BG110479A - Pharmaceutical preparations and their use in the prevention of stroke, diabetes and/or congestive heart failure - Google Patents
Pharmaceutical preparations and their use in the prevention of stroke, diabetes and/or congestive heart failure Download PDFInfo
- Publication number
- BG110479A BG110479A BG11047909A BG11047909A BG110479A BG 110479 A BG110479 A BG 110479A BG 11047909 A BG11047909 A BG 11047909A BG 11047909 A BG11047909 A BG 11047909A BG 110479 A BG110479 A BG 110479A
- Authority
- BG
- Bulgaria
- Prior art keywords
- pharmaceutically acceptable
- angiotensin
- antagonist
- receptor
- diabetes
- Prior art date
Links
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- 206010007559 Cardiac failure congestive Diseases 0.000 title claims abstract description 22
- 206010012601 diabetes mellitus Diseases 0.000 title claims abstract description 15
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Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
- A61K31/519—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
-
- 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
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
-
- 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
- A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
- A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
-
- 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
- A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
-
- 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
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Description
Област на техниката
Настоящето изобретение се отнася до използване на инхибитор от ренин-ангиотензиновата система (RAS) или фармацевтично приемливо негово производно в производството на медикамент за предотвратяване на удар, диабети и/или конгестивна (застойна) сърдечна недостатъчност (CHF).
Предшестващо състояние на техниката
Съединения, които повлияват RAS са добре познати в нивото на техниката и се използват при лечение на кардиоваскуларни заболявалия, по-специално артериална хипертония и сърдечна недостатъчност. Основно RAS може да бъде повлияна инхибиране на ензимни, синтезни ангиотензини или чрез блокиране на съответните рецептори на ефекторни участъци (в молекулата на имуноглобулина). Налични днес са инхибитори на ангиотензинния, превръщащ ензим (АСЕ) и ангиотензин II тип 1 рецептор (AT II) антагонисти.
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Съединения, които повлияват RAS, включително AT II антагонисти са използвани обикновено за лечение на различни кардиоваскуларни заболявания, по-специално при пациенти, проявяващи високо кръвно налягане. Използването на посочените съединения при предотвратяване на кардиоваскуларни разстройства е много по-малко разпространено и използването на посочените съединения при предотвратяване на удар, диабети и/или CHF е досега непознато.
Техническа същност на изобретението
Настоящето изобретение се отнася до използване на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно в производството на медикамент за предотвратяване на удар, по-специално при пациенти проявяващи нормално или ниско кръвно налягане.
Настоящето изобретение по-нататък се отнася до използването на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно в производството на медикамент за предотвратяване на диабети.
Настоящето изобретение също се отнася до използването на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно в производството на медикамент за предотвратяване на развитие на конгестивна сърдечна недостатъчност при пациенти с несъществуваща по-рано конгестивна сърдечна недостатъчност, т.е. без признаци или симптоми на конгестивна сърдечна недостатъчност.
Друг аспект на изобретението е фармацевтичен състав за използване при предотвратяване на удар, диабети и/или конгестивна сърдечна недостатъчност, съдържащ терапевтично ефективно количество ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно.
По-нататъшен аспект на изобретението е използването на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно при предотвратяването на удар, диабет и/или конгестивна сърдечна недостатъчност, чрез приемане на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно от пациент, нуждаещ се от такова предотвратяване.
Подробно описание на изобретението
Изненадващо бе намерено, че кардиоваскуларни и метаболитни разстройства, такива като удар, диабети и конгестивна сърдечна недостатъчност могат да бъдат предотвратени чрез използване на ангиотензин II тип 1 рецепторен (AT II) антагонист.
Настоящето изобретение изненадва особено в това, че специално пациенти с по същество поддържани сърдечни функции и/или инхибиране на нормално или ниско кръвно налягане имат подчертано полза от превантивно действие на ангиотензин II тип 1 рецепторен (AT II) антагонист.
