Patent Application
20230255903
This application claims priority to Japan Patent Application No. 2020-115743 filed on Jul. 3, 2020 and Japan Patent Application No. 2021-093454 filed on Jun. 3, 2021, the disclosures of which are incorporated herein by reference in their entirety.
The present invention relates to a therapeutic agent for treating a lower urinary tract disorder accompanied by residual urine, the therapeutic agent comprising 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof as an active ingredient.
Major pathologies of urinary storage disorders include overactive bladder (OAB). Partial denervation is observed in bladder biopsy specimens from OAB patients (Non-Patent Document 1 and 2). It is speculated that with the progression of denervation, the bladder smooth muscle causes an overreaction to acetylcholine (denervation supersensitivity), and detrusor overactivity (DO) occurs. Symptoms of OAB include urinary storage symptoms, such as urinary urgency, frequent urination (daytime and nighttime), and incontinence, which are often accompanied by involuntary contractions of the bladder (detrusor overactivity) during the storage phase.
It is known that the elderly may have both voiding and storage symptoms. It has been reported that 40% of elderly males who have lower urinary tract symptoms (LUTS) with no observation of bladder outlet obstruction (BOO), such as prostatic hyperplasia, have LUTS symptoms accompanied by only detrusor overactivity; that 31% have LUTS symptoms accompanied by only impaired detrusor contractility; and that 11% have LUTS symptoms accompanied by both detrusor overactivity and impaired detrusor contractility (Non-patent Literature (NPL) 3). Results of an epidemiological study reveal that LUTS include various symptoms, and that voiding and storage symptoms coexist (Non-Patent Literature (NPL) 4).
Chronic ischemia of the bladder is known as one pathogenesis of OAB. Recently, several reports suggest the possibility that chronic ischemia causes DO and changes in the ischemic state from mild to severe progress detrusor underactivity (DU) (Non-Patent Literature (NPL) 5, 6, and 7).
The usefulness of 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one has been reported. Specifically, Patent Literature (PTL) 1 discloses that 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one promotes nerve growth and is useful as a medicament for preventing or treating brain diseases, such as dementia. Patent Literature (PLT) 2 discloses that 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one is useful as a therapeutic agent for treating dysuria. Patent Literature (PLT) 3 discloses that 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one is useful as a therapeutic agent for treating diseases based on vesicoureteral dyssynergia. Patent Literature (PLT) 4 discloses that 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one is useful as a therapeutic agent for treating detrusor hyperactivity with impaired contractility (DHIC).
In order to evaluate the effectiveness and safety of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one on lower urinary tract disorders, such as DU and OAB, clinical studies were performed for patients with lower urinary tract disorders.
In 2018, a working group of the International Continence Society (ICS) reported on the standardization of terminology for lower urinary tract disorders associated with DU. In the report, the definition of the term “underactive bladder” (UAB) is discussed. According to this report (Non-Patent Literature (NPL) 8, UAB is “a symptom syndrome suggesting detrusor underactivity (DU), characterized by a slow urinary stream, hesitancy, and abdominal straining to void, with or without a feeling of incomplete bladder emptying, sometimes with storage symptoms.” Clear definitions of diagnostic criteria etc. for UAB are awaited.
An object of the present invention is to provide a voiding symptom therapeutic agent for a lower urinary tract disorder accompanied by residual urine.
The present inventors conducted extensive research to achieve the above object. As a result, the inventors found that 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one represented by the following formula (I) (also referred to below as “Compound 1”) is useful as a therapeutic agent for treating a voiding symptom in a patient having a lower urinary tract disorder with a residual urine volume of 50 mL or more.
Specifically, the present invention includes the following [1] to [10].
[1] A therapeutic agent for treating a voiding symptom in a patient having a lower urinary tract disorder with a residual urine volume of 50 mL or more, the therapeutic agent comprising 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof.
[2] An agent for improving voiding efficiency in a patient having a lower urinary tract disorder with a residual urine volume of 50 mL or more, the agent comprising 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof.
[3] The therapeutic agent according to [1], wherein the patient has a lower urinary tract disorder with a residual urine volume of 100 mL or more.
[4] The agent for improving voiding efficiency according to [2], wherein the patient has a lower urinary tract disorder with a residual urine volume of 100 mL or more.
