WO2023041927A1 - Azd1656 for use in the treatment of pneumonitis or myocarditis - Google Patents

Azd1656 for use in the treatment of pneumonitis or myocarditis Download PDF

Info

Publication number
WO2023041927A1
WO2023041927A1 PCT/GB2022/052354 GB2022052354W WO2023041927A1 WO 2023041927 A1 WO2023041927 A1 WO 2023041927A1 GB 2022052354 W GB2022052354 W GB 2022052354W WO 2023041927 A1 WO2023041927 A1 WO 2023041927A1
Authority
WO
WIPO (PCT)
Prior art keywords
azd1656
treatment
use according
level
pneumonitis
Prior art date
Application number
PCT/GB2022/052354
Other languages
French (fr)
Inventor
Zoe HOLLOWOOD
James Chorlton
Donna LOCKHART
Original Assignee
Excalibur Medicines Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from GBGB2201069.8A external-priority patent/GB202201069D0/en
Application filed by Excalibur Medicines Limited filed Critical Excalibur Medicines Limited
Publication of WO2023041927A1 publication Critical patent/WO2023041927A1/en

Links

Classifications

    • 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
    • A61K31/4965—Non-condensed pyrazines
    • A61K31/497—Non-condensed pyrazines containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00—Drugs for disorders of the respiratory system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/12—Antivirals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system

