WO2023034467A2 - Cgrp antagonists for treating skin conditions - Google Patents
Cgrp antagonists for treating skin conditions Download PDFInfo
- Publication number
- WO2023034467A2 WO2023034467A2 PCT/US2022/042283 US2022042283W WO2023034467A2 WO 2023034467 A2 WO2023034467 A2 WO 2023034467A2 US 2022042283 W US2022042283 W US 2022042283W WO 2023034467 A2 WO2023034467 A2 WO 2023034467A2
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- oxo
- dihydro
- piperidine
- methyl
- indazol
- Prior art date
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- 229940127597 CGRP antagonist Drugs 0.000 title claims description 38
- 238000000034 method Methods 0.000 claims abstract description 167
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- 229940044551 receptor antagonist Drugs 0.000 claims abstract description 29
- 239000002464 receptor antagonist Substances 0.000 claims abstract description 29
- -1 azido, amino Chemical group 0.000 claims description 158
- 229910052739 hydrogen Inorganic materials 0.000 claims description 93
- 238000011282 treatment Methods 0.000 claims description 89
- 239000001257 hydrogen Substances 0.000 claims description 87
- 125000004435 hydrogen atom Chemical group [H]* 0.000 claims description 87
- 150000001875 compounds Chemical class 0.000 claims description 85
- 239000003735 calcitonin gene related peptide receptor antagonist Substances 0.000 claims description 65
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- 125000000623 heterocyclic group Chemical group 0.000 claims description 49
- 125000003545 alkoxy group Chemical group 0.000 claims description 48
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- RWTNPBWLLIMQHL-UHFFFAOYSA-N fexofenadine Chemical group C1=CC(C(C)(C(O)=O)C)=CC=C1C(O)CCCN1CCC(C(O)(C=2C=CC=CC=2)C=2C=CC=CC=2)CC1 RWTNPBWLLIMQHL-UHFFFAOYSA-N 0.000 claims description 8
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- 125000005073 adamantyl group Chemical group C12(CC3CC(CC(C1)C3)C2)* 0.000 claims description 7
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- OYMBDCCMCHDGNO-UHFFFAOYSA-N 4-(2-oxo-3h-benzimidazol-1-yl)piperidine-1-carboxylic acid Chemical compound C1CN(C(=O)O)CCC1N1C(=O)NC2=CC=CC=C21 OYMBDCCMCHDGNO-UHFFFAOYSA-N 0.000 claims description 6
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- 238000001990 intravenous administration Methods 0.000 claims description 6
- 125000004194 piperazin-1-yl group Chemical group [H]N1C([H])([H])C([H])([H])N(*)C([H])([H])C1([H])[H] 0.000 claims description 6
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- HTJRKEBSSHBANS-UHFFFAOYSA-N 4-(2-oxo-3h-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylic acid Chemical compound C1CN(C(=O)O)CCC1N1C(=O)NC2=NC=CC=C21 HTJRKEBSSHBANS-UHFFFAOYSA-N 0.000 claims description 4
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- IDBLZYJFOOVSBY-FKRCVWNDSA-N [(5s,6s,9r)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5h-cyclohepta[b]pyridin-9-yl] 4-(2-oxo-3h-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylate Chemical compound C1([C@H]2[C@@H](C3=CC=CN=C3[C@H](OC(=O)N3CCC(CC3)N3C(NC4=NC=CC=C43)=O)CC2)O)=CC=CC(F)=C1F IDBLZYJFOOVSBY-FKRCVWNDSA-N 0.000 claims description 4
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- ZZUFCTLCJUWOSV-UHFFFAOYSA-N furosemide Chemical compound C1=C(Cl)C(S(=O)(=O)N)=CC(C(O)=O)=C1NCC1=CC=CO1 ZZUFCTLCJUWOSV-UHFFFAOYSA-N 0.000 claims description 4
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Classifications
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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
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
- A61K31/445—Non condensed piperidines, e.g. piperocaine
- A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
- A61K31/4545—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring hetero atom, e.g. pipamperone, anabasine
-
- 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
- A61K31/517—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with carbocyclic ring systems, e.g. quinazoline, perimidine
-
- 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
- A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
- A61K31/537—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines spiro-condensed or forming part of bridged ring systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P17/00—Drugs for dermatological disorders
Definitions
- CGRP ANTAGONISTS FOR TREATING SKIN CONDITIONS CROSS-REFERENCE TO RELATED APPLICATION This application claims priority to United States Provisional patent application number 63/240,071, filed September 2, 2021, which is hereby incorporated by reference in its entirety.
- FIELD OF THE DISCLOSURE Provided for are methods of treating skin conditions with one or more calcitonin gene-related peptide (CGRP) receptor antagonists and/or pharmaceutical compositions thereof. Such methods are useful for treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of skin conditions in a mammalian subject, such as a human.
- CGRP receptor antagonists such as those according to Formula I, Formula II, and/or Formula III as described herein are useful in methods of treating skin conditions in a subject in need thereof.
- BACKGROUND OF THE DISCLOSURE Redness, rosacea, flushes, and erythema are examples of skin conditions or disorders characterized partly by a vasoactive component that results in aberrant subcutaneous vasodilation and chronic inflammation. Some symptoms may be temporary (transient) or sporadic while others may be long-term (nontransient). Rosacea may present in multiple forms, including erythematotelangiectatic, papulopustular, phymatous, and ocular.
- Erythematotelangiectatic rosacea is characterized by prolonged central facial flushing and persistent central facial erythema, with or without telangiectasia.
- the papulopustular variety is characterized by central facial erythema that is persistent and accompanied by facial papules or pustules.
- Phymatous rosacea develops slowly over time and results in thickened and irregular skin, often on the nose, chin, cheeks, or forehead.
- Ocular rosacea is characterized by several potential symptoms such as burning, stinging, and/or itching of the eye(s), blurred vision or photosensitivity, and telangiectasia of the sclera as well as periorbital edema.
- CGRP calcitonin gene-related peptide
- the peptide is widely distributed in both the peripheral (PNS) and central nervous system (CNS), principally localized in sensory afferent and central neurons, and displays a number of biological effects, including vasodilation.
- CGRP binds to specific cell surface G protein- coupled receptors and exerts its biological action predominantly by activation of intracellular adenylate cyclase (Poyner, D. R. et al, Br J Pharmacol 1992, 105, 441-7; Van Valen, F. et al, Neurosci Lett 1990, 119, 195-8.).
- CGRP1 and CGRP2 Two classes of CGRP receptors, CGRP1 and CGRP2, have been proposed based on the antagonist properties of the peptide fragment CGRP(8-37) and the ability of linear analogues of CGRP to activate CGRP2 receptors (Juaneda, C. et al. TiPS 2000, 21, 432-438). However, there is lack of molecular evidence for the CGRP2 receptor (Brain, S. D. et al, TiPS 2002, 23, 51- 53).
- the CGRP1 receptor has three components: (i) a 7 transmembrane calcitonin receptor-like receptor (CRLR); (ii) the single transmembrane receptor activity modifying protein type one (RAMP1); and (iii) the intracellular receptor component protein (RCP) (Evans B. N. et al., J Biol. Chem. 2000, 275, 31438-43).
- RAMP 1 is required for transport of CRLR to the plasma membrane and for ligand binding to the CGRP-receptor (McLatchie, L. M. et al, Nature 1998, 393, 333-339).
- RCP is required for signal transduction (Evans B. N. et al., J Biol.
- CGRP antagonists or inhibitors are also contemplated to be useful in subjective sensations of itching, pruritus, sensations of burning or heating, sensations of stinging, tingling, discomfort, tightness, and other such sensations having either a neurogenic component or a neurogenic origin. CGRP antagonists have shown efficacy in human clinical trials.
- CGRP receptor antagonists including small molecule CGRP-receptor antagonists, have been disclosed in PCT publications WO 97/09046, WO 98/09630, WO 98/1128, WO 98/56779, WO 00/18764, WO 00/55154, WO 01/32649, WO 01/49676, WO 01/032648, WO 2004/092166, WO 2004/092168, and WO 2007/120590. See also U.S. Pat. No.6,344,449, U.S. Pat. No.6,313,097, U.S. Pat. No.6,521,609, U.S. Pat.
- CGRP receptor antagonists have also been disclosed in US Pat. No.8,314,117, US Pat. No.8,759,372, US Pat. No.7,200,862, US Pat. No.8,481,546, and US Pat. No.9,808,457, each of which are incorporated by reference herein in their entirety.
- the disclosure provides technical advantages, for example, methods to treat, ameliorate, and/or prevent skin conditions including redness, rosacea, flushes, and/or erythema with compounds that inhibit CGRP.
- the methods and compounds provide advantages for pharmaceutical uses, for example, with regard to one or more of their mechanism of action, binding, inhibition efficacy, target selectivity, solubility, safety profiles, or bioavailability.
- SUMMARY OF THE DISCLOSURE The disclosure generally relates to methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of skin conditions, comprising administering to a subject in need thereof one or more CGRP receptor antagonists.
- the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III), or pharmaceutically acceptable salts or optical isomers thereof: wherein, in Formula (I), R1 is hydrogen, cyano, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl; R 2 is piperidinyl substituted with 1 substituent selected from the group consisting of: R 3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R 4 is hydrogen, halo, cyano, alkyl,
- the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III).
- the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III) via an oral administration route, an injection administration route, and/or a topical administration route.
- the disclosure provides for the use of one or more of a compound according to Formula (I), Formula (II), and/or Formula (III) in methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions.
- the disclosure provides for the use of a compound according to Formula (I), Formula (II), and/or Formula (III) in the manufacture of a medicament for the treatment of one or more skin conditions.
- the treatment includes treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of psoriasis.
- Redness, rosacea, flushes, and erythema may be triggered in part by exposure to extreme temperatures, strenuous exercise, heat from sunlight, sunburn, stress, anxiety, alcohol, caffeine, foods high in histamines, and spicy foods. Rosacea may be triggered by topical irritants or medications, including microdermabrasion, chemical peels, isotretinoin, benzoyl peroxide, tretinoin, and topical steroids. In some embodiments, methods of treating, ameliorating, and/or preventing redness, rosacea, flushes, and erythema with a CGRP receptor antagonist may improve a patient’s tolerance to these triggers or risk factors.
- methods of treating, ameliorating, and/or preventing redness, rosacea, flushes, and erythema or other skin conditions with a CGRP receptor antagonist further comprise avoiding or limiting triggers or risk factors.
- Another aspect of the disclosure relates to a method of treatment using combinations of any of Formula I, Formula II, or Formula III with one or more agents selected from ivermectin, azelaic acid, metronidazole, brimonidine, oxymetazoline, xylometazoline, doxycycline, tetracycline and isoretinoin.
- methods of treatment may also comprise limiting of exposure to sunlight, or laser therapy.
- a CGRP receptor antagonist may be used alone or in combination with any known treatment in order to treat, ameliorate, and/or prevent redness, rosacea, flushes, and erythema, other skin conditions, or symptoms associated therewith.
- Skin Conditions The skin conditions contemplated are any skin conditions that may benefit from administration of one or more CGRP receptor antagonists.
- the skin conditions are one or more of redness, rosacea, flushes, erythema, eczema (atopic dermatitis), other types of dermatitis, rashes, inflammation, UV damage/sunburn, polymorphous light eruptions, itch, neuropathic itch, ichthyosis, seborrheic dermatitis, verruca vulgaris, molluscum contagiosum, telangiectasias, malar rash, malar flush, purpura skin, papules, bullae, dry scaly desquamation, linear hyperpigmentation of nails or skin, skin hyperpigmentation, onychodystrophy, necrobiosis lipoidica diabeticorum, poorly healing ulcers, blotching, abnormal sweating, hypohidrosis, angiokeratoma, skin atrophy, hyperkeratosis, chronic ulceration, erythroderma, congenital ichthyosis, ichth
- CGRP Receptor Antagonists useful for the methods of the present invention may be small molecule (molecular weight ⁇ about 2 kDa, or ⁇ about 1 kDa) or a larger construct (molecular weight > about 2 kDa, or > 1 kDa) such as a peptide, biologic, antibody, etc.
- the present disclosure is drawn to methods of treating one or more skin conditions comprising administering to a mammalian or human subject one or more CGRP receptor antagonists.
- CGRP receptor antagonists may be described by various generic or specific chemical formulas.
- the general structure broadly describes a number of chemical structures in the alternative and it can be appreciated that each alternative structure is contemplated.
- Formula I a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (I): (1) where: R 1 is hydrogen, cyano, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl; R 2 is piperidinyl substituted with 1 substituent selected from the group consisting of:
- R 3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy
- R 4 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy
- R 5 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino
- R 6 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino
- R 7 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino
- R 8 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino
- R 9 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino
- the CGRP receptor antagonists described by general Formula I may be selected from any of the following specific formulas: (6R,9R)-6-(2,3-Difluorophenyl)-6-hydroxy-5-oxo-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (9R)-6-(2,3-difluorophenyl)-5-oxo-6,7,8,9-tetrahydro-5H-cyclohepta[b]p- yridin- 9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylate; (5S,6R,9R)-6-(2,3-difluorophenyl)-6-hydroxy
- the CGRP receptor antagonist may be Rimegepant, which has the formula (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro- 5H-cyclohepta[b]pyridine-9-yl-4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridine-1- yl)piperidine-1-carboxylate, and which has the following structure
- a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (II): or a pharmaceutically acceptable salt thereof, wherein V is —N(R 1 )(R 2 ) or OR 4 ; R 4 is H, C 1-6 alkyl, C 1-4 haloalkyl or (C 1-4 alkylene)0-1R 4′ R 4′ is C 3-7 cycloalkyl, phenyl, adamantyl, quinucidyl, azabicyclo[2.2.1]heptyl, azetidinyl, tetrahydrofuranyl, furanyl, dioxolanyl, thieny
- the CGRP receptor antagonists described by general Formula II may be selected from any of the following specific formulas: ( ⁇ )-3-(1H-Indazol-5-yl)-2- ⁇ [4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1- carbonyl]-amino ⁇ -propionic acid; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5 -ylmethyl)-2-oxo-ethyl]-amide; ( ⁇ )-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(
- the CGRP receptor antagonist may be Zavegepant, which has the formula (R)—N-(3-(7-methyl-1H-indazol-5-yl)-1-(4-(1-methylpiperidin- 4-yl)piperazin-1-yl)-1-oxopropan-2-yl)-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1- carboxamide, and which has the following structure or a pharmaceutically acceptable salt thereof.
- a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (III): or a salt thereof or an optical isomer thereof, wherein R 1 is H or Q-(C 1 -C 6 )alkyl; where Q is a bond, C(O) or C(O)O and where the (C 1 - C 6 )alkyl can be optionally substituted by N(C 1 -C 3 alkyl) 2 or CO2H; R 2 is H or forms a spirocyclic heterocyclic ring with R 3 ; R 3 forms a spirocyclic heterocyclic ring with R 2 or is a heterocyclic ring if R 2 is H; and R 4 is an optionally substituted aryl group which may be monocyclic or fused to a further ring
- the CGRP receptor antagonists described by general Formula III may be selected from any of the following specific formulas: N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-( ⁇ (2S)-1-oxo-3-(piperidin-4-yl)-1- [4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl ⁇ amino)propan-2-yl]-4-(2-- oxo-2,3-dihydro- 1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxamide; tert-butyl 4- ⁇ (2S)-2- ⁇ [(2R)-3-(7-methyl-1H-indazol-5-yl)-2-( ⁇ [[4-(2-oxo-1,2- dihydroquinolin-3-yl)piperidin-1-yl]carbonyl ⁇ amino)propanoy
- the CGRP receptor antagonist may be BHV-3100, which has the formula N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-( ⁇ (2S)-1-oxo-3- (piperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl ⁇ amino)propan-2-yl]-2'- oxo-1',2'-dihydro-1H-spiro[piperidine-4,4'-pyrido[2,3-d][1,3]oxazine]-1-carboxamide, and which has the following structure: or a pharmaceutically acceptable salt thereof.
- compositions and Methods of Treatment The compounds of Formula I, Formula II, and/or Formula III inhibit the CGRP receptor. As such, they are useful for treating conditions or disorders associated with aberrant CGRP levels or where modulating CGRP levels may have therapeutic benefit. Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula I with a pharmaceutically acceptable adjuvant, carrier, or diluent. Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula II with a pharmaceutically acceptable adjuvant, carrier, or diluent. Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula III with a pharmaceutically acceptable adjuvant, carrier, or diluent.
- compositions comprised of a therapeutically effective amount of one or more of a compound of Formula I, Formula II, and/or Formula III, or pharmaceutically acceptable salt(s) thereof, and a pharmaceutically acceptable carrier, further optionally containing conventional excipients.
- a therapeutically effective amount is the amount needed to provide a meaningful patient benefit as determined by practitioners in that art.
- Pharmaceutically acceptable carriers are those conventionally known carriers having acceptable safety profiles.
- Compositions encompass all common solid and liquid forms including capsules, tablets, losenges, and powders as well as liquid suspensions, syrups, elixers, and solutions. Solid compositions may by formed in timed or sustained released formulations.
- compositions are made using common formulation techniques and conventional excipients (such as binding and wetting agents) and vehicles (such as water and alcohols).
- the disclosure and methods encompass all conventional modes of administration including oral, parenteral, intranasal, sublingual, topical, and transdermal methods.
- the daily dose may be 0.01-100 mg/kg body weight daily.
- more compound is required orally and less parenterally.
- the specific dosing regime should be determined by a physician using sound medical judgement.
- the standard routes of administration described by the FDA are contemplated herein as shown in Table 1 below (FDA Routes of Administration; retrieved from www.fda.gov; content current as of 11/14/2017). Table 1: FDA Routes of Administration
- the route of administration may be oral, intranasal, inhalation, intravenous, topical, injectable and/or transdermal.
- excipients are used primarily to serve in delivering a safe, stable, and functional pharmaceutical, serving not only as part of the overall vehicle for delivery but also as a means for achieving effective absorption by the recipient of the active ingredient.
- An excipient may fill a role as simple and direct as being an inert filler, or an excipient as used herein may be part of a pH stabilizing system or coating.
- Pharmaceutical compositions may comprise one or more pharmaceutically acceptable carriers, excipients, or diluents.
- pharmaceutically acceptable refers to a substance that is acceptable for use in pharmaceutical applications from a toxicological perspective and does not adversely interact with the active ingredient. Accordingly, pharmaceutically acceptable carriers are those that are compatible with the other ingredients in the formulation and are biologically acceptable. Supplementary active ingredients can also be incorporated into the pharmaceutical compositions.
- Applicable solid carriers can include one or more substances which can also act as flavoring agents, lubricants, solubilizers, suspending agents, fillers, glidants, compression aids, binders or tablet-disintegrating agents, or encapsulating materials.
- Oral formulations containing a compound disclosed herein can comprise any conventionally used oral form, including tablets, capsules, buccal forms, troches, lozenges and oral liquids, suspensions or solutions.
- the carrier in powders, can be a finely divided solid, which is an admixture with a finely divided compound.
- a compound disclosed herein can be mixed with a carrier having the necessary compression properties in suitable proportions and compacted in the shape and size desired.
- the powders and tablets can contain up to 99% of the compound.
- Capsules can contain mixtures of one or more compound(s) disclosed herein with inert filler(s) and/or diluent(s) such as pharmaceutically acceptable starches (e.g., corn, potato or tapioca starch), sugars, artificial sweetening agents, powdered celluloses (e.g., crystalline and microcrystalline celluloses), flours, gelatins, gums, and the like.
- Useful tablet formulations can be made by conventional compression, wet granulation or dry granulation methods and utilize pharmaceutically acceptable diluents, binding agents, lubricants, disintegrants, surface modifying agents (including surfactants), suspending or stabilizing agents, including, but not limited to, magnesium stearate, stearic acid, sodium lauryl sulfate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, methyl cellulose, microcrystalline cellulose, sodium carboxymethyl cellulose, carboxymethylcellulose calcium, polyvinylpyrrolidine, alginic acid, acacia gum, xanthan gum, sodium citrate, complex silicates, calcium carbonate, glycine, sucrose, sorbitol, dicalcium phosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride, low melting waxes, ion exchange resins, benzyl alcohol, eucalyptol
- Surface modifying agents include nonionic and anionic surface modifying agents.
- Representative examples of surface modifying agents include, but are not limited to, poloxamer 188, benzalkonium chloride, calcium stearate, cetostearl alcohol, cetomacrogol emulsifying wax, sorbitan esters, colloidal silicon dioxide, phosphates, sodium dodecylsulfate, magnesium aluminum silicate, and triethanolamine.
- Oral formulations herein can utilize standard delay or time-release formulations to alter the absorption of the compound(s).
- the oral formulation can also consist of administering a compound disclosed herein in water or fruit juice, containing appropriate solubilizers or emulsifiers as needed.
- Liquid carriers can be used in preparing solutions for oral or parenteral administration (such as intravenous, intramuscular, or other injections), including suspensions, emulsions, syrups, elixirs, and additionally for inhaled delivery.
- a compound of the present teachings can be dissolved or suspended in a pharmaceutically acceptable liquid carrier such as water, an organic solvent, or a mixture of both, or pharmaceutically acceptable oils or fats.
- the liquid carrier can contain other suitable pharmaceutical additives such as solubilizers, emulsifiers, buffers, preservatives, sweeteners, flavoring agents, suspending agents, thickening agents, colors, viscosity regulators, stabilizers, and osmo-regulators.
- liquid carriers for oral and parenteral administration include, but are not limited to, water (particularly containing additives as described herein, e.g., cellulose derivatives such as a sodium carboxymethyl cellulose solution), alcohols (including monohydric alcohols and polyhydric alcohols, e.g., glycols) and their derivatives, and oils (e.g., fractionated coconut oil and arachis oil).
- the carrier can be an oily ester such as ethyl oleate and isopropyl myristate.
- Sterile liquid carriers are used in sterile liquid form compositions for parenteral administration.
- the liquid carrier for pressurized compositions can be halogenated hydrocarbon or other pharmaceutically acceptable propellants.
- Liquid pharmaceutical compositions which are sterile solutions or suspensions, can be utilized by, for example, intramuscular, intraperitoneal or subcutaneous injection. Sterile injectable solutions can also be administered intravenously.
- Compositions for oral administration can be in either liquid or solid form.
- the pharmaceutical composition is in unit dosage form, for example, as tablets, capsules, powders, solutions, suspensions, emulsions, granules, or suppositories.
- the pharmaceutical composition can be further sub- divided to contain appropriate quantities of the compound.
- the unit dosage forms can be packaged compositions, for example, packeted powders, vials, ampoules, prefilled syringes or sachets containing liquids.
- the unit dosage form can be a capsule or tablet itself, or it can be the appropriate number of any such compositions in package form.
- Such doses can be administered in any manner useful in directing the compound(s) to the recipient's bloodstream, including orally, via implants, parenterally (including intravenous, intraperitoneal and subcutaneous injections), rectally, vaginally, and transdermally.
