WO2022197627A1 - Polythérapie pour le traitement de la covid-19 - Google Patents

Polythérapie pour le traitement de la covid-19 Download PDF

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Publication number
WO2022197627A1
WO2022197627A1 PCT/US2022/020229 US2022020229W WO2022197627A1 WO 2022197627 A1 WO2022197627 A1 WO 2022197627A1 US 2022020229 W US2022020229 W US 2022020229W WO 2022197627 A1 WO2022197627 A1 WO 2022197627A1
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WIPO (PCT)
Prior art keywords
nevirapine
administered
valacyclovir
etravirine
disease
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PCT/US2022/020229
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English (en)
Inventor
Dayu Teng
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Drugarray, Inc.
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Publication date
Application filed by Drugarray, Inc. filed Critical Drugarray, Inc.
Publication of WO2022197627A1 publication Critical patent/WO2022197627A1/fr
Priority to US18/467,230 priority Critical patent/US20240041801A1/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • 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
    • A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • A61K31/52—Purines, e.g. adenine
    • A61K31/522—Purines, e.g. adenine having oxo groups directly attached to the heterocyclic ring, e.g. hypoxanthine, guanine, acyclovir
    • 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
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the present disclosure is directed to methods of treating coronavirus-associated diseases in an individual comprising administering to the individual an effective amount of nevirapine and an effective amount of a second antiviral agent. Also provided are compositions of nevirapine and a second antiviral agent, and methods and dosing of delivering the combination compositions to an individual.
  • Coronaviruses are known to cause deadly diseases.
  • Coronavirus Disease-2019 (COVID-19), which is caused by SARS-CoV-2 (also known as 2019-nCov; a member of the coronavirus family), may lead to rapid onset of Acute Respiratory Distress Syndrome (ARDS) in addition to causing cardio-pulmonary distress.
  • COVID-19 has a high fatality rate (about 3+%).
  • the unique and devastating characteristics of COVID-19 are attributable to the high transmissibility of SARS-CoV-2, which is akin to the common cold.
  • SARS-CoV-2 and the spread of COVID-19, is nearly impossible to contain due to the high transmissibility and the lengthy, and often asymptomatic, incubation period (on average about 7-14 days, and up to 20+ days in certain cases). Additionally, much like influenza, coronaviruses are RNA viruses and are prone to mutation. It has already been reported that several unique strains of SARS-CoV-2 exist. Vaccine -based approaches for mitigating the spread of COVID-19 may have very limited success due the continual mutation of the virus. Such a strategy will be in a “continuous” catch-up cycle. Other means for preventing and treating coronavirus-associated diseases are urgent needed. BRIEF SUMMARY
  • a method of treating an infectious disease in an individual comprising administering to an individual a) an effective amount of nevirapine and b) and effective amount of a second antiviral agent, wherein the second antiviral agent is selected from the group consisting of a reverse transcriptase inhibitor, a protease inhibitor, an integrase inhibitor, and a viral DNA polymerase inhibitor.
  • provided herein is a method of treating an infectious disease in an individual comprising administering to an individual a) an effective amount of nevirapine and b) and effective amount of valacyclovir.
  • provided herein is a method of treating an infectious disease in an individual comprising administering to an individual a) an effective amount of nevirapine and b) and effective amount of etravirine.
  • the infectious disease is a coronavirus-associated disease.
  • the coronavirus-associated disease is Severe Acute Respiratory Syndrome Coronavirus 2 (COVED- 19), an Angiotensin-Converting Enzyme 2 (ACE2)- associated disease, Acute Respiratory Distress Syndrome (ARDS), Severe Acute Respiratory Syndrome (SARS), or Middle East Respiratory Syndrome (MERS).
  • Coronavirus 2 COVED- 19
  • ACE2 Angiotensin-Converting Enzyme 2
  • ARDS Acute Respiratory Distress Syndrome
  • SARS Severe Acute Respiratory Syndrome
  • MERS Middle East Respiratory Syndrome
  • the nevirapine is administered orally. In other embodiments, the nevirapine is administered intramuscularly. In other embodiments, the nevirapine is administered intravenously. In some embodiments, the valacyclovir is administered orally. In other embodiments, the valacyclovir is administered intramuscularly. In other embodiments, the valacyclovir is administered intravenously. In some embodiments, the etravirine is administered orally. In other embodiments, the etravirine is administered intramuscularly. In other embodiments, the etravirine is administered intravenously.
  • the nevirapine is administered orally once daily for 14 days.
  • the valacyclovir is administered orally twice daily for 10 days.
  • the etravirine is administered orally twice daily for 14 days.
  • the nevirapine and the etravirine are administered simultaneously. In some embodiments, the nevirapine and the etravirine are administered in a single composition.
  • the nevirapine and the valacyclovir are administered simultaneously. In some embodiments, the nevirapine and the valacyclovir are administered in a single composition. [0012] In some embodiments, the nevirapine and the etravirine are administered sequentially. In some embodiments, the nevirapine is administered prior to administration of the etravirine. In some embodiments, the nevirapine is administered following administration of the etravirine.
