WO2022033460A1 - Btk抑制剂治疗疾病的用途 - Google Patents

Btk抑制剂治疗疾病的用途 Download PDF

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WO2022033460A1
WO2022033460A1 PCT/CN2021/111726 CN2021111726W WO2022033460A1 WO 2022033460 A1 WO2022033460 A1 WO 2022033460A1 CN 2021111726 W CN2021111726 W CN 2021111726W WO 2022033460 A1 WO2022033460 A1 WO 2022033460A1
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Prior art keywords
btk inhibitor
neuromyelitis optica
optica spectrum
present disclosure
treatment
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PCT/CN2021/111726
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English (en)
French (fr)
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王敏
吴奕涵
周玲
卢再恋
李保平
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江苏恒瑞医药股份有限公司
瑞石生物医药有限公司
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Priority to CA3188003A priority Critical patent/CA3188003A1/en
Priority to EP21855512.6A priority patent/EP4193995A1/en
Priority to US18/019,465 priority patent/US20230270743A1/en
Priority to KR1020237007341A priority patent/KR20230050363A/ko
Priority to CN202180043292.5A priority patent/CN115701997A/zh
Priority to JP2023507702A priority patent/JP2023536944A/ja
Publication of WO2022033460A1 publication Critical patent/WO2022033460A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/50—Pyridazines; Hydrogenated pyridazines
    • A61K31/5025—Pyridazines; Hydrogenated pyridazines ortho- or peri-condensed with heterocyclic ring systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/4985—Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • 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]

Definitions

  • the present disclosure belongs to the field of medicine, and relates to the use of BTK inhibitors to treat diseases.
  • Neuromyelitis optica also known as Devic syndrome
  • CNS central nervous system
  • LETM long-segment transverse myelitis
  • Clinical features of NMO include optic neuritis with vision loss leading to blindness, as well as ocular pain, optic atrophy, and central scotoma.
  • Spinal cord involvement includes lower extremity or quadriplegia, radicular pain, paroxysmal tonic spasms, nausea, intractable hiccups, vomiting, vertigo, bladder dysfunction, and Lhermitte's phenomenon.
  • Clinical features associated with lesions outside the optic nerve and spinal cord may include excessive somnolence, hyponatremia and hyperprolactinemia associated with hypothalamic-pituitary axis insufficiency, and reversible posterior encephalopathy syndrome.
  • Up to 90% of patients with NMO experience recurrent episodes of optic neuritis (ON) and myelitis, rather than a monophasic course. 60% of patients relapse within 1 year of onset and 90% within 3 years of onset.
  • NMO neuromyelitis optica spectrum disorders
  • AQP4 is the most widely expressed aquaporin in the brain, spinal cord and optic nerve.
  • Experimental data demonstrate that AQP4 antibody induces interleukin 6 (IL-6) production in AQP4-expressing astrocytes, and IL-6 signaling to endothelial cells reduces blood-brain barrier function.
  • IL-6 interleukin 6
  • Astrocytes eventually become no longer supporting surrounding cells, such as oligodendrocytes and neurons. Granulocyte infiltration followed, with oligodendrocyte damage and demyelination.
  • Immune cells can usually be divided into two categories: T cells and B cells.
  • the main function of B cells is to secrete various antibodies to help the body resist various foreign invasions.
  • Bruton tyrosine kinase (BTK) is a member of the tyrosine protein kinase subfamily, belonging to the Tec family of kinases, mainly expressed in B cells and distributed in the lymphatic system, hematopoietic and blood systems.
  • B-cell receptor for subtypes including chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphoma (DLBCL)
  • CLL chronic lymphocytic leukemia
  • NHL non-Hodgkin's lymphoma
  • MCL mantle cell lymphoma
  • DLBCL diffuse large B-cell lymphoma
  • BTK Bruton's tyrosine kinase
  • BTK is a key protein kinase in the BCR signaling pathway. It can regulate the maturation and differentiation of normal B cells, and is also closely related to a variety of B cell lymphoid disorders. Therefore, targeting small-molecule inhibitors of BTK may provide benefits for the treatment of B-cell malignancies and autoimmune diseases.
