilitate the accumulation of endogenous and xenobiotic compounds into hepatocytes for further metabolism or excretion into the bile.
• OAT1, QAT3 and GCT2 are expressed on the basolateral membrane of renal proximal tubules and facilitate the accumulation of compounds into the proximal tubule for further excretion in the urine.
• MATEl and MATE2-K are primarily expressed on the luminal (apical) membrane of the proximal tubular cells and thought to play a role in the excretion of cations and zwitterions into urine.
• MATE1 is also expressed in the liver on the canalicular membrane of hepatocytes and mediates the biliary excretion of cationic drugs MATE!
• MATE2-K may function in cooperation wi th OCT transporters expressed on the canalicular membranes of hepatocytes and the basolateral membranes of proximal tubules to mediate excretion.
• Compounds that are substrates or inhibitors of the transporters may be victims or perpetrators in drag-drug interactions.
• Madin-Darby canine kidney cells (MDCKII), over-expressing human permeability-glycoprotein (P-gp) and breast cancer resistance protein (BCRP), were used to evaluate Compound 1 as a substrate of P- gp and BCRP. and as an inhibitor of BCRP.
• a polarized cell line derived from a human colon carcinoma (Caeo 2) cells, was used to evaluate Compound 1 as an inhibitor of P-gp.
• Membrane vesicles expressing bile salt export pump (BSEP) were used in a vesicular transport assay to evaluate Compound 1 as an inhibitor of BSEP.
• Human embryonic kidney cells (HEK293) transfected with vectors containing human transporter cDNA for organic anion-transporting polypeptide 1B1 (OATP1B 1), organic anion-transporting polypeptide 1B3 (OATP1B3), organic anion transporter 1 (OATl), organic anion transporter 3 (OAT3), organic cation transporter 1 (OCTl), organic cation transporter 2 (OCT2) and control cells (HEK293 cells transfected with only vector) were used in experiments to evaluate Compound 1 as a substrate and an inhibitor of QATP1B1, OATP1B3, OATl, OAT3, OCTl and OCT2.
• HEK293 ceils transfected with vectors containing renal multidrug and toxin extrusion transporters 1 and 2-K were used for evaluating Compound 1 as an inhibitor of MATE ! and MATE2-K.
• Known substrates and inhibitors of ABC and SLC transporters were included as positive controls in all experiments.
• the efflux ratio of Compound 1 (1 mM) across MDCKII-P-gp cells was 1.12 and increased to 3.08 m the presence of the P-gp inhibitor valspodar (10 mM).
• the efflux ratio of Compound 1 (10 mM) across MDCKII-P-gp cells was 3.17 and did not reduce in the presence of valspodar.
• the efflux ratio of Compound 1 across MDCKII-BCRP cells was less than two at I mM, and more than two at 10 mM in the absence and presence of the BCRP inhibitor Kol43 (1 mM). Although the efflux ratio of Compound 1 at 10 mM was 7.36 and was reduced to 3.17 in the presence of KoI43 ( 1 mM), the efflux ratio data of Compound 1 at 1 mM indicate Compound 1 is not a substrate of BCRP. For consideration as a substrate of the BCRP transporter, the efflux ratio of Compound 1 would be appreciably higher at lower concentration (1 mM) than at higher concentration (10 mM), and the consequent inhibition effect would likely be higher at a lower concentration (1 mM). It should be noted that Compound 1 recovery was low ranging from 27 to 48% and is likely due to non-specific binding to the plate.
• Compound 1 was not a substrate of P-gp, BCRP, OATP1B1, OATP1B3, QAT1, OAT3, OCT1 and OCT2 transporters under the conditions evaluated.
• Compound 1 inhibited P-gp, BCRP and OATP!B! with ICso values of -100, 35.7, and -10 mM, respectively.
• Compound 1 (up to 10 mM) caused less than 50% inhibition of all the other transporters examined (BSEP, OATP1B3, OATl, OAT3, OCT1, OCT2, MATE1 and MATE2-K).
• Compound 1 inhibited P-gp, BCRP and OATP1B1 with an IC50 values of -100, 35.7 and -10 mM, respectively.
• Compound 1 (up to 10 mM) caused less than 50% inhibition of the other transporters examined (BSEP, OATP1B3, OATl, QAT3, OCT1, OCT2, MATE1 and MATE2-K). Compound 1 was found to have no inhibition potential with an ICSO > 10 mM on BSEP, OATP1B3, OATl, OATS, OCT1, GCT2, MATEI and MATE2-K transporters.
• Compound 1 was evaluated to assess the single dose relative oral bioavailability of 2 mg tablet and capsule formulations in the fasted state, determine the effect of food on the pharmacokinetics of the 2 mg tablet, assess potential gender differences in Compound 1 pharmacokinetics, and evaluate safety and tolerability in healthy adult subjects.
• a randomized, single-dose, open-label, three-period, cross-over, phase 1 study was conducted in healthy adult subjects.
• a total of 14 subjects (7 males; 7 females) were randomized 1: 1 into two groups, Sequence 1 and Sequence 2.
• the Sequence 1 group received a stngie 2 mg dose of the hard gelatin capsule formulation of Compound 1 (Treatment A)
• the Sequence 2 group received a single 2 mg dose of the tablet formulation of Compound 1 (Treatment B).
