WO2023016551A1 - Pyrrolo six-membered heteroaromatic compound for treating or preventing graft-versus-host disease - Google Patents

Abstract

A pyrrolo six-membered heteroaromatic compound or a pharmaceutically acceptable salt thereof for treating or preventing graft-versus-host disease, the structure of which compound being as represented by the following formula: The present invention specifically relates to the use of the pyrrolo six-membered heteroaromatic compound in the preparation of a drug for treating or preventing graft-versus-host disease. The pyrrolo six-membered heteroaromatic compound can improve the effectiveness of graft-versus-host disease therapy, improve the quality of life of patients, and increase the survival rate of patients.

Description

Pyrrolohexamembered heteroaromatics for treating or preventing anti-host diseases

This application claims the priority of Chinese patent application 2021109254357 with a filing date of August 12, 2021 and Chinese patent application 2021114521269 with a filing date of December 1, 2021. This application cites the full text of the above-mentioned Chinese patent application.

technical field

The present disclosure relates to a pyrrolo six-membered heteroaryl compound for treating or preventing anti-host disease.

Background technique

Graft-versus-host disease (GVHD) is usually divided into acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) based on the time of occurrence and clinical manifestations.

Over the past 40 years, corticosteroids have become the first-line regimen for the treatment of cGvHD, ie, prednisone (starting dose 1 mg/kg/d) or equivalent doses of methylprednisolone for systemic immunosuppressive therapy.

Only about 40% of cGVHD patients respond to first-line treatment (including complete remission and partial remission), and the non-relapse mortality rate of non-responding patients is about 2.5 times higher than that of responding patients. At the same time, studies have shown that adding calmodulin inhibitors (cyclosporine, Prograf, etc.), mycophenolate mofetil, and thalidomide to the basis of prednisone cannot improve the efficacy of first-line treatment.

In addition, there is currently no standard second-line therapy. The drugs used for the second-line treatment of cGVHD include: mTOR inhibitors, mycophenolate mofetil, rituximab, alemtuzumab, thalidomide, imatinib, spray Sistatin and methotrexate, etc. These drugs can relieve some patients, but due to the strong immunosuppression of the drugs, the incidence of fungal, viral, bacterial and other infections increases significantly; and long-term use of glucocorticoids can lead to diabetes, Osteoporosis, negative nitrogen balance, malnutrition. For example, the mTOR inhibitor sirolimus combined with tacrolimus and corticosteroids has an effective rate of 63%, but nephrotoxicity is a concern. How to improve the success rate of first-line treatment of moderate to severe cGVHD has become a key factor in improving the survival rate of patients after transplantation.

The pathogenesis of cGVHD is still under investigation, with past research based on the persistence of alloreactive T cells, B cells that produce self or alloantibodies against host antigens, and donor antigen-presenting cells (APCs) The role of the host to replace the host APC, resulting in the indirect presentation of alloantigens, causing damage to target organs such as the skin, gastrointestinal tract and liver. In the process of cGVHD, T lymphocytes, dendritic cells, NK cells, macrophages, etc. are activated and proliferate as the main effector cells, and release a large amount of inflammatory cytokines to induce apoptosis of target organ cells, resulting in damage to target organ tissues. Complications caused by immunodeficiency after transplantation and long-term application of immunosuppressants will aggravate this disorder, so the interaction mechanism still needs further study.

Studies have confirmed that JAK inhibitors play an important role in the inflammatory response and tissue damage of GVHD. At the same time, JAK inhibitors can block the JAK-STAT molecular pathway and reduce the level of inflammatory cytokines, even in patients with negative JAK mutations.

For example, Ruxolitinib, Baricitinib, etc. have some clinical experience in some GVHD patients, among which Ruxolitinib is approved for the treatment of steroid-refractory acute GVHD in adults and children aged 12 and over. A study retrospectively analyzed the use of Ruxolitinib in 41 steroid-refractory chronic GVHD patients: the overall response rate of patients with chronic GVHD was 85%, the median response time was 3 weeks, and the target organs of GVHD improved .