Definitions

  • This invention relates to the treatment of pneumonitis (destructive inflammation of the lungs) and/or myocarditis (destructive inflammation of the heart).
  • Pneumonitis is a general term that refers to inflammation of lung tissue. Common causes of pneumonitis include airborne irritants or a side-effect of certain drug treatments.
  • pneumonitis The most common symptom of pneumonitis is shortness of breath, which may be accompanied by a dry cough. If pneumonitis is undetected or left untreated, the patient may develop chronic pneumonitis, which can result in scarring (fibrosis) in the lungs.
  • Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect the heart muscle and the heart rhythm, reducing the heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias).
  • Pneumonitis and myocarditis may be associated with viral infection.
  • viral infection is a coronavirus, such as Covid-19.
  • coronavirus pandemic causes of death from the viral infection are pneumonitis and/or myocarditis and there exists a need for new drugs to treat these conditions.
  • Glucokinase is an enzyme that facilitates phosphorylation of glucose to glucose-6- phosphate. Glucokinase occurs in cells in the liver and pancreas of humans and most other vertebrates. In each of these organs it plays an important role in the regulation of carbohydrate metabolism by acting as a glucose sensor, triggering shifts in metabolism or cell function in response to rising or falling levels of glucose, such as occur after a meal or when fasting. Mutations of the gene for this enzyme can cause unusual forms of diabetes or hypoglycemia.
  • Glucokinase (GK) is a hexokinase isozyme, related homologously to at least three other hexokinases.
  • AZD1656 reduces plasma glucose levels in a dose-dependent fashion, with a rapid onset of action, in normo-glycaemic insulin resistant rats and diabetic mice, when dosed acutely and when dosed once daily for up to 28 days.
  • AZD1656 has been studied in single doses of up to 180 mg and multiple doses to 150 mg BID for 8 days in healthy volunteers as well as alone and in combination with other blood glucose control agents in diabetic patients at 200 mg daily for up to 6 months duration. In both healthy volunteers and diabetic patients no significant clinical effects other than glucose lowering were noted.
  • AZD1656 has been shown not to cause hypoglycaemia in healthy, non-diabetic patients when administered in doses of 40 mg or 80 mg (hypoglycaemia was defined in the study as 2.7 mmol/l) (Norjavaara E. et al., J Clin Endocrinol Metab, 2012, 97(9):3319-3325).
  • AZD1656 has the systematic name 3- ⁇ [5-(Azetidin-1-ylcarbonyl)pyrazin-2-yl]oxy ⁇ -5- ⁇ [(1 S)-1-methyl-2-(methyloxy)ethyl]oxy ⁇ -N-(5-methylpyrazin-2-yl)benzamide.
  • AZD1656 has the structure:
  • Vitamin D is a well-known term in the field. It is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (also known as cholecalciferol) and vitamin D2 (ergocalciferol).
  • IL6 is an interleukin that acts as both a pro-inflammatory cytokine and an antiinflammatory myokine. In humans, it is encoded by the IL 6 gene.
  • the present invention is AZD1656, or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, particularly as a result of a coronavirus infection, wherein the subject of treatment has a vitamin D level of less than 25 nmol/L or an IL-6 level of greater than 13 pg/ml.
  • AZD1656 is a molecule which is an activator of glucokinase in regulatory T cells (Tregs). These cells are a specialised sub-population of T cells that act to supress the immune response. In inappropriate inflammation, Tregs can supress T cell proliferation and cytokine production.
  • Tregs regulatory T cells
  • AZD1656 has been found in clinical trials to be clinically beneficial. As shown by the data in the Examples section, it has been surprisingly found in clinical trials that the administration of AZD1656 in the therapy of a coronavirus infection in patients with a vitamin D level of less than 25 nmol/L responded to treatment significantly better than patients with higher than 25 nmol/L of vitamin D.
  • a first aspect of the invention is AZD1656, or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
  • a second aspect of the invention is a use of AZD1656, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
  • a third aspect of the invention provides a method of treating pneumonitis and/or myocarditis comprising administering a patient with AZD1656 or a pharmaceutically acceptable salt thereof, wherein the patient has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
  • treatment or “treating” as used herein, we refer to therapeutic (curative) treatment including amelioration. Treatment also includes stopping the disease from developing or slowing further progression of the disease. For example, treatment may include preventing symptoms from worsening. "Amelioration” is an improvement, or perceived improvement, in the patient's condition, or a change in a patient's condition that makes it, or side-effects, increasingly tolerable. It is well known in the art how to measure a patient s vitamin D levels, for example, the most commonly used 25-hydroxy vitamin D test, which measures the 25-hydroxy cholecalciferol in a subject's peripheral blood. In the instance of the present invention, a "low vitamin D level” is considered to be less than 25 nmol/L.
  • IL6 levels for example, a commonly used immunochemistry panel is the MSD U-Plex multiplex assay.
  • a "high IL6 level" is considered to be more than 13 pg/ml.
  • pneumonitis and/or myocarditis are often caused by a viral infection.
  • pneumonitis and/or myocarditis is characterised as being as a result of or associated with a viral infection, preferably a coronavirus infection, for example SARS (severe acute respiratory syndrome) or SARS-CoV-2, and preferably COVID- 19 or long Covid.
  • a viral infection preferably a coronavirus infection, for example SARS (severe acute respiratory syndrome) or SARS-CoV-2, and preferably COVID- 19 or long Covid.
  • the subject to be treated is infected with, or suspected to be infected with, a coronavirus, such as Covid-19.
  • a coronavirus such as Covid-19.
  • the subject infected with, or suspected to be infected with, a coronavirus is categorised as stage 3, 4, or 5 on the WHO Ordinal Scale for Clinical Improvement. WHO Ordinal Scale for Clinical Improvement measures illness severity over time (Michael O'Kelly & Siying Li (2020), Statistics in Biopharmaceutical Research, 12:4, 451-460).
  • “Covid-19” refers to an infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
  • “Long Covid” or “Post-Covid Syndrome” refers to signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis. The condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body. Many people with post-COVID syndrome can also experience generalised pain, fatigue, persisting high temperature and psychiatric problems. "Patient and subject are used interchangeably and refer to the subject that is to be administered the AZD1656. Preferably, the subject is a human.
  • the invention is suitable for use in both diabetic and non-diabetic patients.
  • the subject has diabetes, preferably type 1 or type 2 diabetes.
  • the subject has a blood glucose level at or above 4 mmol/L.
  • the subject has diabetes and/or has undergone renal transplant.
  • a pharmaceutically acceptable salt is a salt with a pharmaceutically acceptable acid or base.
  • Pharmaceutically acceptable acids include both inorganic acids such as hydrochloric, sulphuric, phosphoric, diphosphoric, hydrobromic or nitric acid and organic acids such as citric, fumaric, maleic, malic, ascorbic, succinic, tartaric, benzoic, acetic, methanesulfonic, ethanesulfonic, salicylic, stearic, benzenesulfonic or p-toluenesulfonic acid.
  • Pharmaceutically acceptable bases include alkali metal (e.g. sodium or potassium) and alkali earth metal (e.g. calcium or magnesium) hydroxides and organic bases such as alkyl amines, aryl amines or heterocyclic amines.
  • the compound of the invention may be formulated as a pharmaceutical composition comprising AZD1656 or a pharmaceutically acceptable salt thereof.
  • AZD1656 is the only active agent in the composition.
  • active agent it is meant that the composition does not contain other components which may be used in the treatment of pneumonitis and/or myocarditis, and/or a viral infection.
  • compositions comprising AZD1656, or a pharmaceutically acceptable salt thereof may contain a pharmaceutically acceptable carrier.
  • pharmaceutically acceptable carrier any diluent or excipient, such as fillers or binders, that is compatible with the other ingredients of the composition, and which is not deleterious to the recipient.
  • the pharmaceutically acceptable carrier can be selected on the basis of the desired route of administration, in accordance with standard pharmaceutical practices.
  • AZD1656 may be administered in a variety of dosage forms.
  • AZD1656 may be formulated in a format suitable for oral, rectal, parenteral, intranasal or transdermal administration or administration by inhalation or by suppository.
  • AZD1656 may be administered orally, for example as tablets, troches, lozenges, aqueous or oily suspensions, dispersible powders or granules.
  • AZD1656 is formulated such that it is suitable for oral administration, for example tablets and capsules.
  • AZD1656 may also be administered parenterally, whether subcutaneously, intravenously, intramuscularly, intrasternally, transdermally or by infusion techniques. AZD1656 may also be administered as suppositories.
  • AZD1656 may also be administered by inhalation.
  • An advantage of inhaled medications is their direct delivery to the area of rich blood supply in comparison to many medications taken by oral route. Thus, the absorption is very rapid as the alveoli have an enormous surface area and rich blood supply and first pass metabolism is bypassed.
  • the present invention also provides an inhalation device containing AZD1656.