  • the nevirapine and the valacyclovir are administered sequentially. In some embodiments, the nevirapine is administered prior to administration of the valacyclovir. In some embodiments, the nevirapine is administered following administration of the valacyclovir.
  • the individual is a human. In some embodiments, the individual suffers from a pre-existing health condition correlated with poor prognosis following SARS-CoV-2 disease.
  • the pre-existing health condition is selected from the group consisting of cancer, chronic kidney disease, chronic obstructive pulmonary disease, Down Syndrome, heart conditions, heart failure, coronary artery disease, cardiomyopathy, immunocompromised states, obesity, pregnancy, sickle cell disease, smoking, Type I diabetes mellitus, Type 2 diabetes mellitus, asthma, cerebrovascular disease, cystic fibrosis, hypertension, neurologic conditions, liver disease, pulmonary fibrosis, thalassemia, and 65 years or greater of age.
  • a second therapy is administered to the individual.
  • the second therapy comprises remdesivir, monoclonal antibodies, mechanical ventilation, or combinations thereof.
  • the second therapy comprises administration of an effective amount of remdesivir.
  • the second therapy comprises administration of an effective amount of a monoclonal antibody targeting against SARS-CoV-2.
  • the second therapy comprises administration of casirivimab and imdevimab intravenously.
  • the second therapy is mechanical ventilation.
  • a pharmaceutical composition comprising a) nevirapine and b) valacyclovir.
  • composition comprising a) nevirapine and b) etravirine.
  • the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule. In some embodiments, the pharmaceutical composition is a caplet. In some embodiments, the pharmaceutical composition is in a vial. [0019] In some embodiments, the weight ratio of the nevirapine and the valacyclovir in the composition is about 25:1 to about 1:25.
  • the weight ratio of the nevirapine and the etravirine in the composition is about 25:1 to about 1:25.
  • the pharmaceutical composition contains about 50-1000 mg nevirapine. In some embodiments, the pharmaceutical composition contains about 0.25 to 5 grams valacyclovir.
  • the pharmaceutical composition contains about 50-1000 mg nevirapine. In some embodiments, the pharmaceutical composition contains about 0.1 to 5 grams etravirine.
  • a pharmaceutical composition according to any one of the pharmaceutical compositions described herein (e.g., including any of the combinations disclosed in FIG. 3 and FIG. 4), for use in the manufacture of a medicament for treating or preventing an infectious disease in a subject in thereof.
  • a pharmaceutical composition according to any one of the pharmaceutical compositions provided herein (e.g., including any of the combinations disclosed in FIG. 3 and FIG. 4), for use in treating or preventing an infectious disease in a subject in thereof.
  • any one of the pharmaceutical described herein e.g., including any of the combinations disclosed in FIG. 3 and FIG. 4 for use in treating or preventing an infectious disease in a subject in thereof.
  • kits comprising agents described herein (e.g., including agents in any of the combinations disclosed in FIG. 3 and FIG. 4).
  • the agents in the kit are in separate compositions.
  • a kit comprising: a) nevirapine; b) at least one other antiviral agent, wherein the other antiviral agent is selected from the group consisting of a reverse transcriptase inhibitor, a protease inhibitor, an integrase inhibitor, and a viral DNA polymerase inhibitor; and optionally c) instructions for using a) and b) in combination for treating or preventing an infectious disease in a subject in thereof.
  • a) and b) in the kit are in separate compositions.
  • the infectious disease is a coronavirus-associated disease.
  • the coronavirus-associated disease is Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19), an Angiotensin-Converting Enzyme 2 (ACE2)- associated disease, Acute Respiratory Distress Syndrome (ARDS), Severe Acute Respiratory Syndrome (SARS), or Middle East Respiratory Syndrome (MERS).
  • Coronavirus 2 COVID-19
  • ACE2 Angiotensin-Converting Enzyme 2
  • ARDS Acute Respiratory Distress Syndrome
  • SARS Severe Acute Respiratory Syndrome
  • MERS Middle East Respiratory Syndrome
  • FIG. 1 shows the effect of various antiviral agents on the growth and proliferation of SARS-CoV-2 in Vero cell culture.
  • FIG. 1A shows antiviral agents and combinations of antiviral agents that result in a low SARS-CoV-2 density per cell from Plate 1.
  • FIG. IB shows antiviral agents and combinations of antiviral agents that result in a low SARS-CoV-2 density per cell from Plate 2.
  • FIG. 2 shows the effect of various antiviral agents on the growth and proliferation of SARS-CoV-2 in Vero cell culture.
  • FIG. 2A shows antiviral agents and combinations of antiviral agents that result in a high SARS-CoV-2 density per cell from Plate 1.
  • FIG. 2B shows antiviral agents and combinations of antiviral agents that have a high SARS-CoV-2 density per cell from Plate 2.
  • FIG. 3 shows the quantified average intensity of SARS-CoV-2 per cell for each antiviral combination tested.
  • FIG. 3 A shows the results for Plate 1.