(3aR,5s,6aS)-N-(3-methoxy-1,2,4-thiadiazol-5-yl)-5-(methyl(7H-pyrrolo[2,3-d]pyrimidine -4-yl)amino)hexahydrocyclopenta[c]pyrrole-2(1H)-carboxamide is a class of JAK kinase inhibitor compounds with in vivo and in vitro activity and high absorption,

However, there is no clinical report that this molecule can be effectively used in the treatment or prevention of graft-host disease.

Contents of the invention

The disclosure (The disclosure) provides the use of the compound represented by formula I or a pharmaceutically acceptable salt thereof in the preparation of a medicament for treating or preventing graft-versus-host disease,

In some embodiments, the graft versus host disease is chronic graft versus host disease. According to the 2014 NIH chronic graft-versus-host disease diagnosis and curative effect grading standards, it is graded, including mild graft-versus-host disease, moderate graft-versus-host disease and severe graft-versus-host disease. In some embodiments, the graft versus host disease is moderate graft versus host disease. In some embodiments, the graft-versus-host disease is more than moderate graft-versus-host disease. In some embodiments, the graft versus host disease is moderate-severe graft versus host disease. In some embodiments, the graft versus host disease is severe graft versus host disease.

In another aspect, a patient with graft-versus-host disease in the present disclosure is one who has undergone cell transplantation. In certain embodiments, the patient with graft versus host disease has undergone allogeneic bone marrow or hematopoietic stem cell transplantation.

In some embodiments, administration is based on the patient's body weight, and the dosage of the compound of formula I or its pharmaceutically acceptable salt in mammals is 0.1-10.0 mg/kg, specifically 0.1 mg/kg, 0.2 mg/kg, 0.3 mg/kg, 0.4mg/kg, 0.5mg/kg, 0.6mg/kg, 0.7mg/kg, 0.8mg/kg, 0.9mg/kg, 1.0mg/kg, 1.2mg/kg, 1.4mg/kg, 1.6 mg/kg, 1.8mg/kg, 2.0mg/kg, 2.2mg/kg, 2.4mg/kg, 2.6mg/kg, 2.8mg/kg, 3.0mg/kg, 3.2mg/kg, 3.4mg/kg, 3.6 mg/kg, 3.8mg/kg, 4.0mg/kg, 4.2mg/kg, 4.4mg/kg, 4.6mg/kg, 4.8mg/kg, 5.0mg/kg, 5.2mg/kg, 5.4mg/kg, 5.6 mg/kg, 5.8mg/kg, 6.0mg/kg, 6.2mg/kg, 6.4mg/kg, 6.6mg/kg, 6.8mg/kg, 7.0mg/kg, 7.2mg/kg, 7.4mg/kg, 7.6 mg/kg, 7.8mg/kg, 8.0mg/kg, 8.2mg/kg, 8.4mg/kg, 8.6mg/kg, 8.8mg/kg, 9.0mg/kg, 9.2mg/kg, 9.4mg/kg, 9.6 mg/kg, 9.8mg/kg, 10.0mg/kg or any value between any two values.

In other embodiments, the dose of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is 0.1-5.0 mg/kg. In other embodiments, the dose of the compound of formula I or its pharmaceutically acceptable salt in mammals is 1.0-5.0 mg/kg. In other embodiments, the dose of the compound of formula I or its pharmaceutically acceptable salt in mammals is 4.0-6.0 mg/kg. In other embodiments, the dosage of the compound of formula I or its pharmaceutically acceptable salt in mammals is 5.0-6.0 mg/kg.

In some embodiments, the dosage of the compound of formula I or its pharmaceutically acceptable salt in mammals is 1-50 mg, specifically 1.0 mg, 1.2 mg, 1.4 mg, 1.6 mg, 1.8 mg, 2.0 mg, 2.2 mg , 2.4mg, 2.6mg, 2.8mg, 3.0mg, 3.2mg, 3.4mg, 3.6mg, 3.8mg, 4.0mg, 4.2mg, 4.4mg, 4.6mg, 4.8mg, 5.0mg, 5.2mg, 5.4mg, 5.6 mg, 5.8mg, 6.0mg, 6.2mg, 6.4mg, 6.6mg, 6.8mg, 7.0mg, 7.2mg, 7.4mg, 7.6mg, 7.8mg, 8.0mg, 8.2mg, 8.4mg, 8.6mg, 8.8mg, 9.0mg, 9.2mg, 9.4mg, 9.6mg, 9.8mg, 10.0mg, 15mg, 20mg, 25mg, 30mg, 35mg, 40mg, 45mg, 50mg or any value between any two values, preferably 2mg, 4mg, 6mg or 10mg.