  • said device is a metered dose inhaler (MDI), which contains a pharmaceutically acceptable chemical propellant to push the medication out of the inhaler.
  • MDI metered dose inhaler
  • AZD1656 may also be administered by intranasal administration.
  • the nasal cavity's highly permeable tissue is very receptive to medication and absorbs it quickly and efficiently.
  • Nasal drug delivery is less painful and invasive than injections, generating less anxiety among patients. By this method absorption is very rapid and first pass metabolism is usually bypassed, thus reducing inter-patient variability.
  • the present invention also provides an intranasal device containing AZD1656.
  • AZD1656 may also be administered by transdermal administration.
  • transdermal and transmucosal patches, creams, ointments, jellies, solutions or suspensions may be employed. The present invention therefore also provides a transdermal patch containing a AZD1656.
  • AZD1656 may also be administered by sublingual administration.
  • the present invention therefore also provides a sub-lingual tablet comprising AZD1656.
  • AZD1656 may also be formulated with an agent which reduces degradation of the substance by processes other than the normal metabolism of the patient, such as anti- bacterial agents, or inhibitors of protease enzymes which might be the present in the patient or in commensural or parasite organisms living on or within the patient, and which are capable of degrading the compound.
  • an agent which reduces degradation of the substance by processes other than the normal metabolism of the patient such as anti- bacterial agents, or inhibitors of protease enzymes which might be the present in the patient or in commensural or parasite organisms living on or within the patient, and which are capable of degrading the compound.
  • Liquid dispersions for oral administration may be syrups, emulsions and suspensions.
  • Suspensions and emulsions may contain as carrier, for example a natural gum, agar, sodium alginate, pectin, methylcellulose, carboxymethylcellulose, or polyvinyl alcohol.
  • the suspension or solutions for intramuscular injections may contain, together with the active compound, a pharmaceutically acceptable carrier, e.g. sterile water, olive oil, ethyl oleate, glycols, e.g. propylene glycol, and if desired, a suitable amount of lidocaine hydrochloride.
  • Solutions for injection or infusion may contain as carrier, for example, sterile water or preferably they may be in the form of sterile, aqueous, isotonic saline solutions.
  • AZD1656 is administered in an effective amount to treat the symptoms of pneumonitis and/or myocarditis.
  • An effective dose will be apparent to one skilled in the art and is dependent on a number of factors including age, sex, weight, which the medical practitioner will be capable of determining.
  • AZD1656 is administered in doses of 0.5 to 400 mg, more preferably 1 to 400 mg, more preferably 2.5 to 400 mg, more preferably 5 mg to 400 mg, more preferably 50 mg to 300 mg, most preferably 150 mg to 300 mg.
  • the lower limit for a dose is preferably 0.5 mg, 1 mg, 1 .5 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 110 mg, 120 mg, 130 mg, 140 mg, 150 mg, 160 mg, 170 mg, 180 mg, 190 mg or 200 mg.
  • the upper limit for a dose is preferably 400 mg, 390 mg, 380 mg, 370 mg, 360 mg, 350 mg, 340 mg, 330, mg, 320 mg, 310 mg, 300 mg, 290 mg, 280 mg, 270 mg, 260 mg, 250 mg, 240 mg, 230 mg, 220 mg or 210 mg. Any of the aforementioned lower or upper limits of the ranges may be combined with each other and are herein disclosed.
  • the dose is 150 mg to 300 mg. In some embodiments, the dose is 2 to 100 mg or about 2.5 mg.
  • any of the above doses may be administered once a day, twice a day, three times a day or four times a day.
  • AZD1656 is administered at least once a day. Preferably it is administered as a single daily dose. Preferably the single daily dose is of 200 mg to 400 mg or 2 to 100 mg. Preferably it is 2.5 mg, 200 mg, 300 mg or 400 mg.
  • AZD1656 is administered twice daily.
  • each dose is 1 to 20 mg or 150 mg to 200 mg, with a total daily dosage of 2 to 40 mg or 300 mg to 400 mg.
  • each dose is 50 to 150 mg, preferably 80 to 120 mg, such as about 100 mg, with a total daily dosage of 100 to 300 mg, preferably 160 to 240 mg, such as 200 mg.
  • each dose is 1 to 20 mg or 100 mg to 130 mg.
  • each dose is 1 to 20 mg or 75 mg to 100 mg.
  • the dosage regime is such that the total daily dosage of AZD1656 does not exceed 400 mg, more preferably 300 mg, even more preferably 250 mg. in order to treat pneumonitis and/or myocarditis, AZD1656 is used in a chronic dosage regime i.e. chronic, iong-term treatment.
  • the present invention also relates to use of AZD1656, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
  • This embodiment of the invention may have any of the preferred features described above.
  • the pneumonitis and/or myocarditis is associated with a coronavirus infection, for example Covid-19 or long Covid.
  • the present invention also relates to a method of treating pneumonitis and/or myocarditis comprising administering the patient with AZD1656 or a pharmaceutically acceptable salt thereof, wherein the patient has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
  • This embodiment of the invention may have any of the preferred features described above.
  • the method of administration may be according to any of the routes described above.
  • the present invention also embraces prodrugs which react in vivo to give a compound of the present invention.
  • the first clinical trial was in patients with diabetes with proven coronavirus infection. These patients are at an increased risk of death compared to non-diabetics.
  • the endpoints were lung imaging, inflammatory markers in the blood, arterial oxygen concentration and cardiac ejection fraction and survival. Later trials of the compound will be undertaken in diabetic and non-diabetic patients when given on the first presentation with symptoms.
  • the compound should prevent and treat lung and heart disease in coronavirus infection.
  • the first (Phase II) clinical trial was conducted in the UK, Romania and Czech Republic to assess the safety and efficacy of AZD1656 hospitalised with suspected or confirmed COVID-19. The quality of the data was deemed high. The Committee had no safety concerns. Patient entry characteristics were equally distributed between test and control group.
  • the primary endpoint is clinical improvement measured as the percentage of subjects at Day 14 who are in categories 1-3 according to the WHO 8-point Ordinal Scale for Clinical Improvement, comparing AZD1656 treatment to placebo.
  • Patient is able to provide written informed consent prior to initiation of any study procedures.
  • AZD1656 administered orally, as 50 mg film-coated tablets to be dosed at 100 mg BID (total daily dose of 200 mg).
  • the tablets were manufactured by Patheon.
  • a treatment duration of 21 days has been selected to explore the effects of AZD1656 on safety and efficacy. Treatment durations of up to 6 months have been evaluated in previous trials, so the duration in this trial is considered safe and is appropriate for this patient population based on the expected duration of hospitalisation for diabetic patients requiring hospital treatment for COVID-19.
  • the study has 3 phases:
  • the study evaluates efficacy across a range of assessments evaluating clinical improvement, glycaemic control, time from hospital admission to hospital discharge and time from hospital admission to receiving intubation/mechanical ventilation.
  • IL6 levels were measured before treatment to determine whether there is any correlation between IL6 level and clinical outcomes.
  • the measurements were taken by the well-known and commonly used immunochemistry panel in the field; the MSD U-Plex multiplex assay. A "high IL6 level" was considered and recorded as such if it was more than 13 pg/ml.
  • the Odds Ratio (OR) of 3.7 means that there was 3.7 times more likelihood of having the outcome (being a responder) in the AZD1656 group compared to the placebo group
  • the Confidence Interval (Cl) confirms that the likelihood was anywhere between 0.04% worse and 14 times better, so the preponderance of probability suggests that being treated with AZD1656 is beneficial if a COVID-19 patient has a vitamin D level less than 25nmol/L
  • the Relative Risk (RR) of 1.4 means that people in the AZD1656 group were 1.4 times more likely to be a responder than those in the comparator group.
  • the Cl confirms that the likelihood was anywhere between 0.03 times less likely and 2 times more likely.
  • the Absolute Risk Difference (ARD) of 0.24 means that 24% more patients in the AZD1656 group with low vitamin D had a positive response compared to placebo treated patients.
  • the Cl tells us that the real answer is somewhere between no difference at all and 48% more, so the preponderance of evidence suggests that treatment with AZD1656 is beneficial for COVID-19 patients with a vitamin D level less than 25nmol/L
  • AZD1656 works particularly well in the treatment of COVID-19 in patients with a low vitamin D level ( ⁇ 25 nmol/L) or a high IL6 level (>13 pg/ml) and thus it is expected that this improved treatment will also have utility in other viral-related diseases/symptoms, such as pneumonitis and/or myocarditis.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Chemical & Material Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Medicinal Chemistry (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Chemical & Material Sciences (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Diabetes (AREA)
  • Engineering & Computer Science (AREA)
  • Emergency Medicine (AREA)
  • Obesity (AREA)
  • Epidemiology (AREA)
  • Pain & Pain Management (AREA)
  • Rheumatology (AREA)
  • Endocrinology (AREA)
  • Hematology (AREA)
  • Pulmonology (AREA)
  • Virology (AREA)
  • Communicable Diseases (AREA)
  • Oncology (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