  • WO2016007185 relates to a compound of formula (I), namely (R)-4-amino-1-(1-(but-2-ynoyl)pyrrolidin-3-yl)-3-(4-(2,6- Difluorophenoxy)phenyl)-1,6-dihydro-7H-pyrrolo[2,3-d]pyridazin-7-one, the compound is a novel BTK kinase inhibitor, in kinase-selective, clinical The efficacy or indications, and safety have been improved, and the structure is as follows:
  • the present disclosure provides the use of a BTK inhibitor in the preparation of treatment or prevention of diseases, and shows good therapeutic effect.
  • One aspect of the present disclosure provides the use of a BTK inhibitor in the preparation of a medicament for preventing or treating neuromyelitis optica spectrum diseases.
  • Another aspect of the present disclosure provides the use of a BTK inhibitor in the preparation of a medicament for preventing the recurrence of neuromyelitis optica spectrum diseases.
  • Another aspect of the present disclosure provides the use of a BTK inhibitor in the preparation of a medicament for the treatment of neuromyelitis optica spectrum diseases in a stable phase.
  • the stable period of the neuromyelitis optica spectrum disease refers to the period in which the condition of the neuromyelitis optica spectrum disease is relieved after the rescue treatment is performed in the acute exacerbation period.
  • the dose of maintenance drugs such as immunosuppressants (eg, tacrolimus, azathioprine, mycophenolate mofetil) and/or oral glucocorticoids must be stable or in the process of tapering
  • rescue therapy eg, IV glucocorticoids, plasma exchange, and/or intravenous immune globulin
  • the BTK inhibitor is selected from ibrutinib, acalabrutinib, GS-4059, spebrutinib, BGB-3111, FIM71224, zanubrutinib, ARQ531, BI-BTK1, vecabrutinib or the compound represented by formula (I) or its pharmaceutically acceptable salt,
  • the BTK inhibitor is a compound represented by formula (I) or a pharmaceutically acceptable salt thereof,
  • tautomer or “tautomeric form” refers to structural isomers of different energies that are interconvertible via a low energy barrier.
  • proton tautomers also known as proton tautomers
  • lactam-lactam equilibrium is between A and B as shown below.
  • the compounds of formula (I) of the present disclosure can be drawn as Form A or Form B.
  • the naming of compounds does not exclude any tautomers.
  • the clinical manifestations of the neuromyelitis optica spectrum disorders described in the present disclosure include optic neuritis, myelitis, medullary resection syndrome, brainstem syndrome, diencephalon syndrome, cerebral syndrome, and the like.
  • the neuromyelitis optica spectrum disorder is an AQP4-IgG positive neuromyelitis optica spectrum disorder.
  • the BTK inhibitor is administered at a dose of 1-1000 mg, such as 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg , 80mg, 85mg, 90mg, 95mg, 100mg, 105mg, 110mg, 115mg, 120mg, 125mg, 130mg, 135mg, 140mg, 145mg, 150mg, 155mg, 160mg, 165mg, 170mg, 175mg, 180mg, 185mg, 190mg, 195mg, 200mg , 205mg, 210mg, 215mg, 220mg, 225mg, 230mg, 235mg, 240mg, 245mg, 250mg, 255mg, 260mg, 265mg, 270mg, 275mg, 280m
  • the BTK inhibitor is administered once a day at a dose of 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg each time , 75mg, 80mg, 85mg, 90mg, 95mg, 100mg, 105mg, 110mg, 115mg, 120mg, 125mg, 130mg, 135mg, 140mg, 145mg, 150mg, 155mg, 160mg, 165mg, 170mg, 175mg, 180mg, 185mg, 190mg, 195mg , 200mg, 205mg, 210mg, 215mg, 220mg, 225mg, 230mg, 235mg, 240mg, 245mg, 250mg, 255mg, 260mg, 265mg, 270mg, 275mg, 280
  • the BTK inhibitor is administered twice a day at a dose of 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65mg, 70mg, 75mg, 80mg, 85mg, 90mg, 95mg, 100mg, 105mg, 110mg, 115mg, 120mg, 125mg, 130mg, 135mg, 140mg, 145mg, 150mg, 155mg, 160mg, 165mg, 170mg, 175mg, 180mg, 185mg, 190mg, 195mg, 200mg, 205mg, 210mg, 215mg, 220mg, 225mg, 230mg, 235mg, 240mg, 245mg, 250mg.