In certain embodiments, the daily dose of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is 2-10 mg. In certain embodiments, the daily dose of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is 2-5 mg. In certain embodiments, the daily dose of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is 4-8 mg.

In other embodiments, the compound of formula I or a pharmaceutically acceptable salt thereof is administered in the form of a pharmaceutical composition, which is in the form of a 1 mg dosage.

In some embodiments, the compound of formula I, or a pharmaceutically acceptable salt thereof, is administered as a pharmaceutical composition in the form of a 2 mg dosage.

In some embodiments, the compound of Formula I, or a pharmaceutically acceptable salt thereof, is administered as a pharmaceutical composition in the form of a 4 mg dosage.

In some embodiments, the compound of Formula I, or a pharmaceutically acceptable salt thereof, is administered as a pharmaceutical composition in the form of a 6 mg dosage.

In some embodiments, the compound of Formula I, or a pharmaceutically acceptable salt thereof, is administered as a pharmaceutical composition in an 8 mg dosage form.

In other embodiments, the administered dose, administered dose or unit dose is based on free base.

In some embodiments, the pharmaceutical composition comprises a compound of formula I, or a pharmaceutically acceptable salt thereof, and one or more pharmaceutically acceptable excipients, diluents or carriers.

In another aspect, in the disclosed uses, the compound of formula I or a pharmaceutically acceptable salt thereof is administered in combination with one or more additional therapeutic agents.

In some embodiments, the additional therapeutic agent is selected from a corticosteroid (including without limitation corticotropin, glucocorticoid, or mineralocorticoid), cyclosporine, mycophenolate mofetil, or combinations thereof.

In certain embodiments, the additional therapeutic agent is a corticosteroid (including but not limited to prednisone, methylprednisone, hydrocortisone, dexamethasone, betamethasone, or beclomethasone dipropionate). In certain embodiments, the additional therapeutic agent is prednisone or methylprednisone.

Further, the compound of formula I or a pharmaceutically acceptable salt thereof in combination with another therapeutic agent has a synergistic pharmacological effect. It can effectively reduce the single dose of the compound of formula I or its pharmaceutically acceptable salt, and reduce the adverse reactions of drugs such as methylprednisone or prednisone.

In some embodiments, additional therapeutic agents such as corticosteroids are administered according to the body weight of the patient, and the dosage in mammals is 0.1-10.0 mg/kg, specifically 0.1 mg/kg, 0.2 mg/kg, 0.3 mg /kg, 0.4mg/kg, 0.5mg/kg, 0.6mg/kg, 0.7mg/kg, 0.8mg/kg, 0.9mg/kg, 1.0mg/kg, 1.2mg/kg, 1.4mg/kg, 1.6mg /kg, 1.8mg/kg, 2.0mg/kg, 2.2mg/kg, 2.4mg/kg, 2.6mg/kg, 2.8mg/kg, 3.0mg/kg, 3.2mg/kg, 3.4mg/kg, 3.6mg /kg, 3.8mg/kg, 4.0mg/kg, 4.2mg/kg, 4.4mg/kg, 4.6mg/kg, 4.8mg/kg, 5.0mg/kg, 5.2mg/kg, 5.4mg/kg, 5.6mg /kg, 5.8mg/kg, 6.0mg/kg, 6.2mg/kg, 6.4mg/kg, 6.6mg/kg, 6.8mg/kg, 7.0mg/kg, 7.2mg/kg, 7.4mg/kg, 7.6mg /kg, 7.8mg/kg, 8.0mg/kg, 8.2mg/kg, 8.4mg/kg, 8.6mg/kg, 8.8mg/kg, 9.0mg/kg, 9.2mg/kg, 9.4mg/kg, 9.6mg /kg, 9.8mg/kg, 10.0mg/kg or any value between any two values.