Пациенти, проявяващи нормално или ниско кръвно налягане са познати като нормотензивни, т.е. с нормално кръвно налягане. Примери в справочни ръководства, дефиниращи стойности на кръвно налягане за групи от различни пациенти, включващи различни възрасти, включват справочни издания от WHO и INC(USA). В настоящето изобретение, подходяща дефиниция за нормално или ниско кръвно налягане може да бъде намерена в INC IV, което е включено тук чрез референция.
В настоящето изобретение удар включва и двата случая фатален и нефатален.
В настоящето изобретение инхибитор от ренин-ангиотензин системата (RAS) или фармацевтично приемливо негово производно включва някое съединение, което само по себе си или при прием блокира негативните ефекти на ангиотензин II върху васкулатурата блокирайки неговия ефект върху рецептора.
В настоящето изобретение диабети включва двата тип I диабети, също познати като инсулинзависещ, захарен диабет (IDMM) и тип II диабет, също познат като не-инсулинзависещ захарен диабет (NIDOM).
Когато ангиотензин II тип 1 рецепторен (AT II) антагонистът, използван в настоящето изобретение има няколко асиметрични въглеродни атома, те могат последователно да съществуват в няколко стереохимични форми. Настоящето изобретение включва смес от изомери, така както и индивидуални стереоизомери. Настоящето изобретение по-нататък включва геометрични изомери, ротационни изомери, енантиомери, рацемати и диастереомери.
Където е подходящо, ангиотензин II тип 1 рецепторни (АТ II) антагонисти могат да бъдат използвани в неутрална форма, например като карбонова киселина или във формата на сол, за предпочитане фармацевтично приемлива сол, такава като натриева, калиева, амониева, калциева или магнезиева сол на изходното съединение. Където е подходящо съединенията изброени по-горе могат да бъдат използвани в хидролизирана естерна форма.
В настоящето изобретение ангиотензин II тип 1 рецепторни (АТ И) антагонисти включват всички техни пролекарства, било то активни или неактивни in vitro. Така, макар че такива защитни производни могат да не притежават фармакологична активност per se, те могат да бъдат приемани, например парентерално или орално, и след това метаболизирани in vivo за да образуват фармакологично активни инхибитори RAS.
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В настоящето изобретение, ангиотензин II тип 1 рецепторните (AT II) антагонисти могат да проявят дълъг срок на действие, среден срок на действие или къс срок на действие.
AT II антагонисти или фармацевтично приемливи техни производни, включително активни метаболити, които могат да бъдат използвани за предотвратяване на удар, диабет и/или конгестивна сърдечна недостатъчност, включват, но не ги ограничават, тези описани в европейски патентни заявки, публикации номера: 253310, © 323841, 324377, 399731, 400974, 401030, 403158, 404159, 407102,
407342, 409332, 411507, 411766, 412594, 412848, 415886, 419048, 420237, 424317, 425211, 425921, 426021, 427463, 429257, 430300, 430709, 432737, 434038, 434249, 435827, 437103, 439969, 442473, 443568, 443983, 445811, 446062, 449699, 450566, 453210, 454511, 454831,456442, 456442, 456510, 459136, 461039, 461040, 465323, 465368, 467207, 467715, 468372, 468470, 470543, 475206, 475898, 479479, 480204, 480659, 481448, 481614, 483683, 485929, 487252, 487745, 488532, 490587, 490820, 492105, 497121, 497150, 497516, 498721,498722, 498723, 499414, 499415, 499416, 500297, 500409, 501269, 501892, 502314, 502575, 502725, 503162, 503785, 503838, 0 504888,505098, 505111, 505893, 505954, 507594, 508393, 508445,
508723,510812, 510813, 511767, 511791, 512675, 512676, 512870, 513533,513979,514192,514193,514197,514198,514216,514217, 515265,515357,515535,515546,515548,516392,517357,517812, 518033, 518931, 520423, 520723, 520724, 521768, 522038,523141, 526001,527534 и 528762.