[5] A method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a lower urinary tract disorder, the method comprising determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be effective when the residual urine volume is equal to or greater than coefficient T (40≤T≤110) mL.
[6] A therapeutic agent for treating a voiding symptom in a patient having a disease with reduced voiding efficiency with a residual urine volume of 50 mL or more, the therapeutic agent comprising 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof.
[7] An agent for improving voiding efficiency in a patient having a disease with reduced voiding efficiency with a residual urine volume of 50 mL or more, the therapeutic agent comprising 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof.
[8] The therapeutic agent according to [6], wherein the patient has a disease with reduced voiding efficiency with a residual urine volume of 100 mL or more.
[9] The agent for improving voiding efficiency according to [7], wherein the patient has a disease with reduced voiding efficiency with a residual urine volume of 100 mL or more.
[10] A method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a disease with reduced voiding efficiency, the method comprising determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be effective when the residual urine volume is equal to or greater than coefficient T (40≤T≤110) mL.
In other embodiments, the present invention is further directed to the following aspects.
determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be effective when the residual urine volume determined in the measurement step is equal to or greater than coefficient T (40≤T≤110) mL; and
administering an effective amount of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to the patient for whom the treatment has been determined to be effective.
According to the present invention, a voiding symptom in a patient having a lower urinary tract disorder with a residual urine volume of 50 mL or more can be treated.
Compound 1 is a known compound, and can be produced, for example, in accordance with the method described in WO1999/008987.
Examples of the “lower urinary tract disorder” in the present invention include detrusor underactivity, underactive bladder, overactive bladder, detrusor hyperactivity with impaired contractility, hypotonic bladder, atonic bladder, neurogenic bladder, detrusor-external urethral sphincter dyssynergia, frequent urination, nocturia, incontinence, benign prostatic hyperplasia, interstitial cystitis, chronic prostatitis, urolithiasis, and the like. The therapeutic agent of the present invention can also treat lower urinary tract disorders that are not caused by bladder-urethra dyssynergia. The therapeutic agent of the present invention can also treat lower urinary tract disorders other than diseases having both detrusor hyperactivity and impaired detrusor contractility. Further, the therapeutic agent of the present invention can treat lower urinary tract disorders other than detrusor hyperactivity with impaired contractility. In a preferred embodiment of the invention, the lower urinary tract disorder is, for example, at least one member selected from the group consisting of detrusor underactivity, underactive bladder, overactive bladder, detrusor hyperactivity with impaired contractility, hypotonic bladder, atonic bladder, and neurogenic bladder.
The patient having “a lower urinary tract disorder accompanied by residual urine” in the present invention is preferably a patient who has, as a lower urinary tract disorder, at least one member selected from the group consisting of detrusor underactivity, underactive bladder, overactive bladder, detrusor hyperactivity with impaired contractility, hypotonic bladder, atonic bladder, and neurogenic bladder and who has a residual urine volume of 50 mL or more. More preferably, the patient having a lower urinary tract disorder accompanied by residual urine is a patient who has, as a lower urinary tract disorder, at least one member selected from the group consisting of detrusor underactivity, underactive bladder, overactive bladder, detrusor hyperactivity with impaired contractility, hypotonic bladder, atonic bladder, and neurogenic bladder and who has a residual urine volume of 100 mL or more. In the present invention, the residual urine volume refers to the amount of urine in the bladder after completion of voiding, and can be measured, for example, by transabdominal ultrasonography or urinary catheterization.
The “disease with reduced voiding efficiency” in the present invention refers to a disease in which a decrease in voiding efficiency is recognized from a decrease in voided urine volume and/or the maximum urinary flow rate as determined by uroflowmetry, or the presence of residual urine as determined by residual urine volume measurement. Examples of the disease with reduced voiding efficiency include detrusor underactivity, underactive bladder, detrusor hyperactivity with impaired contractility, hypotonic bladder, atonic bladder, neurogenic bladder, detrusor-external urethral sphincter dyssynergia, incontinence, benign prostatic hyperplasia, interstitial cystitis, chronic prostatitis, and urolithiasis. The “disease with reduced voiding efficiency” in the present invention also includes voiding symptoms in which the degree of decrease in voiding efficiency does not satisfy the diagnostic criteria for diseases with such voiding symptoms but that are ameliorated by improving voiding efficiency.