In other embodiments, the additional therapeutic agent, such as a corticosteroid, is administered in a mammalian human at a dose of 0.1-10.0 mg/kg. In other embodiments, the additional therapeutic agent, such as a corticosteroid, is administered in a mammalian human at a dose of 1.0-2.0 mg/kg. In other embodiments, the additional therapeutic agent, such as a corticosteroid, is administered in a mammalian human at a dose of 0.1-2.0 mg/kg. In other embodiments, the additional therapeutic agent, such as a corticosteroid, is administered in a mammalian human at a dose of 0.1-1.0 mg/kg.

In some embodiments, a GVHD patient of the present disclosure is not one who has received or is currently receiving systemic therapy for GVHD, except for corticosteroid therapy within 72 hours.

In other embodiments, GVHD patients of the present disclosure are naive or not receiving systemic therapy for GVHD, except for corticosteroid therapy within 72 hours.

In certain embodiments, a patient with GVHD of the present disclosure is naive to systemic treatment for GVHD, or is treated with a corticosteroid within 72 hours.

On the other hand, the administration frequency of the compound of formula I or its pharmaceutically acceptable salt in the use of the present disclosure is once a day, twice a day, once every two days, once every three days, once every four days, once every five days, once every six days, Once a week, three days a week, once a day, four days a week, once a day, or five days a week, once a day.

In some embodiments, the dosage of the compound of formula I and its pharmaceutically acceptable salt in mammals is 2-50 mg, and the administration frequency is once a day.

In some embodiments, the dosage of the compound of formula I and its pharmaceutically acceptable salt is 2-50 mg in mammals and humans, and the administration frequency is twice a day.

In some embodiments, the dosage of the compound of formula I and its pharmaceutically acceptable salt in mammals is 4 mg, and the administration frequency is once a day.

In some embodiments, the dose of the compound of formula I and its pharmaceutically acceptable salt in mammals is 4 mg, and the administration frequency is twice a day.

Another aspect of the present disclosure also provides the use of a compound represented by formula I or a pharmaceutically acceptable salt thereof and a corticosteroid in the preparation of a medicament for treating or preventing graft-versus-host disease,

In some embodiments, the corticosteroid is selected from prednisone, methylprednisone, betamethasone, hydrocortisone, dexamethasone, or combinations thereof.

Another aspect of the present disclosure also provides a compound of formula I or a pharmaceutically acceptable salt thereof for treating or preventing graft-versus-host disease,

In some embodiments, a compound of Formula I, or a pharmaceutically acceptable salt thereof, is administered in combination with an additional therapeutic agent. In certain embodiments, the additional therapeutic agent is selected from a corticosteroid (including without limitation corticotropin, glucocorticoid, or mineralocorticoid), cyclosporine, mycophenolate mofetil, or combinations thereof .

Another aspect of the present disclosure also provides a method for treating or preventing graft-versus-host disease, which comprises administering an effective amount of a compound of formula I or a pharmaceutically acceptable salt thereof to a patient with graft-versus-host disease. In some embodiments, the dose of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is 2-50 mg.

In other embodiments, the method of treating or preventing graft-versus-host disease comprises administering to a patient with graft-versus-host disease an effective amount of a compound of formula I or a pharmaceutically acceptable salt thereof in combination with another therapeutic agent.

In certain embodiments, the additional therapeutic agent is a corticosteroid (including but not limited to prednisone, methylprednisone, hydrocortisone, dexamethasone, betamethasone, or beclomethasone dipropionate). In certain embodiments, the additional therapeutic agent is prednisone or methylprednisone.

In some embodiments, pharmaceutically acceptable salts of compounds of formula I of the present disclosure include, but are not limited to, bisulfate or sulfate salts.