- parenterally including intravenous, intraperitoneal and subcutaneous injections
- rectally rectally, vaginally, and transdermally.
- transdermally transdermally.
- an effective dosage can vary depending upon the particular compound utilized, the pharmaceutical composition formulated, the mode of administration, and severity of the condition being treated, as well as the various physical factors related to the individual being treated.
- a compound of the present teachings can be provided to a patient already suffering from a disease in an amount sufficient to cure or at least partially ameliorate the symptoms of the disease and its complications.
- the dosage to be used in the treatment of a specific individual typically must be subjectively determined by the attending physician.
- the variables involved include the specific condition and its state as well as the size, age and response pattern of the patient.
- the compounds of the present teachings can be formulated into a liquid composition, a solid composition, or an aerosol composition.
- the liquid composition can include, by way of illustration, one or more compounds of the present teachings dissolved, partially dissolved, or suspended in one or more pharmaceutically acceptable solvents and can be administered by, for example, a pump or a squeeze-actuated nebulized spray dispenser.
- the solvents can be, for example, isotonic saline or bacteriostatic water.
- the solid composition can be, by way of illustration, a powder preparation including one or more compounds of the present teachings intermixed with lactose or other inert powders that are acceptable for intrabronchial use, and can be administered by, for example, an aerosol dispenser or a device that breaks or punctures a capsule encasing the solid composition and delivers the solid composition for inhalation.
- the aerosol composition can include, by way of illustration, one or more compounds of the present teachings, propellants, surfactants, and co-solvents, and can be administered by, for example, a metered device.
- the propellants can be a chlorofluorocarbon (CFC), a hydrofluoroalkane (HFA), or other propellants that are physiologically and environmentally acceptable.
- compositions described herein can be administered parenterally or intraperitoneally.
- Solutions or suspensions of these compounds or a pharmaceutically acceptable salts, hydrates, or esters thereof can be prepared in water suitably mixed with a surfactant such as hydroxyl-propylcellulose.
- Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof in oils. Under ordinary conditions of storage and use, these preparations typically contain a preservative to inhibit the growth of microorganisms.
- the pharmaceutical forms suitable for injection can include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions.
- the form can sterile and its viscosity permits it to flow through a syringe.
- the form preferably is stable under the conditions of manufacture and storage and can be preserved against the contaminating action of microorganisms such as bacteria and fungi.
- the carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (e.g., glycerol, propylene glycol and liquid polyethylene glycol), suitable mixtures thereof, and vegetable oils.
- Compounds described herein can be administered transdermally, i.e., administered across the surface of the body and the inner linings of bodily passages including epithelial and mucosal tissues.
- Transdermal administration can be accomplished through the use of a transdermal patch containing a compound, such as a compound disclosed herein, and a carrier that can be inert to the compound, can be non-toxic to the skin, and can allow delivery of the compound for systemic absorption into the blood stream via the skin.
- the carrier can take any number of forms such as creams and ointments, pastes, gels, and occlusive devices.
- the creams and ointments can be viscous liquid or semisolid emulsions of either the oil-in-water or water-in-oil type.
- Pastes comprised of absorptive powders dispersed in petroleum or hydrophilic petroleum containing the compound can also be suitable.
- a variety of occlusive devices can be used to release the compound into the blood stream, such as a semi-permeable membrane covering a reservoir containing the compound with or without a carrier, or a matrix containing the compound. Other occlusive devices are known in the literature.
- Compounds described herein can be administered rectally or vaginally in the form of a conventional suppository.
- Suppository formulations can be made from traditional materials, including cocoa butter, with or without the addition of waxes to alter the suppository's melting point, and glycerin.
- Water-soluble suppository bases such as polyethylene glycols of various molecular weights, can also be used.
- Lipid formulations or nanocapsules can be used to introduce compounds of the present teachings into host cells either in vitro or in vivo. Lipid formulations and nanocapsules can be prepared by methods known in the art. Inhibitors at the receptor level to CGRP are postulated to be useful in pathophysiologic conditions where excessive CGRP receptor activation has occurred. Such excessive CGRP receptor activation occurs in skin conditions.
- Another aspect of the disclosure is a method of inhibiting the CGRP receptor comprising contacting the CGRP receptor with a compound of formula I, formula II, formula III, or a pharmaceutically acceptable salt(s) thereof.
- Another aspect of the disclosure is a method for treating conditions associated with aberrant levels of CGRP comprising the administration of a therapeutically effective amount of a compound of formula I, formula II, and/or formula III to a patient.
- Another aspect of the disclosure is the use of a compound of formula I, formula II, and/or formula III in the manufacture of a medicament for the treatment of conditions related to aberrant levels of CGRP, such as skin conditions including those exemplified herein.
- Another aspect of the disclosure is a compound according to formula I, formula II, and/or formula III useful for the treatment of conditions related to aberrant levels of CGRP, such as skin conditions including those exemplified herein.
- Another aspect of the disclosure is a method of treating one or more skin conditions.
- Another aspect of the disclosure relates to a method of treating inflammation (particularly neurogenic inflammation), pain, and other conditions or symptoms related to one or more skin conditions, the treatment of which can be effected by the antagonism of the CGRP receptor by the administration of pharmaceutical compositions comprising one or more compounds of Formula I, Formula II, and/or Formula III as defined herein.
- Another aspect of the disclosure relates to a method of treatment using combinations of one or more of Formulas I, Formula II, and/or Formula III with one or more therapeutic agents selected from corticosteroids, calcipotriol, anthralin, coal tar, biologics, monoclonal antibodies, secukinumab, brodalumab, guselkumab, certolizumab, usetkinumab, ciclosporin, methotrexate, retinoids, vitamin D, fumaric acid esters paricalcitol, dithranol, desoximetasone, and fluocinonide.
- Methods of treatment may also comprise combinations with moisturizers and emollients such as mineral oil, petroleum jelly, and decubal.
- Methods of treatment may also comprise PUVA and/or UVB phototherapy treatments. Methods of treatment may also comprise systemic agents such as methotrexate, ciclosporin, hydroxycarbamide, vitamin A, fumarates such as dimethyl fumarate, and retinoids. It can be appreciated that a CGRP receptor antagonist may be used alone or in combination with any known treatment in order to treat, ameliorate, and/or prevent skin conditions or symptoms associated therewith. In some embodiments, a method of treating one or more skin conditions with a CGRP receptor antagonist may further comprise an analysis of genetic susceptibility or risk. In some embodiments, a susceptibility or risk analysis may also include hereditary factors.
- a genetic or hereditary analysis may inform dosing with a CGRP receptor antagonist. In some embodiments, a genetic or hereditary analysis may inform prophylaxis in patients with no symptoms or limited symptoms.
- Pharmacokinetics and Dosing a method of treating one or more skin conditions may be characterized by one or more pharmacokinetic parameters such as AUC, C max , Tmax, and others known and understood to persons of skill in the art.
- the term “pharmacokinetic” (PK) as used herein is used in its ordinary sense to mean the pharmacokinetic aspects of drug delivery. By definition pharmacokinetics (PK) is the study of how an organism affect a drug, e.g. how and how fast it metabolizes the drug.
- the pharmacokinetics typically vary based upon the dosage amount of one or more of Formula I, Formula II, and/or Formula III
- the pharmacokinetics may or may not vary as a function of administration route.
- a method of treating one or more skin conditions may be characterized by an AUC for a compound according to Formula I, Formula II, and/or Formula III.
- the AUC 0-t and/or AUC 0-inf may be from about 80 – 125% of a given AUC value.
- the AUC may be within 80 – 125 % of about 25, 50, 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 hr*ng/mL.
- a systemic treatment may have a larger AUC than a localized (such as topical or subdermal) treatment.
- a method of treating one or more skin conditions may be characterized by a Cmax for a compound according to Formula I, Formula II, and/or Formula III.
- the Cmax may be from about 80 – 125% of a given C max value. In some embodiments, the C max may be within 80 – 125 % of about 1, 2, 3, 4, 5, 8, 10, 20, 35, 50, 80,100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 ng/mL. In some embodiments, a systemic treatment may have a larger C max than a localized (such as topical or subdermal) treatment.
- a localized (such as topical or subdermal) treatment such as topical or subdermal
- a ratio Cmax/AUC may be used to characterize a method of treating one or more skin conditions wherein one or more of a compound according to Formula I, Formula II, and/or Formula III are administered to a subject.
- the Cmax/AUC ratio may be from about 80 – 125 % of a given Cmax/AUC ratio.
- the Cmax/AUC ratio may be from about 80 – 125 % of about 0.01, 0.03, 0.05, 0.08, 0.1, 0.13, 0.17, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.6, 0.7, 0.8, and 0.9.
- the Tmax may range from about 0.1 – 16 hours, or from about 0.3 – 8 hours, or from about 0.5 – 4 hours, or from 0.5 – 2 hours, or from about 1 – 2 hours.
- the route of administration which may be any route described herein or known to a person of skill in the art, may affect the Tmax of a compound according to Formula I, Formula II, and/or Formula III.
- Excipients or other pharmaceutically acceptable carriers in pharmaceutical compositions of one or more compounds according to Formula I, Formula II, and/or Formula III may alter the Tmax value by making it larger or smaller than a pharmaceutical composition having the excipient or carrier excluded.
- Solid compositions are normally formulated in dosage units providing from about 0.1 to about 1000 mg of the active ingredient per dose. Some examples of solid dosage units are 0.1 mg, 1 mg, 10 mg, 100 mg, 500 mg, and 1000 mg. Liquid compositions are generally in a unit dosage range of 0.1-100 mg/mL. Some examples of liquid dosage units are 0.1 mg/mL, 1 mg/mL, 10 mg/mL, 25 mg/mL, 50 mg/mL, and 100 mg/mL. In some embodiments, a dose is daily. In some embodiments, a dose is twice daily. In some embodiments, a does is one, two, three, four, or five times daily..
- a dose is once every other day, once every second day, once every third day, once every fourth day, once every fifth day, once every sixth day, weekly, bi-weekly, or monthly.
- a dose may be from 0.01-100 mg/kg body weight, or from .05 – 50 mg/kg body weight, or from 0.1 – 10 mg/kg body weight, or from 0.15 – 5 mg/kg body weight, or from 0.2 – 2 mg/kg body weight, or from 0.5 – 1.5 mg/kg body weight, or from 1 – 1.5 mg/kg body weight.
- the dosing regimen may comprise one or more optional loading doses and a subsequent maintenance dose regimen.
- a loading dose may be larger than the doses given in a subsequent maintenance dose regimen.
- the dosage is adjusted based upon symptoms of one or more skin conditions observed in the patient.
- a symptom-dependent regimen may have a larger treatment dose while symptoms are present and a smaller preventative dose while symptoms are lessened, in remission, controlled, etc.
- a treatment dose may comprise a unit dosage of about 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 75 mg, 80 mg, 100 mg, 120 mg, 140 mg, 160 mg, 180 mg, or 200 mg of a CGRP receptor antagonist compound according to one or more of Formula I, Formula II, and/or Formula III.
- a preventative dose may comprise a unit dosage of about 1 mg, 2 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 75 mg, 80 mg, 100 mg, 120 mg, or 140 mg of a CGRP receptor antagonist compound according to one or more of Formula I, Formula II, and/or Formula III.
- the preventative dose is an amount that is about 7/8, 3/4, 5/8, 1/2, 3/8, 1/4, or about 1/8 of the amount of the treatment dose.
- a treatment dosing regimen may replace the preventative dosing regimen until symptoms have lessened or subsided.
- CGRP Receptor Antagonist generally may refer to any small molecule antagonist of the CGRP receptor that is useful for treating, ameliorating, and/or preventing a disease or indication.
- a CGRP receptor antagonist may be given as a pharmaceutical composition.
- one or more CGRP receptor antagonists may be included in a pharmaceutical composition.
- treating and its derivatives such as “treat” or “treatment,” as used herein, may be used with respect to a particular condition, for example, a condition due to or associated with CGRP and/or abberant levels thereof, such as one or more skin conditions.
- treating and its derivatives are inclusive of several meanings, including (1) to alleviate one or more symptoms, effects, or side effects associated with the condition, (2) to ameliorate the condition and/or one or more of the biological manifestations or underlying causes of the condition, (3) to interfere with one or more of the biological manifestations or underlying causes of the condition or with one or more points in the biological cascade(s) associated with the condition, (4) to slow the progression of, or arrest the development of, the condition or of one or more of the biological manifestations of the condition, (5) to prevent or reduce the risk of a subject developing the condition, in some cases prophylactically when the subject has one or more risk factors for the condition (6) to cause regression of the condition, or improvement or reversal of, the biological manifestations or underlying causes of the conditions.
- Treating may encompass one or more of these meanings simultaneously and that a subject’s condition may change over time or throughout the course of treatment such that the meaning of “treating” as applied to a given subject may change over time or throughout the course of treatment.
- Treating as used herein may also refer to any beneficial effect of administering a CGRP receptor antagonist compound and/or a pharmaceutical composition comprising a CGRP receptor antagonist to a subject or patient having or being at risk for developing one or more skin conditions.
- Treating therefore may encompass alleviating one or more skin conditions and/or the symptoms of one or more skin conditions, prophylaxis or prevention of one or more skin conditions or of the worsening of one or more skin conditions, and reducing the risk that a subject or patient may develop new or worsening skin conditions. “Treatment” may be in combination with other therapies or alone.
- the term “AUC” (area under the curve) typically refers to a total amount of drug absorbed or exposed to a subject. Generally , AUC may be obtained from mathematical method in a plot of drug concentration in the subject over time until the concentration is negligible . The term “ AUC ” may also refer to partial AUC at specified time intervals.
- the AUC may be determined within a certain time period (such as from time 0 to time t; AUC0-t) or may be extrapolated from the last measured point to the point where drug concentration in the subject is zero (AUCinf).
- C max refers to a maximum concentration of a drug in blood , serum , a specified compartment or test area of a subject after administration of a dose or between administration of a first dose and administration of a second dose.
- the term Cmax could also refer to dose normalized ratios, if specified.
- T max refers to a time or period after administration of a drug when the maximum concentration (Cmax) is reached in blood, serum, a specified compartment or test area of a subject.
- Dosing interval refers to the amount of time that elapses between multiple doses of a formulation disclosed herein being administered to a subject. Dosing interval can thus be indicated as ranges.
- Dosing frequency refers to the frequency of administering doses of a formulation disclosed herein in a given time. Dosing frequency can be indicated as the number of doses per a given time, e.g., once a day (daily), twice a day (twice daily), once a week (weekly) or once in two weeks, etc.
- the term “excipient” and “carrier” are used interchangeably throughout the disclosure and said terms are defined herein as, “ingredients which are used in the practice of formulating a safe and effective pharmaceutical composition.” Examples The following examples further describe and demonstrate embodiments within the scope of the present disclosure. The Examples are given solely for purpose of illustration and are not to be construed as limitations of the present disclosure, as many variations thereof are possible without departing from the spirit and scope of the disclosure.
- Example 1 – Oral Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an oral treatment for one or more skin conditions.
- Such oral treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions.
- the oral pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate oral dosage form, including but not limited to as pills, tablets including oral disintegrating tablets, or capsules.
- the pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art.
- the oral pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein.
- a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower.
- the dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein. It is expected that such oral therapies can treat one or more skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure.
- Example 2 – Topical Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as a topical treatment for one or more skin conditions.
- topical treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of such skin conditions.
- the topical pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as lotions, creams, ointments, foams, patches, pastes, gels, suspensions, and solutions.
- the pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art.
- the topical pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein.
- the patients can be monitored for improvement of symptoms associated with the one or more skin conditions.
- treatment may continue beyond the treatment of the skin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence.
- Subgroups of patients having a history of skin conditions and related symptom flares but no current or currently limited symptoms can be treated prophylactically with the expectation that further symptom flares can be reduced or avoided.
- a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower.
- the dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein.
- topical pharmaceutical compositions can be applied directly onto, or adjacent to affected skin areas for treatment of active symptoms having visible and/or actively symptomatic area(s) on the skin.
- topical pharmaceutical compositions can be applied as a preventative to regions of the skin having prior symptoms of one or more skin conditions.
- Example 3 Injectable Pharmaceutical Compositions for Treating Skin Conditions
- the CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an injectable treatment for one or more skin conditions.
- injectable treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions.
- the injectable pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as sterile solutions, suspensions, dispersions, or emulsions.
- the pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art.
- the injectable pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with the one or more skin conditions.
- treatment may continue beyond the treatment of one or more skin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence.
- a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower.
- injectable pharmaceutical compositions can be injected intravenously, intramuscularly, subcutaneously, or via any other appropriate route for a systemic treatment of one or more skin conditions.
- injectable pharmaceutical compositions can be injected locally at or adjacent to an affected skin area or region at risk for development of symptoms. It is expected that such injectable therapies can treat skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure.
- Example 4 Intranasal Pharmaceutical Compositions for Treating Skin Conditions
- the CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an intranasal treatment for one or more skin conditions.
- Intranasal pharmaceutical compositions are described generally in WO 2021/112707A1 published June 24, 2021, which is incorporated by reference in its entirety herein.
- Such intranasal treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions.
- the intranasal pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as sterile solutions, saline solutions, isotonic solutions, buffered solutions, suspensions, dispersions, and emulsions.
- the pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art.
- the intranasal pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with one or more skin conditions.
- treatment may continue beyond the treatment of one or more kin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence.
- a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower.
- Example 5 Combination Treatments for Treating Skin Conditions
- Some patients having active symptoms of one or more skin conditions can be treated in a study with one or more of an oral, topical, intranasal and/or injectable pharmaceutical composition according to Examples 1 – 4 simultaneously, alternatively, or initially via one route initially in a first treatment phase followed by a second route in a second treatment phase.
- a local topical treatment can be applied in a first treatment phase followed by an oral, intranasal, or injectable systemic treatment in a second treatment phase following the first.
- the local topical treatment i.e. the first treatment phase
- the systemic oral, intranasal, or injectable treatment i.e. the second treatment phase
- systemic oral, intranasal, or injectable treatment can be applied in a first treatment phase followed by a topical local treatment in a second treatment phase following the first.
- the systemic oral, intranasal, or injectable, i.e. the first treatment phase can be applied for a set period of time or until a change or improvement of symptoms is observed, after which a second treatment phase can be applied.
- the local topical treatment, i.e. the second treatment phase would then be applied either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares.
- systemic oral, intranasal, or injectable treatment can be applied concurrently with a topical local treatment.
- some patients can discontinue the local topical treatment and continue receiving the systemic oral, intranasal, or injectable treatment either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares.
- some patients can discontinue the oral, intranasal, or injectable systemic treatment and continue receiving the local topical treatment either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares.
- combination therapies can treat one or more skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment for one or more skin conditions using the compounds, compositions, and methods of the present disclosure.
Abstract
Provided for are methods of treating skin conditions with one or more CGRP receptor antagonists and/or pharmaceutical compositions thereof. Such methods are useful for treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions in a mammalian subject, such as a human. In particular, CGRP receptor antagonists such as those according to Formula I, Formula II, and/or Formula III as described herein are useful in methods of treating skin conditions in a subject in need thereof.
Description
CGRP ANTAGONISTS FOR TREATING SKIN CONDITIONS CROSS-REFERENCE TO RELATED APPLICATION This application claims priority to United States Provisional patent application number 63/240,071, filed September 2, 2021, which is hereby incorporated by reference in its entirety. FIELD OF THE DISCLOSURE Provided for are methods of treating skin conditions with one or more calcitonin gene-related peptide (CGRP) receptor antagonists and/or pharmaceutical compositions thereof. Such methods are useful for treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of skin conditions in a mammalian subject, such as a human. In particular, CGRP receptor antagonists such as those according to Formula I, Formula II, and/or Formula III as described herein are useful in methods of treating skin conditions in a subject in need thereof. BACKGROUND OF THE DISCLOSURE Redness, rosacea, flushes, and erythema are examples of skin conditions or disorders characterized partly by a vasoactive component that results in aberrant subcutaneous vasodilation and chronic inflammation. Some symptoms may be temporary (transient) or sporadic while others may be long-term (nontransient). Rosacea may present in multiple forms, including erythematotelangiectatic, papulopustular, phymatous, and ocular. Erythematotelangiectatic rosacea is characterized by prolonged central facial flushing and persistent central facial erythema, with or without telangiectasia. The papulopustular variety is characterized by central facial erythema that is persistent and accompanied by facial papules or pustules. Phymatous rosacea develops slowly over time and results in thickened and irregular skin, often on the nose, chin, cheeks, or forehead. Ocular rosacea is characterized by several potential symptoms such as burning, stinging, and/or itching of the eye(s), blurred vision or photosensitivity, and telangiectasia of the sclera as well as periorbital edema.