  • FIG. 3B shows the results for Plate 2.
  • FIG. 4 shows the quantified intensity per cell for each antiviral combination for Plates 1 and 2.
  • a method of treating a coronavirus-associated disease in an individual comprising administering to the individual an effective amount of nevirapine and an effective amount of a second antiviral agent.
  • the present disclosure is based on the surprising finding that combinations of nevirapine with valacyclovir or etravirine can be useful for treating a coronavirus-associated disease by reducing the replication and proliferation of SARS-CoV-2.
  • the present application thus in one aspect provides a method of treating a coronavirus -associated disease in an individual comprising administering to an individual an effective amount of nevirapine and an effective amount of valacyclovir or etravirine.
  • a pharmaceutical composition comprising nevirapine and valacyclovir.
  • a pharmaceutical composition comprising nevirapine and etravirine.
  • Antiviral refers to a category of antimicrobial drugs that are used specifically for treating viral infections by inhibiting the development of the viral pathogen inside the host cell.
  • Antivirals and antiviral agents described herein include, but are not limited to, several categories based on their target, including: 1) entry blockers, which interfere with the attachment and penetration of the virus into the host cell; 2) nucleoside/nucleotide analogues and nonnucleoside analogues, which interfere with nucleic acid synthesis by blocking viral polymerases; this class includes viral DNA polymerase inhibitors and reverse transcriptase inhibitors.; 3) protein synthesis inhibitors, which interfere with viral replication; 4) protease inhibitors, which interfere with the maturation of the virus and its infectivity; and 5) integrase inhibitors. (DeClercq, Antiviral drugs in current clinical use , J. Clin. Virol., 30, 115-33, 2004).
  • “Viral DNA polymerase inhibitor” is an antiviral agent that inhibits the function of a viral DNA polymerase required for viral replication.
  • Reverse transcriptase inhibitor is an antiviral agent that inhibits the function of a reverse transcriptase enzyme required for viral replication.
  • Treating” a disease or disorder with the compounds and methods discussed herein is defined as administering one or more of the compounds discussed herein, with or without additional therapeutic agents, in order to reduce or eliminate either the disease or disorder or one or more symptoms of the disease or disorder, or to retard the progression of the disease or disorder or of one or more symptoms of the disease or disorder, or to reduce the severity of the disease or disorder or of one or more symptoms of the disease or disorder.
  • an “effective amount,” as used herein, refers to an amount of a compound or composition sufficient to treat a specified disorder, condition, or disease such as ameliorate, palliate, lessen, and/or delay one or more of its symptoms.
  • an “effective amount” may be in one or more doses, e.g., a single dose or multiple doses may be required to achieve the desired treatment endpoint.
  • An effective amount may be considered in the context of administering one or more therapeutic agents, and combinations may be considered to be given in an effective amount if a desirable or beneficial result may be or is achieved.
  • an effective amount of a combination therapy includes an amount of the first therapy and an amount of the second therapy that when administered sequentially, simultaneously, or concurrently produces a desired outcome.
  • “In conjunction with” or “in combination with” refers to administration of one treatment modality in addition to another treatment modality. As such, “in conjunction with” or “in combination with” refers to administration of one treatment modality before, during or after delivery of the other treatment modality to the individual.
  • the term “simultaneous administration,” as used herein, means that a first agent and second agent in a combination therapy are administered with a time separation of no more than about 15 minutes, such as no more than about any of 10, 5, or 1 minutes.
  • the first and second agents may be contained in the same composition (e.g., a composition comprising both a first and second agent) or in separate compositions (e.g., a first agent is contained in one composition and a second agent is contained in another composition).
  • the term “sequential administration” means that the first agent and second agent in a combination therapy are administered with a time separation of more than about 15 minutes, such as more than about any of 20, 30, 40, 50, 60, or more minutes. Either the first agent or the second agent may be administered first.
  • the first and second agents are contained in separate compositions, which may be contained in the same or different packages or kits.
  • a “subject,” “individual,” or “patient” is a vertebrate.
  • the vertebrate is a mammal.
  • the subject, individual, or patient is a food animal, such as a chicken, turkey, duck, goose, cow, lamb, sheep, pig, or goat.
  • the subject, individual, or patient is a domestic animal, such as a cat, dog, bird, rabbit, or guinea pig.
  • the compounds, compositions, and methods disclosed herein can be used in human medicine and in veterinary medicine.
  • the individual is a human.
  • composition administered to a patient without causing any significant undesirable biological effects or interacting in a deleterious manner with any of the other components of the composition in which it is contained.
  • pharmaceutically acceptable carriers, excipients, or salts have preferably met the required standards of toxicological and manufacturing testing and/or are included on the Inactive Ingredient Guide prepared by the U.S. Food and Drug administration.
  • references to “about” a value or parameter herein includes (and describes) variations that are directed to that value or parameter per se.
  • description referring to “about X” includes description of “X.”
  • numerical designations are provided herein for ease of understanding the scope of the present disclosure, wherein the numerical designations are calculated from experimental values and may include approximations, e.g., rounded weight percentages calculated from an amount of a starting material.