The present disclosure also provides a pharmaceutical combination for treating graft-versus-host disease, which comprises a therapeutically effective amount of a compound of formula I or a pharmaceutically acceptable salt thereof. Further, the pharmaceutical combination also includes another therapeutic agent.

Unless otherwise explained, terms in this disclosure have the following meanings:

"Combination" or "joint use" or "combined administration" in the present disclosure refers to a mode of administration, which refers to the administration of at least one dose of a compound of formula I or a pharmaceutically acceptable salt thereof and at least one dose within a certain period of time. An additional therapeutic agent for which both substances exhibit pharmacological effects. The time period can be within one administration cycle, preferably within 4 weeks, within 3 weeks, within 2 weeks, within 1 week, or within 24 hours, more preferably within 12 hours. The compound of formula I, or a pharmaceutically acceptable salt thereof, and the additional therapeutic agent may be administered simultaneously or sequentially. This period includes treatments wherein the compound of formula I, or a pharmaceutically acceptable salt thereof, and the additional therapeutic agent are administered by the same route of administration or by different routes of administration. The administration mode of the combination described in the present application is selected from simultaneous administration, independent formulation and co-administration or independent formulation and sequential administration.

"Pharmaceutical composition" means a mixture containing one or more compounds described herein, or a physiologically acceptable salt or prodrug thereof, and other chemical components, as well as other components such as physiologically acceptable carriers and excipients. agent. The purpose of the pharmaceutical composition is to promote the administration to the organism, facilitate the absorption of the active ingredient and thus exert biological activity.

An "effective amount" or "therapeutically effective amount" as used in the present disclosure includes an amount sufficient to ameliorate or prevent a symptom or condition of a medical condition. An effective amount also means an amount sufficient to allow or facilitate diagnosis. Effective amounts for a particular patient or veterinary subject may vary depending on factors such as the condition being treated, the general health of the patient, the method, route and dosage of administration, and the severity of side effects. An effective amount may be the maximum dose or dosing regimen that avoids significant side effects or toxic effects.

Complete remission (CR): The symptoms of chronic GVHD disappear completely and last for more than 3 weeks.

Partial remission (PR): The measurable disease indicators in the affected organs of chronic GVHD are improved or improved by more than 50%, and there is no disease progression in any affected organ or part, and lasts for more than 3 weeks.

Ineffective treatment: the symptoms of chronic GVHD do not improve, the severity of any organ is aggravated by at least one level, chronic GVHD of a certain organ appears newly, and other drugs need to be added to treat chronic GVHD.

Treatment failure: refers to intolerable side effects, disease progression during treatment, no improvement or recurrence after treatment.

Detailed ways

The following examples are used to further describe the present disclosure, but these examples do not limit the scope of the present disclosure.

Example 1

The research population selected patients aged 18 to 70 who received allogeneic peripheral blood hematopoietic stem cell transplantation due to blood system diseases, and were diagnosed with moderate-severe chronic GVHD according to the 2014 chronic GVHD NIH grading criteria;

Chronic GVHD that has started hormone therapy for no more than 72 hours;

Patients may be receiving other immunosuppressants for the prevention or treatment of acute GVHD, but if the subject is receiving prednisone for the prevention or treatment of acute GVHD, it must be <0.5mg/kg/d or equivalent dose of other glucocorticoids;

And exclude any systemic treatment for cGVHD, except for corticosteroids for cGVHD within 72 hours before signing the informed consent.

Dosing regimen:

Drug A: (3aR,5s,6aS)-N-(3-methoxy-1,2,4-thiadiazol-5-yl)-5-(methyl(7H-pyrrolo[2,3- d]pyrimidin-4-yl)amino)hexahydrocyclopenta[c]pyrrole-2(1H)-carboxamide hydrogen sulfate, tablet (specification: 1mg/tablet, 2mg/tablet, 4mg/tablet) orally, continuous Take orally for at least 4 weeks; unless the disease progresses during treatment, the primary tumor relapses or cannot tolerate the treatment of drug A, the total course of treatment is not less than 6 months; the specific dosage regimen is as follows:

group	Dose/day
1	1mg/day
2	2mg/day
3	4mg/day
4	6mg/day
5	8mg/day

Drug B: prednisone, starting dose 1 mg/kg/day or equivalent dose of methylprednisolone orally once in the morning (maximum adult dose of prednisone 100 mg/day); oral prednisone 1 mg/kg/day if present Intolerance or inappropriate conditions, such as uncontrollable hyperglycemia, hypertension, aseptic necrosis, osteoporosis, severe emotional disorders, etc., the initial dose is 0.5mg/kg/day.