Други всички антагонисти, включително тези разкрити в международни патентни заявки, публикации номера: WO 91/00277, WO 91/00281, WO 91/11909, WO 91/11999, WO 91/12001, WO 91/12002, WO 91/13063, WO 91/15209, WO 91/15479, WO 91/16313, WO 91/17148, WO 91/18888, WO 91/19697, WO 91/19715, WO • · ···· ···· · · · · · · ··· · · · ··· ···· ·· ·· ·· ·· ··
92/00067, WO 92/00068, WO 92/00977, WO 92/02510, WO 92/04335, WO 92/04343, WO 92/05161, WO 92/06081, WO 92/07834, WO 92/07852, WO 92/09278, WO 92/09600, WO 92/10189, WO 92/11255, WO 92/14714, WO 91/16523, WO 92/16552, WO 92/17469, WO s 92/18092, WO 92/19211, WO 92/20651, WO 92/20660, WO 92/20687, ' WO 92/21666, WO 92/22533, WO 93/00341, WO 93/01177, WO
93/03018, WO 93/03033 и WO 93/03040.
Съдържанията на горепосочените европейски и международни патентни заявки са включени чрез споменаване в добавка към него.
Q
Предпочитаните AT II антагонисти или фармацевтично приемливи техни производни за използване в настоящето изобретение включват, но не го ограничават, съединения със следните общи, родови имена: кандесартан, кандесартан цилексетил, лосартан, валсартан, ирбесартан, тазосартан, телмисартан и епросартан.
Особено предпочитаните AT II антагонисти или фармацевтично приемливи техни производни за използване в настоящето изобретение са кандесартан и кандесартан целексетил. Кандесартан и кандесартан цилексетил са познати от —κ европейски патент № 459136 В1, US 5,196,444 и US 5,703,
110 на Takeda Chemical Industries. Кандесартан цилексетил обикновено се произвежда и продава широко в света от AstraZeneca и Takeda, например под търговски имена Atacand ®, Amias® и Biopress®.
Ренин-инхибитори или фармацевтично приемливи техни производни, включващи активни метаболити, които могат да бъдат използвани за предотвратяване на удар, диабети и/или конгестивна сърдечна недостатъчност включват, но не ограничават, следните съединения: еналкреин, RO 42-5892; А 65317; СР 80794; ES 1005; ES 8891; SQ 34017; CGP 29287; CGP 38560; SR 43845; U-71O38; А 62198 и А 64662.
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Фармацевтични рецептурни състави
В един аспект, настоящето изобретение се отнася до фармацевтични рецептурни състави, съдържащи като активен инградиент ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно или пролекарство, включващо метаболити, за използване в предотвратяването на удар, диабети и/или конгестивна сърдечна недостатъчност (CHF).
За клинична употреба, ангиотензин II тип 1 рецепторен (AT II) антагонист се оформя във фармацевтичен рецептурен състав за орален, интравенозен, подкожен, трахеален, бронхиален, вътреносов, белодробен, трансдермален, през бузата (вътреустно), ректален, парентерален или някакъв друг начин на приемане.
Фармацевтичната рецептура може да съдържа инхибитора в смес с фармацевтично приемлив аджувант, разтворител и/или носител.
В приготвянето на фармацевтичните рецептурни състави от настоящето изобретение активният инградиент може да бъде смесен с твърди, прахообразни инградиенти, такива като лактоза, захароза, сорбитол, манитол, скорбяла, амилопектин, целулозни производни, желатин или друг подходящ инградиент, така както и с дезинтегриращи агенти и лубрикантни агенти, такива като магнезиев стеарат, калциев стеарат, натриев стеарил фумарат и полиетилен гликолови восъци. Сместа може след това да бъде обработена в гранули или пресована в таблетки.
Активният инградиент може да бъде отделно примесен с други, неактивни инградиенти, преди да бъде смесен за да образува рецептурния състав.