The subcutaneous vasodilation associated with redness, rosacea, flushes, erythema, and other skin conditions is thought to involve a neurogenic component involving overexpression of neuropeptides such as calcitonin gene-related peptide (CGRP). CGRP is a naturally occurring 37-amino-acid peptide first identified in 1982 (Amara, S. G. et al, Science 1982, 298, 240-244). Two forms of the peptide are expressed (αCGRP and βCGRP) which differ by one and three amino acids in rats and humans, respectively. The peptide is widely distributed in both the peripheral (PNS) and central nervous system (CNS), principally localized in sensory afferent and central neurons, and displays a number of biological effects, including vasodilation. When released from the cell, CGRP binds to specific cell surface G protein- coupled receptors and exerts its biological action predominantly by activation of intracellular adenylate cyclase (Poyner, D. R. et al, Br J Pharmacol 1992, 105, 441-7; Van Valen, F. et al, Neurosci Lett 1990, 119, 195-8.). Two classes of CGRP receptors, CGRP1 and CGRP2, have been proposed based on the antagonist properties of the peptide fragment CGRP(8-37) and the ability of linear analogues of CGRP to activate CGRP2 receptors (Juaneda, C. et al. TiPS 2000, 21, 432-438). However, there is lack of molecular evidence for the CGRP2 receptor (Brain, S. D. et al, TiPS 2002, 23, 51- 53). The CGRP1 receptor has three components: (i) a 7 transmembrane calcitonin receptor-like receptor (CRLR); (ii) the single transmembrane receptor activity modifying protein type one (RAMP1); and (iii) the intracellular receptor component protein (RCP) (Evans B. N. et al., J Biol. Chem. 2000, 275, 31438-43). RAMP 1 is required for transport of CRLR to the plasma membrane and for ligand binding to the CGRP-receptor (McLatchie, L. M. et al, Nature 1998, 393, 333-339). RCP is required for signal transduction (Evans B. N. et al., J Biol. Chem.2000, 275, 31438-43). There are known species-specific differences in binding of small molecule antagonists to the CGRP-receptor with typically greater affinity seen for antagonism of the human receptor than for other species (Brain, S. D. et al, TiPS 2002, 23, 51-53). The amino acid sequence of RAMP1 determines the species selectivity, in particular, the amino acid residue Trp74 is responsible for the phenotype of the human receptor (Mallee et al. J Biol Chem 2002, 277, 14294-8). Inhibitors at the receptor level to CGRP are herein postulated to be useful in pathophysiologic conditions where excessive CGRP receptor activation has occurred. Some of these include neurogenic vasodilation, neurogenic inflammation, migraine,
cluster headache and other headaches, thermal injury, circulatory shock, and asthma, as well as various skin conditions having a neurogenic component including psoriasis, redness, rosatia, discrete erythema, flushing, menopausal flushing, rash, and hyperseborrhoea. CGRP antagonists or inhibitors are also contemplated to be useful in subjective sensations of itching, pruritus, sensations of burning or heating, sensations of stinging, tingling, discomfort, tightness, and other such sensations having either a neurogenic component or a neurogenic origin. CGRP antagonists have shown efficacy in human clinical trials. See Davis C D, Xu C. Curr Top Med. Chem.20088(16):1468-79; Benemei S, Nicoletti P, Capone J G, Geppetti P. Curr Opin Pharmacol.20099(1):9-14. Epub 2009 Jan. 20; Ho T W, Ferrari M D, Dodick D W, Galet V, Kost J, Fan X, Leibensperger H, Froman S, Assaid C, Lines C, Koppen H, Winner P K. Lancet.2008372:2115. Epub 2008 Nov.25; Ho T W, Mannix L K, Fan X, Assaid C, Furtek C, Jones C J, Lines C R, Rapoport A M; Neurology 200870:1304. Epub 2007 Oct.3. CGRP receptor antagonists, including small molecule CGRP-receptor antagonists, have been disclosed in PCT publications WO 97/09046, WO 98/09630, WO 98/1128, WO 98/56779, WO 00/18764, WO 00/55154, WO 01/32649, WO 01/49676, WO 01/032648, WO 2004/092166, WO 2004/092168, and WO 2007/120590. See also U.S. Pat. No.6,344,449, U.S. Pat. No.6,313,097, U.S. Pat. No.6,521,609, U.S. Pat. No.6,552,043, US 20030181462, US 20030191068 and WO 03/076432 and related applications. CGRP receptor antagonists have also been disclosed in US Pat. No.8,314,117, US Pat. No.8,759,372, US Pat. No.7,200,862, US Pat. No.8,481,546, and US Pat. No.9,808,457, each of which are incorporated by reference herein in their entirety. The disclosure provides technical advantages, for example, methods to treat, ameliorate, and/or prevent skin conditions including redness, rosacea, flushes, and/or erythema with compounds that inhibit CGRP. Additionally, the methods and compounds provide advantages for pharmaceutical uses, for example, with regard to one or more of their mechanism of action, binding, inhibition efficacy, target selectivity, solubility, safety profiles, or bioavailability. SUMMARY OF THE DISCLOSURE
The disclosure generally relates to methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of skin conditions, comprising administering to a subject in need thereof one or more CGRP receptor antagonists. In an embodiment, the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III), or pharmaceutically acceptable salts or optical isomers thereof:
wherein, in Formula (I), R1 is hydrogen, cyano, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl;
R2 is piperidinyl substituted with 1 substituent selected from the group consisting of:
R3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R4 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R5 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino;
R6 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R7 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R8 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R9 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R10 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R11 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, dialkylamino, alkoxycarbonyl, or benzyloxycarbonyl; or R10 and R11 taken together is O or N—OH; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl substituted with 0-3 substituents selected from the group consisting of cyano, halo, alkyl, haloalkyl, alkoxy, haloalkoxy, and alkylSO2; X is O, CH2, or NH; and Y is a bond, O, CH2, or NH; wherein, in Formula (II), V is —N(R1)(R2) or OR4; R4 is H, C1-6alkyl, C1-4haloalkyl or (C1-4alkylene)0-1R4′ R4′ is C3-7cycloalkyl, phenyl, adamantyl, quinucidyl, azabicyclo[2.2.1]heptyl, azetidinyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino or dioxolanyl; and R4′ is optionally substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1-4alkyl, C1-4haloalkyl, C1- 4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1-3dialkylamino, (C1- 3alkyl)0-2ureido, phenyl and benzyl; and
R4′ optionally contains 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the ring structure of R4′; R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1-6alkyl, C2-6alkenyl, C2-6alkynyl, —C1-6alkylene-amino (C1- 3alkyl)2, C3-7cycloalkyl, phenyl, azetidinyl, adamantyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino and dioxolmnyl; and R1 and R2 are each optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1-4alkyl, C1-4haloalkyl, C1-4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1-4dialkylamino, (C1-3alkyl)0-2ureido, phenyl and benzyl; R1 and R2 optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising R1 and R2; wherein L1 is optionally and independently interrupted from the nitrogen to which it is attached by L2, wherein L2 is independently C1-3alkylene or C1- 3alkylidene; or R1 and R2 together with the nitrogen to which they are attached form X, wherein X is azetidinyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolizyl, imidazolidinyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, piperazinyl, piperidinyl, morpholino or thiomorpholino; wherein X is optionally substituted with Y, wherein Y is dioxolanyl, C1-9alkyl, C2-9alkenyl, C2-9alkynyl, C1-4alkylamino, C1-4dialkylamino, C1-4alkoxy, C3- 7cycloalkyl, phenyl, azetidinyl, furanyl, thienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, pyrrolidinonyl, imidazolyl, imidazolinyl, imidazolidinyl, imidazolidinonyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, pyridyl, pyrimidinyl, dihaydrobenzimidazolonyl, piperazinyl, piperidinyl, morpholino, benzothiazolyl, benzisothiazolyl or thiomorpholino;
and wherein X and Y are optionally interrupted with Z, wherein Z is— NHC(O)O—, —NHC(O)NH—, NC(Q)NH2,—NH—, —C1-3alkylene—, C1- 3alkenylene-NHC(O)O—C1-3alkylene-; and optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of C1-4alkyl, amino, C1- 3alkylamino, —C1-3alkylene-amiao(C1-3alkyl)2, (C1-3alkyl)0-2ureido, phenyl and benzyl; X and Y optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising X and Y; provided that if X is substituted with Y, and if X and Y are not interrupted with Z, then X and Y optionally share one carbon atom and together form a spirocyclic moiety; Q is Q′ or Q″; wherein Q′ is (Sy)SR3; and Q″ is NH(Sy)SR3, NHC(O)(Sy)SR3, NHC(O)O(Sy)SR3, NHC(O)NH(Sy) sR3, O(Sy)SR3, (Sy)3NHR3, (Sy)SNHC(O)R3,(Sy)SNHC(O)OR3, (Sy)SNHC(O)NHR3; or (Sy)SOR3; wherein Sy is C1-3alkylene or C1-3alkylidene and a is 0 or 1; U is CH2 or NH; provided that if Q is Q″, then U is CH2; R3 is R3a or R3b wherein R3a is (i) a heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to five of the same or different beteroatoms selected from the group consisting of O, N and S, and said heterocycle optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused rings;
(ii) a 4 to 6 membered heterocycle containing one to three of the same or different heteroatoms selected from the group consisting of O, N and S, optionally containing 1 to 2 carbonyls, wherein the carbon atom of said carbonyl is a member of said 4 to 6 membered heterocycle; (iii) C3-7cycloalkyl; (iv) carbazolyl, fluorenyl, phenyl, —O-phenyl, —O—C1-4alklylene-phenyl, or napthyl; or (v) C1-8alkyl, C2-7alkenyl, —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′,— C(O)O—R3′or C2-7alkynyl; and wherein R3a is optionally substituted with 1 to 3 of the same or different substituents selected from the group consisting of benzyl, phenyl, —O-phenyl, — O—C1-3alkylenephenyl, —C1-3alkylene-O—C(O)-phenyl, cyano, amino, nitro, halo, C1-6alkyl, C1-3mono-bi-tri-haloalkyl, C1-3mono-bi-tri-haloalkyloxy, (C1-3alkyl)1- 2amine, —OR3′, —C(O)R3′, —C(O)O—R3′, —O—C(O)R3′, —N(R3′)2, — C(O)N(R3′)2, —N(R3′)C(O)(R3′)2, —N(R3′)C(O)N(R3′)2, —N(R3′)C(O)OR3′, —O— C(O)N(R3′)2, —N(R3′)SO2R3′, —SO2N(R3′)2 and —SO2R3′; R3′is H or —C1-6alkyl; provided that if R3a is , —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or — C(O)O—R3′, then said —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or — C(O)O—R3′are unsubstituted; R3b is R3a but is not phenyl, 1-naphthyl, 2-naphthyl, 1,2,3,4-tetrahydro-1- naphthyl, 1H-indol-3-yl, 1-methyl-1H-indol-3-yl, 1-formyl-1H-indol-3-yi, 1 -(1,1- dirnethylethoxycarbonyl)- 1H-indol-3-yl, 4-imidazolyl, 1-methyl-4-imidazolyl, 2- thienyl, 3-thienyl, thiazolyl, 1H-indazol-3-yl, 1-methyl-1H-indazol-3-yl, benzo[b]fur- 3-yl, benzo[b]thien-3-yl, pyridinyl, quinolinyl or isoquinolinyl; optionally substituted in the carbon skeleton with mono-, di- or trisubstituted by fluorine, chlorine or bromine atoms or by branched or unbranched alkyl groups, C3-8-cycloalkyl groups, phenylalkyl groups, alkenyl, alkoxy, phenyl, phenylalkoxy, trifluoromethyl, alkoxycoarbonylalkyl, carboxyalkyl, alkoxycarbonyl, carboxy, dialkylaminoalkyl, dialkylaminoalkoxy, hydroxy, nitro, amino, acetylamino, propionylamino, benzoyl, benzoylamino, benzoylmethylamino, methylsulphonyloxy, aminocarbonyl, alkylaminocarbonyl, dialkylaminocarbonyl, alkanoyl, cyano, tetrazolyl, phenyl,
pyridinyl, thiazolyl, furyl, trifluoromethoxy, trifluoromethylthio, trifluoromethylsulphinyl- or trifluoromethylsulphonyl groups; wherein said substituents may be the same or different and the above- mentioned benzoyl, benzoylaznino- and benzoylmnethylamino groups may in turn additionally be substituted in the phenyl moiety by a fluorine, chlorine or bromine atom, or by an alkyl, trifluoromethyl, amino or acetylamino group; D is O, NCN or NSO2C1-3alkyl; A is CH; m and n are each 1; E is N, CE or C; p is 1; G, J and E together form Ax; Ax is a fused heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to four of the same or different heteroatoms selected from the group consisting of O, N and S; and optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused heterocycle; and further provided that if Q is Q″, then R3 is R3a; and if Q is Q′, then R3 is R3b; and wherein, in Formula (III), R1 is H or Q-(C1-C6)alkyl; where Q is a bond, C(O) or C(O)O and where the (C1-C6)alkyl can be optionally substituted by N(C1-C3alkyl)2 or CO2H; R2 is H or forms a spirocyclic heterocyclic ring with R3; R3 forms a spirocyclic heterocyclic ring with R2 or is a heterocyclic ring if R2 is H; and
R4 is an optionally substituted aryl group which may be monocyclic or fused to a further ring. In another embodiment, the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III). In another embodiment, the disclosure describes methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of a compound according to Formula (I), Formula (II), and/or Formula (III) via an oral administration route, an injection administration route, and/or a topical administration route. In another embodiment, the disclosure provides for the use of one or more of a compound according to Formula (I), Formula (II), and/or Formula (III) in methods of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions. In another embodiment, the disclosure provides for the use of a compound according to Formula (I), Formula (II), and/or Formula (III) in the manufacture of a medicament for the treatment of one or more skin conditions. In some embodiments, the treatment includes treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of psoriasis. These and further embodiments will become apparent to a person of skill in the art based upon the disclosure herein. DETAILED DESCRIPTION OF THE DISCLOSURE Overexpression of CGRP has been associated with skin conditions such as redness, rosacea, flushes, and erythema. The disclosure provides for methods to treat, ameliorate, and/or prevent one or more skin conditions including, but not limited to, redness, rosacea, flushes, and erythema, with compounds and therapeutic
or pharmaceutical compositions that inhibit the CGRP receptor. Inhibition of the CGRP receptor with one or more CGRP receptor antagonists may prevent symptoms or disease associated with overexpression of CGRP, including redness, rosacea, flushes, and erythema. Redness, rosacea, flushes, and erythema, among other skin conditions, may be triggered in part by exposure to extreme temperatures, strenuous exercise, heat from sunlight, sunburn, stress, anxiety, alcohol, caffeine, foods high in histamines, and spicy foods. Rosacea may be triggered by topical irritants or medications, including microdermabrasion, chemical peels, isotretinoin, benzoyl peroxide, tretinoin, and topical steroids. In some embodiments, methods of treating, ameliorating, and/or preventing redness, rosacea, flushes, and erythema with a CGRP receptor antagonist may improve a patient’s tolerance to these triggers or risk factors. In some embodiments, methods of treating, ameliorating, and/or preventing redness, rosacea, flushes, and erythema or other skin conditions with a CGRP receptor antagonist further comprise avoiding or limiting triggers or risk factors. Another aspect of the disclosure relates to a method of treatment using combinations of any of Formula I, Formula II, or Formula III with one or more agents selected from ivermectin, azelaic acid, metronidazole, brimonidine, oxymetazoline, xylometazoline, doxycycline, tetracycline and isoretinoin. In some embodiments, methods of treatment may also comprise limiting of exposure to sunlight, or laser therapy. It can be appreciated that a CGRP receptor antagonist may be used alone or in combination with any known treatment in order to treat, ameliorate, and/or prevent redness, rosacea, flushes, and erythema, other skin conditions, or symptoms associated therewith. Skin Conditions The skin conditions contemplated are any skin conditions that may benefit from administration of one or more CGRP receptor antagonists. In some embodiments, the skin conditions are one or more of redness, rosacea, flushes, erythema, eczema (atopic dermatitis), other types of dermatitis, rashes, inflammation, UV damage/sunburn, polymorphous light eruptions, itch, neuropathic itch, ichthyosis, seborrheic dermatitis, verruca vulgaris, molluscum contagiosum, telangiectasias,
malar rash, malar flush, purpura skin, papules, bullae, dry scaly desquamation, linear hyperpigmentation of nails or skin, skin hyperpigmentation, onychodystrophy, necrobiosis lipoidica diabeticorum, poorly healing ulcers, blotching, abnormal sweating, hypohidrosis, angiokeratoma, skin atrophy, hyperkeratosis, chronic ulceration, erythroderma, congenital ichthyosis, ichthyosiform erythroderma, hypopigmentation and hyperpigmentation, arteritis of skin, sebaceous and epithelial nevi, linear nevus sebaceous, erythematous photosensitive rash, erythema, glossitis, rhagades, verrucous angiomas, Raynaud's phenomenon, poikiloderma, erythema nodosum, maculopapular rash; pernio, plaques, scars, keloids, photosensitivity, discoid lupus, flexural eczema, scleroderma, subcutaneous calcification, atrophy, actinic keratosis, angioma, alopecia, cutis laxa, petechiae, Osler’s nodes, splinter haemorrhages, erythematous necrotic skin lesions, livedo reticularis, xanthanomas, pseudoxanthomas, xanthelasma, generalized hypotrichosis, multiple papules, peau d’orange skin, discoid lupus, angioneurotic oedema, subcutaneous nodules, palpable purpura, erythema multiforme, or any other skin disease known to a person of skill in the art. The term “skin conditions” as used herein is meant to encompass these skin conditions, as well as any other known skin conditions that may benefit from administration of one or more CGRP receptor antagonists. CGRP Receptor Antagonists CGRP Receptor Antagonists useful for the methods of the present invention may be small molecule (molecular weight < about 2 kDa, or < about 1 kDa) or a larger construct (molecular weight > about 2 kDa, or > 1 kDa) such as a peptide, biologic, antibody, etc. In particular, the present disclosure is drawn to methods of treating one or more skin conditions comprising administering to a mammalian or human subject one or more CGRP receptor antagonists. Such CGRP receptor antagonists may be described by various generic or specific chemical formulas. In the following exemplary chemical formulas, the general structure broadly describes a number of chemical structures in the alternative and it can be appreciated that each alternative structure is contemplated.
Formula I In some embodiments, a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (I):
(1) where: R1 is hydrogen, cyano, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl; R2 is piperidinyl substituted with 1 substituent selected from the group consisting of:
R3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R4 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R5 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R6 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R7 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R8 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R9 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R10 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R11 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, dialkylamino, alkoxycarbonyl, or benzyloxycarbonyl; or R10 and R11 taken together is O or N—OH; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl substituted with 0-3 substituents selected from the group consisting of cyano, halo, alkyl, haloalkyl, alkoxy, haloalkoxy, and alkylSO2; X is O, CH2, or NH; and Y is a bond, O, CH2, or NH; or a pharmaceutically acceptable salt thereof.