  • the pharmaceutically acceptable salts of the medicaments described in the present disclosure can be hydrochloride, phosphate, hydrogenphosphate, sulfate, hydrogensulfate, sulfite, acetate, oxalate, malonate, valerate , glutamate, oleate, palmitate, stearate, laurate, borate, p-toluenesulfonate, mesylate, isethionate, maleate.
  • the BTK inhibitors described in this disclosure can also be administered in combination with other drugs.
  • the mode of administration of the combination is selected from simultaneous administration, separate formulation and co-administration, or separate formulation and sequential administration.
  • the route of administration of the drug described in the present disclosure is selected from oral administration, parenteral administration, and transdermal administration, and the parenteral administration includes but is not limited to intravenous injection, subcutaneous injection, and intramuscular injection.
  • the present disclosure further relates to a method of treating a neuromyelitis optica spectrum disorder comprising administering to a patient a BTK inhibitor.
  • the present disclosure relates to a method of treating a neuromyelitis optica spectrum disorder comprising administering to a patient a compound of formula (I), or a pharmaceutically acceptable salt thereof.
  • the present disclosure further relates to a compound of formula (I) or a pharmaceutically acceptable salt thereof for treating neuromyelitis optica spectrum disorders.
  • the present disclosure further relates to a method of preventing recurrence of neuromyelitis optica spectrum disease comprising administering to a patient a BTK inhibitor.
  • the present disclosure relates to a method of preventing recurrence of neuromyelitis optica spectrum disease comprising administering to a patient a compound of formula (I), or a pharmaceutically acceptable salt thereof.
  • the present disclosure further relates to a BTK inhibitor for preventing recurrence of neuromyelitis optica spectrum disease.
  • the present disclosure relates to a compound of formula (I), or a pharmaceutically acceptable salt thereof, for preventing recurrence of neuromyelitis optica spectrum disorders.
  • the present disclosure further relates to a method for stable phase treatment of neuromyelitis optica spectrum disease comprising administering to a patient a BTK inhibitor.
  • the present disclosure relates to a method for the treatment of stable neuromyelitis optica spectrum disease comprising administering to a patient a compound of formula (I) or a pharmaceutically acceptable salt thereof.
  • the present disclosure further relates to a BTK inhibitor for the treatment of neuromyelitis optica spectrum disorders in stable phase.
  • the present disclosure relates to a compound of formula (I) or a pharmaceutically acceptable salt thereof for use in the treatment of neuromyelitis optica spectrum disorders in stable phase.
  • the present disclosure also relates to a pharmaceutical composition
  • a pharmaceutical composition comprising a compound represented by formula (I) or a pharmaceutically acceptable salt thereof and one or more pharmaceutically acceptable carriers, excipients and diluents.
  • the pharmaceutical composition can be formulated into any pharmaceutically acceptable dosage form. For example, it can be formulated into tablets, capsules, pills, granules, solutions, suspensions, syrups, injections (including injectable solutions, sterile powders for injection and concentrated solutions for injection), suppositories, inhalants or sprays agent.
  • the present disclosure also provides a pharmaceutical packaging box, in which the pharmaceutical composition of the compound represented by formula (I) or a pharmaceutically acceptable salt thereof described in the present disclosure is packaged.
  • a “therapeutically effective amount” refers to an amount of a therapeutic agent that produces the desired effect for which it is administered. In some embodiments, the term refers to an amount sufficient to treat a disease, disorder, and/or condition when administered according to a regimen to a population having or susceptible to the disease, disorder, and/or condition. In some embodiments, a therapeutically effective amount is an amount that reduces the incidence and/or severity of, and/or delays the onset of, one or more symptoms of a disease, disorder, and/or condition. One of ordinary skill in the art will appreciate that the term “therapeutically effective amount” is not actually required to achieve successful treatment in a particular individual.
  • a therapeutically effective amount can be that amount that, when administered to a patient in need of such treatment, provides a particular desired pharmacological response in a large number of subjects.
  • reference to a therapeutically effective amount can refer to as in one or more specific tissues (eg, tissues affected by a disease, disorder or condition) or fluids (eg, blood, saliva, serum, sweat, tears, urine, etc.).