Меки желатинови капсули могат да бъдат приготвени с капсули съдържащи смес на активен инградиент на изобретението, • · ♦ ·· · · ·· • · ···· 9 9 99 β · · · · · · ··· 99 9999 ° 9 9 9 9 9 9 9 99
9999 99 99 99 9999 растително масло, мазнина или друго подходящо свързващо вещество за меки желатинови капсули. Твърди желатинови капсули i могат да съдържат гранули на активните инградиенти. Твърди желатинови капсули могат също да съдържат активните инградиенти в комбинация с твърди прахообразни инградиенти, такива като лактоза, захароза, сорбитол, менитол, картофено нишесте, церевично нишесте, амилопектин, целулозни производни или желатин.
Дозираните единици за ректално предписание могат да бъдат предпочитано
Q (i) във формата на свещички, които съдържат активната субстанция, смесена с неутрална маста основа;
(ii) във формата на желатинова ректална капсула, която съдържа
I активната субстанция в смес с растително масло, парафиново масло или друго подходящо свързващо вещество за желатинови ректални капсули;
(iii) във формата на готово приготвена микроклизма или ф (iv) във формата на суха микроклизмена рецептура, която се връща в първоначалното състояние с подходящ разтворител само предварително предписан
Течните препарати могат да бъдат приготвени във формата на сиропи или суспензии, например разтвори или суспензии съдържащи активните инграниенти и останалата част състояща се, например от захари, захарни алкохоли и смес на етанол, вода, глицерол, пропилей гликол и полиетилен гликол. Ако се желае, такива течни препарати могат да съдържат оцветяващи агенти, вкусови агенти, кансерванти, захарин и карбоксиметилцелулоза или други сгъстяващи агенти. Течните препарати могат също да бъдат приготвяни във формата на сух прах, който може да бъде върнат в първоначалното състояние с подходящ разтворител преди употреба.
Разтвори за парентерално предписание могат да бъдат приготвяни като разтвор на рецептура от изобретението във фармацевтично подходящ разтворител . Тези разтвори могат също да съдържат стабилизиращи инградиенти, консерванти и/или буферни инградиенти. Разтворите за парентерално предписание могат също да бъдат приготвяни като сух препарат с подходящ разтворител преди употреба.
Общото количество от активния инградиент подходящо се намира в границите от около 0.1% тегловни до около 95% тегловни от състава, за предпочитане от 0.5% до 50% тегловни и по-специални от 1% до 25%.
Фармацевтичните състави могат да съдържат между около 0.1 и около 1 000 mg от активния инградиент, за предпочитане между и 100 mg от активния инградиент.
Дозата на активния инградиент за да бъде предписана ще зависи от съответната индикация, възрастта, теглото и пола на пациента и може да бъде определена от лекар. Дозата ще бъде подходяща в граници от около 0.01 mg/kg до около 20 mg/kg, за предпочитане между 0.1 mg/kg и 10 mg/kg.
Характерната дневна доза на активните инградиенти варира в широки граници и ще зависи от различни фактори, такива като съответната индикация, начина на предписание, възрастта, теглото и пола на пациента, и може да бъде определена от лекар. Обикновено, дозите, и по-специално оралните и парентерални дози, ще бъдат в граници от около 0.1 до около 100 mg на ден от активния инградиент, за предпочитане между 1 и 50 mg на ден активен инградиент.
10.·
Примерно изпълнение на изобретението
Следващият пример е предназначен да илюстрира, но по никакъв начин не ограничава обхвата на закрила на изобретението.
Пример
Широкомащабен клиничен опит бе определен да експериментира ефекта на АСЕ инхибитор рамиприл, версия плацебо в намаляващи кардиоваскуларни случаи.
Изследването бе проведено в 267 центъра в 19 страни за период от шест години и включва 9541 участници, които са с висок риск за кардиоваскуларни случаи, дължащи се на прекарани преди исхемична болест на сърцето, удар, периферни артериални заболявания или особено с диабети.