In some embodiments, the CGRP receptor antagonists described by general Formula I may be selected from any of the following specific formulas: (6R,9R)-6-(2,3-Difluorophenyl)-6-hydroxy-5-oxo-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (9R)-6-(2,3-difluorophenyl)-5-oxo-6,7,8,9-tetrahydro-5H-cyclohepta[b]p- yridin- 9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylate; (5S,6R,9R)-6-(2,3-difluorophenyl)-5,6-dihydroxy-6,7,8,9-tetrahydro-5H-- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6R,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-azido-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (6S,9R)-6-(2,3-difluorophenyl)-6-hydroxy-6,7,8,9-tetrahydro-5H-cyclohe- pta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-amino-6-(3,5-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-6-(3,5-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate;
(6S,8R,9S)-6-(2,3-difluorophenyl)-8-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-(methylamino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-(dimethylamino)-6,7,8,9-tetrahydro- -5H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,9R,Z)-6-(2,3-difluorophenyl)-5-(hydroxyimino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (6S,9R,E)-6-(2,3-difluorophenyl)-5-(hydroxyimino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 2'-oxo-1,1',2',3-tetrahydrospiro[indene-2,3'-pyrrolo[2,3-b]pyridine]- 5-yl- carbamate; tert-butyl(5S,6S,9R)-9-amino-6-(2,3-difluorophenyl)-6,7,8,9-tet- rahydro-5H- cyclohepta[b]pyridin-5-ylcarbamate; tert-butyl (5S,6S,9S)-6-(2,3-difluorophenyl)-9-(2- oxo-2-(4-(2-oxo-2,3-dihydro-1H-imi- dazo[4,5-b]pyridin-1-yl)piperidin-1-yl)ethyl)- 6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-5-yl-carbamate; tert-butyl (5S,6S,9R)-6-(2,3-difluorophenyl)-9-(2-oxo-2-(4-(2-oxo-2,3-dihydro- 1H-imi- dazo[4,5-b]pyridin-1-yl)piperidin-1-yl)ethyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-5-ylcarbamate; and 1-(1-(2-((5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H- cyclohepta[b]pyridin-9-yl)acetyl)piperidin-4-yl)-1H-imidazo[4,5-b]pyridin-2(3H)-one; or a pharmaceutically acceptable salt thereof. In some embodiments, the CGRP receptor antagonist may be Rimegepant, which has the formula (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro- 5H-cyclohepta[b]pyridine-9-yl-4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridine-1- yl)piperidine-1-carboxylate, and which has the following structure
or a pharmaceutically acceptable salt thereof, including the hemisulfate salt and the hemisulfate sesquihydrate. Formula II In some embodiments, a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (II):
or a pharmaceutically acceptable salt thereof, wherein V is —N(R1)(R2) or OR4; R4 is H, C1-6alkyl, C1-4haloalkyl or (C1-4alkylene)0-1R4′ R4′ is C3-7cycloalkyl, phenyl, adamantyl, quinucidyl, azabicyclo[2.2.1]heptyl, azetidinyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl,
pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino or dioxolanyl; and R4′ is optionally substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1-4alkyl, C1-4haloalkyl, C1-4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1-3dialkylamino, (C1-3alkyl)0-2ureido, phenyl and benzyl; and R4′ optionally contains 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the ring structure of R4′; R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1-6alkyl, C2-6alkenyl, C2-6alkynyl, —C1-6alkylene-amino (C1-3alkyl)2, C3-7cycloalkyl, phenyl, azetidinyl, adamantyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino and dioxolmnyl; and R1 and R2 are each optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1- 4alkyl, C1-4haloalkyl, C1-4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1- 4dialkylamino, (C1-3alkyl)0-2ureido, phenyl and benzyl; R1 and R2 optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising R1 and R2; wherein L1 is optionally and independently interrupted from the nitrogen to which it is attached by L2, wherein L2 is independently C1-3alkylene or C1-3alkylidene; or R1 and R2 together with the nitrogen to which they are attached form X,
wherein X is azetidinyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolizyl, imidazolidinyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, piperazinyl, piperidinyl, morpholino or thiomorpholino; wherein X is optionally substituted with Y, wherein Y is dioxolanyl, C1-9alkyl, C2-9alkenyl, C2-9alkynyl, C1-4alkylamino, C1-4dialkylamino, C1-4alkoxy, C3-7cycloalkyl, phenyl, azetidinyl, furanyl, thienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, pyrrolidinonyl, imidazolyl, imidazolinyl, imidazolidinyl, imidazolidinonyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, pyridyl, pyrimidinyl, dihaydrobenzimidazolonyl, piperazinyl, piperidinyl, morpholino, benzothiazolyl, benzisothiazolyl or thiomorpholino; and wherein X and Y are optionally interrupted with Z, wherein Z is— NHC(O)O—, —NHC(O)NH—, NC(Q)NH2,—NH—, —C1-3alkylene—, C1-3alkenylene- NHC(O)O—C1-3alkylene-; and optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of C1-4alkyl, amino, C1-3alkylamino, —C1-3alkylene-amiao(C1-3alkyl)2, (C1-3alkyl)0-2ureido, phenyl and benzyl; X and Y optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising X and Y; provided that if X is substituted with Y, and if X and Y are not interrupted with Z, then X and Y optionally share one carbon atom and together form a spirocyclic moiety; Q is Q′ or Q″; wherein Q′ is (Sy)SR3; and Q″ is NH(Sy)SR3, NHC(O)(Sy)SR3, NHC(O)O(Sy)SR3, NHC(O)NH(Sy) sR3, O(Sy)SR3, (Sy)3NHR3, (Sy)SNHC(O)R3,(Sy)SNHC(O)OR3, (Sy)SNHC(O)NHR3; or (Sy)SOR3; wherein Sy is C1-3alkylene or C1-3alkylidene and a is 0 or 1; U is CH2 or NH;
provided that if Q is Q″, then U is CH2; R3 is R3a or R3b wherein R3a is (i) a heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to five of the same or different beteroatoms selected from the group consisting of O, N and S, and said heterocycle optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused rings; (ii) a 4 to 6 membered heterocycle containing one to three of the same or different heteroatoms selected from the group consisting of O, N and S, optionally containing 1 to 2 carbonyls, wherein the carbon atom of said carbonyl is a member of said 4 to 6 membered heterocycle; (iii) C3-7cycloalkyl; (iv) carbazolyl, fluorenyl, phenyl, —O-phenyl, —O—C1-4alklylene-phenyl, or napthyl; or (v) C1-8alkyl, C2-7alkenyl, —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′,— C(O)O—R3′or C2-7alkynyl; and wherein R3a is optionally substituted with 1 to 3 of the same or different substituents selected from the group consisting of benzyl, phenyl, —O-phenyl, —O— C1-3alkylenephenyl, —C1-3alkylene-O—C(O)-phenyl, cyano, amino, nitro, halo, C1- 6alkyl, C1-3mono-bi-tri-haloalkyl, C1-3mono-bi-tri-haloalkyloxy, (C1-3alkyl)1-2amine, — OR3′, —C(O)R3′, —C(O)O—R3′, —O—C(O)R3′, —N(R3′)2, —C(O)N(R3′)2, — N(R3′)C(O)(R3′)2, —N(R3′)C(O)N(R3′)2, —N(R3′)C(O)OR3′, —O—C(O)N(R3′)2, — N(R3′)SO2R3′, —SO2N(R3′)2 and —SO2R3′; R3′is H or —C1-6alkyl; provided that if R3a is , —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or — C(O)O—R3′, then said —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or —C(O)O— R3′are unsubstituted; R3b is R3a but is not phenyl, 1-naphthyl, 2-naphthyl, 1,2,3,4-tetrahydro-1- naphthyl, 1H-indol-3-yl, 1-methyl-1H-indol-3-yl, 1-formyl-1H-indol-3-yi, 1 -(1,1- dirnethylethoxycarbonyl)- 1H-indol-3-yl, 4-imidazolyl, 1-methyl-4-imidazolyl, 2-thienyl, 3-thienyl, thiazolyl, 1H-indazol-3-yl, 1-methyl-1H-indazol-3-yl, benzo[b]fur-3-yl,
benzo[b]thien-3-yl, pyridinyl, quinolinyl or isoquinolinyl; optionally substituted in the carbon skeleton with mono-, di- or trisubstituted by fluorine, chlorine or bromine atoms or by branched or unbranched alkyl groups, C3-8-cycloalkyl groups, phenylalkyl groups, alkenyl, alkoxy, phenyl, phenylalkoxy, trifluoromethyl, alkoxycoarbonylalkyl, carboxyalkyl, alkoxycarbonyl, carboxy, dialkylaminoalkyl, dialkylaminoalkoxy, hydroxy, nitro, amino, acetylamino, propionylamino, benzoyl, benzoylamino, benzoylmethylamino, methylsulphonyloxy, aminocarbonyl, alkylaminocarbonyl, dialkylaminocarbonyl, alkanoyl, cyano, tetrazolyl, phenyl, pyridinyl, thiazolyl, furyl, trifluoromethoxy, trifluoromethylthio, trifluoromethylsulphinyl- or trifluoromethylsulphonyl groups; wherein said substituents may be the same or different and the above- mentioned benzoyl, benzoylaznino- and benzoylmnethylamino groups may in turn additionally be substituted in the phenyl moiety by a fluorine, chlorine or bromine atom, or by an alkyl, trifluoromethyl, amino or acetylamino group; D is O, NCN or NSO2C1-3alkyl; A is CH; m and n are each 1; E is N, CE or C; p is 1; G, J and E together form Ax; Ax is a fused heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to four of the same or different heteroatoms selected from the group consisting of O, N and S; and optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused heterocycle; and further provided that if Q is Q″, then R3 is R3a; and if Q is Q′, then
R3 is R3b. In some embodiments, the CGRP receptor antagonists described by general Formula II may be selected from any of the following specific formulas: (±)-3-(1H-Indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1- carbonyl]-amino}-propionic acid; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5 -ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indol-5-ylmethyl)-2-oxo-ethyl]-am- ide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxyl- ic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl- ]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carb- oxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-- amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carbox- ylic acid [1- (1H-indol-5 -ylmethyl)-2-(4-isobutyl-piperazin-1-yl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2-(1,4- dioxa-8-aza-spiro[4.5]dec-8-yl)-1-(1H-indol-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [1-(1H- indazol-5-ylmthyl) -2-(4-isobutyl-piperazin-1-yl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2-(1,4- dioxa-8-aza -spiro[4.5]dec-8-yl)-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2-(1,4- dioxa-8-aza -spiro[4.5]dec-8-yl)-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-piperidin-1-yl-ethyl]-am- ide;
(±)4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxyli- c acid [1- dimethylcarbamoyl-2-(7-methyl-1H-indazol-5-yl)-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-1-(7- methyl-1H-indazol-5-ylmethyl)-2-(4-methyl-piperazin-1-yl)-2-- oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-pyrrolidin-1-yl-ethyl]- -amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carbo- xylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-(4-pyridin-4-yl-pip- erazin-1-yl)-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-(4-pyridin-2-yl-piperazi- n-1-yl)-ethyl]-amide; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid {1-(1-1H- indazol-5-ylmethyl)-2-oxo-2-[4-(2-oxo-1,4-dihydro-2H-quinazolin-- 3-yl)-piperidine-1- yl]-ethyl}-amide; 4-(3-(1H-Indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piper- idine-1- carbonyl]-amino}-propionyl)-piperazine-1-carboxylic acid benzyl ester; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(1H- indazol-5-ylmethyl)-2-oxo-2-piperazin-1-yl-ethyl]-amide; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid {1-(1H- indazol-5-ylmethyl)-2-[4-(2-methyl-butyl)-piperazin-1-yl]-2-oxo-et- hyl}-amide;
3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid cyclohexyl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid 1-benzyl-piperidin-4-yl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1-methyl-piperidin-4-yl ester, 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid 4-phenyl-cyclohexyl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid (R)-1-pyridin-4-yl-etyl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid (S)-1-pyridin-4-yl-ethyl ester; (±)-3-(7-Chloro-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-pipeine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-chloro-1H-indazol-5-ylmethyl)-2-oxo-eth- yl]-amide; (±)-3-(7-Ethyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-- quinazolin-3- yl)piperidine-1-carbonyl]-amino}-propionic acid methyl ester (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-ethyl-1H-indazol-5-ylmethyl)-2oxo-- ethyl]-amide;
(R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(2-methyl-1H-benzoimidazol-5-ylmethyl)-2-o- xo-ethyl]- amide; (R)-4(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(2-oxo-2,3-dihydro-benzooxazol-6-ylm- ethyl)-ethyl]- amide; (R)-3-(1H-Benzotriazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(1H- benzotriazol-5-ylmethyl)-2-[1,4']bipiperidinyl-1'-yl-2-oxo-ethyl]-- amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxyli- c acid [2[1,4']bipiperidinyl-1'-yl-2-oxo-1-(2-oxo-2,3-dihydro-1H-indol-5-y- lmethyl)-ethyl]- amide; (±)-4(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(4- benzyloxy-2-oxo-2H pyridin-1-ylmethyl)-2-[1,4']bipiperidinyl-1'-yl-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4'bipiperidnyl-1'-yl-1-(4-hydroxy-2-oxo-2H-pyridin-1-ylmethyl)- -2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4'bipiperidinyl-1'-yl-1-(4-hydroxy-piperidin-1-ylmethyl)-2-oxo- -ethy]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(1,4,6,7-tetrahydro-pyrazolo[4,- 3-c]pyridin-5- ylmethyl)-ethyl]-amide; (±)-3-(7,7-Dimethyl-1,4,6,7-tetrahydro-pyrazolo[4,3-c]pyridin-5-yl)-2-- {[4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carbo- xylic acid [2[1,4'bipiperidinyl-1'-yl-1-(7,7-dimethyl-1,4,6,7-tetrahydro-p- yrazolo[4,3-c]pyridin-5- ylmethyl)-2-oxo-ethyl]-amide; (±)-4(2Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2[1,4']bipiperidinyl-1'-yl-1-(6methoxy-pyridin-3-ylmethyl)-2-oxo-et- hyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(2-methoxy-pyrimidin-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [(1-(6- benzyloxy-pyridin-3-ylmethyl)-2-[1,4'bipiperidinyl-1'-yl-2-ox- o-ethyl]-amide;
(±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(6-oxo-1,6-dihydro-pyridin-3-yl- methyl)-ethyl]-amide; (±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-1,4-dihydro-2- H- quinazolin-3-yl)-piperidin-1-yl]-butyric acid methyl ester; (±)-1-[1,4']Bipiperidinyl-1'-yl-2-(7-methyl-1H-indazol-5-ylmethyl)-4-[- 4-(2-oxo-1,4- dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]butane-1,4-dione; (±)-1-(1,4-Dioxa-8-aza-spiro[4.5]dec-8-yl)-2-(7-methyl-1H-indazol-5-yl- methyl)-4- [4-(2-oxo-1,4-dihydro -2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-N,N-Dimethyl-2-(7-methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-- 1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butyramide; (±)-1-(2,6-Dimethyl-morpholin-4-yl)-2-(7-methyl-1H-indazol-5-ylmethyl)- -4-[4-(2- oxo-1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-1-(4-methyl-piperidin-1-yl)-4-[- 4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-2-(7-Methyl1H-indazol-5-ylmethyl)-1-morpholin-4-yl-4-[4-(2-oxo-1,4- -dihydro- 2H-quinazolin-3-yl) -piperidin-1-yl]-butane-1,4-dione; (±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-4-[4-(2-oxo-1,4-dihydro-2H-quin- azolin-3- yl)-piperidin-1-yl]-1-piperidin-1-yl-butane-1,4-dione; (±)-1-(1,4-Dioxa-8-aza-spiro[4.5]dec-8-yl)-2-(1H-indazol-5-ylmethyl)-4- -[4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-2-(1H-Indazol-5-ylmethyl)-N,N-dimethyl-4-oxo-4-[4-(2-oxo-1,4-dihyd- ro-2H- quinazolin-3-yl) -piperidine-1-yl]-butyramide; (±)-5-{2-([1,4']Bipiperidinyl-1'-carbonyl)-4-oxo-4-[4-(2-oxo-1,4-dihyd- ro-2H- quinazolin-3-yl)-piperidin -1-yl]-butyl}-indazole-1-carboxylic acid tert-butyl ester; (±)- 2-(7-Methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-1,4-dihydro-2- H-quinazolin-3- yl)-piperidin-1yl]-N-prop-2-ynyl-butyramide; (L)-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-2H- - quinazolin-3-yl)-piperidin-1-yl]-propyl}-carbamic acid tert-butyl ester; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(1H-indol-5-ylamino)-4-[4-(2-oxo-1,4-di- hydro-2H- quinazolin-3-yl) -piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(5-chloro-2-nitro-phenylamino)-4-[4-(2-- oxo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4'Bipiperidinyl-1'-yl-2-(6-chloro-pyrimidin-4-ylamino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione;
(L)-1-[1,4']Bipiperidinyl-1'-yl-2-(2-chloro-9H-purin-6-ylamino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-2-(4-Amino-6-methyl-5-nitro-pyrimidin-2-ylamino)-1-[1,4']bipiperidiny- l-1'-yl-4- [4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane- -1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(4,5-diamino-6-methyl-pyrimidin-2-ylami- no)-4-[4- (2-oxo-1,4-dihydro -2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(7-methyl-1H-[1,2,3]triazo[4,5-d]pyrimi- din-5- ylamino)-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]- -butane-1,4- dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-((2'-pyridyl)-methyl-amino)-4-]4-(2-oxo- -1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-((5'-indazolyl)-methyl-amino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-((3'-methyl-phenyll)-methyl-amino)-4-[4- -(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-y- l)- piperidin-1-yl]-2-(pyrimidin -4-ylamino)-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(4-hydroxy-cyclohexylamino-4-[4-(2-oxo-- 1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-[(1H-imidazol-4-ylmethyl)-amino]-4-[4-(- 2-oxo-1,4- dihydro-2H -quinazolin-3-yl)piperidin-1-yl]-butane-1,4-dione; (L)-N-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-- 2H- quinazolin-3-yl)-piperidin-1-yl]-propyl}-4-hydroxy-benzamide; (L)-N-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-- 2H- quinazolin-3-yl)-piperidin-1-yl]-propyl}-4-hydroxy-benzamide; (L)-1H-Pyrazole-3-carboxylic acid{1-([1,4']bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2- oxo-1,4-dihydro-2H- -quinazolin-3-yl)-piperidin-1-yl]-propyl}-amide;
(±)-1-[1,4']Bipiperidinyl-1'-yl-2-(1H-indazol-5-ylamino)-4-[4-(2-oxo-1- ,4-dihydro- 2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-3-(3-Cyano-1H-indol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3- -yl)- piperidin-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl -1-(3-cyano-1H-indol-5-yl-methyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(3-cyano-7-methyl-1H-indol-5-yl-methyl- )-2-oxo-ethyl]- amide; (±)-3-(7-Isopropyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dibydro-2H-quinaz- olin-3-yl)- piperidin-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(7-isopropyl-1H-indazol-5-yl-methyl)-2- -oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(7-ethyl-1H-indazol-5-yl-methyl)-2-oxo- -ethyl]-amide; (±)-4-
(2,2-Dioxo-1,4-dihydro-2H-2.lamda..sup.6-benzo[1,2,6]thiadiazin-- 3-yl)-piperidine-1- carboxylic acid [2-[1,4']bipiperidinyl-1'-yl-1(7-methyl-1H-indazol-5-yl-methyl)-2-oxo- eth- yl]-amide; (±)-4-(2,2-Dioxo-1,4-dihydro-2H-2.lamda..sup.6-benzo[1,2,6]t- hiadiazin-3-yl)- piperidin-1-carboxylic acid [2-[1,4'bipiperidinyl-1'-yl-1(7-ethyl-3-methyl-1H-indazol-5- yl-methyl)-2-- oxo-ethyl]-amide; (±)-2-[4-(6-Cyano-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)piperidine-1-car- bonyl]- amino]-3-(7-methyl-1H-indazol-5-yl)-propionic acid methyl ester; (±)-4-(6-Cyano-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-carbo- xylic acid{2-[1,4'bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(2-Oxo-1,2,4,5-tetrahydro-benzo[d][1,3]diazepin-3-yl-1-carboxyli- c acid{2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(6-Hydroxy-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-car- boxylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(8-Methoxy-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-car- boxylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4(8-Chloro-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-carbo- xylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-N-(3-(7-Ethyl-1H-indazol-5-yl)-1-(6,7-dihydro-1H-pyrazolo[4,3-c]py- ridin- 5(4H)-yl)-1-oxopropan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)- piperidine-1- carboxamide; (±)-Methyl 2-(4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1- carboxam- ide)-3-(7-methyl-1H-indazol-5-yl)propanoate; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1- H- indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-2-yl)piperidine-1- carboxamide; (±)4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1H- -indazol- 5-yl)-1-oxo-1-(4-phenylpiperazin-1-yl)propan-2-yl)piperidine-1-carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(1-(- 4-(4- fluorophenyl)piperazin-1-yl)-3-(7-methy-1H-indazol-5-yl)-1-oxopropan-- 2- yl)piperidine-1-carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(1-(4-(2-fluor- ophenyl)piperazin-1-yl)-3-(7-methyl-1H-indazol-5-yl)-1-oxopropan-2-yl)pipe- ridine-1- carboxamide;
(±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1- H- indazol-5-yl)-1-oxo-1-(4-o-tolylpiperazin-1-yl)propan-2-yl)piperidine-1-- carboxamide; (±)-Methyl 2-(4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1- carboxam- ide)-3-(7-ethyl -3-methyl-1H-indazol-5-yl)propanoate; (±)-N-(3-(7-Ethyl-3-methyl-1H-indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1- yl)propan-2-yl)-4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)- -yl)piperidine-1- carboxamide; (R)-N-((R)-3-(2-Oxo-2,3-dihydro-benzooxazol-6-yl)-1-oxo-1-(4-(piperidin-1- - yl)propan-2-yl)-4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidi- ne-1- carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2,4-dioxoquinazolin-3(4H)-yl)-N-(3-(7-meth- yl-1H- indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-2-yl)- piperidine-1- carboxamide; N-((R)-3-(2-(trifluoromethyl)-1H-benzo[d]imidazol-5-yl)-1-oxo-1-(4-(piper- idin-1- yl)piperidin-1-yl)propan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)- -yl)piperidine-1- carboxamide; N-((R)-1-(dimethylcarbamoyl)-2-(2-trifluoromethyl)-1H-benzo[d]imidazol-5-- yl)ethyl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-carboxamide- ; (R)-methyl 2-(4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-carboxamide)- 3-(2- ,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-yl)propanoate; N-((R)-3-(2,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-yl)-1-oxo-1(4-piperidine-1- yl)propan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-c- arboxamide; N-((R)-1-(dimnethylcarbamoyl)-2-(2,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-- yl)ethyl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H))-yl)piperidine-1-carboxamid- e; 4-(1,2-dihydro-2,4-dioxoquinazolin-3-(4H)-yl)-N-((R)-3-(7-methyl-1H-ben- zo[d][1,2,3]triazol-5-yl-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-- 2- yl)piperidine-1-carboxamide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-(4- cyclohexyl-piperazin-1-yl)-2-oxo-1-(2-oxo-2,3-dihydro-benzooxaz- ol-6-ylmethyl)- ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-(4- isopropyl-piperazin-1-yl)-2-oxo-1-(2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)- ethyl]-amide;
(R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-chloro-2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(5-chloro-2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-bromo-2-oxo-2,3-dihydro-benzooxazol- -6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(5-bromo-2-oxo-2,3-dihydro-benzooxazol- -6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-iodo-2-oxo-2,3-dihydro-benzooxazol-- 6-ylmethyl)-2-oxo- ethyl]-amide; (±)-N-(1-Benzyl-2-hydroxy-ethyl)-2-(7-methyl-1H-indazol-5-ylmethyl)-4-- oxo-4-[4- (2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butyramide- ; (4Phenyl-acetic acid N'-{2-(7-methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo- 1,4-dihydro 2H -quinazolin-3-yl)-piperidin-1-yl)-butyryl}-hydrazide; (±)-1-[1,4']Bipiperidinyl-1'-yl-4-[4-(8-fluoro-2-oxo-1,4-dihydro-2H-qu- inazolin-3-yl)- piperidin-1-yl]-2-(7-methyl-1H-indazol-5-ylmethyl)-butane-1- ,4-dione; (±)1-(4-Cyclohexyl-piperazin-1-yl)-2-(2-oxo-2,3-dihydro-benzo- oxazol-6- ylmethyl)-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1- -yl]-butane-1,4- dione; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)piperidine-1-carboxylic acid[2-(4- cyclohexyl -piperazin-1-yl)-1-(7-methyl-1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-[4-(4- fluoro-phenyl)-piperazin-1-yl]-1-(7-methyl-1H-indazol-5-ylme- thyl)-2-oxo-ethyl]- amide; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)}-propionic acid tert-butyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-}[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1-methyl cyclohexyl ester;
(±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-qu- inazolin-3-yl)- piperidine-1-carbonyl}-amino}-propionic acid 1-aza-bicyclo[2.2.2]oct-3-yl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid piperidin-4-yl ester; (±)-4-(3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinaz- olin-3-yl)- piperidine-1-carbonyl[-amino}-propionyloxy)-piperidine-1-carbox- ylic acid tert-butyl ester, (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 3,4,5,6-tetrahydro-2H-[1,4']bipyridinyl-4- yl ester, (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)-propionic acid 1-diethylamino-1-methyl-ethyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1,1-dimethyl-2-phenyl-ethyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)-propionic acid 1,1-dimethyl-3-phenyl-propyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid ethyl ester; and (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1d-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-ylmethyl)-2-oxo- -ethyl]amide. In some embodiments, the CGRP receptor antagonist may be Zavegepant, which has the formula (R)—N-(3-(7-methyl-1H-indazol-5-yl)-1-(4-(1-methylpiperidin- 4-yl)piperazin-1-yl)-1-oxopropan-2-yl)-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1- carboxamide, and which has the following structure
or a pharmaceutically acceptable salt thereof. Formula III In some embodiments, a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, may comprise administering to a subject in need thereof a CGRP receptor antagonist according to Formula (III):
or a salt thereof or an optical isomer thereof, wherein R1 is H or Q-(C1-C6)alkyl; where Q is a bond, C(O) or C(O)O and where the (C1- C6)alkyl can be optionally substituted by N(C1-C3alkyl)2 or CO2H; R2 is H or forms a spirocyclic heterocyclic ring with R3; R3 forms a spirocyclic heterocyclic ring with R2 or is a heterocyclic ring if R2 is H; and R4 is an optionally substituted aryl group which may be monocyclic or fused to a further ring. In some embodiments, the CGRP receptor antagonists described by general Formula III may be selected from any of the following specific formulas: N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-yl)-1- [4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-2,3-dihydro- 1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxamide;
tert-butyl 4-{(2S)-2-{[(2R)-3-(7-methyl-1H-indazol-5-yl)-2-({[[4-(2-oxo-1,2- dihydroquinolin-3-yl)piperidin-1-yl]carbonyl}amino)propanoyl]amino}-3-oxo-3-[4-(py- ridin-4-yl)piperazin-1-yl]propyl}piperidine-1-carboxylate; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-- yl)- 1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-1,2- dihydroquinolin-3-yl)piperidine-1-carboxamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(1- propylpiperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-y- l]-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1-carboxamide; 3,5-dibromo-Nα-{[4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidin-1-yl]carbonyl}-N- {(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-y- l]propan-2-yl}-D- tyrosinamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(1- pentanoylpiperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2- yl]-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1-carboxamide; N-[(2R)-1-({(2S)-3-(1-ethylpiperidin-4-yl)-1-oxo-1-[4-(pyridin-4-yl)piperazin-1- yl]propan-2-yl}amino)-3-(7-methyl-1H-indazol-5-yl)-1-oxopropan-2-yl- ]-4-(2-oxo-1,2- dihydroquinolin-3-yl)piperidine-1-carboxamide; 3,5-dibromo-Nα-{[4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidin- 1-yl]carbonyl}-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4- -yl)piperazin-1- yl]propan-2-yl}-D-tyrosinamide; 3,5-dibromo-Nα-{[4-(2-oxo-1,4-dihydroquinazolin-3(2H)-yl)piperidin-1- yl]carbonyl}-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4-yl)piperaz- in-1-yl]propan- 2-yl}-D-tyrosinamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-- yl)- 1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-1,4- dihydroquinazolin-3(2H)-yl)piperidine-1-carboxamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-yl)-1- [4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-2'-oxo-1',2'-dihydro-1H- spiro[piperidine-4,4'-pyrido[2,3-d][1,3]oxazine]-1-carboxamide; N-[(2R)-1-({(2S)-3-{1-[2-(dimethylamino)ethyl]piperidin-4-yl}-1-oxo-1-[4- (pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)-3-(7-methyl-1H-ind- azol-5-yl)-1- oxopropan-2-yl]-4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin- -1-yl)piperidine-1- carboxamide;
3-(4-{(2S)-2-{[(2R)-3-(7-methyl-1H-indazol-5-yl)-2-({[4-(2-oxo-2,3-dihydro-1H- imidazo[4,5-b]pyridin-1-yl)piperidin-1-yl]carbonyl}amino)propanoyl]am- ino}-3-oxo-3- [4-(pyridin-4-yl)piperazin-1-yl]propyl}piperidin-1-yl)-3-oxop- ropanoic acid, ammonium salt; and 3, 5-dibromo-Nα-[(2'-oxo-1',2'-dihydro-1H-spiro[piperidine-4,4'-pyrido- [2,3- d][1,3]oxazin]-1-yl)carbonyl]-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(- pyridin-4- yl)piperazin-1-yl]propan-2-yl}-D-tyrosinamide; or a salt thereof or an optical isomer thereof. In some embodiments, the CGRP receptor antagonist may be BHV-3100, which has the formula N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3- (piperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-2'- oxo-1',2'-dihydro-1H-spiro[piperidine-4,4'-pyrido[2,3-d][1,3]oxazine]-1-carboxamide, and which has the following structure:
or a pharmaceutically acceptable salt thereof. Pharmaceutical Compositions and Methods of Treatment The compounds of Formula I, Formula II, and/or Formula III inhibit the CGRP receptor. As such, they are useful for treating conditions or disorders associated with aberrant CGRP levels or where modulating CGRP levels may have therapeutic benefit. Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula I with a pharmaceutically acceptable adjuvant, carrier, or diluent.
Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula II with a pharmaceutically acceptable adjuvant, carrier, or diluent. Accordingly, another aspect of the disclosure is a pharmaceutical composition comprising a compound of Formula III with a pharmaceutically acceptable adjuvant, carrier, or diluent. Compounds are generally given as pharmaceutical compositions comprised of a therapeutically effective amount of one or more of a compound of Formula I, Formula II, and/or Formula III, or pharmaceutically acceptable salt(s) thereof, and a pharmaceutically acceptable carrier, further optionally containing conventional excipients. A therapeutically effective amount is the amount needed to provide a meaningful patient benefit as determined by practitioners in that art. Pharmaceutically acceptable carriers are those conventionally known carriers having acceptable safety profiles. Compositions encompass all common solid and liquid forms including capsules, tablets, losenges, and powders as well as liquid suspensions, syrups, elixers, and solutions. Solid compositions may by formed in timed or sustained released formulations. Compositions are made using common formulation techniques and conventional excipients (such as binding and wetting agents) and vehicles (such as water and alcohols). The disclosure and methods encompass all conventional modes of administration including oral, parenteral, intranasal, sublingual, topical, and transdermal methods. Typically, the daily dose may be 0.01-100 mg/kg body weight daily. Generally, more compound is required orally and less parenterally. The specific dosing regime, however, should be determined by a physician using sound medical judgement. Among other routes of administration, the standard routes of administration described by the FDA are contemplated herein as shown in Table 1 below (FDA Routes of Administration; retrieved from www.fda.gov; content current as of 11/14/2017). Table 1: FDA Routes of Administration
In some embodiments, the route of administration may be oral, intranasal, inhalation, intravenous, topical, injectable and/or transdermal. The formulator will understand that excipients are used primarily to serve in delivering a safe, stable, and functional pharmaceutical, serving not only as part of the overall vehicle for delivery but also as a means for achieving effective absorption by the recipient of the active ingredient. An excipient may fill a role as simple and direct as being an inert filler, or an excipient as used herein may be part of a pH stabilizing system or coating. Pharmaceutical compositions may comprise one or more pharmaceutically acceptable carriers, excipients, or diluents. Examples of such carriers are well known to those skilled in the art and can be prepared in accordance with acceptable pharmaceutical procedures, such as, for example, those described in Remington's Pharmaceutical Sciences, 17th edition, ed. Alfonoso R. Gennaro, Mack Publishing Company, Easton, Pa. (1985), the entire disclosure of which is incorporated by reference herein for all purposes. As used herein, “pharmaceutically acceptable” refers to a substance that is acceptable for use in pharmaceutical applications from a toxicological perspective and does not adversely interact with the active ingredient. Accordingly, pharmaceutically acceptable carriers are those that are compatible with the other ingredients in the formulation and are biologically acceptable. Supplementary active ingredients can also be incorporated into the pharmaceutical compositions.
Compounds of the present teachings can be administered orally or parenterally, neat or in combination with conventional pharmaceutical carriers. Applicable solid carriers can include one or more substances which can also act as flavoring agents, lubricants, solubilizers, suspending agents, fillers, glidants, compression aids, binders or tablet-disintegrating agents, or encapsulating materials. Oral formulations containing a compound disclosed herein can comprise any conventionally used oral form, including tablets, capsules, buccal forms, troches, lozenges and oral liquids, suspensions or solutions. In powders, the carrier can be a finely divided solid, which is an admixture with a finely divided compound. In tablets, a compound disclosed herein can be mixed with a carrier having the necessary compression properties in suitable proportions and compacted in the shape and size desired. The powders and tablets can contain up to 99% of the compound. Capsules can contain mixtures of one or more compound(s) disclosed herein with inert filler(s) and/or diluent(s) such as pharmaceutically acceptable starches (e.g., corn, potato or tapioca starch), sugars, artificial sweetening agents, powdered celluloses (e.g., crystalline and microcrystalline celluloses), flours, gelatins, gums, and the like. Useful tablet formulations can be made by conventional compression, wet granulation or dry granulation methods and utilize pharmaceutically acceptable diluents, binding agents, lubricants, disintegrants, surface modifying agents (including surfactants), suspending or stabilizing agents, including, but not limited to, magnesium stearate, stearic acid, sodium lauryl sulfate, talc, sugars, lactose, dextrin, starch, gelatin, cellulose, methyl cellulose, microcrystalline cellulose, sodium carboxymethyl cellulose, carboxymethylcellulose calcium, polyvinylpyrrolidine, alginic acid, acacia gum, xanthan gum, sodium citrate, complex silicates, calcium carbonate, glycine, sucrose, sorbitol, dicalcium phosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride, low melting waxes, ion exchange resins, benzyl alcohol, eucalyptol, gelatin, limonene, mannitol, menthol, menthone, menthyl acetate, sucralose, and vanillin. Surface modifying agents include nonionic and anionic surface modifying agents. Representative examples of surface modifying agents include, but are not limited to, poloxamer 188, benzalkonium chloride, calcium stearate, cetostearl alcohol, cetomacrogol emulsifying wax, sorbitan esters, colloidal silicon dioxide, phosphates, sodium dodecylsulfate, magnesium aluminum silicate, and triethanolamine. Oral formulations herein can utilize standard delay or time-release formulations to alter the
absorption of the compound(s). The oral formulation can also consist of administering a compound disclosed herein in water or fruit juice, containing appropriate solubilizers or emulsifiers as needed. Liquid carriers can be used in preparing solutions for oral or parenteral administration (such as intravenous, intramuscular, or other injections), including suspensions, emulsions, syrups, elixirs, and additionally for inhaled delivery. A compound of the present teachings can be dissolved or suspended in a pharmaceutically acceptable liquid carrier such as water, an organic solvent, or a mixture of both, or pharmaceutically acceptable oils or fats. The liquid carrier can contain other suitable pharmaceutical additives such as solubilizers, emulsifiers, buffers, preservatives, sweeteners, flavoring agents, suspending agents, thickening agents, colors, viscosity regulators, stabilizers, and osmo-regulators. Examples of liquid carriers for oral and parenteral administration include, but are not limited to, water (particularly containing additives as described herein, e.g., cellulose derivatives such as a sodium carboxymethyl cellulose solution), alcohols (including monohydric alcohols and polyhydric alcohols, e.g., glycols) and their derivatives, and oils (e.g., fractionated coconut oil and arachis oil). For parenteral administration, the carrier can be an oily ester such as ethyl oleate and isopropyl myristate. Sterile liquid carriers are used in sterile liquid form compositions for parenteral administration. The liquid carrier for pressurized compositions can be halogenated hydrocarbon or other pharmaceutically acceptable propellants. Liquid pharmaceutical compositions, which are sterile solutions or suspensions, can be utilized by, for example, intramuscular, intraperitoneal or subcutaneous injection. Sterile injectable solutions can also be administered intravenously. Compositions for oral administration can be in either liquid or solid form. Preferably the pharmaceutical composition is in unit dosage form, for example, as tablets, capsules, powders, solutions, suspensions, emulsions, granules, or suppositories. In such form, the pharmaceutical composition can be further sub- divided to contain appropriate quantities of the compound. The unit dosage forms can be packaged compositions, for example, packeted powders, vials, ampoules, prefilled syringes or sachets containing liquids. Alternatively, the unit dosage form can be a capsule or tablet itself, or it can be the appropriate number of any such compositions in package form. Such doses can be administered in any manner useful in directing the compound(s) to the recipient's bloodstream, including orally, via implants,
parenterally (including intravenous, intraperitoneal and subcutaneous injections), rectally, vaginally, and transdermally. When administered for the treatment or inhibition of a particular disease state or disorder, it is understood that an effective dosage can vary depending upon the particular compound utilized, the pharmaceutical composition formulated, the mode of administration, and severity of the condition being treated, as well as the various physical factors related to the individual being treated. In therapeutic applications, a compound of the present teachings can be provided to a patient already suffering from a disease in an amount sufficient to cure or at least partially ameliorate the symptoms of the disease and its complications. The dosage to be used in the treatment of a specific individual typically must be subjectively determined by the attending physician. The variables involved include the specific condition and its state as well as the size, age and response pattern of the patient. In some cases it may be desirable to administer a compound directly to the airways of the patient, using devices such as, but not limited to, metered dose inhalers, breath-operated inhalers, multidose dry-powder inhalers, pumps, squeeze-actuated nebulized spray dispensers, aerosol dispensers, and aerosol nebulizers. For administration by intranasal or intrabronchial inhalation, the compounds of the present teachings can be formulated into a liquid composition, a solid composition, or an aerosol composition. The liquid composition can include, by way of illustration, one or more compounds of the present teachings dissolved, partially dissolved, or suspended in one or more pharmaceutically acceptable solvents and can be administered by, for example, a pump or a squeeze-actuated nebulized spray dispenser. The solvents can be, for example, isotonic saline or bacteriostatic water. The solid composition can be, by way of illustration, a powder preparation including one or more compounds of the present teachings intermixed with lactose or other inert powders that are acceptable for intrabronchial use, and can be administered by, for example, an aerosol dispenser or a device that breaks or punctures a capsule encasing the solid composition and delivers the solid composition for inhalation. The aerosol composition can include, by way of illustration, one or more compounds of the present teachings, propellants, surfactants, and co-solvents, and can be administered by, for example, a metered device. The propellants can be a chlorofluorocarbon (CFC), a hydrofluoroalkane (HFA), or other propellants that are physiologically and environmentally acceptable.
Compounds described herein can be administered parenterally or intraperitoneally. Solutions or suspensions of these compounds or a pharmaceutically acceptable salts, hydrates, or esters thereof can be prepared in water suitably mixed with a surfactant such as hydroxyl-propylcellulose. Dispersions can also be prepared in glycerol, liquid polyethylene glycols, and mixtures thereof in oils. Under ordinary conditions of storage and use, these preparations typically contain a preservative to inhibit the growth of microorganisms. The pharmaceutical forms suitable for injection can include sterile aqueous solutions or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In some embodiments, the form can sterile and its viscosity permits it to flow through a syringe. The form preferably is stable under the conditions of manufacture and storage and can be preserved against the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (e.g., glycerol, propylene glycol and liquid polyethylene glycol), suitable mixtures thereof, and vegetable oils. Compounds described herein can be administered transdermally, i.e., administered across the surface of the body and the inner linings of bodily passages including epithelial and mucosal tissues. Such administration can be carried out using the compounds of the present teachings including pharmaceutically acceptable salts, hydrates, or esters thereof, in lotions, creams, foams, patches, suspensions, solutions, and suppositories (rectal and vaginal). Transdermal administration can be accomplished through the use of a transdermal patch containing a compound, such as a compound disclosed herein, and a carrier that can be inert to the compound, can be non-toxic to the skin, and can allow delivery of the compound for systemic absorption into the blood stream via the skin. The carrier can take any number of forms such as creams and ointments, pastes, gels, and occlusive devices. The creams and ointments can be viscous liquid or semisolid emulsions of either the oil-in-water or water-in-oil type. Pastes comprised of absorptive powders dispersed in petroleum or hydrophilic petroleum containing the compound can also be suitable. A variety of occlusive devices can be used to release the compound into the blood stream, such as a semi-permeable membrane covering a reservoir containing the compound with or without a carrier, or a matrix containing the compound. Other occlusive devices are known in the literature.
Compounds described herein can be administered rectally or vaginally in the form of a conventional suppository. Suppository formulations can be made from traditional materials, including cocoa butter, with or without the addition of waxes to alter the suppository's melting point, and glycerin. Water-soluble suppository bases, such as polyethylene glycols of various molecular weights, can also be used. Lipid formulations or nanocapsules can be used to introduce compounds of the present teachings into host cells either in vitro or in vivo. Lipid formulations and nanocapsules can be prepared by methods known in the art. Inhibitors at the receptor level to CGRP are postulated to be useful in pathophysiologic conditions where excessive CGRP receptor activation has occurred. Such excessive CGRP receptor activation occurs in skin conditions. Another aspect of the disclosure is a method of inhibiting the CGRP receptor comprising contacting the CGRP receptor with a compound of formula I, formula II, formula III, or a pharmaceutically acceptable salt(s) thereof. Another aspect of the disclosure is a method for treating conditions associated with aberrant levels of CGRP comprising the administration of a therapeutically effective amount of a compound of formula I, formula II, and/or formula III to a patient. Another aspect of the disclosure is the use of a compound of formula I, formula II, and/or formula III in the manufacture of a medicament for the treatment of conditions related to aberrant levels of CGRP, such as skin conditions including those exemplified herein. Another aspect of the disclosure is a compound according to formula I, formula II, and/or formula III useful for the treatment of conditions related to aberrant levels of CGRP, such as skin conditions including those exemplified herein. Another aspect of the disclosure is a method of treating one or more skin conditions. Another aspect of the disclosure relates to a method of treating inflammation (particularly neurogenic inflammation), pain, and other conditions or symptoms related to one or more skin conditions, the treatment of which can be effected by the antagonism of the CGRP receptor by the administration of pharmaceutical compositions comprising one or more compounds of Formula I, Formula II, and/or Formula III as defined herein. Another aspect of the disclosure relates to a method of treatment using combinations of one or more of Formulas I, Formula II, and/or Formula III with one or more therapeutic agents selected from corticosteroids, calcipotriol, anthralin, coal tar, biologics, monoclonal antibodies, secukinumab, brodalumab, guselkumab, certolizumab, usetkinumab, ciclosporin, methotrexate, retinoids, vitamin D, fumaric
acid esters paricalcitol, dithranol, desoximetasone, and fluocinonide. Methods of treatment may also comprise combinations with moisturizers and emollients such as mineral oil, petroleum jelly, and decubal. Methods of treatment may also comprise PUVA and/or UVB phototherapy treatments. Methods of treatment may also comprise systemic agents such as methotrexate, ciclosporin, hydroxycarbamide, vitamin A, fumarates such as dimethyl fumarate, and retinoids. It can be appreciated that a CGRP receptor antagonist may be used alone or in combination with any known treatment in order to treat, ameliorate, and/or prevent skin conditions or symptoms associated therewith. In some embodiments, a method of treating one or more skin conditions with a CGRP receptor antagonist may further comprise an analysis of genetic susceptibility or risk. In some embodiments, a susceptibility or risk analysis may also include hereditary factors. In some embodiments, a genetic or hereditary analysis may inform dosing with a CGRP receptor antagonist. In some embodiments, a genetic or hereditary analysis may inform prophylaxis in patients with no symptoms or limited symptoms. Pharmacokinetics and Dosing In some embodiments, a method of treating one or more skin conditions may be characterized by one or more pharmacokinetic parameters such as AUC, Cmax, Tmax, and others known and understood to persons of skill in the art. The term “pharmacokinetic” (PK) as used herein is used in its ordinary sense to mean the pharmacokinetic aspects of drug delivery. By definition pharmacokinetics (PK) is the study of how an organism affect a drug, e.g. how and how fast it metabolizes the drug. The pharmacokinetics typically vary based upon the dosage amount of one or more of Formula I, Formula II, and/or Formula III The pharmacokinetics may or may not vary as a function of administration route. In some embodiments, a method of treating one or more skin conditions may be characterized by an AUC for a compound according to Formula I, Formula II, and/or Formula III. In some embodiments, the AUC0-t and/or AUC0-inf (collectively referred to in the alternative as, simply, AUC) may be from about 80 – 125% of a given AUC value. In some embodiments, the AUC may be within 80 – 125 % of about 25, 50, 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 hr*ng/mL.
In some embodiments, a systemic treatment may have a larger AUC than a localized (such as topical or subdermal) treatment. In some embodiments, a method of treating one or more skin conditions may be characterized by a Cmax for a compound according to Formula I, Formula II, and/or Formula III. In some embodiments, the Cmax may be from about 80 – 125% of a given Cmax value. In some embodiments, the Cmax may be within 80 – 125 % of about 1, 2, 3, 4, 5, 8, 10, 20, 35, 50, 80,100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 ng/mL. In some embodiments, a systemic treatment may have a larger Cmax than a localized (such as topical or subdermal) treatment. In some embodmients, a ratio Cmax/AUC may be used to characterize a method of treating one or more skin conditions wherein one or more of a compound according to Formula I, Formula II, and/or Formula III are administered to a subject. In some embodiments, the Cmax/AUC ratio may be from about 80 – 125 % of a given Cmax/AUC ratio. In some embodiments, the Cmax/AUC ratio may be from about 80 – 125 % of about 0.01, 0.03, 0.05, 0.08, 0.1, 0.13, 0.17, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.6, 0.7, 0.8, and 0.9. In some emboidments, the Tmax may range from about 0.1 – 16 hours, or from about 0.3 – 8 hours, or from about 0.5 – 4 hours, or from 0.5 – 2 hours, or from about 1 – 2 hours. In some embodiments, the route of administration, which may be any route described herein or known to a person of skill in the art, may affect the Tmax of a compound according to Formula I, Formula II, and/or Formula III. Excipients or other pharmaceutically acceptable carriers in pharmaceutical compositions of one or more compounds according to Formula I, Formula II, and/or Formula III may alter the Tmax value by making it larger or smaller than a pharmaceutical composition having the excipient or carrier excluded. Solid compositions are normally formulated in dosage units providing from about 0.1 to about 1000 mg of the active ingredient per dose. Some examples of solid dosage units are 0.1 mg, 1 mg, 10 mg, 100 mg, 500 mg, and 1000 mg. Liquid compositions are generally in a unit dosage range of 0.1-100 mg/mL. Some examples of liquid dosage units are 0.1 mg/mL, 1 mg/mL, 10 mg/mL, 25 mg/mL, 50 mg/mL, and 100 mg/mL. In some embodiments, a dose is daily. In some embodiments, a dose is twice daily. In some embodiments, a does is one, two, three, four, or five times daily.. In
some embodiments, a dose is once every other day, once every second day, once every third day, once every fourth day, once every fifth day, once every sixth day, weekly, bi-weekly, or monthly. Typically, a dose may be from 0.01-100 mg/kg body weight, or from .05 – 50 mg/kg body weight, or from 0.1 – 10 mg/kg body weight, or from 0.15 – 5 mg/kg body weight, or from 0.2 – 2 mg/kg body weight, or from 0.5 – 1.5 mg/kg body weight, or from 1 – 1.5 mg/kg body weight. In some embodiments, the dosing regimen may comprise one or more optional loading doses and a subsequent maintenance dose regimen. A loading dose may be larger than the doses given in a subsequent maintenance dose regimen. In some embodiments, the dosage is adjusted based upon symptoms of one or more skin conditions observed in the patient. A symptom-dependent regimen may have a larger treatment dose while symptoms are present and a smaller preventative dose while symptoms are lessened, in remission, controlled, etc. In some embodiments, a treatment dose may comprise a unit dosage of about 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 75 mg, 80 mg, 100 mg, 120 mg, 140 mg, 160 mg, 180 mg, or 200 mg of a CGRP receptor antagonist compound according to one or more of Formula I, Formula II, and/or Formula III. In some embodiments, a preventative dose may comprise a unit dosage of about 1 mg, 2 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, 60 mg, 70 mg, 75 mg, 80 mg, 100 mg, 120 mg, or 140 mg of a CGRP receptor antagonist compound according to one or more of Formula I, Formula II, and/or Formula III. In some embodiments, the preventative dose is an amount that is about 7/8, 3/4, 5/8, 1/2, 3/8, 1/4, or about 1/8 of the amount of the treatment dose. In some embodiments, if a patient receiving a preventative dosing regimen experiences recurrence or onset of symptoms, a treatment dosing regimen may replace the preventative dosing regimen until symptoms have lessened or subsided. Each of the treatment and/or preventative doses may be adjusted during the regimen based upon the severity of symptoms of one or more skin conditions. Definitions "Therapeutically effective" means there is a meaningful patient benefit as understood by medical practitioners. "Patient" means a person who may benefit from treatment as determined by medical practitioners.