  • tissue e.g, tissues affected by a disease, disorder or condition
  • fluids eg, blood, saliva, serum, sweat, tears, urine, etc.
  • a therapeutically effective amount of a particular agent or therapy can be formulated and/or administered in a single dose.
  • a therapeutically effective agent may be formulated and/or administered in multiple doses, eg, as part of a regimen.
  • ARR Average annualized recurrence rate
  • the compound represented by the formula (I) of the present disclosure or a pharmaceutically acceptable salt thereof in the treatment of neuromyelitis optica spectrum diseases can achieve an ARR ⁇ 2.1 of subjects after baseline medication.
  • the compound represented by the formula (I) of the present disclosure or a pharmaceutically acceptable salt thereof in the treatment of neuromyelitis optica spectrum diseases can achieve the effect that the ARR of the subject after the baseline medication can be selected from 0, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 1.9 and 2.0.
  • Example 1 Clinical study of the compound represented by formula (I) in the treatment of neuromyelitis optica spectrum disorders (NMOSD)
  • the age is 18-75 years old (including 18 years old and 75 years old), male or female;
  • Relapse history requirements 2 or more NMOSD recurrence history requiring rescue therapy within 1 year before baseline, rescue therapy may include IV glucocorticoid, plasma exchange and/or intravenous immunoglobulin (IVIG);
  • IVIG intravenous immunoglobulin
  • Subjects must be on stable treatment (if any) for more than 1 month before starting study drug treatment, as defined below:
  • immunosuppressants such as tacrolimus, azathioprine, mycophenolate mofetil
  • oral glucocorticoids must be stable or in the process of reduction, and rescue therapy in the acute phase (such as IV glucocorticoids, plasma replacement and/or intravenous immunoglobulin) must be terminated more than 1 month.
  • Qualified subjects after screening take the test drug in the morning on an empty stomach, once a day, one tablet at a time, 100 mg per tablet.