  • numerical designations provided herein, e.g., weight percentages may vary ( ⁇ ) by increments of 0.1 to 0.5.
  • Reference to “about” a value or parameter herein includes (and describes) variations that are directed to that value or parameter per se. For example, description referring to “about X” includes description of “X.”
  • the second antiviral agent is a reverse transcriptase inhibitor.
  • the other antiviral agent is a protease inhibitor.
  • the other antiviral agent is an integrase inhibitor.
  • the other antiviral agent is a viral DNA polymerase inhibitor.
  • the second antiviral agent is valacyclovir.
  • the second antiviral agent is etravirine.
  • the virus is an enveloped virus.
  • enveloped viruses are well known in the art and include, without limitation, the virus families of Arenavirus, Arterivirus, Asfarvirus, Baculovirus, Bunyavirus, Coronavirus, Cystovirus, Deltavirus, Filovirus, Flavivirus, Fusellovirus, Hepadnavirus, Herpesvirus, Iridovirus, Lipothrixivirus, Orthomyxovirus, Paramyxovirus, Plasmavirus, Polydnavirus, Poxvirus, Retrovirus, Rhabdovirus, and Togavirus.
  • the virus is a Coronavirus, e.g., severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or Middle East respiratory syndrome-related coronavirus (MERS-CoV).
  • the virus is an Orthomyxovirus, e.g., influenza virus A, B, or C.
  • the virus is an Orthopneumovirus, e.g., respiratory syncytial virus (RSV).
  • an individual has been diagnosed with a coronavirus- associated disease.
  • an individual has been diagnosed with Severe Acute Respiratory Syndrome Coronavirus 2 (COVID-19).
  • an individual has or has been diagnosed with acute respiratory distress syndrome (ARDS), e.g., prior to treatment with the combination therapy.
  • ARDS acute respiratory distress syndrome
  • Methods for diagnosis of ARDS include, without limitation, chest X-ray, CT scanning, and/or measurement of oxygen levels.
  • ARDS acute respiratory distress syndrome
  • Methods for diagnosis of ARDS include, without limitation, chest X-ray, CT scanning, and/or measurement of oxygen levels.
  • an individual has been diagnosed with an Angiotensin-Converting Enzyme 2 (ACE2)-associated disease.
  • ACE2 Angiotensin-Converting Enzyme 2
  • an individual has been diagnosed with Severe Acute Respiratory Syndrome (SARS).
  • SARS Severe Acute Respiratory Syndrome
  • MERS Middle East Respiratory Syndrome
  • an individual is treated with a combination of nevirapine and etravirine.
  • the nevirapine is administered orally.
  • the nevirapine is administered intramuscularly.
  • the nevirapine is administered orally.
  • an individual is treated with a combination of nevirapine and etravirine.
  • the nevirapine is administered orally.
  • the nevirapine is administered intramuscularly.
  • the nevirapine is administered orally.
  • the valacyclovir is administered orally. In some embodiments, the valacyclovir is administered intramuscularly. In other embodiments, the valacyclovir is administered intravenously. In some embodiments, the nevirapine and the valacyclovir are administered simultaneously.
  • the etravirine is administered orally. In some embodiments, the etravirine is administered intramuscularly. In other embodiments, the etravirine is administered intravenously. In some embodiments, the nevirapine and the etravirine are administered simultaneously.
  • the nevirapine and the valacyclovir are administered in a single composition.
  • the single composition is administered orally.
  • the single composition is administered intravenously.
  • the single composition is administered intramuscularly.
  • the nevirapine and the etravirine are administered in a single composition.
  • the single composition is administered orally.
  • the single composition is administered intravenously.
  • the single composition is administered intramuscularly.
  • composition comprising nevirapine and the valacyclovir can be administered simultaneously (i.e., simultaneous administration and/or sequentially (i.e., sequential administration)).
  • composition comprising nevirapine and the etravirine can be administered simultaneously (i.e., simultaneous administration and/or sequentially (i.e., sequential administration)).
  • the nevirapine and the valacyclovir are administered simultaneously.
  • the term “simultaneous administration,” as used herein, means that the nevirapine and the valacyclovir agent are administered with a time separation no more than about 15 minutes(s), such as no more than about any of 10, 5, or 1 minutes.
  • the nevirapine and valacyclovir may be contained in the same composition (e.g., a composition comprising the nevirapine and the valacyclovir) or in separate compositions (e.g., the nevirapine is contained in one composition and the valacyclovir is contained in another composition).
  • the nevirapine and the etravirine are administered simultaneously.
  • the nevirapine and etravirine may be contained in the same composition (e.g., a composition comprising the nevirapine and the etravirine) or in separate compositions (e.g., the nevirapine is contained in one composition and the etravirine is contained in another composition).
  • the nevirapine and the valacyclovir are administered sequentially.
  • the term “sequential administration” as used herein means that the nevirapine and the valacyclovir are administered with a time separation of more than about 15 minutes, such as more than any of 20, 30, 40, 50, or more minutes. Either the nevirapine or the valacyclovir may be administered first.