“CGRP Receptor Antagonist” as used herein generally may refer to any small molecule antagonist of the CGRP receptor that is useful for treating, ameliorating, and/or preventing a disease or indication. In some embodiments, a CGRP receptor antagonist may be given as a pharmaceutical composition. In some embodiments, one or more CGRP receptor antagonists may be included in a pharmaceutical composition. The terms "treating" and its derivatives such as “treat” or "treatment," as used herein, may be used with respect to a particular condition, for example, a condition due to or associated with CGRP and/or abberant levels thereof, such as one or more skin conditions. In reference to a particular condition, “treating” and its derivatives are inclusive of several meanings, including (1) to alleviate one or more symptoms, effects, or side effects associated with the condition, (2) to ameliorate the condition and/or one or more of the biological manifestations or underlying causes of the condition, (3) to interfere with one or more of the biological manifestations or underlying causes of the condition or with one or more points in the biological cascade(s) associated with the condition, (4) to slow the progression of, or arrest the development of, the condition or of one or more of the biological manifestations of the condition, (5) to prevent or reduce the risk of a subject developing the condition, in some cases prophylactically when the subject has one or more risk factors for the condition (6) to cause regression of the condition, or improvement or reversal of, the biological manifestations or underlying causes of the conditions. It can be appreciated that “treating” may encompass one or more of these meanings simultaneously and that a subject’s condition may change over time or throughout the course of treatment such that the meaning of “treating” as applied to a given subject may change over time or throughout the course of treatment. “Treating” as used herein may also refer to any beneficial effect of administering a CGRP receptor antagonist compound and/or a pharmaceutical composition comprising a CGRP receptor antagonist to a subject or patient having or being at risk for developing one or more skin conditions. “Treating” therefore may encompass alleviating one or more skin conditions and/or the symptoms of one or more skin conditions, prophylaxis or prevention of one or more skin conditions or of the worsening of one or more skin conditions, and reducing the risk that a subject or patient may develop new or worsening skin conditions. “Treatment” may be in combination with other therapies or alone. The term “AUC” (area under the curve) typically refers to a total amount of drug absorbed or exposed to a subject. Generally , AUC may be obtained from
mathematical method in a plot of drug concentration in the subject over time until the concentration is negligible . The term “ AUC ” may also refer to partial AUC at specified time intervals. The AUC may be determined within a certain time period (such as from time 0 to time t; AUC0-t) or may be extrapolated from the last measured point to the point where drug concentration in the subject is zero (AUCinf). The term "Cmax” refers to a maximum concentration of a drug in blood , serum , a specified compartment or test area of a subject after administration of a dose or between administration of a first dose and administration of a second dose. The term Cmax could also refer to dose normalized ratios, if specified. The term “Tmax” refers to a time or period after administration of a drug when the maximum concentration (Cmax) is reached in blood, serum, a specified compartment or test area of a subject. The term “dosing interval” refers to the amount of time that elapses between multiple doses of a formulation disclosed herein being administered to a subject. Dosing interval can thus be indicated as ranges. The term “dosing frequency” refers to the frequency of administering doses of a formulation disclosed herein in a given time. Dosing frequency can be indicated as the number of doses per a given time, e.g., once a day (daily), twice a day (twice daily), once a week (weekly) or once in two weeks, etc. For the purposes of the present disclosure, the term “excipient” and “carrier” are used interchangeably throughout the disclosure and said terms are defined herein as, “ingredients which are used in the practice of formulating a safe and effective pharmaceutical composition.” Examples The following examples further describe and demonstrate embodiments within the scope of the present disclosure. The Examples are given solely for purpose of illustration and are not to be construed as limitations of the present disclosure, as many variations thereof are possible without departing from the spirit and scope of the disclosure.
Example 1 – Oral Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an oral treatment for one or more skin conditions. Such oral treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions. The oral pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate oral dosage form, including but not limited to as pills, tablets including oral disintegrating tablets, or capsules. The pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art. In a study, the oral pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with the one or more skin conditions. In some patients, treatment may continue beyond the treatment of the one or more skin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence. Subgroups of patients having a history of one or more skin conditions and symptom flares but no current or currently limited symptoms can be treated prophylactically with the expectation that further symptom flares can be reduced or avoided. As described herein, a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower. The dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein. It is expected that such oral therapies can treat one or more skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure.
Example 2 – Topical Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as a topical treatment for one or more skin conditions. Such topical treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of such skin conditions. The topical pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as lotions, creams, ointments, foams, patches, pastes, gels, suspensions, and solutions. The pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art. In a study, the topical pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with the one or more skin conditions. In some patients, treatment may continue beyond the treatment of the skin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence. Subgroups of patients having a history of skin conditions and related symptom flares but no current or currently limited symptoms can be treated prophylactically with the expectation that further symptom flares can be reduced or avoided. As described herein, a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower. The dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein. In some patients, topical pharmaceutical compositions can be applied directly onto, or adjacent to affected skin areas for treatment of active symptoms having visible and/or actively symptomatic area(s) on the skin. In some patients, topical
pharmaceutical compositions can be applied as a preventative to regions of the skin having prior symptoms of one or more skin conditions. It is expected that such topical therapies can treat skin disorders with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure. Example 3 – Injectable Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an injectable treatment for one or more skin conditions. Such injectable treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions. The injectable pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as sterile solutions, suspensions, dispersions, or emulsions. The pharmaceutical compositions may be formulated with one or more pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art. In a study, the injectable pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with the one or more skin conditions. In some patients, treatment may continue beyond the treatment of one or more skin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence. Subgroups of patients having a history of one or more skin conditions and symptom flares but no current or currently limited symptoms can be treated prophylactically with the expectation that further symptom flares can be reduced or avoided. As described herein, a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or
Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower. The dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein. In some patients, injectable pharmaceutical compositions can be injected intravenously, intramuscularly, subcutaneously, or via any other appropriate route for a systemic treatment of one or more skin conditions. In some patients, injectable pharmaceutical compositions can be injected locally at or adjacent to an affected skin area or region at risk for development of symptoms. It is expected that such injectable therapies can treat skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure. Example 4 – Intranasal Pharmaceutical Compositions for Treating Skin Conditions The CGRP receptor antagonists of one or more of a compound according to Formula I, Formula II, and/or Formula III can be formulated as an intranasal treatment for one or more skin conditions. Intranasal pharmaceutical compositions are described generally in WO 2021/112707A1 published June 24, 2021, which is incorporated by reference in its entirety herein. Such intranasal treatments are expected to be useful for the treatment, prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions. The intranasal pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be prepared in any appropriate dosage form, including but not limited to as sterile solutions, saline solutions, isotonic solutions, buffered solutions, suspensions, dispersions, and emulsions. The pharmaceutical compositions may be formulated with one or more
pharmaceutically acceptable excipients as disclosed herein or as known to a person of skill in the art. In a study, the intranasal pharmaceutical compositions of one or more of a compound according to Formula I, Formula II, and/or Formula III can be administered to patients having one or more skin conditions using a dosing regimen described herein. The patients can be monitored for improvement of symptoms associated with one or more skin conditions. In some patients, treatment may continue beyond the treatment of one or more kin conditions to prophylactically treat, prevent, and/or prevent the risk of symptom recurrence. Subgroups of patients having a history of one or more skin conditions and symptom flares but no current or currently limited symptoms can be treated prophylactically with the expectation that further symptom flares can be reduced or avoided. As described herein, a treatment dose may differ in the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered compared to a preventative dose, where the amount of one or more of a compound according to Formula I, Formula II, and/or Formula III administered in the preventative dose may be, but is not necessarily, lower. The dosage amounts and particular dosage regimen applied to each patient can be decided upon by a medical professional using sound judgement according to the disclosure herein. It is expected that such intranasal therapies can treat one or more skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies, physicians can identify an effective course of treatment using the compounds, compositions, and methods of the present disclosure. Example 5 – Combination Treatments for Treating Skin Conditions Some patients having active symptoms of one or more skin conditions can be treated in a study with one or more of an oral, topical, intranasal and/or injectable pharmaceutical composition according to Examples 1 – 4 simultaneously, alternatively, or initially via one route initially in a first treatment phase followed by a second route in a second treatment phase.
In a first subset of patients, a local topical treatment can be applied in a first treatment phase followed by an oral, intranasal, or injectable systemic treatment in a second treatment phase following the first. The local topical treatment, i.e. the first treatment phase, can be applied for a set period of time or until a change or improvement of symptoms is observed, after which a second treatment phase can be applied. The systemic oral, intranasal, or injectable treatment, i.e. the second treatment phase, would then be applied either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares. In a second subset of patients, systemic oral, intranasal, or injectable treatment can be applied in a first treatment phase followed by a topical local treatment in a second treatment phase following the first. The systemic oral, intranasal, or injectable, i.e. the first treatment phase, can be applied for a set period of time or until a change or improvement of symptoms is observed, after which a second treatment phase can be applied. The local topical treatment, i.e. the second treatment phase, would then be applied either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares. In a third subset of patients, systemic oral, intranasal, or injectable treatment can be applied concurrently with a topical local treatment. Within the subset, after a set period of time or after improvement of symptoms is observed, some patients can discontinue the local topical treatment and continue receiving the systemic oral, intranasal, or injectable treatment either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares. For other patients within the subset, after a set period of time or after improvement of symptoms is observed, some patients can discontinue the oral, intranasal, or injectable systemic treatment and continue receiving the local topical treatment either i) until symptoms have been reduced or cleared and/or ii) for a prolonged period for prophylaxis, prevention, and reduction in the risk that the patient has further symptom flares. It is expected that such combination therapies can treat one or more skin conditions with varying degrees of success in different patients having different types of skin conditions and symptoms, and that, guided by these developed therapies,
physicians can identify an effective course of treatment for one or more skin conditions using the compounds, compositions, and methods of the present disclosure. Incorporation by Reference The entire disclosure of each of the patent documents, including certificates of correction, patent application documents, scientific articles, governmental reports, websites, and other references referred to herein is incorporated by reference herein in its entirety for all purposes. In case of a conflict in terminology, the present specification controls. Equivalents The invention can be embodied in other specific forms without departing from the spirit or essential characteristics thereof. The foregoing embodiments are to be considered in all respects illustrative rather than limiting on the invention described herein. In the various embodiments of the present invention, where the term comprises is used with respect to the recited components or methods, it is also contemplated that the invention consists essentially of, or consists of, the recited components or methods. Furthermore, it should be understood that the order of steps or order for performing certain actions is immaterial so long as the invention remains operable. Moreover, two or more steps or actions can be conducted simultaneously. In the specification, the singular forms also include the plural forms, unless the context clearly dictates otherwise. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. In the case of conflict, the present specification will control. All percentages and ratios used herein, unless otherwise indicated, are by weight. It is recognized the mass of an object is often referred to as its weight in everyday usage and for most common scientific purposes, but that mass technically refers to the amount of matter of an object, whereas weight refers to the force experienced by an object due to gravity. Also, in common usage the “weight” (mass) of an object is what one determines when one “weighs” (masses) an object on a scale or balance.
Claims
CLAIMS What is claimed is: 1. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a CGRP receptor antagonist according to Formula (I):
where: R1 is hydrogen, cyano, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl; R2 is piperidinyl substituted with 1 substituent selected from the group consisting of:
R3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R4 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R5 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R6 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R7 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R8 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R9 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R10 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R11 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, dialkylamino, alkoxycarbonyl, or benzyloxycarbonyl; or R10 and R11 taken together is O or N—OH; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl substituted with 0-3 substituents selected from the group consisting of cyano, halo, alkyl, haloalkyl, alkoxy, haloalkoxy, and alkylSO2; X is O, CH2, or NH; and Y is a bond, O, CH2, or NH; or a pharmaceutically acceptable salt thereof.
2. The method of claim 1 where:
R1 is hydrogen, cyano, halo, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl; R2 is piperidinyl substituted with 1 substituent selected from the group consisting of
, R3 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R4 is hydrogen, halo, cyano, alkyl, haloalkyl, alkoxy, or haloalkoxy; R5 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R6 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R7 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R8 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R9 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino;
R10 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; R11 is hydrogen, hydroxy, alkoxy, haloalkoxy, azido, amino, alkylamino, or dialkylamino; or R10 and R11 taken together is oxo; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl substituted with 0-3 substituents selected from the group consisting of cyano, halo, alkyl, haloalkyl, alkoxy, haloalkoxy, and alkylSO2; X is O, CH2, or NH; and Y is a bond, O, CH2, or NH; or a pharmaceutically acceptable salt thereof.
4. The method of claim 3 where R1 is hydrogen, halo, cyano, amino, alkylamino, or dialkylamino; R2 is piperidinyl substituted with 1 substituent selected from the group consisting of
; R3 is hydrogen or halo; R4 is hydrogen or halo; R5 is hydrogen or hydroxy; R6 is hydrogen; R7 is hydrogen; R8 is hydrogen; R9 is hydrogen or hydroxy; R10 is hydrogen, hydroxy, azido, amino, alkylamino, or dialkylamino; R11 is hydrogen; or R10 and R11 taken together is oxo; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl substituted with 0-2 halo substituents; X is O, CH2, or NH; and Y is O; or a pharmaceutically acceptable salt thereof.
5. The method of claim 4 where R1 is hydrogen; R2 is piperidinyl substituted with 1 substituent selected from the group consisting of:
R5 is hydrogen or hydroxy; R6 is hydrogen; R7 is hydrogen; R8 is hydrogen; R9 is hydrogen or hydroxy; R10 is hydroxy, azido, or amino; R11 is hydrogen; or R10 and R11 taken together is oxo; provided that at least one of R5, R6, R7, R8, R9, R10, or R11 is not hydrogen; Ar1 is phenyl or difluorophenyl; X is O, CH2, or NH; and Y is O; or a pharmaceutically acceptable salt thereof.
6. The method of claim 1 where R1 is hydrogen, cyano, halo, alkyl, haloalkyl, alkoxy, amino, alkylamino, dialkylamino, azetidinyl, pyrrolidinyl, or piperidinyl.
7. The method of claim 1 where R2 is N-piperidinyl and is 4-substituted.
8. The method of claim 7 where the substituent is:
9. The method of claim 1 where: R5 is hydrogen, R6 is hydrogen, R7 is hydrogen, R8 is hydrogen, R9 is hydrogen, R10 is hydroxy, azido, or amino, and R11 is hydrogen; or where R5 is hydrogen, R6 is hydrogen, R7 is hydrogen, R8 is hydrogen, R9 is hydrogen or hydroxy, and R10 and R11 taken together is oxo; or where R5 is hydrogen, R6 is hydrogen, R7 is hydrogen, R8 is hydrogen, R9 is hydroxy, R10 is hydrogen or hydroxy, and R11 is hydrogen; or where R5 is hydroxy, R6 is hydrogen, R7 is hydrogen, R8 is hydrogen, R9 is hydrogen, R10 is hydrogen, and R11 is hydrogen.
10. The method of claim 1 where Ar1 is phenyl substituted with 2 halo substituents.
11. The method of claim 10 where Ar1 is 2,3-difluorophenyl.
12. The method of claim 1 where X is O.
13. The method of claim 1, wherein the CGRP antagonist is selected from the group consisting of: (6R,9R)-6-(2,3-Difluorophenyl)-6-hydroxy-5-oxo-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate;
(9R)-6-(2,3-difluorophenyl)-5-oxo-6,7,8,9-tetrahydro-5H-cyclohepta[b]p- yridin- 9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxylate; (5S,6R,9R)-6-(2,3-difluorophenyl)-5,6-dihydroxy-6,7,8,9-tetrahydro-5H-- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6R,9R)-6-(2,3-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-azido-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (6S,9R)-6-(2,3-difluorophenyl)-6-hydroxy-6,7,8,9-tetrahydro-5H-cyclohe- pta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-5-amino-6-(3,5-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (5S,6S,9R)-6-(3,5-difluorophenyl)-5-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate; (6S,8R,9S)-6-(2,3-difluorophenyl)-8-hydroxy-6,7,8,9-tetrahydro-5H-cycl- ohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1- carboxylate;
(5S,6S,9R)-6-(2,3-difluorophenyl)-5-(methylamino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-6-(2,3-difluorophenyl)-5-(dimethylamino)-6,7,8,9-tetrahydro- -5H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,9R,Z)-6-(2,3-difluorophenyl)-5-(hydroxyimino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (6S,9R,E)-6-(2,3-difluorophenyl)-5-(hydroxyimino)-6,7,8,9-tetrahydro-5- H- cyclohepta[b]pyridin-9-yl 4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1- yl)piperidine-1-carboxylate; (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-9-yl 2'-oxo-1,1',2',3-tetrahydrospiro[indene-2,3'-pyrrolo[2,3-b]pyridine]- 5-yl- carbamate; tert-butyl(5S,6S,9R)-9-amino-6-(2,3-difluorophenyl)-6,7,8,9-tet- rahydro-5H- cyclohepta[b]pyridin-5-ylcarbamate; tert-butyl (5S,6S,9S)-6-(2,3-difluorophenyl)-9-(2- oxo-2-(4-(2-oxo-2,3-dihydro-1H-imi- dazo[4,5-b]pyridin-1-yl)piperidin-1-yl)ethyl)- 6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-5-yl-carbamate; tert-butyl (5S,6S,9R)-6-(2,3-difluorophenyl)-9-(2-oxo-2-(4-(2-oxo-2,3-dihydro- 1H-imi- dazo[4,5-b]pyridin-1-yl)piperidin-1-yl)ethyl)-6,7,8,9-tetrahydro-5H-cycloh- epta[b]pyridin-5-ylcarbamate; and 1-(1-(2-((5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H- cyclohepta[b]pyridin-9-yl)acetyl)piperidin-4-yl)-1H-imidazo[4,5-b]pyridin-2(3H)-one; or a pharmaceutically acceptable salt thereof.
14. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin diseases, the method comprising administering to a subject in need thereof a CGRP receptor antagonist, wherein CGRP receptor antagonist is the compound (5S,6S,9R)-5-amino-6-(2,3-difluorophenyl)-6,7,8,9-tetrahydro-5H- cyclohepta[b]pyridine-9-yl-4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridine-1- yl)piperidine-1-carboxylate, which has the following structure:
15. The method of claim 14, wherein the pharmaceutically acceptable salt thereof is a hemisulfate salt.
16. The method of claim 15, wherein the hemisulfate salt is a sesquihydrate.
17. The method of any one of claims 1 – 16, wherein the CGRP antagonist is administered in a unit dosage selected from the group consisting of about 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 75 mg, about 80 mg, about 100 mg, about 120 mg, about 140 mg, about 160 mg, about 180 mg, or about 200 mg.
18. The method of any one of claims 1 – 16, wherein the CGRP antagonist is administered in a dosage of 0.01-100 mg/kg body weight, or from .05 – 50 mg/kg body weight, or from 0.1 – 10 mg/kg body weight, or from 0.15 – 5 mg/kg body weight, or from 0.2 – 2 mg/kg body weight, or from 0.5 – 1.5 mg/kg body weight, or from 1 – 1.5 mg/kg body weight.
19. The method of any one of claims 1 – 16, wherein the CGRP antagonist is administered in an amount corresponding to an area under curve (AUC) within about 80 – 125 % of about 25, 50, 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, or 100,000 hr*ng/mL. 20. The method of any one of claims 1 – 16, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax value within about 80 – 125 % of about 1, 2, 3, 4, 5, 8, 10, 20, 35, 50, 80,100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000,
20,000, 30,000, 50,000, and/or 100,000 ng/mL.
21. The method of any one of claims 19 and 20, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax/AUC ratio within about 80 – 125 % of about 0.01, 0.03, 0.05, 0.08, 0.1, 0.13, 0.17, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.6, 0.7, 0.8, and 0.9.
22. The method of any one of claims 1 – 21, wherein the CGRP antagonist is administered at an interval of daily, twice daily, once every other day, once every two days, once every three days, once every four days, once every five days, once every six days, or once weekly.
23. The method of any one of claims 1 – 22, wherein the CGRP antagonist is administered by a route selected from oral, intrabuccal, intranasal, inhalation, parenteral, intravenous, topical, injectable and/or transdermal.
24. The method of any one of claims 1 – 16, wherein the CGRP antagonist is administered in a unit dosage of 75 mg.
25. The method of claim 24, wherein the CGRP antagonist is administered orally.
26. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a CGRP receptor antagonist according to Formula (II):
or a pharmaceutically acceptable salt thereof, wherein V is —N(R1)(R2) or OR4; R4 is H, C1-6alkyl, C1-4haloalkyl or (C1-4alkylene)0-1R4′ R4′ is C3-7cycloalkyl, phenyl, adamantyl, quinucidyl, azabicyclo[2.2.1]heptyl, azetidinyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino or dioxolanyl; and R4′ is optionally substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1-4alkyl, C1-4haloalkyl, C1-4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1-3dialkylamino, (C1-3alkyl)0-2ureido, phenyl and benzyl; and R4′ optionally contains 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the ring structure of R4′; R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1-6alkyl, C2-6alkenyl, C2-6alkynyl, —C1-6alkylene-amino (C1-3alkyl)2,
C3-7cycloalkyl, phenyl, azetidinyl, adamantyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazolyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl, piperazinyl, morpholino, thiomorpholino and dioxolmnyl; and R1 and R2 are each optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of halo, cyano, C1- 4alkyl, C1-4haloalkyl, C1-4alkoxy, hydroxy, amino, C3-7cycloalkyl, C1-3alkylamino, C1- 4dialkylamino, (C1-3alkyl)0-2ureido, phenyl and benzyl; R1 and R2 optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising R1 and R2; wherein L1 is optionally and independently interrupted from the nitrogen to which it is attached by L2, wherein L2 is independently C1-3alkylene or C1-3alkylidene; or R1 and R2 together with the nitrogen to which they are attached form X, wherein X is azetidinyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolizyl, imidazolidinyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, piperazinyl, piperidinyl, morpholino or thiomorpholino; wherein X is optionally substituted with Y, wherein Y is dioxolanyl, C1-9alkyl, C2-9alkenyl, C2-9alkynyl, C1-4alkylamino, C1-4dialkylamino, C1-4alkoxy, C3-7cycloalkyl, phenyl, azetidinyl, furanyl, thienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, pyrrolidinonyl, imidazolyl, imidazolinyl, imidazolidinyl, imidazolidinonyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, pyridyl, pyrimidinyl, dihaydrobenzimidazolonyl, piperazinyl, piperidinyl, morpholino, benzothiazolyl, benzisothiazolyl or thiomorpholino; and wherein X and Y are optionally interrupted with Z, wherein Z is— NHC(O)O—, —NHC(O)NH—, NC(Q)NH2,—NH—, —C1-3alkylene—, C1-3alkenylene- NHC(O)O—C1-3alkylene-; and
optionally and independently substituted with 1 or 2 of the same or different substituents selected from the group consisting of C1-4alkyl, amino, C1-3alkylamino, —C1-3alkylene-amiao(C1-3alkyl)2, (C1-3alkyl)0-2ureido, phenyl and benzyl; X and Y optionally and independently contain 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of the heterocycles comprising X and Y; provided that if X is substituted with Y, and if X and Y are not interrupted with Z, then X and Y optionally share one carbon atom and together form a spirocyclic moiety; Q is Q′ or Q″; wherein Q′ is (Sy)SR3; and Q″ is NH(Sy)SR3, NHC(O)(Sy)SR3, NHC(O)O(Sy)SR3, NHC(O)NH(Sy) sR3, O(Sy)SR3, (Sy)3NHR3, (Sy)SNHC(O)R3,(Sy)SNHC(O)OR3, (Sy)SNHC(O)NHR3; or (Sy)SOR3; wherein Sy is C1-3alkylene or C1-3alkylidene and a is 0 or 1; U is CH2 or NH; provided that if Q is Q″, then U is CH2; R3 is R3a or R3b wherein R3a is (i) a heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to five of the same or different beteroatoms selected from the group consisting of O, N and S, and said heterocycle optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused rings; (ii) a 4 to 6 membered heterocycle containing one to three of the same or different heteroatoms selected from the group consisting of O, N and S, optionally containing 1 to 2 carbonyls, wherein the carbon atom of said carbonyl is a member of said 4 to 6 membered heterocycle; (iii) C3-7cycloalkyl;
(iv) carbazolyl, fluorenyl, phenyl, —O-phenyl, —O—C1-4alklylene-phenyl, or napthyl; or (v) C1-8alkyl, C2-7alkenyl, —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′,— C(O)O—R3′or C2-7alkynyl; and wherein R3a is optionally substituted with 1 to 3 of the same or different substituents selected from the group consisting of benzyl, phenyl, —O-phenyl, —O— C1-3alkylenephenyl, —C1-3alkylene-O—C(O)-phenyl, cyano, amino, nitro, halo, C1- 6alkyl, C1-3mono-bi-tri-haloalkyl, C1-3mono-bi-tri-haloalkyloxy, (C1-3alkyl)1-2amine, — OR3′, —C(O)R3′, —C(O)O—R3′, —O—C(O)R3′, —N(R3′)2, —C(O)N(R3′)2, — N(R3′)C(O)(R3′)2, —N(R3′)C(O)N(R3′)2, —N(R3′)C(O)OR3′, —O—C(O)N(R3′)2, — N(R3′)SO2R3′, —SO2N(R3′)2 and —SO2R3′; R3′is H or —C1-6alkyl; provided that if R3a is , —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or — C(O)O—R3′, then said —C(O)R3′, CHC(O)O—R3′, CH(CH3)C(O)O—R3′or —C(O)O— R3′are unsubstituted; R3b is R3a but is not phenyl, 1-naphthyl, 2-naphthyl, 1,2,3,4-tetrahydro-1- naphthyl, 1H-indol-3-yl, 1-methyl-1H-indol-3-yl, 1-formyl-1H-indol-3-yi, 1 -(1,1- dirnethylethoxycarbonyl)- 1H-indol-3-yl, 4-imidazolyl, 1-methyl-4-imidazolyl, 2-thienyl, 3-thienyl, thiazolyl, 1H-indazol-3-yl, 1-methyl-1H-indazol-3-yl, benzo[b]fur-3-yl, benzo[b]thien-3-yl, pyridinyl, quinolinyl or isoquinolinyl; optionally substituted in the carbon skeleton with mono-, di- or trisubstituted by fluorine, chlorine or bromine atoms or by branched or unbranched alkyl groups, C3-8-cycloalkyl groups, phenylalkyl groups, alkenyl, alkoxy, phenyl, phenylalkoxy, trifluoromethyl, alkoxycoarbonylalkyl, carboxyalkyl, alkoxycarbonyl, carboxy, dialkylaminoalkyl, dialkylaminoalkoxy, hydroxy, nitro, amino, acetylamino, propionylamino, benzoyl, benzoylamino, benzoylmethylamino, methylsulphonyloxy, aminocarbonyl, alkylaminocarbonyl, dialkylaminocarbonyl, alkanoyl, cyano, tetrazolyl, phenyl, pyridinyl, thiazolyl, furyl, trifluoromethoxy, trifluoromethylthio, trifluoromethylsulphinyl- or trifluoromethylsulphonyl groups; wherein said substituents may be the same or different and the above- mentioned benzoyl, benzoylaznino- and benzoylmnethylamino groups may in turn additionally be substituted in the phenyl moiety by a fluorine, chlorine or bromine atom, or by an alkyl, trifluoromethyl, amino or acetylamino group;
D is O, NCN or NSO2C1-3alkyl; A is CH; m and n are each 1; E is N, CE or C; p is 1; G, J and E together form Ax; Ax is a fused heterocycle having two fused rings with 5 to 7 members in each of said rings, said heterocycle containing one to four of the same or different heteroatoms selected from the group consisting of O, N and S; and optionally containing 1 or 2 carbonyls wherein the carbon atom of said carbonyl is a member of said fused heterocycle; and further provided that if Q is Q″, then R3 is R3a; and if Q is Q′, then R3 is R3b.