  • ARR total number of attacks of subjects / (number of subjects * observation time)
  • the annualized relapse rate of existing subjects after baseline medication was observed to be 0.7.
  • a 42-year-old female patient with a history of NMOSD for 7 years had severe symptoms (inability to stand) before participating in the trial.
  • the indicated compounds showed a marked improvement in mobility after 4 weeks, with the ability to stand and walk a few steps with assistance. At the 7th week of medication, the patient could walk more than 20 meters with assistance, and could basically take care of himself.

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Abstract

公开了BTK抑制剂治疗疾病的用途。具体公开了BTK抑制剂在制备预防或治疗视神经脊髓炎谱系疾病的药物中的用途。

Description

BTK抑制剂治疗疾病的用途 技术领域
本公开属于医药领域，涉及BTK抑制剂治疗疾病的用途。
背景技术
视神经脊髓炎(NMO，也称为Devic综合征)是一种罕见的慢性、自身免疫性、炎性中枢神经系统(CNS)脱髓鞘性疾病，好侵犯视神经和脊髓。其特征为可能同时发生或孤立发生的视神经炎和长节段横贯性脊髓炎(LETM)反复发作。
NMO的临床特征包括视神经炎伴视力损失导致失明，以及眼痛、视神经萎缩和中央暗点。脊髓受累包括下肢或四肢轻瘫、神经根痛、阵发性强直性痉挛、恶心、顽固性呃逆、呕吐、眩晕、膀胱功能障碍和Lhermitte现象。与视神经和脊髓之外的病变相关的临床特征可能包括与下丘脑-垂体轴功能不全有关的过度嗜睡、低钠血症和高催乳素血症，以及可逆性后部脑病综合征。高达90％的NMO患者出现视神经炎(ON)和脊髓炎反复发作，而不是单相病程。60％的患者在发病后1年内复发，90％的患者在发病后3年内复发。
以往，NMO被认为是多发性硬化(MS)的一种与之存在症状重叠的亚型。但目前NMO已被证明是不同于MS的一种独特的脱髓鞘疾病。与MS不同，NMO两次发作之间的恢复不完全，每次接替发作导致残疾程度加重。直到2004年才鉴定出抗原靶标，水通道蛋白4(AQP4)，通过检测AQP4抗体可以可靠地区分这两种疾病。后来，诊断指南的迭代更新将抗体阴性和抗体阳性的NMO统一归入视神经脊髓炎谱系疾病(NMOSD)。尽管病例系列研究和观察性研究表明患者可获益于免疫治疗，但迄今为止仅有2种疗法(依库珠单抗/Eculizumab和Satralizumab)被批准用于治疗NMOSD。
AQP4是大脑、脊髓和视神经中最广泛表达的水通道蛋白。实验数据表明，AQP4抗体在表达AQP4的星形胶质细胞中可诱导白细胞介素6(IL-6)的产生，而IL-6向内皮细胞传导信号可降低血脑屏障功能。AQP4抗体一旦与AQP4受体的胞外域结合，不仅会导致谷氨酸转运蛋白EAAT-2内化，还会引起补体和细胞介导的星形胶质细胞损伤。星形胶质细胞最终会变得不再支持周围细胞，例如少突胶质细胞和神经元。随后出现粒细胞浸润，伴少突胶质细胞损伤和脱髓鞘。
免疫细胞通常可以分为T细胞与B细胞两类，其中B细胞的主要职能是分泌各种抗体帮助人体抵御各种外来的侵入。Bruton酪氨酸蛋白激酶(BTK)是酪氨酸蛋白激酶亚家族的成员之一，属于Tec家族激酶，主要在B细胞中表达，分布于淋巴系统、造血及血液系统。B细胞受体(BCR)对于包括慢性淋巴细胞性白血病(CLL)和非霍奇金淋巴瘤的(NHL)亚型，套细胞淋巴瘤(MCL)，和弥漫性大B细胞淋巴瘤(DLBCL)在内的多种淋巴瘤的增殖及生存具有至关重要的调控作用，此外，B细胞在类风湿关节炎，系统性红斑狼疮，多发性硬化症，以及其他免疫疾病的发病机制中的作用已被临床证实。Bruton酪氨酸蛋白激酶(BTK)是BCR信号通路中的一个关键的蛋白激酶。能够调节正常B细胞的成熟、分化，也与多种B细胞淋巴组织失调疾病密切相关。因此，靶向小分子抑制剂BTK可对B细胞恶性肿瘤和自身免疫疾病的治疗提供效益。
