Patent Application
20050182089
This applications claims priority of EP Application Nos. 04001283 and 04005818, which are incorporated herein by reference in their entirties.
1. Technical Field
The present invention relates to a combination of a monoamine neurotransmitter re-uptake inhibitor and an NMDA receptors antagonist, and the use of the combination in treating neurodegenerative conditions such as dementia of Alzheimer type, cerebrovascular disease, and depression.
2. Background Information
Alzheimer's Disease and dementia of Alzheimer-type are insufficiently understood neurodegenerative conditions mainly affecting the elderly, but also younger people who are mainly genetically predisposed to it.
One postulated method of treatment comprises the administration of antagonists of NMDA receptors.
The tropane derivative having dopamine reuptake inhibitor activity for use according to the invention may, in particular, be tropane derivatives such as those disclosed by patent applications EP 604355, EP 604352, U.S. Pat. No. 5,444,070, EP 604354, WO 95/28401, and WO 97/30997, all of which are encorporated herein in their entirties.
The International patent application WO 97/30997 discloses tropane derivatives, which are monoamine neurotransmitter re-uptake inhibitors. Similar compounds are known from the International patent application WO 93/09814.
However, there is no hint to combine these compounds with an NMDA receptor antagonists.
The present invention provides a new and surprisingly effective combination of an NMDA receptor antagonist and a monoamine neurotransmitter re-uptake inhibitor for separate, sequential, or simultaneous administration.
Surprisingly the combination provides:
Accordingly, the invention relates to a pharmaceutical composition comprising a monoamine neurotransmitter re-uptake inhibitor comprising a 2,3-disubstituted tropane moiety, or a tautomer, a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof, and at least one NMDA receptor antagonists or a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof.
The present invention provides a greater than expected improvement than would be expected from administration of the active ingredients alone in the condition of subjects suffering from a neurodegenerative disorder with an associated cognitive deficit, such as Alzheimer's Disease, dementia of Alzheimer-type, Lewy Body dementia, fronto-temporal dementia, or from a cognitive deficit that may arise from a normal process, such as aging-like cerebrovascular dementia, multi-infarct dementia, and milder forms, such as age-associated memory impairment (AAMI) or mild cognitive impairment (MCI), or from an abnormal process, such as injury, than would be expected from administration of the active ingredients alone. Further, the combination allows for a lower overall dose of each of the active ingredients to be administered, thus reducing side effects and decreasing any reduction in the effectiveness of each of the active ingredients over time.
There is also provided a kit of parts comprising at least two separate unit dosage forms (A) and (B):
There is also provided the use of a combination of a monoamine neurotransmitter re-uptake inhibitor comprising a 2,3-disubstituted tropane moiety, or a tautomer, a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof (I), and at least one NMDA receptor antagonist, or a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof in a combined form, or separately, or separately and sequentially, wherein the sequential administration is close in time or remote in time, for the prevention or treatment of a disease or a disorder, which is responsive to the inhibition of monoamine neurotransmitter re-uptake and/or to NMDA inhibition.
There is also disclosed a method of prevention or treatment of a disease or disorder, which disease or disorder is responsive to the inhibition of monoamine neurotransmitter re-uptake, which method comprises administration of effective amounts of a monoamine neurotransmitter re-uptake inhibitor comprising a 2,3-disubstituted tropane moiety, or a tautomer, a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof, and at least one NMDA receptor antagonist or a pharmaceutically acceptable salt, solvate, or physiologically functional derivative thereof to a patient in need thereof in a combined form, or separately, or separately and sequentially, wherein the sequential administration is close in time or remote in time.
Diseases and/or disorders that may be prevented or treated by the present invention include: depression, dementia, pseudodementia, presenile dementia, senile dementia, dementia of Alzheimer-type, fronto-temporal dementia, HIV-related dementia, multi-infarct dementia, cerebrovascular dementia, Alzheimer's Disease, Lewy Body disease, Down syndrome, Pick's disease, Parkinson's Disease, memory deficits, attention deficits, cognitive dysfunction, memory dysfunction, age associated memory impairment, mild cognitive impairment, ageing-associated cognitive decline, age-related cognitive decline, multiple system atrophy, and neurodegenerative disorder with an associated cognitive deficit.
As a rule the monoamine neurotransmitter re-uptake inhibitor comprising a 2,3-disubstituted tropane moiety are compounds of the general formula (I)
or a pharmaceutical acceptable addition salt thereof, or the N-oxide thereof, wherein
In a special embodiment of the compound of general formula (I), R3 is
In a further special embodiment of the compound of general formula (I), R3 is
In a still further embodiment of the compound of general formula (I), R3 is
In a further special embodiment of the compound of general formula (I), R4 is phenyl, which is substituted once or twice with substituents selected from the group consisting of halogen, CF3, CN, alkoxy, cycloalkoxy, alkyl, cycloalkyl, alkenyl, alkynyl, amino, nitro, and heteroaryl.