  • the nevirapine is administered prior to administration of the valacyclovir.
  • the nevirapine is administered following administration of the valacyclovir.
  • the nevirapine and the valacyclovir are contained in separate compositions, which may be contained in the same or different packages.
  • the nevirapine and the etravirine are administered sequentially. Either the nevirapine or the etravirine may be administered first. In some embodiments, the nevirapine is administered prior to administration of the etravirine. In some embodiments, the nevirapine is administered following administration of the etravirine.
  • the nevirapine and the etravirine are contained in separate compositions, which may be contained in the same or different packages.
  • the individual is a human. In some embodiments, the individual suffers from a pre-existing health condition correlated with poor prognosis following SARS-CoV2- disease.
  • the pre-existing health condition is cancer. In some embodiments, the pre-existing health condition is chronic kidney disease. In some embodiments, the pre-existing health condition is chronic obstructive pulmonary disease. In some embodiments, the pre-existing health condition is Down Syndrome. In some embodiments, the pre-existing health condition is a heart condition. In some embodiments, the pre-existing health condition is heart failure. In some embodiments, the pre-existing health condition is coronary artery disease. In some embodiments, the pre-existing health condition is cardiomyopathy.
  • the pre-existing health condition is an immunocompromised state. In some embodiments, the pre-existing health condition is obesity. In some embodiments, the pre-existing health condition is pregnancy. In some embodiments, the pre-existing health condition is sickle cell disease. In some embodiments, the pre-existing health condition is smoking. In some embodiments, the pre-existing health condition is Type I diabetes mellitus. In some embodiments, the pre-existing health condition is Type 2 diabetes mellitus. In some embodiments, the pre-existing health condition is asthma. In some embodiments, the pre-existing health condition is cerebrovascular disease. In some embodiments, the pre-existing health condition is cystic fibrosis.
  • the pre-existing health condition is hypertension. In some embodiments, the pre-existing health condition is a neurologic condition. In some embodiments, the pre-existing health condition is liver disease. In some embodiments, the pre-existing health condition is pulmonary fibrosis. In some embodiments, the pre-existing health condition is thalassemia. In some embodiments, the pre-existing health condition is 65 years or greater of age.
  • the nevirapine and the valacyclovir or the nevirapine and the etravirine is accompanied by a second therapy administered to the individual.
  • the second therapy is remdesivir.
  • the second therapy is monoclonal antibody.
  • the monoclonal antibody is targeted against SARS-CoV-2.
  • the second therapy is casirivimab and imdevimab.
  • the second therapy is administered intravenously.
  • the second therapy is mechanical ventilation.
  • Nevirapine is an antiviral compound that belongs to the class of reverse transcriptase inhibitors.
  • Reverse transcriptase inhibitors are a class of anti- viral drug that is used to treat HIV/AIDS.
  • Reverse transcriptase inhibitors inhibit the activity of reverse transcriptase, an enzyme required for the replication of retroviruses.
  • Nevirapine is a non-nucleoside reverse transcriptase inhibitor. Non-nucleoside reverse transcriptase inhibitors function through binding directly to the reverse transcriptase enzyme, thereby altering its conformation to prevent DNA binding.
  • Nevirapine is administered orally and has been approved for the treatment of HIV/AIDS.
  • the nevirapine is administered intravenously.
  • the nevirapine is administered intramuscularly.
  • the nevirapine is administered orally.
  • the individual is administered about 200 mg orally once daily for 14 days.
  • the individual is administered about 50, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, or 1000 mg nevirapine.
  • the individual is administered about 1500-2500 mg or more of nevirapine.
  • Valacyclovir is an antiviral compound that belongs to the class of viral DNA polymerase inhibitors. Viral DNA polymerases function through inhibition of the viral DNA polymerase, which prevents viral genome replication and transcription.
  • Valacyclovir is approved for treating outbreaks of herpes simplex or herpes zoster (shingles), and it can also be used to prevent cytomegalovirus following kidney transplant.
  • the valacyclovir is administered intravenously.
  • the valacyclovir is administered intramuscularly.
  • the valacyclovir is administered orally.
  • the valacyclovir is administered 1 gram twice daily for 10 days.
  • the individual is administered about 0.25, 0.5, 0.75, 1, 2, 3, 4, or 5 grams valacyclovir. In other embodiments, the individual is administered 5-8 grams valacyclovir or more.
  • Etravirine is an antiviral compound that belongs to the class of reverse transcriptase inhibitors. Etravirine inhibits reverse transcriptase by binding at a non-substrate site on the enzyme, different than that for nucleoside analog reverse transcriptase inhibitors (NRTIs) and nucleotide analog reverse transcriptase inhibitors (NtRTIs). Upon binding to the enzyme at a site proximal to the polymerase active site, etravirine can inhibit the movement of protein domains that are needed to carry out the process of DNA synthesis.