The “voiding symptoms” in the present invention refers to at least one member selected from the group consisting of reduction in voiding efficiency, decrease in voided volume, reduction in the maximal urinary flow rate, presence of residual urine, slow urinary stream, splitting▪spraying, intermittent stream, hesitancy, abdominal straining to void, terminal dribbling, feeling of residual urine, post-micturition dribbling, dysuria, and urinary retention. Preferably, the voiding symptom is a reduction in voiding efficiency.
Compound 1 may also be in the form of a pharmaceutically acceptable salt; specifically, an acid addition salt or a salt with a base. As long as the salt is a pharmaceutically acceptable salt, embodiments using such a salt are included within the scope of the present invention. Specific examples include acid addition salts with inorganic acids, such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, nitric acid, and phosphoric acid; acid addition salts with organic acids, such as formic acid, acetic acid, propionic acid, oxalic acid, malonic acid, succinic acid, fumaric acid, maleic acid, lactic acid, malic acid, citric acid, tartaric acid, carbonic acid, picric acid, methanesulfonic acid, paratoluenesulfonic acid, and glutamic acid; salts with inorganic bases, such as sodium, potassium, magnesium, calcium, and aluminum; salts with organic bases, such as methylamine, ethylamine, meglumine, and ethanolamine; salts with basic amino acids, such as lysine, arginine, and ornithine; and ammonium salts.
3-(15-Hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof, which is an active ingredient of the therapeutic agent of the present invention, can be produced in various dosage forms by using one or more pharmaceutically acceptable carriers by a commonly known pharmaceutical method. The dosage form is not particularly limited, and examples include oral agents such as tablets, coated tablets, pills, powders, granules, capsules, liquids, suspensions, and emulsions; and parenteral agents such as injections or suppositories.
The pharmaceutical carrier can be any of various organic or inorganic carrier substances conventionally used as materials for pharmaceutical preparations. Examples include excipients, binders, disintegrants, lubricants, coating agents, and the like used in solid preparations; and solubilizing agents, suspending agents, isotonizing agents, pH adjusters▪buffers, soothing agents, and the like used in liquid preparations. Additives for pharmaceutical preparations, such as antiseptics, antioxidants, coloring agents, flavoring▪odor-masking agents, and stabilizers, can also be used, if necessary.
Examples of excipients include lactose, sucrose, D-mannitol, starch, crystalline cellulose, calcium silicate, and the like.
Examples of binders include hydroxypropyl cellulose, methyl cellulose, polyvinylpyrrolidone, candy powder, hypromellose, and the like.
Examples of disintegrators include sodium starch glycolate, carmellose calcium, croscarmellose sodium, crospovidone, low-substituted hydroxypropyl cellulose, partially pregelatinized starch, and the like.
Examples of lubricants include talc, magnesium stearate, sucrose fatty acid ester, stearic acid, sodium stearyl fumarate, and the like.
Examples of coating agents include ethyl cellulose, aminoalkyl methacrylate copolymer RS, hypromellose, sucrose, and the like.
Examples of solvents include water, propylene glycol, physiological saline, and the like.
Examples of solubilizing agents include polyethylene glycol, ethanol, α-cyclodextrin, macrogol 400, polysorbate 80, and the like.
Examples of suspending agents include carrageenan, crystalline cellulose▪carmellose sodium, polyoxyethylene hydrogenated castor oil, and the like.
Examples of isotonizing agents include sodium chloride, glycerin, potassium chloride, and the like.
Examples of pH adjusters▪buffers include sodium citrate, hydrochloric acid, lactic acid, phosphoric acid, sodium dihydrogen phosphate, and the like.
Examples of soothing agents include procaine hydrochloride, lidocaine, and the like.
Examples of antiseptics include ethyl paraoxybenzoate, cresol, benzalkonium chloride, and the like.
Examples of antioxidants include sodium sulfite, ascorbic acid, natural vitamin E, and the like.
Examples of coloring agents include titanium oxide, iron sesquioxide, Food Blue No. 1, copper chlorophyll, and the like.
Examples of flavoring▪odor-masking agents include aspartame, saccharin, sucralose, l-menthol, mint flavor, and the like.