Систолното кръвно налягане при инклузия на пациентите бе средно 138тт Н§ стълб и така пациентите бяха с нормално кръвно налягане преди започване на изследването.
След терапия от един месец или с рамиприл или с плацебо, систолното кръвно налягане бе намалено с 5.48 mm Hg стълб и 1.59 mm Hg стълб, респективно.
Първоначалната крайна точка на изследването бе миокарден инфаркт (MI) и удар и кардиоваскуларна (CV) некроза.
Проучването бе спирано преждевременно, понеже при пациенти вземащи рамиприл се наблюдаваше много ясно понижаване при комбинирана крайна точка от кардиоваскуларна некроза, сърдечни атаки и удари. В допълнение към горните изгоди, бе също и намаляване между четири и пет от нуждаещите се от васкуларизационни процедури (такивакато коронарна артериална байпасна хирургия, балонна пластична
операция на съдовете) и диабетични компликации.
Бяха отбелязани 32% намаляване при рамиприлната група в броя на пациентите, които са развили удар, и това е изненадващо, тъй като пациентите бяха с нормално кръвно налягане, когато бяха набирани за изследването.
Броят на пациентите, които развиха конгестивна сърдечна недостатъчност бе изненадващо намален до 21% при рамиприлната група, което е неочаквано, тъй като пациентите нямаха признаци или симптоми на конгестивна сърдечна недостатъчност преди започване на изследването.
При еднакви условия, изненадващо е маркираното 36%-но намаление в броя на пациентите, които развиват диабети при рамиприлната група.
Абревиатури
АТ П ангиотензин II тип 1 рецептор
CHF конгестивна сърдечна недостатъчност
IDMM инсулин-зависим захарен диабет
INC обща национална комисия
NIDOM не-инсулин зависим захарен диабет
WHO световна здравна организация
Claims (6)
- ПАТЕНТНИ ПРЕТЕНЦИИ1. Използване на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно за производството на медикамент за предотвратяване на удар.
- 2. Използване на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно за производството на медикамент за предотвратяване на удар при пациенти, проявяващи нормално или ниско кръвно налягане.
- 3. Използване на ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно за производството на медикамент за предотвратяване на диабет.
- 4. Използване ангиотензин II тип 1 рецепторен (AT II) антагонист или фармацевтично приемливо негово производно за производството на медикамент за предотвратяване развитието на конгестивна сърдечна недостатъчност (CHF) в пациенти с по-рано несъсществуваща CHF.
- 5. Използване, съгласно някоя от предходните претенции, от1 до 4, където AT II антагонистът или фармацевтично приемливо негово производно е избрано от групата, състояща се от кандесартан, кандесартан цилексетил, лозартан, валсартан, ирбесартан, тазосартан, телмисартан и епросартан.
- 6. Използване, съгласно претенция 5, където AT II антагонистът или фармацевтично приемливо негово производно е избрано от групата, състояща се от кандесартан и кандерантан цилексетил.
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| PCT/EP2000/008341 WO2001015673A2 (en) | 1999-08-27 | 2000-08-25 | Pharmaceutical formulations and use thereof in the prevention of stroke, diabetes and/or congestive heart failure |
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| BG106319A BG66115B1 (bg) | 1999-08-27 | 2002-01-18 | Използване на рамиприл или негова фармацевтично приемлива сол за предотвратяване на конгестивна сърдечна недостатъчност |
| BG11047909A BG110479A (en) | 1999-08-27 | 2002-01-18 | Pharmaceutical preparations and their use in the prevention of stroke, diabetes and/or congestive heart failure |
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| BG106319A BG66115B1 (bg) | 1999-08-27 | 2002-01-18 | Използване на рамиприл или негова фармацевтично приемлива сол за предотвратяване на конгестивна сърдечна недостатъчност |
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