  • NRTIs nucleoside analog reverse transcriptase inhibitors
  • NtRTIs nucleotide analog reverse transcriptase inhibitors
  • Etravirine is currently approved for human immunodeficiency virus (HIV) infection.
  • the etravirine is administered intravenously.
  • the etravirine is administered intramuscularly.
  • the etravirine is administered orally.
  • the etravirine is administered 0.2 gram twice daily.
  • the individual is administered about 0.05, 0.1, 0.15, 0.2, 0.25, 0.3, 0.4, 0.5, 1, 2, 3, 4, or 5 grams etravirine.
  • the individual is administered 1-5 grams of etravirine.
  • a method of treating an infectious disease in an individual comprising administering to an individual: a) an effective amount of nevirapine, and b) an effective amount of valacyclovir.
  • the valacyclovir is administered intravenously.
  • the valacyclovir is administered intramuscularly.
  • the valacyclovir is administered orally.
  • the valacyclovir is administered 1 gram twice daily for 10 days.
  • the individual is administered about 0.25, 0.5, 0.75, 1, 2, 3, 4, or 5 grams valacyclovir.
  • the individual is administered 5-8 grams valacyclovir or more.
  • the nevirapine is administered intravenously. In other embodiments, the nevirapine is administered intramuscularly. In other embodiments, the nevirapine is administered orally. In some embodiments, the individual is administered about 200 mg orally once daily for 14 days. In other embodiments, the individual is administered about 50, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850,
  • the individual is administered about 1500-2500 mg or more of nevirapine.
  • a pharmaceutical composition comprising nevirapine and valacyclovir.
  • a method of treating an infectious disease in an individual comprising administering to an individual: a) an effective amount of nevirapine, and b) an effective amount of etravirine.
  • the etravirine is administered intravenously.
  • the etravirine is administered intramuscularly.
  • the etravirine is administered orally.
  • the etravirine is administered 0.2 gram twice daily.
  • the individual is administered about 0.05, 0.1, 0.15, 0.2, 0.25, 0.3, 0.4, 0.5, 1, 2, 3, 4, or 5 grams etravirine.
  • the individual is administered 1-5 grams etravirine or more.
  • the nevirapine is administered intravenously.
  • the nevirapine is administered intramuscularly.
  • the nevirapine is administered orally.
  • the individual is administered about 200 mg orally once daily for 14 days.
  • the individual is administered about 50, 100, 150, 200, 250, 300, 350, 400, 450, 500, 550, 600, 650, 700, 750, 800, 850, 900, 950, or 1000 mg nevirapine.
  • the individual is administered about 1500-2500 mg or more of nevirapine.
  • a pharmaceutical composition comprising nevirapine and etravirine.
  • compositions comprising nevirapine and valacyclovir.
  • Pharmaceutical compositions containing the compounds of the present disclosure may be in any form suitable for the intended method of administration.
  • the pharmaceutical composition is suitable for oral administration.
  • Formulations suitable for oral administration can consist of (a) liquid solutions, such as an effective amount of the compound dissolved in diluents, such as water, saline, or orange juice, (b) capsules, sachets or tablets, each containing a predetermined amount of the active ingredient, as solids or granules, (c) suspensions in an appropriate liquid, and (d) suitable emulsions.
  • Tablet forms can include one or more of lactose, mannitol, com starch, potato starch, microcrystalline cellulose, acacia, gelatin, colloidal silicon dioxide, croscarmellose sodium, talc, magnesium stearate, stearic acid, and other excipients, colorants, diluents, buffering agents, moistening agents, preservatives, flavoring agents, and pharmacologically compatible excipients.
  • Lozenge forms can comprise the active ingredient in a flavor, usually sucrose and acacia or tragacanth, as well as pastilles comprising the active ingredient in an inert base, such as gelatin and glycerin, or sucrose and acacia, emulsions, gels, and the like containing, in addition to the active ingredient, such excipients as are known in the art.
  • a flavor usually sucrose and acacia or tragacanth
  • pastilles comprising the active ingredient in an inert base, such as gelatin and glycerin, or sucrose and acacia, emulsions, gels, and the like containing, in addition to the active ingredient, such excipients as are known in the art.
  • suitable carriers, excipients, and diluents include, but are not limited to, lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum acacia, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, water, saline solution, syrup, methylcellulose, methyl- and propylhydroxybenzoates, talc, magnesium stearate, and mineral oil.
  • the formulations can additionally include lubricating agents, wetting agents, emulsifying and suspending agents, preserving agents, sweetening agents or flavoring agents.
  • Solid dosage forms for oral administration may include capsules, tablets, pills, powders and granules.
  • the active compound may be admixed with at least one inert diluent such as sucrose, lactose, or starch.
  • Such dosage forms may also comprise additional substances other than inert diluents, e.g., lubricating agents such as magnesium stearate.
  • the dosage forms may also comprise buffering agents. Tablets and pills can additionally be prepared with enteric coatings.
  • Liquid dosage forms for oral administration may include pharmaceutically acceptable emulsions, solutions, suspensions, syrups, and elixirs containing inert diluents commonly used in the art, such as water.