The present invention relates to AZD1656 or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, which may be associated with or caused by a coronavirus infection, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.

Description

AZD1656 FOR USE IN THE TREATMENT OF PNEUMONITIS OR MYOCARDITIS
Field of the invention
This invention relates to the treatment of pneumonitis (destructive inflammation of the lungs) and/or myocarditis (destructive inflammation of the heart).
Background of the invention
Pneumonitis is a general term that refers to inflammation of lung tissue. Common causes of pneumonitis include airborne irritants or a side-effect of certain drug treatments.
The most common symptom of pneumonitis is shortness of breath, which may be accompanied by a dry cough. If pneumonitis is undetected or left untreated, the patient may develop chronic pneumonitis, which can result in scarring (fibrosis) in the lungs.
Myocarditis is an inflammation of the heart muscle (myocardium). Myocarditis can affect the heart muscle and the heart rhythm, reducing the heart's ability to pump and causing rapid or abnormal heart rhythms (arrhythmias).
Pneumonitis and myocarditis may be associated with viral infection. One such viral infection is a coronavirus, such as Covid-19. In the present coronavirus pandemic, causes of death from the viral infection are pneumonitis and/or myocarditis and there exists a need for new drugs to treat these conditions.
Glucokinase is an enzyme that facilitates phosphorylation of glucose to glucose-6- phosphate. Glucokinase occurs in cells in the liver and pancreas of humans and most other vertebrates. In each of these organs it plays an important role in the regulation of carbohydrate metabolism by acting as a glucose sensor, triggering shifts in metabolism or cell function in response to rising or falling levels of glucose, such as occur after a meal or when fasting. Mutations of the gene for this enzyme can cause unusual forms of diabetes or hypoglycemia. Glucokinase (GK) is a hexokinase isozyme, related homologously to at least three other hexokinases. AZD1656 is a potent, selective (>100-fold versus hexokinase 1 and 2 and a pharmacology screening panel), activator of human and rat glucokinase in vitro, EC50's - 0.057 and 0.072μM, respectively, for the recombinant enzymes, which translates into cellular systems (EC50's = 1.39 and 0.47pM in human and rat hepatocytes, respectively). AZD1656 reduces plasma glucose levels in a dose-dependent fashion, with a rapid onset of action, in normo-glycaemic insulin resistant rats and diabetic mice, when dosed acutely and when dosed once daily for up to 28 days.
AZD1656 has been studied in single doses of up to 180 mg and multiple doses to 150 mg BID for 8 days in healthy volunteers as well as alone and in combination with other blood glucose control agents in diabetic patients at 200 mg daily for up to 6 months duration. In both healthy volunteers and diabetic patients no significant clinical effects other than glucose lowering were noted.
Preclinical studies of up to 12-month duration have been performed. These revealed a potent glucose lowering effect, and thereby, the results of chronic toxicology studies in healthy animals were confounded by severe hypoglycaemia at higher doses and sequalae such as Wallerian type nerve degeneration and skeletal muscle fibre degeneration. Additional changes, also considered secondary to hypoglycaemia, were seen in the liver (loss of hepatocellular glycogen).
In a Phase 2 study in Japanese type 2 diabetic subjects, AZD1656, given BID at high (40-200mg/day), medium (20-140mg/day) and low (10-80mg/day) doses over a 4 month period, has been found to lower HbA1 c and fasting plasma blood (PPG) glucose levels with a 50mg dose producing compound levels of ~2 x EC50 in plasma. However, this effect was transient trending towards pre-dose levels between weeks 8 and 16 and there was no statistically significant change in either HbA1c or FPG from baseline at 4 months.
AZD1656 has been shown not to cause hypoglycaemia in healthy, non-diabetic patients when administered in doses of 40 mg or 80 mg (hypoglycaemia was defined in the study as 2.7 mmol/l) (Norjavaara E. et al., J Clin Endocrinol Metab, 2012, 97(9):3319-3325). AZD1656 has the systematic name 3-{[5-(Azetidin-1-ylcarbonyl)pyrazin-2-yl]oxy}-5- {[(1 S)-1-methyl-2-(methyloxy)ethyl]oxy}-N-(5-methylpyrazin-2-yl)benzamide.
AZD1656 has the structure:
Figure imgf000004_0001
Vitamin D is a well-known term in the field. It is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (also known as cholecalciferol) and vitamin D2 (ergocalciferol).
IL6 is an interleukin that acts as both a pro-inflammatory cytokine and an antiinflammatory myokine. In humans, it is encoded by the IL 6 gene.
Summary of the invention
The present invention is AZD1656, or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, particularly as a result of a coronavirus infection, wherein the subject of treatment has a vitamin D level of less than 25 nmol/L or an IL-6 level of greater than 13 pg/ml.
AZD1656 is a molecule which is an activator of glucokinase in regulatory T cells (Tregs). These cells are a specialised sub-population of T cells that act to supress the immune response. In inappropriate inflammation, Tregs can supress T cell proliferation and cytokine production. AZD1656 has been found in clinical trials to be clinically beneficial. As shown by the data in the Examples section, it has been surprisingly found in clinical trials that the administration of AZD1656 in the therapy of a coronavirus infection in patients with a vitamin D level of less than 25 nmol/L responded to treatment significantly better than patients with higher than 25 nmol/L of vitamin D.
As shown by the data in the Examples section, it has been surprisingly found in clinical trials that the administration of AZD1656 in the therapy of a coronavirus infection in patients with an IL6 level of more than 13 pg/ml responded to treatment significantly better than patients with less than 13 pg/ml of IL6.
Accordingly, a first aspect of the invention is AZD1656, or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
A second aspect of the invention is a use of AZD1656, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
A third aspect of the invention provides a method of treating pneumonitis and/or myocarditis comprising administering a patient with AZD1656 or a pharmaceutically acceptable salt thereof, wherein the patient has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
Detailed description
By the term "treatment" or "treating" as used herein, we refer to therapeutic (curative) treatment including amelioration. Treatment also includes stopping the disease from developing or slowing further progression of the disease. For example, treatment may include preventing symptoms from worsening. "Amelioration" is an improvement, or perceived improvement, in the patient's condition, or a change in a patient's condition that makes it, or side-effects, increasingly tolerable. it is well known in the art how to measure a patient s vitamin D levels, for example, the most commonly used 25-hydroxy vitamin D test, which measures the 25-hydroxy cholecalciferol in a subject's peripheral blood. In the instance of the present invention, a "low vitamin D level" is considered to be less than 25 nmol/L.
It is well known in the art how to measure a patient's IL6 levels, for example, a commonly used immunochemistry panel is the MSD U-Plex multiplex assay. In the instance of the present invention, a "high IL6 level" is considered to be more than 13 pg/ml.
Pneumonitis and/or myocarditis are often caused by a viral infection. Thus, in one embodiment, pneumonitis and/or myocarditis is characterised as being as a result of or associated with a viral infection, preferably a coronavirus infection, for example SARS (severe acute respiratory syndrome) or SARS-CoV-2, and preferably COVID- 19 or long Covid.
In one embodiment, the subject to be treated is infected with, or suspected to be infected with, a coronavirus, such as Covid-19. In a further embodiment, the subject infected with, or suspected to be infected with, a coronavirus is categorised as stage 3, 4, or 5 on the WHO Ordinal Scale for Clinical Improvement. WHO Ordinal Scale for Clinical Improvement measures illness severity over time (Michael O'Kelly & Siying Li (2020), Statistics in Biopharmaceutical Research, 12:4, 451-460). "Covid-19" refers to an infectious disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). "Long Covid" or "Post-Covid Syndrome" refers to signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis. The condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body. Many people with post-COVID syndrome can also experience generalised pain, fatigue, persisting high temperature and psychiatric problems. "Patient and subject are used interchangeably and refer to the subject that is to be administered the AZD1656. Preferably, the subject is a human.