In a more special embodiment, R4 is phenyl substituted once or twice with chlorine.
In a further special embodiment, the tropane derivative having dopamine reuptake inhibitor activity is a (1R, 2R, 3S)-2,3-disubstituted tropane derivative of formula (I).
In a still further embodiment, the tropane derivative having dopamine reuptake inhibitory activity is a compound of general formula (I), wherein
In a still further embodiment, the tropane derivative having dopamine reuptake inhibitory activity is a compound of general formula (I) wherein R is hydrogen, methyl, ethyl, or propyl.
In a still further embodiment, the tropane derivative having dopamine reuptake inhibitory activity is a compound of general formula I wherein R4 is 3,4-dichlorophenyl.
Preferably those monoamine neurotransmitter re-uptake inhibitor comprising a 2,3-disubstituted tropane moiety are compounds of formula (I1)
wherein
As used herein, the expression “C1-6 alkyl” includes methyl and ethyl groups, and straight-chained and branched propyl, butyl, pentyl, and hexyl groups. Particular alkyl groups are methyl, ethyl, n-propyl, isopropyl, and t-butyl.
The expression “C3-6 cycloalkyl,” as used herein, includes cyclic propyl, butyl, pentyl, and hexyl groups, such as cyclopropyl and cyclohexyl.
The term “halogen,” as used herein, includes fluorine, chlorine, bromine, and iodine, of which fluorine and chlorine are preferred.
The term “physiologically functional derivative,” as used herein, includes derivatives obtained from the compound of formula (I) under physiological conditions, these are, for example, N-oxides, which are formed under oxidative conditions.
The term “pharmaceutically acceptable acid addition salt,” as used herein, includes those salts that are selected from among the acid addition salts formed with hydrochloric acid, hydrobromic acid, sulphuric acid, phosphoric acid, methanesulphonic acid, acetic acid, fumaric acid, succinic acid, lactic acid, citric acid, tartaric acid, and maleic acid, the salts obtained from hydrochloric acid, hydrobromic acid, sulphuric acid, phosphoric acid, and acetic acid being particularly preferred. The salts of citric acid are of particular significance.
In a special embodiment, the tropane derivative having dopamine reuptake inhibitor activity is a compound of the general formula (I) selected from:
Most preferred is the compound of formula (IA)
or a pharmaceutically acceptable salt thereof, in particular the citrate thereof.
NMDA receptor antagonists that may be used include any that are known to the skilled person and those which will become available in the future. Examples are aptiganel, budipine, eliprodil, felbamate gacyclidine, remacemide, lanicemine, memantine, midafotel, remacemide, selfotel, and sinnabidol.
Most preferred is a combination of the compound of formula (IA) with memantine, which is 3,5-dimethyl-1-adamantanamine of formula (II),
in particular in form of its hydrochloride or sulfate.
The pharmaceutical compositions of the present invention are suitable for oral, intravenous, intravascular, intraperitoneal, subcutaneous, intramuscular, inhalative, topical, patch, or suppository administration.
The pharmaceutical compositions of the present invention are preferably in unit dosage forms, such as tablets, pills, capsules, powders, granules, sterile parenteral solutions, or suspensions, metered aerosol or liquid sprays, drops, ampoules, transdermal patches, auto-injector devices, or suppositories; for oral, parenteral, intranasal, sublingual, or rectal administration, or for administration by inhalation or insufflation. For preparing solid compositions such as tablets, the principal active ingredient is mixed with a pharmaceutical carrier, e.g., conventional tableting ingredients, such as corn starch, cellulose, carboxymethylcellulose, hydroxypropylmethylcellulose, lactose, sucrose, sorbitol, talc, silicon dioxide, polyethylene glycol, stearic acid, magnesium stearate, and dicalcium phosphate, or gums, or surfactants, such as sorbitan monooleate, polyethylene glycol, and other pharmaceutical diluents, e.g., water, to form a solid pre-formulation composition containing a homogeneous mixture of a compound of the present invention, or a pharmaceutically acceptable salt thereof. When referring to these pre-formulation compositions as homogeneous, it is meant that the active ingredient is dispersed evenly throughout the composition so that the composition may be readily subdivided into equally effective unit dosage forms, such as tablets, pills, and capsules.
This solid pre-formulation composition is then subdivided into unit dosage forms of the type described above containing from 0.05 to 10,000 mg, in particular 0.1 to about 500 mg, most preferably 0.1 to 250 mg, of each active ingredient of the present invention. Typical unit dosage forms contain from 0.1 to 100 mg, for example 0.1, 0.5, 1, 2, 5, 10, 25, 50, or 100 mg, of each active ingredient.