WO2016007185涉及一种式(I)化合物，即(R)-4-氨基-1-(1-(丁-2-炔酰基)吡咯烷-3-基)-3-(4-(2,6-二氟苯氧基)苯基)-1,6-二氢-7H-吡咯并[2,3-d]哒嗪-7-酮，该化合物为新型BTK激酶抑制剂，在激酶选择性，临床疗效或适应症，及安全性等方面均有所改善，其结构如下所示：
Figure PCTCN2021111726-appb-000001
本公开提供了一种BTK抑制剂在制备治疗或预防疾病的用途，并显示了良好的治疗效果。
发明内容
本公开一方面提供了一种BTK抑制剂在制备预防或治疗视神经脊髓炎谱系疾病的药物中的用途。
本公开另一方面提供了一种BTK抑制剂在制备预防视神经脊髓炎谱系疾病复发的药物中的用途。
本公开另一方面提供了一种BTK抑制剂在制备用于视神经脊髓炎谱系疾病稳定期治疗的药物中的用途。
所述的视神经脊髓炎谱系疾病稳定期是指在急性发作期进行补救治疗后，视神经脊髓炎谱系疾病病情有所缓解的时期。例如，使用BTK抑制剂治疗时，维持治疗的药物例如免疫抑制剂(如他克莫司，硫唑嘌呤、麦考酚酯类)和/或口服糖皮质激素的剂量须稳定或者处于减量过程中，补救治疗(如IV糖皮质激素、血浆置换和/或静脉注射免疫球蛋白)须结束1个月以上。
在某些实施方式中，所述的BTK抑制剂选自ibrutinib、acalabrutinib、GS-4059、spebrutinib、BGB-3111、FIM71224、zanubrutinib、ARQ531、BI-BTK1、vecabrutinib或式(I)所示化合物或其可药用盐，
Figure PCTCN2021111726-appb-000002
在某些实施方式中，所述的BTK抑制剂为式(I)所示化合物或其可药用盐，
Figure PCTCN2021111726-appb-000003
本公开的化合物还可以以不同的互变异构体形式存在，所有的互变异构形式均在本公开的范围内。术语“互变异构体”或“互变异构体形式”是指可经由低能垒互变的不同能量的结构异构体。例如，质子互变异构体(也称为质子转移互变异构体)包括经由质子迁移 的互变，如酮-烯醇及亚胺-烯胺异构化。内酰胺-内酰亚胺平衡实例是在如下所示的A和B之间。
Figure PCTCN2021111726-appb-000004
在某些实施方式中，本公开的式(I)所示化合物可以被画成A型或B型。化合物的命名不排除任何互变异构体。本公开所述的视神经脊髓炎谱系疾病的临床表现包括视神经炎、脊髓炎、延髓最后区综合征、脑干综合征、间脑综合征、大脑综合征等。
在某些实施方式中，所述的视神经脊髓炎谱系疾病为AQP4-IgG阳性视神经脊髓炎谱系疾病。
在某些实施方式中，所述BTK抑制剂的给药剂量为1-1000mg，例如可以10mg、15mg、20mg、25mg、30mg、35mg、40mg、45mg、50mg、55mg、60mg、65mg、70mg、75mg、80mg、85mg、90mg、95mg、100mg、105mg、110mg、115mg、120mg、125mg、130mg、135mg、140mg、145mg、150mg、155mg、160mg、165mg、170mg、175mg、180mg、185mg、190mg、195mg、200mg、205mg、210mg、215mg、220mg、225mg、230mg、235mg、240mg、245mg、250mg、255mg、260mg、265mg、270mg、275mg、280mg、285mg、290mg、295mg、300mg、310mg、320mg、330mg、340mg、350mg、360mg、370mg、380mg、390mg、400mg、410mg、420mg、430mg、440mg、450mg、460mg、470mg、480mg、490mg、500mg。给药频次可以是一日一次、一日二次、一日三次、二日一次、三日一次、一周一次等。
在某些实施方式中，所述BTK抑制剂的给药频次为一日一次，剂量为每次10mg、15mg、20mg、25mg、30mg、35mg、40mg、45mg、50mg、55mg、60mg、65mg、70mg、75mg、80mg、85mg、90mg、95mg、100mg、105mg、110mg、115mg、120mg、125mg、130mg、135mg、140mg、145mg、150mg、155mg、160mg、165mg、170mg、175mg、180mg、185mg、190mg、195mg、200mg、205mg、210mg、215mg、220mg、225mg、230mg、235mg、240mg、245mg、250mg、255mg、260mg、265mg、270mg、275mg、280mg、285mg、290mg、295mg、300mg、310mg、320mg、330mg、340mg、350mg、360mg、370mg、380mg、390mg、400mg、410mg、420mg、430mg、440mg、450mg、460mg、470mg、480mg、490mg、500mg。