The invention is suitable for use in both diabetic and non-diabetic patients. In some embodiments, the subject has diabetes, preferably type 1 or type 2 diabetes.
In some embodiments, the subject has a blood glucose level at or above 4 mmol/L.
In some embodiments, the subject has diabetes and/or has undergone renal transplant.
As used herein, a pharmaceutically acceptable salt is a salt with a pharmaceutically acceptable acid or base. Pharmaceutically acceptable acids include both inorganic acids such as hydrochloric, sulphuric, phosphoric, diphosphoric, hydrobromic or nitric acid and organic acids such as citric, fumaric, maleic, malic, ascorbic, succinic, tartaric, benzoic, acetic, methanesulfonic, ethanesulfonic, salicylic, stearic, benzenesulfonic or p-toluenesulfonic acid. Pharmaceutically acceptable bases include alkali metal (e.g. sodium or potassium) and alkali earth metal (e.g. calcium or magnesium) hydroxides and organic bases such as alkyl amines, aryl amines or heterocyclic amines.
The skilled practitioner would understand that the compound of the invention may be formulated as a pharmaceutical composition comprising AZD1656 or a pharmaceutically acceptable salt thereof. In one embodiment, AZD1656 is the only active agent in the composition. By only active agent it is meant that the composition does not contain other components which may be used in the treatment of pneumonitis and/or myocarditis, and/or a viral infection.
The compositions comprising AZD1656, or a pharmaceutically acceptable salt thereof, may contain a pharmaceutically acceptable carrier. By "pharmaceutically acceptable carrier" is meant any diluent or excipient, such as fillers or binders, that is compatible with the other ingredients of the composition, and which is not deleterious to the recipient. The pharmaceutically acceptable carrier can be selected on the basis of the desired route of administration, in accordance with standard pharmaceutical practices. in the present invention, AZD1656 may be administered in a variety of dosage forms. In one embodiment, AZD1656 may be formulated in a format suitable for oral, rectal, parenteral, intranasal or transdermal administration or administration by inhalation or by suppository.
AZD1656 may be administered orally, for example as tablets, troches, lozenges, aqueous or oily suspensions, dispersible powders or granules. Preferably, AZD1656 is formulated such that it is suitable for oral administration, for example tablets and capsules.
AZD1656 may also be administered parenterally, whether subcutaneously, intravenously, intramuscularly, intrasternally, transdermally or by infusion techniques. AZD1656 may also be administered as suppositories.
AZD1656 may also be administered by inhalation. An advantage of inhaled medications is their direct delivery to the area of rich blood supply in comparison to many medications taken by oral route. Thus, the absorption is very rapid as the alveoli have an enormous surface area and rich blood supply and first pass metabolism is bypassed.
The present invention also provides an inhalation device containing AZD1656. Typically said device is a metered dose inhaler (MDI), which contains a pharmaceutically acceptable chemical propellant to push the medication out of the inhaler.
AZD1656 may also be administered by intranasal administration. The nasal cavity's highly permeable tissue is very receptive to medication and absorbs it quickly and efficiently. Nasal drug delivery is less painful and invasive than injections, generating less anxiety among patients. By this method absorption is very rapid and first pass metabolism is usually bypassed, thus reducing inter-patient variability. Further, the present invention also provides an intranasal device containing AZD1656. AZD1656 may also be administered by transdermal administration. For topical delivery, transdermal and transmucosal patches, creams, ointments, jellies, solutions or suspensions may be employed. The present invention therefore also provides a transdermal patch containing a AZD1656.
AZD1656 may also be administered by sublingual administration. The present invention therefore also provides a sub-lingual tablet comprising AZD1656.
AZD1656 may also be formulated with an agent which reduces degradation of the substance by processes other than the normal metabolism of the patient, such as anti- bacterial agents, or inhibitors of protease enzymes which might be the present in the patient or in commensural or parasite organisms living on or within the patient, and which are capable of degrading the compound.
Liquid dispersions for oral administration may be syrups, emulsions and suspensions.
Suspensions and emulsions may contain as carrier, for example a natural gum, agar, sodium alginate, pectin, methylcellulose, carboxymethylcellulose, or polyvinyl alcohol. The suspension or solutions for intramuscular injections may contain, together with the active compound, a pharmaceutically acceptable carrier, e.g. sterile water, olive oil, ethyl oleate, glycols, e.g. propylene glycol, and if desired, a suitable amount of lidocaine hydrochloride.
Solutions for injection or infusion may contain as carrier, for example, sterile water or preferably they may be in the form of sterile, aqueous, isotonic saline solutions.
In an embodiment of the invention, AZD1656 is administered in an effective amount to treat the symptoms of pneumonitis and/or myocarditis. An effective dose will be apparent to one skilled in the art and is dependent on a number of factors including age, sex, weight, which the medical practitioner will be capable of determining.
In a preferred embodiment, AZD1656 is administered in doses of 0.5 to 400 mg, more preferably 1 to 400 mg, more preferably 2.5 to 400 mg, more preferably 5 mg to 400 mg, more preferably 50 mg to 300 mg, most preferably 150 mg to 300 mg. The lower limit for a dose is preferably 0.5 mg, 1 mg, 1 .5 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 55 mg, 60 mg, 65 mg, 70 mg, 75 mg, 80 mg, 85 mg, 90 mg, 95 mg, 100 mg, 110 mg, 120 mg, 130 mg, 140 mg, 150 mg, 160 mg, 170 mg, 180 mg, 190 mg or 200 mg. The upper limit for a dose is preferably 400 mg, 390 mg, 380 mg, 370 mg, 360 mg, 350 mg, 340 mg, 330, mg, 320 mg, 310 mg, 300 mg, 290 mg, 280 mg, 270 mg, 260 mg, 250 mg, 240 mg, 230 mg, 220 mg or 210 mg. Any of the aforementioned lower or upper limits of the ranges may be combined with each other and are herein disclosed. In some embodiments, the dose is 150 mg to 300 mg. In some embodiments, the dose is 2 to 100 mg or about 2.5 mg.
Any of the above doses may be administered once a day, twice a day, three times a day or four times a day.
In an embodiment of the invention, AZD1656 is administered at least once a day. Preferably it is administered as a single daily dose. Preferably the single daily dose is of 200 mg to 400 mg or 2 to 100 mg. Preferably it is 2.5 mg, 200 mg, 300 mg or 400 mg.
It will be appreciated that a lower dose may be needed in a pediatric patient.
In an embodiment of the invention, AZD1656 is administered twice daily. Preferably each dose is 1 to 20 mg or 150 mg to 200 mg, with a total daily dosage of 2 to 40 mg or 300 mg to 400 mg. Suitably each dose is 50 to 150 mg, preferably 80 to 120 mg, such as about 100 mg, with a total daily dosage of 100 to 300 mg, preferably 160 to 240 mg, such as 200 mg.
Alternatively, it may be administered three times per day. Preferably each dose is 1 to 20 mg or 100 mg to 130 mg.
Alternatively, it may be administered four times per day. Preferably each dose is 1 to 20 mg or 75 mg to 100 mg.
Preferably, the dosage regime is such that the total daily dosage of AZD1656 does not exceed 400 mg, more preferably 300 mg, even more preferably 250 mg. in order to treat pneumonitis and/or myocarditis, AZD1656 is used in a chronic dosage regime i.e. chronic, iong-term treatment.
The present invention also relates to use of AZD1656, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml. This embodiment of the invention may have any of the preferred features described above.
In one embodiment, the pneumonitis and/or myocarditis is associated with a coronavirus infection, for example Covid-19 or long Covid.
The present invention also relates to a method of treating pneumonitis and/or myocarditis comprising administering the patient with AZD1656 or a pharmaceutically acceptable salt thereof, wherein the patient has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml. This embodiment of the invention may have any of the preferred features described above. The method of administration may be according to any of the routes described above.