The tablets or pills of the novel composition can be coated or otherwise compounded to provide a dosage form affording the advantage of prolonged action. For example, the tablet or pill can comprise an inner dosage and an outer dosage component, the latter being in the form of an envelope over the former. The two components can be separated by an enteric layer, which serves to resist disintegration in the stomach and permits the inner component to pass intact into the duodenum or to be delayed in release. A variety of materials can be used for such enteric layers or coatings, such materials including a number of polymeric acids and mixtures of polymeric acids with such materials as shellac, cetyl alcohol, and cellulose acetate.
Similarly, cachets and lozenges are included. Tablets, powders, capsules, pills, cachets, and lozenges can be used as solid forms suitable for oral administration.
The liquid forms in which the novel compositions of the present invention may be incorporated for administration orally or by injection include aqueous solutions, suitably flavoured syrups, aqueous or oil suspensions, and flavoured emulsions with edible oils, such as cottonseed oil, sesame oil, coconut oil, or peanut oil, as well as elixirs and similar pharmaceutical vehicles. Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums, such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone, or gelatin.
For preparing suppositories, a low melting wax, such as admixture of fatty acid glycerides or cocoa butter, is first melted and the active component is dispersed homogeneously therein, as by stirring. The molten homogenous mixture is then poured into convenient sized molds, allowed to cool, and thereby to solidify.
Formulations suitable for vaginal administration may be presented as pessaries, tampons, creams, gels, pastes, foams, or sprays containing, in addition to the active ingredient, such carriers as are known in the art to be appropriate.
Administration to the respiratory tract may also be achieved by means of an aerosol formulation in which the active ingredient is provided in a pressurised pack with a suitable propellant such as a chlorofluorocarbon (CFC) or fluorohydrocarbon (HFC), for example, dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, 1,1,1,2-tetrafluoroethan (HFC-134(a)), or 1,1,1,2,3,3,3-heptafluoroprpane, carbon dioxide, or other suitable gas. The aerosol may conveniently also contain a surfactant such as lecithin and/or a co-solvent such as ethanol. The dose of drug may be controlled by provision of a metered valve.
Alternatively, the active ingredients may be provided in the form of a dry powder, for example, a powder mix of the compound in a suitable powder base, such as lactose, starch, and starch derivatives, such as hydroxypropylmethyl cellulose and polyvinylpyrrolidone (PVP). Conveniently, the powder carrier will form a gel in the nasal cavity. The powder composition may be presented in unit dose form, for example, in capsules or cartridges of, e.g., gelatin, or blister packs from which the powder may be administered by means of an inhaler.
In formulations intended for administration to the respiratory tract, including intranasal formulations, the compound will generally have a small particle size, for example, of the order of 5 microns or less. Such a particle size may be obtained by means known in the art, for example by micronization.
For the treatment of a neurodegenerative condition, a suitable dosage level is about 0.01 to 250 mg/kg per day, preferably about 0.01 to 100 mg/kg per day, and especially about 0.01 to 5 mg/kg of body weight per day of each active ingredient. The compounds may be administered on a regimen of 1 to 4 times per day. In some cases, however, dosage outside these limits may be used.
Most preferably the composition of the invention will be used for the treatment or prevention of one or more of the following neurodegenerative conditions: pseudodementia, dementia, including dementia of Alzheimer-type, Alzheimer's Disease, presenile dementia, senile dementia, Lewy-Body dementia, Down syndrome, fronto-temporal dementia, HIV-related dementia, Pick's Disease, Parkinson's Disease, cerebrovascular dementia, multi-infarct dementia, memory deficits, attention deficits, cognitive dysfunction, memory dysfunction, mild cognitive impairment (MCI), age-associated memory impairment (AAMI), ageing-associated cognitive decline, age-related cognitive decline, ALS, and multiple system atrophy.
Preferably the weight ratio of the monoamine neurotransmitter re-uptake inhibitor to the NMDR receptors antagonist ranges from 50:1 to 1:300, in particular from 1:1 to 1:200, most preferably from 1:2 to 1:100.
Most preferred are the following daily dose rates: 0.5-20 mg, preferably 1.0-10 mg of memantine and 0.01-2.0 mg of the compound of formula (IA);
The Examples that follow serve to illustrate some formulations according to the invention. They are intended solely as possible procedures described by way of example, without restricting the invention to their content.
*does not appear in final product
*does not appear in final product
The advantageous effect of the combination of the present invention can be shown, for example, by comparing the combined dosage of the combination with dosages of the same amount of each of the active ingredients separately on subjects using the Mini-Mental State Examination (MMSE), as described in Folstein and Folstein, J. Psychiat. Res., 1975, 12,189-198, or a variant thereof, as discussed in Tombaugh and Mcintyre, JAGS, 1992, 40, 922-935.
| Number | Date | Country | Kind |
|---|---|---|---|
| 04 001 283 | Jan 2004 | EP | regional |
| 04 005 818 | Mar 2004 | EP | regional |