• the two groups crossed over in the second treatment period to receive the alternate treatment under fasted conditions.
• Treatment C a single 2 mg dose of the tablet formulation of Compound 1 under fed conditions; i.e., FDA-standard lugh-fat high-calorie meal
• Blood samples for determination of plasma concentrations of Compound 1 were collected at prespecified time points up to 120 hours post dose. Plasma samples were analyzed for Compound 1 using a validated LC/MS/MS assay.
• the Compound 1 plasma concentration time data were analyzed by noncompartmental methods in PhoenixTM WinNonlin® (Version 6.3, Pharsight Corporation) to determine plasma pharmacokinetic parameters including peak concentration time to peak concentration (T, , ⁇ attire « ), and area under the concentration-time curve from time-zero to the time of the last quantifiable concentration (AUCo- t ) or to infinity (AUC M ).
• Safety and tolerability were evaluated using physical examination, ophthalmological examination, neurological and progressive multifocal leukoencephalopathy (PML) examination, vital sign measurements (supine blood pressure, heart rate, temperature, and respiratory' rate), clinical laboratory evaluations, electrocardiograms (ECGs), telemetry monitoring, tuberculosis (TB) screening, pulmonary function testing (PFT, using spirometry), and reported or observed adverse events (AEs).
• PML progressive multifocal leukoencephalopathy
• Compound 1 mean plasma concentrations and exposure parameters w3 ⁇ 4re only moderately higher in females compared to males across treatments. A total of eight AEs was reported by three subjects over the course of the study and consistent with what was seen previously in healthy volunteer studies. All AEs were considered treatment emergent, with only three AEs considered related to the administration of study medication. There were no serious AEs (SAEs) or AEs that led to sub j ect discontinuation. No clinically significant abnormalities in ECGs or physical exams were observed. There were no AEs related to clinically significant out-of-range vital signs.
• SAEs serious AEs
• EXAMPLE 6 Compound 1 (1 mg , 2 mg) is evaluated in an open-label, three-treatment, randomized, fixed sequence study to assess plasma pharmacokinetics (PK), pharmacodynamics (PD), safety, and tolerability in the presence and absence of dosing of fluconazole (a moderate inhibitor of CYP2C9), gemfibrozil (a strong inhibitor of CYP2C8), or rifampin (a moderate inducer of both CYP2C8 and CYP2C9) in healthy adult subjects.
• PK plasma pharmacokinetics
• PD pharmacodynamics
• rifampin a moderate inducer of both CYP2C8 and CYP2C9 in healthy adult subjects.
• Compound 1 Based on results from completed in vitro metabolism studies and a human mass balance clinical study, Compound 1 appears to be extensively metabolized (>25% overall) by oxidative (CYP2C8 and CYP2C9) and conjugation (UGT1 A7, minor extent UGT1 Al and UGT1 A4) pathways. Compound 1 is eliminated from the systemic circulation mainly due to metabolism and biliary/fecal excretion. Potential changes in Compound 1 pharmacokinetics are evaluated in the presence and absence of co-administered drugs that can impact one or more of these metabolism/elimination pathways— fluconazole or gemfi brozil due to the significant CYP inhibition effects, and rifampin due to the Significant CYP induction effects.
• the study entails one of three treatments: 1) Compound 1 (1 mg) alone and in the presence of steady state fluconazole (400 mg loading dose followed by daily oral dose 200 mg); 2) Compound 1 (1 mg) alone and in the presence of steady state gemfibrozil (600 mg BID oral dose); and 3) Compound 1 (2 mg) alone and in the presence of steady state rifampin (600 mg daily oral dose).
• Each treatment consists of two periods: period 1 (administration of a single oral dose of Compound 1 alone) and period 2 (administration of Compound 1 in the presence of an inhibitor or inducer drug). Each period will be separated by 7-day washout period.
• Treatment A On day 8, subjects will be administered a single dose of fluconazole (400 mg) followed by once daily dosing of fluconazole (200 mg) up to day 23 On day 12, following an overnight fast of at least 8 hours, a single dose of Compound 1 (1 rng) will be administered 30 min following daily- dose of fluconazole.
• Treatment B On day 8, subjects will be administered twice daily gemfibrozil (600 mg) up to day 23. On day 12, following an overnight fast of at least 8 hours, a single dose of Compound 1 ( 1 mg) will be administered 30 minutes following daily dose of gemfibrozil.
• Treatment C On day 8, subjects will be administered once daily rifampin (600 mg) up to day 23. On day 15, following an overnight fast of at least 8 hours, a single dose of Compound 1 (2 mg) will be administered 30 min following daily dose of rifampin.
• PK and PD profiles of Compound 1 are assessed after dose administration on day 1 (Compound 1 alone) and day 12/15 (in the presence of steady-state CYP2C8/CYP2C9 inhibitor or inducer). Measured PK parameters will include the following assessed using an analysis of covariance model for each comparison (i.e., Compound 1 alone versus the CYP2C8/CYP2C9 inhibitor or inducer):
• AUC0-168 area under the concentration -time curve (AUC) zero to 168 hour calculated using the linear-log trapezoidal rule
• AUClast AUC from time zero to the time of the last quantifiable concentration (tlast) calculated using the linear-log trapezoidal rule

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