For the avoidance of doubt, the present invention also embraces prodrugs which react in vivo to give a compound of the present invention.
The following examples illustrate the invention.
Examples
Study
The first clinical trial was in patients with diabetes with proven coronavirus infection. These patients are at an increased risk of death compared to non-diabetics. The endpoints were lung imaging, inflammatory markers in the blood, arterial oxygen concentration and cardiac ejection fraction and survival. Later trials of the compound will be undertaken in diabetic and non-diabetic patients when given on the first presentation with symptoms. The compound should prevent and treat lung and heart disease in coronavirus infection. The first (Phase II) clinical trial was conducted in the UK, Romania and Czech Republic to assess the safety and efficacy of AZD1656 hospitalised with suspected or confirmed COVID-19. The quality of the data was deemed high. The Committee had no safety concerns. Patient entry characteristics were equally distributed between test and control group.
Study Design
This is a Phase II, randomised, placebo-controlled, double-blind clinical trial to assess the safety and efficacy of AZD1656 on the cardiorespiratory complications of COVID- 19 in hospitalised diabetic patients with known or suspected COVID-19.
All patients received usual care plus either AZD1656 or placebo. The World Health Organization (WHO) 8-point Ordinal Scale for Clinical Improvement is used as the standard methodology for measuring patient outcomes.
Primary endpoints:
The primary endpoint is clinical improvement measured as the percentage of subjects at Day 14 who are in categories 1-3 according to the WHO 8-point Ordinal Scale for Clinical Improvement, comparing AZD1656 treatment to placebo.
Secondary endpoints:
(a) Clinical improvement measured as the percentage of patients categorised at each severity rating on the WHO 8-point Ordinal Scale at Day 7, Day 14 and Day 21 versus baseline, comparing AZD1656 treatment with placebo.
(b) Degree of glycaemic control as measured by the need to increase baseline medication requirements or the need to add additional diabetic medications to maintain appropriate blood glucose levels in patients receiving AZD1656 compared with placebo.
(c) Proportion of Treatment Emergent Adverse Events (TEAEs) leading to study drug discontinuation in patients receiving AZD1656 compared with placebo.
(d) Proportion of Serious Adverse Events (SAEs) in patients receiving AZD1656 compared with placebo.
(e) Time from hospital admission to hospital discharge (in hours) in patients receiving AZD1656 compared with placebo. (f) Time from hospital admission to receiving intubation/ mechanical ventilation in patients receiving AZD1656 compared with placebo.
(g) Mortality Rate in patients receiving AZD1656 compared with placebo.
Study Protocol
Approximately 165 patients have been screened to achieve 150 patients randomly assigned to AZD1656 or placebo. All patients receive usual care plus either AZD1656 or placebo.
Inclusion Criteria
1. Male or Female.
2. Aged 18 and older.
3. Have either type 1 or type 2 diabetes.
4. Hospitalised with suspected or confirmed novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)) infection at time of enrolment, categorised as stage 3, 4 or 5 on the WHO Ordinal Scale for Clinical Improvement.
5. Blood glucose level at or above 4 mmol/L
6. Able to take oral (tablet) formulation of medication.
7. Patient is able to provide written informed consent prior to initiation of any study procedures.
Dose
AZD1656 administered orally, as 50 mg film-coated tablets to be dosed at 100 mg BID (total daily dose of 200 mg). The tablets were manufactured by Patheon.
Duration
A treatment duration of 21 days has been selected to explore the effects of AZD1656 on safety and efficacy. Treatment durations of up to 6 months have been evaluated in previous trials, so the duration in this trial is considered safe and is appropriate for this patient population based on the expected duration of hospitalisation for diabetic patients requiring hospital treatment for COVID-19. The study has 3 phases:
1. Screening/Randomisation (Day -2 to 1)
2. Double-Blind treatment (Day 1 to Day 21)
3. Safety Follow-up (7 days after completion of the study treatment)
The study evaluates efficacy across a range of assessments evaluating clinical improvement, glycaemic control, time from hospital admission to hospital discharge and time from hospital admission to receiving intubation/mechanical ventilation.
Vitamin D
In 50 of the patients, their 25-hydroxyvitamin D levels were measured before treatment to determine whether there is any correlation between Vitamin D level and clinical outcomes. The measurements were taken by the well-known and commonly used in the field test; the 25-hydroxy vitamin D test, which measures the 25-hydroxy cholecalciferol in a subject's peripheral blood. A "low vitamin D level" was considered and recorded as such if it was less than 25 nmol/L.
IL6
In 153 of the patients, their IL6 levels were measured before treatment to determine whether there is any correlation between IL6 level and clinical outcomes. The measurements were taken by the well-known and commonly used immunochemistry panel in the field; the MSD U-Plex multiplex assay. A "high IL6 level" was considered and recorded as such if it was more than 13 pg/ml.
Results
As shown in Table 1 below, patients with a low vitamin D level (<25 nmol/L) were found to respond better to AZD1656 and thus had a greater than expected clinical improvement. Table 1; patients with a Sow vitamin D level
Figure imgf000015_0001
Table 2; patients with a high vitamin D level
Figure imgf000015_0002
The p-value was assessed by means of a chi squared test on the one-sided significance level of 2.5%.
In Table 1 , the Odds Ratio (OR) of 3.7 means that there was 3.7 times more likelihood of having the outcome (being a responder) in the AZD1656 group compared to the placebo group The Confidence Interval (Cl) confirms that the likelihood was anywhere between 0.04% worse and 14 times better, so the preponderance of probability suggests that being treated with AZD1656 is beneficial if a COVID-19 patient has a vitamin D level less than 25nmol/L In Table 1 , the Relative Risk (RR) of 1.4 means that people in the AZD1656 group were 1.4 times more likely to be a responder than those in the comparator group. The Cl confirms that the likelihood was anywhere between 0.03 times less likely and 2 times more likely.
In Table 1 , the Absolute Risk Difference (ARD) of 0.24 means that 24% more patients in the AZD1656 group with low vitamin D had a positive response compared to placebo treated patients. The Cl tells us that the real answer is somewhere between no difference at all and 48% more, so the preponderance of evidence suggests that treatment with AZD1656 is beneficial for COVID-19 patients with a vitamin D level less than 25nmol/L
Table 3; patients with high IL6 levels
Figure imgf000016_0001
Table 4; patients with low IL6 levels
Figure imgf000016_0002
In patients with baseline IL-6 values > 13 pg/mL, the mean time from randomisation to hospital discharge was over 3 days earlier in AZD1656 than Placebo, with a trend towards a statistically significant difference between groups (p = 0.0564). Additionally, for patients with baseline IL-6 values > 13 pg/mL who were discharged from hospital with WHO OSCI ratings of 1 or 2, there was a statistically significant lower probability of staying in hospital In AZD1656 than Placebo (p = 0.0213). Additional analysis results also showed that a higher proportion of patients with IL-6 values > 13 pg/mL in AZD1656 than Placebo were discharged from hospital by Day 7 (30.0% vs. 12.0%), whereas similar proportions of patients with IL-6 values < 13 pg/mL in AZD1656 and Placebo were discharged from hospital by Day 7 (36.8% and 33.3%) (Tables 2 and 3).
Further post hoc analyses performed to explore the time from randomisation to death in the study population, in the sub-population of patients who died, in those who had high baseline IL-6 values, and in those who died within 7 days (168 h) showed that significantly fewer patients in AZD1656 died within 7 days (p“0.0105) and that most patients who died during the study had IL-6 values > 13 pg/mL
Conclusions
AZD1656 works particularly well in the treatment of COVID-19 in patients with a low vitamin D level (<25 nmol/L) or a high IL6 level (>13 pg/ml) and thus it is expected that this improved treatment will also have utility in other viral-related diseases/symptoms, such as pneumonitis and/or myocarditis.