Conclusion: Based on evaluable patients, the overall effective rate (CR+PR) for 28 days of medication is 94.4% (17/18), of which the effective rate of 1mg/day dose group is 66.7%, 2mg/day, 4mg/day, 6mg/day, 8mg/day The /daily dose group was 100%; the overall effective rate (CR+PR) was 93.5% (15/16) after 24 weeks of medication. The effective rate (about 50%) is higher than the current first-line treatment (glucocorticoid combined with or without calmodulin inhibitor).

In terms of safety, the incidence of grade ≥3 drug A-related AEs in this study was 22.2%, including 16.7% decrease in platelet count and 5.6% anemia. The short-term drug safety was relatively high, and no new safety risks were added. Compared with similar drug ruxolitinib (the incidence of cGVHD ≥ grade 3 AE in the treatment of ruxolitinib was 57%, the most common ≥ grade 3 AE were thrombocytopenia 15.2% and anemia 12.7%), the hematological toxicity was lower. On the other hand, first-line standard therapy for cGVHD had a 56% incidence of grade ≥3 AEs and a 37% incidence of life-threatening/fatal infections.

Claims (15)

1. Use of the compound represented by formula I or a pharmaceutically acceptable salt thereof in the preparation of a medicament for the treatment or prevention of graft-versus-host disease,

   
2. The use according to claim 1, wherein the graft-versus-host disease is chronic graft-versus-host disease.
3. The use according to claim 1 or 2, wherein the graft-versus-host disease is moderate-severe graft-versus-host disease, preferably moderate-severe chronic graft-versus-host disease.
4. The use according to any one of claims 1-3, wherein the patient has received cell transplantation, and the cell transplantation is preferably allogeneic bone marrow or hematopoietic stem cell transplantation.
5. The use according to any one of claims 1-4, wherein the dosage of the compound of formula I or a pharmaceutically acceptable salt thereof in mammals is selected from 1-50 mg, preferably 2 mg, 4 mg, 6 mg or 10 mg.
6. The use according to any one of claims 1-5, wherein the compound of formula I or a pharmaceutically acceptable salt thereof is administered once a day or twice a day.
7. The use according to any one of claims 1-6, wherein the compound of formula I or a pharmaceutically acceptable salt thereof is administered in combination with one or more additional therapeutic agents.
8. The use according to claim 7, wherein the additional therapeutic agent is selected from corticosteroids, cyclosporine, mycophenolate mofetil or combinations thereof, preferably corticosteroids, more preferably prednisone or formazan base prednisone.
9. The use according to any one of claims 1-8, wherein the patient with graft-versus-host disease has not received or is receiving systemic treatment for graft-versus-host disease, unless receiving corticosteroid therapy within 72 hours .
10. The use according to any one of claims 1-8, wherein the patient with graft-versus-host disease has not received systemic treatment for graft-versus-host disease, or has received corticosteroid therapy for no more than 72 hours.
11. The use of a compound represented by formula I or a pharmaceutically acceptable salt thereof in combination with a corticosteroid in the preparation of a medicament for treating or preventing graft-versus-host disease,

    
12. The use according to claim 11, wherein the corticosteroid is selected from prednisone, methylprednisone, betamethasone, hydrocortisone, dexamethasone or a combination thereof.
13. The use according to claim 1 or 11, wherein the pharmaceutically acceptable salt of the compound shown in formula I is bisulfate or sulfate.
14. A compound of formula I or a pharmaceutically acceptable salt thereof for the treatment or prevention of graft-versus-host disease,

    
15. A compound of formula I, or a pharmaceutically acceptable salt thereof, according to claim 14, which is administered in combination with one or more additional therapeutic agents.