  • Such compositions may also comprise adjuvants, such as wetting agents, emulsifying and suspending agents, cyclodextrins, and sweetening, flavoring, and perfuming agents.
  • the formulation is suitable for intravenous administration. In other embodiments, the formulation is suitable for intramuscular administration.
  • Formulations suitable for intravenous and intramuscular administration include aqueous and non-aqueous, isotonic sterile injection solutions, which can contain anti-oxidants, buffers, bacteriostats, and solutes that render the formulation compatible with the blood of the intended recipient, and aqueous and non-aqueous sterile suspensions that can include suspending agents, solubilizers, thickening agents, stabilizers, and preservatives.
  • the formulations can be presented in unit-dose or multi-dose sealed containers, such as ampules and vials, and can be stored in a freeze-dried (lyophilized) condition requiring only the addition of the sterile liquid excipient, for example, water, for injections, immediately prior to use.
  • Extemporaneous injection solutions and suspensions can be prepared from sterile powders, granules, and tablets of the kind previously described.
  • the ratio by weight of the nevirapine and the valacyclovir in the pharmaceutical composition is about 1 to 1. In some embodiments, the weight ratio may be between about 0.001 to about 1 and about 1000 to about 1, or between about 0.01 to about 1 and 100 to about 1. In some embodiments, the ratio by weight of the nevirapine and the valacyclovir is less than any of about 1000:1, 900:1, 800:1, 700:1, 600:1, 500:1, 400:1, 300:1, 200:1, 100:1, 50:1, 30:1, 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1, 3:1, 2:1, and 1:1.
  • the ratio by weight of the nevirapine and the valacyclovir is more than any of about 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 10:1, 30:1, 50:1, 75:1, 100:1, 200:1, 300:1, 400:1, 500:1, 600:1, 700:1, 800:1, 900:1, and 1000:1.
  • the ratio by weight of the nevirapine and the valacyclovir is less than any of about 1:1, 1:2, 1:3, 1:4, 1:5, 1:6, 1:7, 1:8, 1:9, 1:10, 1:30, 1:50, 1:100, 1:200, 1:300, 1:400, 1:500, 1:600, 1:700, 1:800, 1:900, and 1:1000.
  • the ratio by weight of the nevirapine and the valacyclovir is more than any of about 1:1000, 1:900, 1:800, 1:700, 1:600, 1:500, 1:400, 1:300, 1:200, 1:100, 1:50, 1:30, 1:10, 1:9, 1:8, 1:7, 1:6, 1:5, 1:4, 1:3, 1:2, and 1:1. Other ratios are contemplated. [0086] In some embodiments, the ratio by weight of the nevirapine and the etravirine in the pharmaceutical composition is about 1 to 1. In some embodiments, the weight ratio may be between about 0.001 to about 1 and about 1000 to about 1, or between about 0.01 to about 1 and 100 to about 1.
  • the ratio by weight of the nevirapine and the etravirine is less than any of about 1000:1, 900:1, 800:1, 700:1, 600:1, 500:1, 400:1, 300:1, 200:1, 100:1, 50:1, 30:1, 10:1, 9:1, 8:1, 7:1, 6:1, 5:1, 4:1, 3:1, 2:1, and 1:1.
  • the ratio by weight of the nevirapine and the etravirine is more than any of about 1:1, 2:1, 3:1, 4:1, 5:1, 6:1, 7:1, 8:1, 9:1, 10:1, 30:1, 50:1, 75:1, 100:1, 200:1, 300:1, 400:1, 500:1, 600:1, 700:1, 800:1, 900:1, and 1000:1.
  • the ratio by weight of the nevirapine and the etravirine is less than any of about 1:1, 1:2, 1:3, 1:4, 1:5, 1:6, 1:7, 1:8, 1:9, 1:10, 1:30, 1:50, 1:100, 1:200, 1:300, 1:400, 1:500, 1:600, 1:700, 1:800, 1:900, and 1:1000.
  • the ratio by weight of the nevirapine and the etravirine is more than any of about 1:1000, 1:900, 1:800, 1:700, 1:600, 1:500, 1:400, 1:300, 1:200, 1:100, 1:50, 1:30, 1:10, 1:9, 1:8, 1:7, 1:6, 1:5, 1:4, 1:3, 1:2, and 1:1. Other ratios are contemplated.
  • a pharmaceutical composition comprising: a) nevirapine, and b) valacyclovir.
  • the composition is suitable for intravenous administration.
  • the composition is suitable for oral administration.
  • the composition is suitable for intramuscular administration.
  • the weight ratio of the nevirapine to valganciclovir in the pharmaceutical composition is about any of 10:1, 9:2, 8:1, 7:1, 6:1, 5:1. 4:1, 3:1, 2:1, 1:1, 1:2, 1:3, 1:4, 1:5, 1:6, 1:7, 1:8, 1:9, or 1:10.
  • kits comprising a combination therapy described herein.