Claims

Claims
1. AZD1656, or a pharmaceutically acceptable salt thereof, for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
2. AZD1656 for use according to claim 1 , wherein the subject of treatment has diabetes, preferably type 1 or type 2 diabetes.
3. AZD1656 for use according to either claim 1 or 2 wherein the subject of treatment is human.
4. AZD1656 for use according to any of claims 1 to 3, wherein the dose of AZD1656 is 1 to 400 mg, preferably 50 mg to 400 mg, preferably 50 mg to 300 mg, most preferably 150 mg to 300 mg.
5. AZD1656 for use according to any preceding claim, wherein administration is by a single daily dose.
6. AZD1656 for use according to claim 5, wherein the single daily dose is 1 to 400 mg, preferably 300 mg to 400 mg.
7. AZD1656 for use according to any of claims 1 to 4, where administration is by a dose twice per day.
8. AZD1656 for use according to claim 7, wherein the dose is 1 to 5 mg or 80 to 120 mg, or 150 mg to 200 mg.
9. AZD1656 for use according to any one of claims 1 to 7, wherein the dose is 40 to 300 mg.
10. AZD1656 for use according to any one of claims 1 to 7, wherein the lower limit for a dose is 80 mg and the higher limit for a dose is 210 mg.
11 . AZD1656 for use according to any preceding claim, to be administered orally.
12. AZD1656 for use according to any of claims 1 to 10, to be administered by parenteral, transdermal, sublingual, rectal or inhaled administration.
13. AZD1656 for use according to any preceding claim, wherein the pneumonitis and/or myocarditis is associated with or caused by a coronavirus infection, such as Covid-19.
14. AZD1656 for use according to any preceding claim, wherein the subject to be treated is infected with, or suspected to be infected with, a coronavirus, such as Covid- 19.
15. AZD1656 for use according to any preceding claim, wherein the subject to be treated has long COVID.
16. Use of AZD1656, or a pharmaceutically acceptable salt thereof, for the manufacture of a medicament for use in the treatment of pneumonitis and/or myocarditis, wherein the subject of treatment has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
17. The use of AZD1656, or a pharmaceutically acceptable salt thereof, according to claim 16 having any of the additional features of claims 2 to 15.
18. A method of treating pneumonitis and/or myocarditis comprising administering the patient with AZD1656 or a pharmaceutically acceptable salt thereof, wherein the patient has (a) a vitamin D level of less than 25 nmol/L; and/or (b) an IL6 level of more than 13 pg/ml.
19. The method according to claim 18 having any of the additional features of claims 2 to 15.
PCT/GB2022/052354 2021-09-16 2022-09-16 Azd1656 for use in the treatment of pneumonitis or myocarditis WO2023041927A1 (en)