27. The method of claim 26, wherein Q is Q' and R3 is R3b.
28. The method of claim 26, wherein Q is Q''.
29. The method of claim 28, wherein Q'' is NH(Sy)SR3.
30. The method of claim 28, wherein Q'' is NHC(O)(Sy)SR3.
31. The method of claim 28, wherein Q'' is NHC(O)O(Sy)SR3.
32. The method of claim 28, wherein Q'' is NHC(O)NH(Sy)SR3.
33. The method of claim 28, wherein Q'' is O(Sy)SR3.
34. The method of claim 28, wherein Q'' is (Sy)SNHR3.
35. The method of claim 28, wherein Q'' is (Sy)SNHC(O)R3.
36. The method of claim 28, wherein Q'' is (Sy)SNHC(O)OR3.
37. The method of claim 28, wherein Q'' is (Sy)SNHC(O)NHR3.
38. The method of claim 28, wherein Q'' is (Sy)SOR3.
39. The method of claim 26, wherein V is OR4.
40. The method of claim 26, wherein V is -N(R1)(R2).
41. The method of claim 26, wherein R4 is H, C1-6alkyl or (C1-4alkylene)0-1R4' and R4' is C3-7cycloalkyl.
42. The method of claim 26, wherein V is -N(R1)(R2) and R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1-6alkyl, - C1-6alkylene-amino(C1-3alkyl)2, C3-7cycloalkyl, phenyl, azetidinyl, adamantyl, tetrahydrofuranyl, furanyl, dioxolanyl, thienyl, tetrahydrothienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, oxazolyl, isoxazolyl, thiazoiyl, isothiazolyl, oxadiazolyl, thiadiazolyl, triazolyl, pyranyl, pyridyl, pyrimidinyl, pyrazinyl, pyridazinyl, triazinyl, piperidinyl., piperazinyl, morpholino, thiomorpholino and dioxolanyl; or R1 and R2 together with the nitrogen to which they are attached form X, wherein X is azetidinyl, pyrrolinyl, pyrrolidinyl, imidazolinyl, imidazolidinyl, pyrazolinyl, pyrazolidinyl, azepinyl, diazepinyl, piperazinyl, piperidinyl, morpholino or thiomorpholino; wherein x is substituted with Y, wherein Y is dioxolanyl, C1-4alkyl, C1-4alkoxy, C3-7cycloalkyl, phenyl, azetidinyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, pyrrolidinonyl, imidazolyl, irnidazolinyl, imidazolidinyl, imidazolidinonyl, pyrazolyl, pyrazolinyl, pyrazolidinyl,
azepinyl, diazepinyl, pyridyl, pyrimidinyl, dihydrobenzimidazolonyl, piperazinyl, piperidinyl, morpholino, benzothiazolyl, benzisothiazolyl or thiomorpholino; and wherein X and Y optionally share one carbon atom and together form a spirocyclic moiety.
43. The method of claim 26, wherein V is -N(R1)(R2) and R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1-6alkyl, or R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperidinyl or morpholino; wherein X is substituted with Y, wherein Y is dioxolanyl, C1-4alkyl or piperidinyl; and wherein X and Y optionally share one carbon atom and together form a spirocydic moiety.
44. The method of claim 26, wherein V is -N(R1)(R2) and wherein R1 and R2 are each independently L1, wherein L1 is selected from the group consisting of H, C1- 6alkyl.
45. The method of claim 26, wherein V is -N(R1)(R) and wherein R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperidinyl or morpholino; wherein X is substituted with Y, wherein Y is dioxolanyl, C1-4alkyl or piperidinyl; and wherein X and Y optionally share one carton atom and together form a spirocyclic moiety.
46. The method of claim 26, wherein V is -N(R1)(R2) and wherein R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperidinyl; wherein X is substituted with Y, wherein Y is piperidinyl.
47. The method of claim 26, wherein V is -N(R1)(R2) and wherein R1 and R2 together with the nitrogen to which they are attached form X, wherein X is morpholino; wherein X is substituted with Y, wherein Y is C1-4alkyl.
48. The method of claim 26, wherein V is -N(R1)(R2) and wherein R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperidinyl; wherein X is substituted with Y, wherein Y is C1-4alkyl.
49. The method of claim 26, wherein V is -N(R1)(R2) and wherein R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperidinyl; wherein X is substituted with Y, wherein Y is dioxolanyl; and wherein X and Y share one carbon atom and together form a spirocyclic moiety.
50. The method of claim 26, wherein R3 is R3a and R3a is substituted or unsubstituted phenyl, hydroxyphenyl, azetidinyl, napthyl, C1-6alkyl, C2-6alkenyl, C2- 6alkynl, dihydroquinolinonyl, hydroquinolinonyl, quinolinyl, dihydroisoquinolinonyl, hydroisoquinolinonyl, isoquinolinyl, diydroquinazolinonyl, hydroquinazolinonyl, quinazolinyl, dihydroquinoxalinonyl, hydroquinoxalinonyl, quinoxalinyl, benzimidazolyl, indazolyl, dihydrobenzimiidazolonyl, hydrobenzimidazolonyl, benzimidazolinyl, dihydro-benzthiazolonyl, hydrobenztblazolonyl, benzthiazolyl, dihydrobenzoxazolyl, benzotriazolyl, dihydrobeuzotbiophenonyl, hydrobeuzothiophenonyl, beuzothienyl, dihydrobenzofuranonyl, hydrobenzofuranonyl, benzofuranyl, benzdioxolanyl, dihydroindolonyl, hydroindolonyl, indolyl, indolizinyl, isoindolyl, indoliny, indazolyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, furanyl, thienyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyridyl, purinyl, carbazolyl, pyrimidinyl, piperidinyl, triazolopyrimidinyl, tetrahydropyrazolopyridinyl, piperazinyl or morpholino.
51. The method of claim 26, wherein R3 is R3b and R3b is substituted or unsubstituted dihydrobenzimidazolonyl, hydrobenzimidazolonyl, benzimidazolinyl, dihydro-benzthiazolonyl, hydrobenzthiazolonyl, benzthiazolyl, dihydrobenzothiophenonyl, hydrobenzothiophenonyl, dihydrobeuzofuranonyl, hydrobenzofuranonyl, 1H-indazol-5-yl, benzdioxalanyl, dihydrobeuzoxazolyl, benzotriazolyl, dihydroindolonyl, hydroindolonyl, indolizinyl, isoindolyl, indolinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, furanyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolinyl, imidazolidinyl, purinyl, carbazolyl, pyrimidinyl, piperidinyl, piperazinyl or morpholino.
52. The method of claim 26, wherein D is O and m and n are each 1.
53. The method of claim 26, wherein p is 1; and G, J and E together form Ax.
54. The method of claim 26 wherein R3 is R3b and R3b is: 1H-Indol-5-yl
1H-Indazol-5-yl
1H-Benzotriazol-5-yl
1,3-Dihydro-indol-2-on-5-yl
3H-Benzooxazol-2-on-6-yl
1,3-Dihydro-benzoimidazol-2-on-5-yl
1-Methyl-1,3-dihydro-benzoimidazol-2-on-6-yl
3,4-Dihydro-1H-quinolin-2-on-6-yl
1,4-Dihydro-benzo[d][1,3]oxazin-2-on-6-yl
3,4-Dihydro-1H-quinazolin-2-on-6-yl
55. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a
pharmaceutical composition comprising a CGRP receptor antagonist according to Formula (II):
or a pharmaceutically acceptable salt thereof, wherein V is -N(R1)(R2); R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperazinyl; wherein X is substituted with Y, wherein Y is piperidinyl; Q is Q'; wherein Q'is (Sy)SR3; wherein Sy is C1-alkylene and s is 1; U is NH; R3 is R3b; wherein R3b is 3H-Benzooxazol-2-on-6-yl
wherein Ty is H; D is O; A is CH; m and n are each 1; E is N; p is 1; G, J and E together form Ax; Ax is a fused heterocycle having two fused rings with 6 members in each of said rings, said heterocyole containing two nitrogen atoms; and containing 1 carbonyl wherein the carbon atom of said carbonyl is a member of said fused heterocycle.
56. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a pharmaceutical composition comprising a CGRP receptor antagonist according to Formula (II)
or a pharmaceutically acceptable salt thereof wherein V is -N(R1)(R2); R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperazinyl; wherein X is substituted with Y, wherein Y is piperidinyl; Q is Q'; wherein Q' is (Sy)SR3; wherein Sy is C1-alkylene and s is 1; U is NH; R3 is R3b wherein R3b is 1H-Benzotriazol-5-yl
wherein Ty is H; D is O; A is CH; m and n are each 1; E is N; p is 1; G, J and E together form Ax; Ax is a fused heterocycle having two fused rings with 6 members in each of said rings, said heterocycle containing two nitrogen atoms; and containing 1 carbonyl wherein the carbon atom of said carbonyl is a member of said fused heterocycle.
57. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a pharmaceutical composition comprising a CGRP receptor antagonist according to Formula (II)
or a pharmaceutically acceptable salt thereof wherein V is -N(R1)(R2); R1 and R2 together with the nitrogen to which they are attached form X, wherein X is piperazinyl; wherein X is substituted with Y, wherein Y is piperidinyl; and wherein X and Y are optionally and independently substituted with 1 or 2 of the same or different sub stituents selected from the group consisting of C1-4alkyl; Q is Q'; wherein Q'is (Sy)sR3; wherein Sy is C1-alkylene and s is 1; U is NH; R3 is R3b wherein R3b is 1H-Indazol-5-yl
wherein Ty is C1-4alkyl; D is O; A is CH; m and n are each 1; E is C;
p is 1; G, J and E together form Ax; Ax is a fused hetero cycle having two fused rings with 6 members in each of said rings, said heterocycle containing one nitrogen atom; and containing 1 carbonyl wherein the carbon atom of said carbonyl is a member of said fused heterocycle.
58. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a pharmaceutical composition comprising a CGRP receptor antagonist selected from the group consisting of (±)-3-(1H-Indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1- carbonyl]-amino}-propionic acid; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5 -ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indol-5-ylmethyl)-2-oxo-ethyl]-am- ide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxyl- ic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl- ]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carb- oxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-- amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carbox- ylic acid [1- (1H-indol-5 -ylmethyl)-2-(4-isobutyl-piperazin-1-yl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2- (1,4-dioxa-8-aza-spiro[4.5]dec-8-yl)-1-(1H-indol-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [1- (1H-indazol-5-ylmthyl) -2-(4-isobutyl-piperazin-1-yl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-2,3-dihydro-benzoimidazol-1-yl)-piperidine-1-carboxylic acid [2- (1,4-dioxa-8-aza -spiro[4.5]dec-8-yl)-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide;
(±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2-(1,4- dioxa-8-aza -spiro[4.5]dec-8-yl)-1-(1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-piperidin-1-yl-ethyl]-am- ide; (±)4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxyli- c acid [1- dimethylcarbamoyl-2-(7-methyl-1H-indazol-5-yl)-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-1-(7- methyl-1H-indazol-5-ylmethyl)-2-(4-methyl-piperazin-1-yl)-2-- oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-pyrrolidin-1-yl-ethyl]- -amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carbo- xylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-(4-pyridin-4-yl-pip- erazin-1-yl)-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(7- methyl-1H-indazol-5-ylmethyl)-2-oxo-2-(4-pyridin-2-yl-piperazi- n-1-yl)-ethyl]-amide; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid {1-(1-1H- indazol-5-ylmethyl)-2-oxo-2-[4-(2-oxo-1,4-dihydro-2H-quinazolin-- 3-yl)-piperidine-1- yl]-ethyl}-amide; 4-(3-(1H-Indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piper- idine-1- carbonyl]-amino}-propionyl)-piperazine-1-carboxylic acid benzyl ester; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(1H- indazol-5-ylmethyl)-2-oxo-2-piperazin-1-yl-ethyl]-amide; 4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid {1-(1H- indazol-5-ylmethyl)-2-[4-(2-methyl-butyl)-piperazin-1-yl]-2-oxo-et- hyl}-amide;
3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid cyclohexyl ester;
3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid 1-benzyl-piperidin-4-yl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1-methyl-piperidin-4-yl ester, 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid 4-phenyl-cyclohexyl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid (R)-1-pyridin-4-yl-etyl ester; 3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid (S)-1-pyridin-4-yl-ethyl ester; (±)-3-(7-Chloro-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-pipeine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-chloro-1H-indazol-5-ylmethyl)-2-oxo-eth- yl]-amide; (±)-3-(7-Ethyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-- quinazolin-3- yl)piperidine-1-carbonyl]-amino}-propionic acid methyl ester (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(7-ethyl-1H-indazol-5-ylmethyl)-2oxo-- ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(2-methyl-1H-benzoimidazol-5-ylmethyl)-2-o- xo-ethyl]- amide; (R)-4(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(2-oxo-2,3-dihydro-benzooxazol-6-ylm- ethyl)-ethyl]- amide; (R)-3-(1H-Benzotriazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)- - piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(1H- benzotriazol-5-ylmethyl)-2-[1,4']bipiperidinyl-1'-yl-2-oxo-ethyl]-- amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxyli- c acid [2[1,4']bipiperidinyl-1'-yl-2-oxo-1-(2-oxo-2,3-dihydro-1H-indol-5-y- lmethyl)-ethyl]- amide; (±)-4(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [1-(4- benzyloxy-2-oxo-2H pyridin-1-ylmethyl)-2-[1,4']bipiperidinyl-1'-yl-2-oxo-ethyl]-amide;
(±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4'bipiperidnyl-1'-yl-1-(4-hydroxy-2-oxo-2H-pyridin-1-ylmethyl)- -2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4'bipiperidinyl-1'-yl-1-(4-hydroxy-piperidin-1-ylmethyl)-2-oxo- -ethy]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(1,4,6,7-tetrahydro-pyrazolo[4,- 3-c]pyridin-5- ylmethyl)-ethyl]-amide; (±)-3-(7,7-Dimethyl-1,4,6,7-tetrahydro-pyrazolo[4,3-c]pyridin-5-yl)-2-- {[4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidine-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carbo- xylic acid [2[1,4'bipiperidinyl-1'-yl-1-(7,7-dimethyl-1,4,6,7-tetrahydro-p- yrazolo[4,3-c]pyridin-5- ylmethyl)-2-oxo-ethyl]-amide; (±)-4(2Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2[1,4']bipiperidinyl-1'-yl-1-(6methoxy-pyridin-3-ylmethyl)-2-oxo-et- hyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1-(2-methoxy-pyrimidin-5-ylmethyl)-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [(1-(6- benzyloxy-pyridin-3-ylmethyl)-2-[1,4'bipiperidinyl-1'-yl-2-ox- o-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-2-oxo-1-(6-oxo-1,6-dihydro-pyridin-3-yl- methyl)-ethyl]-amide; (±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-1,4-dihydro-2- H- quinazolin-3-yl)-piperidin-1-yl]-butyric acid methyl ester; (±)-1-[1,4']Bipiperidinyl-1'-yl-2-(7-methyl-1H-indazol-5-ylmethyl)-4-[- 4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]butane-1,4-dione; (±)-1-(1,4-Dioxa-8-aza-spiro[4.5]dec-8-yl)-2-(7-methyl-1H-indazol-5-yl- methyl)- 4-[4-(2-oxo-1,4-dihydro -2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-N,N-Dimethyl-2-(7-methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-- 1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butyramide; (±)-1-(2,6-Dimethyl-morpholin-4-yl)-2-(7-methyl-1H-indazol-5-ylmethyl)- -4-[4-(2- oxo-1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione;
(±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-1-(4-methyl-piperidin-1-yl)-4-[- 4-(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-2-(7-Methyl1H-indazol-5-ylmethyl)-1-morpholin-4-yl-4-[4-(2-oxo-1,4- - dihydro-2H-quinazolin-3-yl) -piperidin-1-yl]-butane-1,4-dione; (±)-2-(7-Methyl-1H-indazol-5-ylmethyl)-4-[4-(2-oxo-1,4-dihydro-2H-quin- azolin- 3-yl)-piperidin-1-yl]-1-piperidin-1-yl-butane-1,4-dione; (±)-1-(1,4-Dioxa-8-aza-spiro[4.5]dec-8-yl)-2-(1H-indazol-5-ylmethyl)-4- -[4-(2- oxo-1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-2-(1H-Indazol-5-ylmethyl)-N,N-dimethyl-4-oxo-4-[4-(2-oxo-1,4-dihyd- ro-2H- quinazolin-3-yl) -piperidine-1-yl]-butyramide; (±)-5-{2-([1,4']Bipiperidinyl-1'-carbonyl)-4-oxo-4-[4-(2-oxo-1,4-dihyd- ro-2H- quinazolin-3-yl)-piperidin -1-yl]-butyl}-indazole-1-carboxylic acid tert-butyl ester; (±)- 2-(7-Methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo-1,4-dihydro-2- H-quinazolin-3- yl)-piperidin-1yl]-N-prop-2-ynyl-butyramide; (L)-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-2H- - quinazolin-3-yl)-piperidin-1-yl]-propyl}-carbamic acid tert-butyl ester; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(1H-indol-5-ylamino)-4-[4-(2-oxo-1,4-di- hydro-2H- quinazolin-3-yl) -piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(5-chloro-2-nitro-phenylamino)-4-[4-(2-- oxo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4'Bipiperidinyl-1'-yl-2-(6-chloro-pyrimidin-4-ylamino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(2-chloro-9H-purin-6-ylamino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin -3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-2-(4-Amino-6-methyl-5-nitro-pyrimidin-2-ylamino)-1-[1,4']bipiperidiny- l-1'-yl-4- [4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane- -1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(4,5-diamino-6-methyl-pyrimidin-2-ylami- no)-4-[4- (2-oxo-1,4-dihydro -2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(7-methyl-1H-[1,2,3]triazo[4,5-d]pyrimi- din-5- ylamino)-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]- -butane-1,4- dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-((2'-pyridyl)-methyl-amino)-4-]4-(2-oxo- -1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione;
(L)-1-[1,4']Bipiperidinyl-1'-yl-2-((5'-indazolyl)-methyl-amino)-4-[4-(2-o- xo-1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-((3'-methyl-phenyll)-methyl-amino)-4-[4- -(2-oxo- 1,4-dihydro-2H -quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-y- l)- piperidin-1-yl]-2-(pyrimidin -4-ylamino)-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-(4-hydroxy-cyclohexylamino-4-[4-(2-oxo-- 1,4- dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (L)-1-[1,4']Bipiperidinyl-1'-yl-2-[(1H-imidazol-4-ylmethyl)-amino]-4-[4-(- 2-oxo-1,4- dihydro-2H -quinazolin-3-yl)piperidin-1-yl]-butane-1,4-dione; (L)-N-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-- 2H- quinazolin-3-yl)-piperidin-1-yl]-propyl}-4-hydroxy-benzamide; (L)-N-{1-([1,4']Bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2-oxo-1,4-dihydro-- 2H- quinazolin-3-yl)-piperidin-1-yl]-propyl}-4-hydroxy-benzamide; (L)-1H-Pyrazole-3-carboxylic acid{1-([1,4']bipiperidinyl-1'-carbonyl)-3-oxo-3-[4-(2- oxo-1,4-dihydro-2H- -quinazolin-3-yl)-piperidin-1-yl]-propyl}-amide;
(±)-1-[1,4']Bipiperidinyl-1'-yl-2-(1H-indazol-5-ylamino)-4-[4-(2-oxo-1- ,4-dihydro- 2H-quinazolin-3-yl)-piperidin-1-yl]-butane-1,4-dione; (±)-3-(3-Cyano-1H-indol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3- -yl)- piperidin-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl -1-(3-cyano-1H-indol-5-yl-methyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(3-cyano-7-methyl-1H-indol-5-yl-methyl- )-2-oxo-ethyl]- amide; (±)-3-(7-Isopropyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dibydro-2H-quinaz- olin-3- yl)-piperidin-1-carbonyl]-amino}-propionic acid methyl ester; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(7-isopropyl-1H-indazol-5-yl-methyl)-2- -oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2- [1,4']bipiperidinyl-1'-yl-1(7-ethyl-1H-indazol-5-yl-methyl)-2-oxo- -ethyl]-amide; (±)-4- (2,2-Dioxo-1,4-dihydro-2H-2.lamda..sup.6-benzo[1,2,6]thiadiazin-- 3-yl)-piperidine-1- carboxylic acid [2-[1,4']bipiperidinyl-1'-yl-1(7-methyl-1H-indazol-5-yl-methyl)-2-oxo- eth- yl]-amide; (±)-4-(2,2-Dioxo-1,4-dihydro-2H-2.lamda..sup.6-benzo[1,2,6]t- hiadiazin-3-yl)- piperidin-1-carboxylic acid [2-[1,4'bipiperidinyl-1'-yl-1(7-ethyl-3-methyl-1H-indazol-5- yl-methyl)-2-- oxo-ethyl]-amide; (±)-2-[4-(6-Cyano-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)piperidine-1-car- bonyl]- amino]-3-(7-methyl-1H-indazol-5-yl)-propionic acid methyl ester;