Examples of stabilizers include sodium pyrosulfite, sodium edetate, erythorbic acid, magnesium oxide, dibutylhydroxytoluene, and the like.
When oral solid preparations are to be prepared, tablets, coated tablets, granules, powders, capsules, or the like can be produced by ordinary methods using excipients, binders, disintegrants lubricants, coloring agents, flavoring▪odor-masking agents, etc.
When injections are to be prepared, subcutaneous, intramuscular, or intravenous injections can be produced by an ordinary method using pH adjusters, buffers, stabilizers, isotonizing agents, topical anesthetics, etc.
The amount of Compound 1 or a salt thereof to be incorporated in each of such dosage unit forms varies depending on, for example, the condition of the patient to whom Compound 1 is to be administered, or the dosage form. In general, in the case of oral agents, the amount of Compound 1 per dosage unit form is preferably 0.005 to 1000 mg, more preferably 1 to 800 mg, and even more preferably 5 to 500 mg. In the case of injections, the amount of Compound 1 or a salt thereof per dosage unit form is preferably about 0.001 to 500 mg, more preferably 0.02 to 400 mg, and even more preferably 1 to 250 mg. In the case of suppositories, the amount of Compound 1 or a salt thereof per dosage unit form is preferably about 0.01 to 1,000 mg, more preferably 1 to 800 mg, and even more preferably 5 to 500 mg. The patient to whom Compound 1 or a salt thereof is to be administered is a human.
The daily dosage of the active ingredient in such a dosage form varies depending on the condition, body weight, age, sex, etc. of the patient, and cannot be generalized. For example, the daily dosage of the active ingredient for a human adult may generally be about 0.005 to 5000 mg, preferably 0.01 to 2000 mg, even more preferably 10 to 1600 mg, still even more preferably 20 to 800 mg, further even more preferably 100 to 400 mg, still further even more preferably 200 to 400 mg, and most preferably 400 mg. This dosage is preferably administered in one dose, or in about two to four divided doses, per day, and more preferably administered in two divided doses per day.
The present invention provides a method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a lower urinary tract disorder, wherein when the residual urine volume is equal to or greater than coefficient T (40≤T≤110) mL, the treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof is determined to be effective.
As described above, in the method of the present invention, when a patient has a residual urine volume that is equal to or greater than coefficient T (mL), a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof is determined to be effective. Coefficient T can be set within the range of 40≤T≤110. Accordingly, the method of the present invention includes, for example, a method comprising determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be effective when a patient has a residual urine volume that is equal to or greater than a coefficient of 50 (mL). In a preferred embodiment, coefficient T can be set within the range satisfying 70≤T≤110, and more preferably the range satisfying 90≤T≤110.
The present invention further provides a method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a lower urinary tract disorder, the method comprising determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be ineffective when a patient has a residual urine volume that is less than coefficient T (mL) described above.
The present invention provides a method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a disease with reduced voiding efficiency, wherein when the residual urine volume is equal to or greater than coefficient T (40≤T≤110) mL, a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof is determined to be effective.
As described above, in the method of the present invention, when a patient has a residual urine volume that is equal to or greater than coefficient T (mL), a treatment using 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof is determined to be effective. Coefficient T can be set within the range satisfying 40≤T≤110. Accordingly, the method of the present invention includes, for example, a method of determining a treatment using 3-(15-hydroxypentadecyl)-2,4,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof to be effective when a patient has a residual urine volume that is equal to or greater than a coefficient of 50 (mL). In a preferred embodiment, coefficient T can be set within the range satisfying 70≤T≤110, and more preferably the range satisfying 90≤T≤110.
The present invention further provides a method using a residual urine volume as an indicator for a therapeutic effect of 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof on a disease with reduced voiding efficiency, wherein when a patient has a residual urine volume that is less than coefficient T (mL) described above, a treatment using 3-(15-hydroxypentadecyl)-2,4,4-trimethyl-2-cyclohexen-1-one or a salt thereof is determined to be ineffective.
When pharmacokinetics vary depending on the difference in drug dosage form, formulation additives, etc., the daily dosage can be increased or decreased to make the pharmacokinetics comparable to those exhibited in a given dosage form.