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
GB202113265 2021-09-16
GB2113265.9 2021-09-16
GB2201069.8 2022-01-27
GBGB2201069.8A GB202201069D0 (en) 2022-01-27 2022-01-27 Treatment

Publications (1)

Publication Number Publication Date
WO2023041927A1 true WO2023041927A1 (en) 2023-03-23

Family

ID=83508888

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/GB2022/052354 WO2023041927A1 (en) 2021-09-16 2022-09-16 Azd1656 for use in the treatment of pneumonitis or myocarditis

Country Status (1)

Country Link
WO (1) WO2023041927A1 (en)

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019053435A1 (en) * 2017-09-14 2019-03-21 Queen Mary University Of London Agent
WO2021186151A1 (en) * 2020-03-14 2021-09-23 Excalibur Medicines Limited Azd1656 for use in the treatment of pneumonitis and/or mycorditis caused by a coronavirus

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2019053435A1 (en) * 2017-09-14 2019-03-21 Queen Mary University Of London Agent
WO2021186151A1 (en) * 2020-03-14 2021-09-23 Excalibur Medicines Limited Azd1656 for use in the treatment of pneumonitis and/or mycorditis caused by a coronavirus

Non-Patent Citations (3)

* Cited by examiner, † Cited by third party
Title
ANONYMOUS: "NCT04516759: A Phase II, Randomised, Double-blind, Placebo-controlled Clinical Trial to Assess the Safety and Efficacy of AZD16 Patients Hospitalised With Suspected or Confirmed COVID-19", 16 August 2020 (2020-08-16), XP055807675, Retrieved from the Internet <URL:https://clinicaltrials.gov/ct2/history/NCT04516759?V_1=View#StudyPageTop> [retrieved on 20210526] *
CHORLTON JAMIE ET AL: "A randomised, double-blind, placebo-controlled, multicentre clinical trial of AZD1656 in diabetic patients hospitalised with COVID-19: The ARCADIA Trial - implications for therapeutic immune modulation", ECLINICAL MEDICINE, vol. 51, 18 August 2022 (2022-08-18), pages 101604, XP093006116, ISSN: 2589-5370, Retrieved from the Internet <URL:https://www.thelancet.com/action/showPdf?pii=S2589-5370(22)00334-0> DOI: 10.1016/j.eclinm.2022.101604 *
NORJAVAARA E., J CLIN ENDOCRINOL METAB, vol. 97, no. 9, 2012, pages 3319 - 3325

Similar Documents

Publication Publication Date Title
EP2707017B1 (en) Lixisenatide and metformin for treatment of diabetes type 2
US6395747B1 (en) Remedies for multiple sclerosis
EP3666258B1 (en) Method of treating prader-willi syndrome
US6693133B1 (en) Methods of cardioprotection using dichloroacetate in combination with an inotrope
Annecke et al. Propofol-related infusion syndrome induced by “moderate dosage” in a patient with severe head trauma
US20200261483A1 (en) Methods and compositions for treating cystic fibrosis
WO2021186151A1 (en) Azd1656 for use in the treatment of pneumonitis and/or mycorditis caused by a coronavirus
US20230128032A1 (en) Early Drug Interventions to Reduce COVID-19 Related Respiratory Distress, Need for Respirator Assist and Death
EP3355909B1 (en) Methods for treating diseases mediated by erbb4-positive pro-inflammatory macrophages
WO2023041927A1 (en) Azd1656 for use in the treatment of pneumonitis or myocarditis
KR20220157313A (en) Composition for treating COVID-19 comprising taurodeoxycholic acid or pharmaceutically acceptable salts thereof as an active ingredient
EP1708692B1 (en) Dichloroacetate in combination with an inotrope for cardioprotection
CN114630657A (en) SGLT inhibitor and application thereof
Trofimova et al. Medicinal Peptide Drugs: A Promising Direction in Modern Pharmacology
JP7579356B2 (en) Peptides for treating or preventing COVID-19
EP4051307B1 (en) Peptide for prevention or treatment of covid-19
US20060154902A1 (en) Shortening of hospital stay and improving survival in patients with chronic kidney disease
CN109985034A (en) The net new indication of En Gelie
Cotae et al. RARE CASE OF LIFE-THREATENING METFORMIN-ASSOCIATED ACIDOSIS WITHOUT HYPERLACTATEMIA IN POSTOPERATIVE PERIOD
Prakash et al. EFFECTIVENESS OF DAPAGLIFLOZIN IN THE MANAGEMENT OF TYPE-2 DIABETES MELLITUS IN COMBINATION WITH OTHER OHA’S &/OR INSULIN
US20130079416A1 (en) Homeopathic medicament comprising phenacetin for the treatment of cancer
Shannon Theophylline: Its rise, demise, and resurrection
Wei et al. Hydroxychloroquine Treatment may Benefit Nucleic Acid Testing of SARS-CoV-2 Turning Negative in Critically ill COVID-19 Patients: Report of 3 Cases
CA2847250A1 (en) Therapeutic methods and compositions for treating diabetes
WO2021012694A1 (en) Ethyl methyl hydroxypyridine malate or pharmaceutical composition thereof, and a use in preventing and/or treating type-ii diabetes

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 22782933

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

32PN Ep: public notification in the ep bulletin as address of the adressee cannot be established

Free format text: NOTING OF LOSS OF RIGHTS PURSUANT TO RULE 112(1) EPC (EPO FORM 1205A DATED 19.06.2024)