在某些实施方式中，所述BTK抑制剂的给药频次为一日二次，剂量为每次5mg、10mg、 15mg、20mg、25mg、30mg、35mg、40mg、45mg、50mg、55mg、60mg、65mg、70mg、75mg、80mg、85mg、90mg、95mg、100mg、105mg、110mg、115mg、120mg、125mg、130mg、135mg、140mg、145mg、150mg、155mg、160mg、165mg、170mg、175mg、180mg、185mg、190mg、195mg、200mg、205mg、210mg、215mg、220mg、225mg、230mg、235mg、240mg、245mg、250mg。
本公开所述药物的可药用盐可以是盐酸盐、磷酸盐、磷酸氢盐、硫酸盐、硫酸氢盐、亚硫酸盐、乙酸盐、草酸盐、丙二酸盐、戊酸盐、谷氨酸盐、油酸盐、棕榈酸盐、硬脂酸盐、月桂酸盐、硼酸盐、对甲苯磺酸盐、甲磺酸盐、羟乙基磺酸盐、马来酸盐。苹果酸盐、酒石酸盐、苯甲酸盐、双羟萘酸盐、水杨酸盐、香草酸盐、扁桃酸盐、琥珀酸盐、葡萄糖酸盐、乳糖酸盐或月桂基磺酸盐等。
本公开所述的BTK抑制剂还可以与其他药物联合给药。联合的给药方式选自同时给药、独立地配制并共给药或独立地配制并相继给药。
本公开所述药物的给药途径选自经口给药、胃肠外给药、经皮给药，所述胃肠外给药包括但不限于静脉注射、皮下注射、肌肉注射。
本公开进一步涉及一种治疗视神经脊髓炎谱系疾病的方法，包括向患者施用BTK抑制剂。
在某些实施方案中，本公开涉及一种治疗视神经脊髓炎谱系疾病的方法，包括向患者给予式(I)所示化合物或其可药用盐。
本公开进一步涉及一种治疗视神经脊髓炎谱系疾病的式(I)所示化合物或其可药用盐。
本公开进一步涉及一种预防视神经脊髓炎谱系疾病复发的方法，包括向患者施用BTK抑制剂。
在某些实施方案中，本公开涉及一种预防视神经脊髓炎谱系疾病复发的方法，包括向患者施用式(I)所示化合物或其可药用盐。
本公开进一步涉及一种预防视神经脊髓炎谱系疾病复发的BTK抑制剂。
在某些实施方案中，本公开涉及一种预防视神经脊髓炎谱系疾病复发的式(I)所示化合物或其可药用盐。
本公开进一步涉及一种用于视神经脊髓炎谱系疾病稳定期治疗的方法，包括向患者施用BTK抑制剂。
在某些实施方案中，本公开涉及一种用于视神经脊髓炎谱系疾病稳定期治疗的方法， 包括向患者施用式(I)所示化合物或其可药用盐。
本公开进一步涉及一种用于视神经脊髓炎谱系疾病稳定期治疗的BTK抑制剂。
在某些实施方案中，本公开涉及一种用于视神经脊髓炎谱系疾病稳定期治疗的式(I)所示化合物或其可药用盐。
本公开还涉及一种包含式(I)所示化合物或其可药用盐以及一种或多种药用载体、赋形剂、稀释剂的药物组合物。所述药物组合物可以制成药学上可接受的任一剂型。例如，可以配制为片剂、胶囊剂、丸剂、颗粒剂、溶液剂、混悬剂、糖浆剂、注射剂(包括注射液、注射用无菌粉末与注射用浓溶液)、栓剂、吸入剂或喷雾剂。
本公开还提供了一种药物包装盒，其中包装有本公开所述的式(I)所示化合物或其可药用盐的药物组合物。
“治疗有效量”指产生它为了其施用的所需效应的治疗剂的量。在一些实施方式中，该术语指当根据方案施用于患有或易患疾病、病症和/或状况的群体时，足以治疗所述疾病、病症和/或状况的量。在一些实施方式中，治疗有效量是降低疾病、病症和/或状况的一种或多种症状的发生率和/或严重性，和/或延迟其发作的量。本领域普通技术人员将了解，术语“治疗有效量”实际上不需要实现在特定个体中的成功治疗。相反，治疗有效量可以是当施用于需要此类治疗的患者时，在大量受试者中提供特定的所需药理学应答的量。在一些实施方式中，提及治疗有效量可以指如在一种或多种特定组织(例如，受疾病、病症或状况影响的组织)或流体(例如，血液、唾液、血清、汗液、泪、尿等)中测量的量。本领域普通技术人员将了解，在一些实施方式中，治疗有效量的特定试剂或疗法可以以单一剂量配制和/或施用。在一些实施方式中，治疗有效试剂可以以多个剂量配制和/或施用，例如，作为方案的部分。
平均年化复发率(ARR)＝受试者总体发作次数/(受试者人数*观察时间)。
本公开式(I)所示化合物或其可药用盐治疗视神经脊髓炎谱系疾病可达到的效果为基线用药后受试者的ARR<2.1。
本公开式(I)所示化合物或其可药用盐治疗视神经脊髓炎谱系疾病可达到的效果为基线用药后受试者的ARR可选0、0.1、0.2、0.3、0.4、0.5、0.6、0.7、0.8、0.9、1.0、1.1、1.2、1.3、1.4、1.5、1.6、1.7、1.8、1.9和2.0。
具体实施方式
实施例1：式(I)所示化合物治疗视神经脊髓炎谱系疾病(NMOSD)的临床研究