The present invention is described in more detail below with reference to Test Examples. However, the present invention is not limited thereto.
Patients having detrusor underactivity (DU) and at least one voiding symptom associated with DU, such as abdominal straining to void, slow urinary stream, intermittent stream, residual urine, and reduced voiding efficiency, were used as subjects. Using such subjects, a placebo-controlled double-blind comparative study was performed to examine the effectiveness and safety of Compound 1 (this test was performed using patients also having overactive bladder as subjects). Under double-blind conditions (in which neither the doctor who prescribed the drug nor the patients knew which drug was administered to each patient), 200 mg of Compound 1 or a placebo was orally administered twice a day after a meal for 12 weeks to evaluate the effectiveness and safety of Compound 1.
To evaluate the effectiveness, BVE (bladder voiding efficiency) was evaluated. BVE (%) was calculated by the following formula:
Voided volume/(Voided volume+Residual urine volume)×100.
The voided volume refers to the amount of urine per urination. The residual urine volume refers to the amount of urine that resides in the bladder as measured by transabdominal ultrasonography after completion of urination. The difference between the baseline (before administration) and the measurement value after 12 weeks of the administration was evaluated by using a paired t-test, whereas the difference in amount of BVE variation between the Compound 1 group and the placebo group was evaluated by using Student's t-test. As shown in Table 1, the mean BVE change after 12 weeks of the administration in the Compound 1 group was 10.91, which was greater than that of the placebo group, but was not recognized as significantly difference from that of the placebo group (p=0.178).
To study the effect of Compound 1 on voiding effectiveness, BVE changes were evaluated only in a group of patients with more severe lower urinary tract disorder with a residual urine volume of 50 mL or more. As shown in Table 2, a significant increase in BVE after 12 weeks of the administration was observed in the Compound 1 group, as compared to the BVE before administration (p<0.001). In contrast, no tendency toward increased BVE was observed in the placebo group (p=0.489). Further, the mean BVE change after 12 weeks of the administration in the Compound 1 group was 18.41, and a significant difference from that of the placebo group was also observed (p=0.031).
To further study the effect of Compound 1 on voiding efficiency in more detail, BVE changes were evaluated only in a group of patients having more severe lower urinary tract disorders with a residual urine volume of 100 mL or more. As shown in Table 3, a significant increase in BVE after 12 weeks of the administration was observed in the Compound 1 group, as compared to the BVE before administration (p<0.001). In contrast, no tendency toward increased BVE was observed in the placebo group (p=0.708). Further, the mean BVE change after 12 weeks of the administration in the Compound 1 group was 23.57, and a significant difference from that of the placebo group (p=0.025) was observed. Further, the difference in amount of BVE change between the Compound 1 group and the placebo group after 12 weeks of the administration was 21.47, which was greater than the difference therebetween in a group of patients with a residual urine volume of 50 mL or more (15.53; see Table 2).
BVE changes in a group of only patients having lower urinary tract disorders with a residual urine volume of less than 50 mL was evaluated. As shown in Table 4, no significant increase in BVE after 12 weeks of the administration was observed (p=0.928).
The above results show that while Compound 1 did not significantly increase the voiding efficiency in patients with a residual urine volume of less than 50 mL, Compound 1 significantly increased the voiding efficiency in patients having more severe lower urinary tract disorders with a residual urine volume of 50 mL or more or with a residual volume of 100 mL or more.
To study the safety of Compound 1 in patients having lower urinary tract disorders, adverse events (any unfavorable medical event that occurred in patients who participated in this study; whether or not there is a causal relationship with the active ingredient) and adverse drug reactions (adverse events that are determined to “have a reasonable possibility” of a causal relationship with the drug) were measured. As shown in Table 5, the incidence of adverse events in the Compound 1 group was 46.2%, and no significant difference from that in the placebo group (37.5%) was observed. In the compound 1 group, no adverse effects were exhibited. The above results confirmed that oral administration of 200 mg of Compound 1 twice a day for 12 weeks has no safety problems and this compound is well tolerated.
| Number | Date | Country | Kind |
|---|---|---|---|
| 2020-115743 | Jul 2020 | JP | national |
| 2021-093454 | Jun 2021 | JP | national |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/JP2021/025056 | 7/2/2021 | WO |