(±)-4-(6-Cyano-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-carbo- xylic acid{2-[1,4'bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(2-Oxo-1,2,4,5-tetrahydro-benzo[d][1,3]diazepin-3-yl-1-carboxyli- c acid{2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(6-Hydroxy-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-car- boxylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4-(8-Methoxy-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-car- boxylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-4(8-Chloro-2-oxo-1,4-dihydro-2H-qinazolin-3-yl)-piperidine-1-carbo- xylic acid{2-[1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-yl methyl)-2-oxo-ethyl}-amide; (±)-N-(3-(7-Ethyl-1H-indazol-5-yl)-1-(6,7-dihydro-1H-pyrazolo[4,3-c]py- ridin- 5(4H)-yl)-1-oxopropan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)- piperidine-1- carboxamide; (±)-Methyl 2-(4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1- carboxam- ide)-3-(7-methyl-1H-indazol-5-yl)propanoate; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1- H- indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-2-yl)piperidine-1- carboxamide; (±)4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1H- - indazol-5-yl)-1-oxo-1-(4-phenylpiperazin-1-yl)propan-2-yl)piperidine-1-carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(1-(- 4-(4- fluorophenyl)piperazin-1-yl)-3-(7-methy-1H-indazol-5-yl)-1-oxopropan-- 2- yl)piperidine-1-carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(1-(4-(2-fluor- ophenyl)piperazin-1-yl)-3-(7-methyl-1H-indazol-5-yl)-1-oxopropan-2-yl)pipe- ridine-1- carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)-N-(3-(7-methyl-1- H- indazol-5-yl)-1-oxo-1-(4-o-tolylpiperazin-1-yl)propan-2-yl)piperidine-1-- carboxamide; (±)-Methyl 2-(4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1- carboxam- ide)-3-(7-ethyl -3-methyl-1H-indazol-5-yl)propanoate;
(±)-N-(3-(7-Ethyl-3-methyl-1H-indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1- yl)propan-2-yl)-4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)- -yl)piperidine-1- carboxamide; (R)-N-((R)-3-(2-Oxo-2,3-dihydro-benzooxazol-6-yl)-1-oxo-1-(4-(piperidin-1- - yl)propan-2-yl)-4-(8-fluoro-1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidi- ne-1- carboxamide; (±)-4-(8-Fluoro-1,2-dihydro-2,4-dioxoquinazolin-3(4H)-yl)-N-(3-(7-meth- yl-1H- indazol-5-yl)-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-2-yl)- piperidine-1- carboxamide; N-((R)-3-(2-(trifluoromethyl)-1H-benzo[d]imidazol-5-yl)-1-oxo-1-(4-(piper- idin-1- yl)piperidin-1-yl)propan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)- -yl)piperidine-1- carboxamide; N-((R)-1-(dimethylcarbamoyl)-2-(2-trifluoromethyl)-1H-benzo[d]imidazol-5-- yl)ethyl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-carboxamide- ; (R)-methyl 2-(4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-carboxamide)- 3-(2- ,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-yl)propanoate; N-((R)-3-(2,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-yl)-1-oxo-1(4-piperidine-1- yl)propan-2-yl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H)-yl)piperidine-1-c- arboxamide; N-((R)-1-(dimnethylcarbamoyl)-2-(2,3-dihydro-2-oxo-1H-benzo[d]imidazol-6-- yl)ethyl)-4-(1,2-dihydro-2-oxoquinazolin-3(4H))-yl)piperidine-1-carboxamid- e; 4-(1,2-dihydro-2,4-dioxoquinazolin-3-(4H)-yl)-N-((R)-3-(7-methyl-1H-ben- zo[d][1,2,3]triazol-5-yl-1-oxo-1-(4-(piperidin-1-yl)piperidin-1-yl)propan-- 2- yl)piperidine-1-carboxamide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-(4- cyclohexyl-piperazin-1-yl)-2-oxo-1-(2-oxo-2,3-dihydro-benzooxaz- ol-6-ylmethyl)- ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-(4- isopropyl-piperazin-1-yl)-2-oxo-1-(2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)- ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-chloro-2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)-2- oxo-ethyl]-amide;
(R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(5-chloro-2-oxo-2,3-dihydro-benzooxazo- l-6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-bromo-2-oxo-2,3-dihydro-benzooxazol- -6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(5-bromo-2-oxo-2,3-dihydro-benzooxazol- -6-ylmethyl)-2- oxo-ethyl]-amide; (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(4-iodo-2-oxo-2,3-dihydro-benzooxazol-- 6-ylmethyl)-2-oxo- ethyl]-amide; (±)-N-(1-Benzyl-2-hydroxy-ethyl)-2-(7-methyl-1H-indazol-5-ylmethyl)-4-- oxo-4- [4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1-yl]-butyramide- ; (4Phenyl-acetic acid N'-{2-(7-methyl-1H-indazol-5-ylmethyl)-4-oxo-4-[4-(2-oxo- 1,4-dihydro 2H -quinazolin-3-yl)-piperidin-1-yl)-butyryl}-hydrazide; (±)-1-[1,4']Bipiperidinyl-1'-yl-4-[4-(8-fluoro-2-oxo-1,4-dihydro-2H-qu- inazolin-3- yl)-piperidin-1-yl]-2-(7-methyl-1H-indazol-5-ylmethyl)-butane-1- ,4-dione; (±)1-(4-Cyclohexyl-piperazin-1-yl)-2-(2-oxo-2,3-dihydro-benzo- oxazol-6- ylmethyl)-4-[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidin-1- -yl]-butane-1,4- dione; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)piperidine-1-carboxylic acid[2-(4- cyclohexyl -piperazin-1-yl)-1-(7-methyl-1H-indazol-5-ylmethyl)-2-oxo-ethyl]-amide; (±)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid[2-[4-(4- fluoro-phenyl)-piperazin-1-yl]-1-(7-methyl-1H-indazol-5-ylme- thyl)-2-oxo-ethyl]- amide; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)}-propionic acid tert-butyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-}[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1-methyl cyclohexyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-qu- inazolin-3-yl)- piperidine-1-carbonyl}-amino}-propionic acid 1-aza-bicyclo[2.2.2]oct-3-yl ester;
(±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid piperidin-4-yl ester; (±)-4-(3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinaz- olin-3- yl)-piperidine-1-carbonyl[-amino}-propionyloxy)-piperidine-1-carbox- ylic acid tert- butyl ester, (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 3,4,5,6-tetrahydro-2H-[1,4']bipyridinyl-4- yl ester, (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)-propionic acid 1-diethylamino-1-methyl-ethyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid 1,1-dimethyl-2-phenyl-ethyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino)-propionic acid 1,1-dimethyl-3-phenyl-propyl ester; (±)-3-(7-Methyl-1H-indazol-5-yl)-2-{[4-(2-oxo-1,4-dihydro-2H-quinazoli- n-3-yl)- piperidine-1-carbonyl]-amino}-propionic acid ethyl ester; and (R)-4-(2-Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1d-carboxylic acid[2- [1,4']bipiperidinyl-1'-yl-1-(7-methyl-1H-indazol-5-ylmethyl)-2-oxo- -ethyl]amide.
59. The method of claim 58, wherein the CGRP receptor antagonist is (R)-4-(2- Oxo-1,4-dihydro-2H-quinazolin-3-yl)-piperidine-1-carboxylic acid [2-[1,4']bipiperidinyl- 1'-yl-2-oxo-1-(2-oxo-2,3-dihydro-benzooxazol-- 6-ylmethyl)-ethyl]-amide or a pharmaceutically acceptable salt thereof.
60. The method of claim 58, wherein the CGRP receptor antagonist is (R)-3-(1H- Benzotriazol-5-yl-2-{[4-(2-oxo-1,4-dihydro-2H-quinazolin-3-- yl)-piperidine-1- carbonyl]-amino}-propionic acid methyl ester or a pharmaceutically acceptable salt thereof.
61. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin
conditions, the method comprising administering to a subject in need thereof a CGRP receptor antagonistwherein the CGRP receptor antagonist is the compound (R)—N-(3-(7-methyl-1H-indazol-5-yl)-1-(4-(1-methylpiperidin-4-yl)piperazin-1-yl)-1- oxopropan-2-yl)-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1-carboxamide, which has the following structure:
or a pharmaceutically acceptable salt thereof.
62. The method of any one of claims 26 – 61, wherein the CGRP antagonist is administered in a unit dosage selected from the group consisting of about 5 mg, 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 75 mg, about 80 mg, about 100 mg, about 120 mg, about 140 mg, about 160 mg, about 180 mg, or about 200 mg.
63. The method of any one of claims 26– 61, wherein the CGRP antagonist is administered in a dosage of 0.01-100 mg/kg body weight, or from .05 – 50 mg/kg body weight, or from 0.1 – 10 mg/kg body weight, or from 0.15 – 5 mg/kg body weight, or from 0.2 – 2 mg/kg body weight, or from 0.5 – 1.5 mg/kg body weight, or from 1 – 1.5 mg/kg body weight.
64. The method of any one of claims 26 – 61, wherein the CGRP antagonist is administered in an amount corresponding to an area under curve (AUC)
within about 80 – 125 % of about 25, 50, 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, or 100,000 hr*ng/mL.
65. The method of any one of claims 26 - 61, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax value within about 80 – 125 % of about 1, 2, 3, 4, 5, 8, 10, 20, 35, 50, 80,100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 ng/mL.
66. The method of any one of claims 64 and 65, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax/AUC ratio within about 80 – 125 % of about 0.01, 0.03, 0.05, 0.08, 0.1, 0.13, 0.17, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.6, 0.7, 0.8, and 0.9.
67. The method of any one of claims 26 - 66, wherein the CGRP antagonist is administered at an interval of daily, twice daily, once every other day, once every two days, once every three days, once every four days, once every five days, once every six days, or once weekly.
68. The method of any one of claims 26 – 67, wherein the CGRP antagonist is administered by a route selected from oral, intrabuccal, intranasal, inhalation, parenteral, intravenous, topical, injectable and/or transdermal.
69. The method of any one of claims 26 - 61, wherein the CGRP antagonist is administered in a unit dosage of 5 mg, 10 mg, or 20 mg.
70. The method of claim 69, wherein the CGRP antagonist is administered intranasally.
71. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or
more skin conditions, the method comprising administering to a subject in need thereof CGRP receptor antagonist according to Formula (III):
or a salt thereof or an optical isomer thereof, wherein R1 is H or Q-(C1-C6)alkyl; where Q is a bond, C(O) or C(O)O and where the (C1- C6)alkyl can be optionally substituted by N(C1-C3alkyl)2 or CO2H; R2 is H or forms a spirocyclic heterocyclic ring with R3; R3 forms a spirocyclic heterocyclic ring with R2 or is a heterocyclic ring if R2 is H; and R4 is an optionally substituted aryl group which may be monocyclic or fused to a further ring.
72. The method of claim 71, wherein R4 is a substituted phenyl group wherein the substituents are selected from halo or hydroxy.
74. The method of claim 73, wherein X is Br.
78. The method of claim 71, wherein R2 forms a spirocyclic heterocyclic ring with R3 to form:
79. The method of claim 71, wherein R2 is H or forms a spirocyclic heterocyclic ring with R3 to form:
and wherein when R2 is H, R3 is:
and R4 is:
80. The method of claim 71, wherein R1 is H, CO2 tBu, CH2CH3, CH2CH2CH3, COCH2CH2CH2CH3, CH2CH2N(CH3)2, or COCH2CO2H.
81. The method of claim 80, wherein R1 is H.
82. The method of claim 71, wherein the CGRP antagonist is selected from the group consisting of: N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-yl)-1- [4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-2,3-dihydro- 1H-imidazo[4,5-b]pyridin-1-yl)piperidine-1-carboxamide; tert-butyl 4-{(2S)-2-{[(2R)-3-(7-methyl-1H-indazol-5-yl)-2-({[[4-(2-oxo-1,2- dihydroquinolin-3-yl)piperidin-1-yl]carbonyl}amino)propanoyl]amino}-3-oxo-3-[4-(py- ridin-4-yl)piperazin-1-yl]propyl}piperidine-1-carboxylate; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-- yl)- 1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-1,2- dihydroquinolin-3-yl)piperidine-1-carboxamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(1- propylpiperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-y- l]-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1-carboxamide; 3,5-dibromo-Nα-{[4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidin-1-yl]carbonyl}-N- {(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-y- l]propan-2-yl}-D- tyrosinamide;
N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(1- pentanoylpiperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2- yl]-4-(2-oxo-1,2-dihydroquinolin-3-yl)piperidine-1-carboxamide; N-[(2R)-1-({(2S)-3-(1-ethylpiperidin-4-yl)-1-oxo-1-[4-(pyridin-4-yl)piperazin-1- yl]propan-2-yl}amino)-3-(7-methyl-1H-indazol-5-yl)-1-oxopropan-2-yl- ]-4-(2-oxo-1,2- dihydroquinolin-3-yl)piperidine-1-carboxamide; 3,5-dibromo-Nα-{[4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin-1-yl)piperidin- 1-yl]carbonyl}-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4- -yl)piperazin-1- yl]propan-2-yl}-D-tyrosinamide; 3,5-dibromo-Nα-{[4-(2-oxo-1,4-dihydroquinazolin-3(2H)-yl)piperidin-1- yl]carbonyl}-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4-yl)piperaz- in-1-yl]propan- 2-yl}-D-tyrosinamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-- yl)- 1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-4-(2-- oxo-1,4- dihydroquinazolin-3(2H)-yl)piperidine-1-carboxamide; N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1-({(2S)-1-oxo-3-(piperidin-4-yl)-1- [4-(pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)propan-2-yl]-2'-oxo-1',2'-dihydro-1H- spiro[piperidine-4,4'-pyrido[2,3-d][1,3]oxazine]-1-carboxamide; N-[(2R)-1-({(2S)-3-{1-[2-(dimethylamino)ethyl]piperidin-4-yl}-1-oxo-1-[4- (pyridin-4-yl)piperazin-1-yl]propan-2-yl}amino)-3-(7-methyl-1H-ind- azol-5-yl)-1- oxopropan-2-yl]-4-(2-oxo-2,3-dihydro-1H-imidazo[4,5-b]pyridin- -1-yl)piperidine-1- carboxamide; 3-(4-{(2S)-2-{[(2R)-3-(7-methyl-1H-indazol-5-yl)-2-({[4-(2-oxo-2,3-dihydro-1H- imidazo[4,5-b]pyridin-1-yl)piperidin-1-yl]carbonyl}amino)propanoyl]am- ino}-3-oxo-3- [4-(pyridin-4-yl)piperazin-1-yl]propyl}piperidin-1-yl)-3-oxop- ropanoic acid, ammonium salt; and 3, 5-dibromo-Nα-[(2'-oxo-1',2'-dihydro-1H-spiro[piperidine-4,4'-pyrido- [2,3- d][1,3]oxazin]-1-yl)carbonyl]-N-{(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(- pyridin-4- yl)piperazin-1-yl]propan-2-yl}-D-tyrosinamide; or a salt thereof or an optical isomer thereof.
83. The method of claim 82, wherein the CGRP antagonist is:
85. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions, the method comprising administering to a subject in need thereof a CGRP receptor antagonist, wherein the CGRP receptor antagonist is the compound N-[(2R)-3-(7-methyl-1H-indazol-5-yl)-1-oxo-1- ({(2S)-1-oxo-3-(piperidin-4-yl)-1-[4-(pyridin-4-yl)piperazin-1-yl]propan-2- yl}amino)propan-2-yl]-2'-oxo-1',2'-dihydro-1H-spiro[piperidine-4,4'-pyrido[2,3- d][1,3]oxazine]-1-carboxamide, which has the following structure:
86. The method of any one of claims 71 – 85, wherein the CGRP antagonist is administered in a unit dosage selected from the group consisting of about 5 mg, 10 mg, about 20 mg, about 30 mg, about 40 mg, about 50 mg, about 60 mg, about 70 mg, about 75 mg, about 80 mg, about 100 mg, about 120 mg, about 140 mg, about 160 mg, about 180 mg, or about 200 mg.
87. The method of any one of claims 71– 85, wherein the CGRP antagonist is administered in a dosage of 0.01-100 mg/kg body weight, or from .05 – 50 mg/kg body weight, or from 0.1 – 10 mg/kg body weight, or from 0.15 – 5 mg/kg body weight, or from 0.2 – 2 mg/kg body weight, or from 0.5 – 1.5 mg/kg body weight, or from 1 – 1.5 mg/kg body weight.
88. The method of any one of claims 71 – 85, wherein the CGRP antagonist is administered in an amount corresponding to an area under curve (AUC) within about 80 – 125 % of about 25, 50, 100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, or 100,000 hr*ng/mL.
89. The method of any one of claims 71 - 85, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax value within about 80 – 125 % of about 1, 2, 3, 4, 5, 8, 10, 20, 35, 50, 80,100, 150, 200, 250, 300, 400, 500, 600, 700, 800, 900, 1000, 1300, 1600, 1900, 2500, 3500, 5000, 7500, 10,000, 15,000, 20,000, 30,000, 50,000, and/or 100,000 ng/mL.
90. The method of any one of claims 88 and 89, wherein the CGRP antagonist is administered in an amount corresponding to a Cmax/AUC ratio within about 80 – 125 % of about 0.01, 0.03, 0.05, 0.08, 0.1, 0.13, 0.17, 0.2, 0.25, 0.3, 0.35, 0.4, 0.45, 0.5, 0.6, 0.7, 0.8, and 0.9.
91. The method of any one of claims 71 - 90, wherein the CGRP antagonist is administered at an interval of daily, twice daily, once every other day, once every two days, once every three days, once every four days, once every five days, once every six days, or once weekly.
92. The method of any one of claims 71 – 91, wherein the CGRP antagonist is administered by a route selected from oral, intrabuccal, intranasal, inhalation, parenteral, intravenous, topical, injectable and/or transdermal.
93. The method of any one of claims 71 - 85, wherein the CGRP antagonist is administered in a unit dosage of 5 mg, 10 mg, or 20 mg.
94. The method of claim 93, wherein the CGRP antagonist is administered intranasally.
95. The method of any one of claims 71 – 85, wherein the CGRP antagonist is administered in a unit dosage of 75 mg.
96. The method of claim 95, wherein the CGRP antagonist is administered orally.
97. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin diseases, the method comprising administering to a subject in need thereof one or more CGRP receptor antagonists according to one or more of claims 1 – 96.
98. A method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or
more skin diseases, the method comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of claims 1 – 96, and one or more pharmaceutically acceptable carriers.
99. The method of claim 98 wherein the composition is formulated for oral administration.
100. The method of claim 98 wherein the composition is formulated for injectable administration.
101. The method of claim 98 wherein the composition is formulated for topical administration.
102. The method of any one of claims 1 – 101 wherein the skin condition is one or more of a skin condition selected from the group consisting of redness, rosacea, flushes, erythema, eczema (atopic dermatitis), other types of dermatitis, rashes, inflammation, UV damage/sunburn, polymorphous light eruptions, itch, neuropathic itch, ichthyosis, seborrheic dermatitis, verruca vulgaris, molluscum contagiosum, telangiectasias, malar rash, malar flush, purpura skin, papules, bullae, dry scaly desquamation, linear hyperpigmentation of nails or skin, skin hyperpigmentation, onychodystrophy, necrobiosis lipoidica diabeticorum, poorly healing ulcers, blotching, abnormal sweating, hypohidrosis, angiokeratoma, skin atrophy, hyperkeratosis, chronic ulceration, erythroderma, congenital ichthyosis, ichthyosiform erythroderma, hypopigmentation and hyperpigmentation, arteritis of skin, sebaceous and epithelial nevi, linear nevus sebaceous, erythematous photosensitive rash, erythema, glossitis, rhagades, verrucous angiomas, Raynaud's phenomenon, poikiloderma, erythema nodosum, maculopapular rash; pernio, plaques, scars, keloids, photosensitivity, discoid lupus, flexural eczema, scleroderma, subcutaneous calcification, atrophy, actinic keratosis, angioma, alopecia, cutis laxa, petechiae, Osler’s nodes, splinter haemorrhages, erythematous necrotic skin lesions, livedo reticularis, xanthanomas, pseudoxanthomas, xanthelasma, generalized hypotrichosis, multiple papules, peau d’orange skin,
discoid lupus, angioneurotic oedema, subcutaneous nodules, palpable purpura, and erythema multiforme.
103. The method of claim 102 wherein the skin condition is selected from the group consisting of redness, rosacea, flushes, and erythema.
104. A pharmaceutical composition for use in a method of treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin diseases, the method comprising administering to a subject in need thereof a pharmaceutical composition comprising one or more CGRP receptor antagonists according to one or more of claims 1 – 96, and one or more pharmaceutically acceptable carriers.
105. The use of one or more CGRP antagonists of any one of claims 1 – 96 in the manufacture of a medicament for the treatment of one or more skin conditions.
106. The use of claim 104 wherein the treatment includes treating, ameliorating, alleviating, providing for prophylaxis or prevention of, halting the progression of, and/or reducing the risk of one or more skin conditions.
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US20210121541A1 (en) * | 2019-07-05 | 2021-04-29 | Allergan Pharmaceuticals International Limited | CGRP Antagonists and Clostridial Derivatives for the Treatment of Neuropsychiatric and Neurological Disorders |
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