  • the kit can include one or more other elements including: instructions for use; devices or other materials for preparing the compositions for administration; pharmaceutically acceptable carriers; and devices or other materials for administration to a subject.
  • compositions disclosed herein can be administered to cells in culture, in vitro or ex vivo , or to a subject, e.g., a human subject, to treat, prevent, and/or diagnose a variety of disorders, such as viral infection, e.g., SARS- CoV-2 infection.
  • a subject e.g., a human subject
  • the individual is a human. In some embodiments, the individual is a male. In some embodiments, the individual is a female. In some embodiments, the individual is at least about any of 12, 24, 36, 48, 50, 55, 60, 65, 70, 75, or 80 years old, or older. In some embodiments, the individual is no more than about 60, 50, 40, 30, 20, or 10 years old, or younger. In some embodiments, the individual is clinically obese. In some embodiments, the individual is overweight. In other embodiments, the individual is normal weight. In other embodiments, the individual is underweight. In some embodiments, the individual has a body mass index (BMI) of about >30. In other embodiments, the individual has a BMI between about 25 and 30.
  • BMI body mass index
  • the individual has a BMI between bout 18.5 and 25. In other embodiments, the individual has a BMI under about 18.5. [0091] In some embodiments, the individual suffers from a pre-existing health condition correlated with poor prognosis following SARS-CoV2- disease.
  • the pre-existing health condition is cancer. In some embodiments, the pre-existing health condition is chronic kidney disease. In some embodiments, the pre-existing health condition is chronic obstructive pulmonary disease. In some embodiments, the pre-existing health condition is Down Syndrome. In some embodiments, the pre-existing health condition is a heart condition. In some embodiments, the pre-existing health condition is heart failure.
  • the pre-existing health condition is coronary artery disease. In some embodiments, the pre-existing health condition is cardiomyopathy. In some embodiments, the pre-existing health condition is an immunocompromised state. In some embodiments, the pre-existing health condition is obesity. In some embodiments, the pre-existing health condition is pregnancy. In some embodiments, the pre-existing health condition is sickle cell disease. In some embodiments, the pre-existing health condition is smoking. In some embodiments, the pre-existing health condition is Type I diabetes mellitus. In some embodiments, the pre-existing health condition is Type 2 diabetes mellitus. In some embodiments, the pre-existing health condition is asthma. In some embodiments, the pre existing health condition is cerebrovascular disease.
  • the pre-existing health condition is cystic fibrosis. In some embodiments, the pre-existing health condition is hypertension. In some embodiments, the pre-existing health condition is a neurologic condition. In some embodiments, the pre-existing health condition is liver disease. In some embodiments, the pre-existing health condition is pulmonary fibrosis. In some embodiments, the pre-existing health condition is thalassemia. In some embodiments, the pre-existing health condition is 65 years or greater of age.
  • Example 1 In vitro Screening of Combined Antiviral Activity: Screen Studies in an In Vitro Model of Inhibiting SARS-CoV-2 Growth and Proliferation
  • Combinations of antiviral agents were shown to inhibit the growth of SARS-CoV-2 in vitro.
  • Two 96- well plates were seeded with Vero (African green monkey kidney epithelial) cells. The cells were then infected with SARS-CoV-2 virus and treated with 192 different antiviral agent combinations. The antiviral agent combinations were introduced to the 96- well plate cell cultures using pin-array technology.

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Abstract

La présente invention concerne des procédés de traitement de maladies associées au coronavirus chez un individu, comprenant l'administration à l'individu d'une quantité efficace de névirapine et d'une quantité efficace de valacyclovir et/ou de névirapine. L'invention concerne également des formulations et des procédés d'administration des formulations à un individu.
PCT/US2022/020229 2021-03-15 2022-03-14 Polythérapie pour le traitement de la covid-19 WO2022197627A1 (fr)

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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20160058775A1 (en) * 2013-04-12 2016-03-03 Vyome Biosciences Pvt. Ltd. Composition and formulation of antimicrobial agents, processes thereof and methods for treating microbial infections
US20200345699A1 (en) * 2019-04-17 2020-11-05 Gilead Sciences, Inc. Hiv protease inhibitors
US20200397791A1 (en) * 2019-02-25 2020-12-24 Elian Llc Viral prophylaxis treatment methods and pre-exposure prophylaxis kits
WO2021224356A1 (fr) * 2020-05-07 2021-11-11 4Living Biotech Nouvelles compositions et procédés de traitement de la covid-19

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20160058775A1 (en) * 2013-04-12 2016-03-03 Vyome Biosciences Pvt. Ltd. Composition and formulation of antimicrobial agents, processes thereof and methods for treating microbial infections
US20200397791A1 (en) * 2019-02-25 2020-12-24 Elian Llc Viral prophylaxis treatment methods and pre-exposure prophylaxis kits
US20200345699A1 (en) * 2019-04-17 2020-11-05 Gilead Sciences, Inc. Hiv protease inhibitors
WO2021224356A1 (fr) * 2020-05-07 2021-11-11 4Living Biotech Nouvelles compositions et procédés de traitement de la covid-19

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