1、试验药物
式(I)所示化合物的片剂，规格为100mg/片。
2、入组标准
1)年龄为18-75岁(含18岁和75岁)，男女不限；
2)根据2015IPND诊断标准诊断为AQP4-IgG阳性NMOSD患者；
3)复发史要求：在基线前1年内有2次或2次以上需要补救治疗的NMOSD复发史，补救治疗可包括IV糖皮质激素、血浆置换和/或静脉注射免疫球蛋白(IVIG)；
4)受试者必须在开始研究药物治疗前稳定治疗(如有)1个月以上，定义如下：
免疫抑制剂(如他克莫司，硫唑嘌呤、麦考酚酯类)和/或口服糖皮质激素的剂量须稳定或者处于减量过程中，急性期补救治疗(如IV糖皮质激素、血浆置换和/或静脉注射免疫球蛋白)须结束1个月以上。
2、给药方案
经筛选合格的受试者，在早晨空腹状态下服用试验药物，每天一次，一次一片，每片100mg。
3、试验结果
研究目前已完成所有10例受试者入组，所有受试者入组前的平均年化复发率(ARR＝受试者总体发作次数/(受试者人数*观察时间))为2.1。截至目前，观察到基线用药后现有受试者的年化复发率为0.7，其中1例42岁NMOSD病史7年的女性患者参加试验前症状较重(无法站立)，该患者在服用式(I)所示化合物的4周后行动能力明显改善，可站立并在辅助下行走数步。用药第7周时患者可在辅助下行走20米以上，生活基本可以自理。

Claims (10)

  1. BTK抑制剂在制备预防或治疗视神经脊髓炎谱系疾病的药物中的用途。
  2. BTK抑制剂在制备预防视神经脊髓炎谱系疾病复发的药物中的用途。
  3. BTK抑制剂在制备用于视神经脊髓炎谱系疾病稳定期治疗的药物中的用途。
  4. 根据权利要求1-3任意一项所述的用途，所述的视神经脊髓炎谱系疾病为AQP4-IgG阳性视神经脊髓炎谱系疾病。
  5. 根据权利要求1-4任意一项所述的用途，所述BTK抑制剂的剂量范围选自1-1000mg。
  6. 根据权利要求1-4任意一项所述的用途，所述BTK抑制剂的给药频次选自一日一次、一日二次、一日三次、二日一次、三日一次、一周一次。
  7. 根据权利要求1-4任意一项所述的用途，所述BTK抑制剂的给药频次为一日一次，剂量为每次10mg、15mg、20mg、25mg、30mg、35mg、40mg、45mg、50mg、55mg、60mg、65mg、70mg、75mg、80mg、85mg、90mg、95mg、100mg、105mg、110mg、115mg、120mg、125mg、130mg、135mg、140mg、145mg、150mg、155mg、160mg、165mg、170mg、175mg、180mg、185mg、190mg、195mg、200mg、205mg、210mg、215mg、220mg、225mg、230mg、235mg、240mg、245mg、250mg、255mg、260mg、265mg、270mg、275mg、280mg、285mg、290mg、295mg、300mg、310mg、320mg、330mg、340mg、350mg、360mg、370mg、380mg、390mg、400mg、410mg、420mg、430mg、440mg、450mg、460mg、470mg、480mg、490mg、500mg。
  8. 根据权利要求1-4任意一项所述的用途，所述BTK抑制剂的给药频次为一日二次，剂量为每次5mg、10mg、15mg、20mg、25mg、30mg、35mg、40mg、45mg、50mg、55mg、60mg、65mg、70mg、75mg、80mg、85mg、90mg、95mg、100mg、105mg、110mg、115mg、120mg、125mg、130mg、135mg、140mg、145mg、 150mg、155mg、160mg、165mg、170mg、175mg、180mg、185mg、190mg、195mg、200mg、205mg、210mg、215mg、220mg、225mg、230mg、235mg、240mg、245mg、250mg。
  9. 根据权利要求1-8任意一项所述的用途，其中所述的BTK抑制剂选自ibrutinib、acalabrutinib、GS-4059、spebrutinib、BGB-3111、FIM71224、zanubrutinib、ARQ531、BI-BTK1、vecabrutinib或式(I)所示化合物或其可药用盐，
    Figure PCTCN2021111726-appb-100001
  10. 根据权利要求1-8任意一项所述的用途，其中所述的BTK抑制剂为式(I)所示化合物或其可药用盐，
    Figure PCTCN2021111726-appb-100002
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