EP1210076A2 - Traitement therapeutique du syndrome des jambes sans repos - Google Patents

Traitement therapeutique du syndrome des jambes sans repos

Info

Publication number
EP1210076A2
EP1210076A2 EP00956413A EP00956413A EP1210076A2 EP 1210076 A2 EP1210076 A2 EP 1210076A2 EP 00956413 A EP00956413 A EP 00956413A EP 00956413 A EP00956413 A EP 00956413A EP 1210076 A2 EP1210076 A2 EP 1210076A2
Authority
EP
European Patent Office
Prior art keywords
active ingredient
combination according
ingredient combination
particularly preferably
oral administration
Prior art date
Legal status (The legal status 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 status listed.)
Withdrawn
Application number
EP00956413A
Other languages
German (de)
English (en)
Inventor
Hans-Michael Brecht
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Boehringer Ingelheim Pharma GmbH and Co KG
Boehringer Ingelheim Pharmaceuticals Inc
Original Assignee
Boehringer Ingelheim Pharma GmbH and Co KG
Boehringer Ingelheim Pharmaceuticals Inc
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
Application filed by Boehringer Ingelheim Pharma GmbH and Co KG, Boehringer Ingelheim Pharmaceuticals Inc filed Critical Boehringer Ingelheim Pharma GmbH and Co KG
Publication of EP1210076A2 publication Critical patent/EP1210076A2/fr
Withdrawn legal-status Critical Current

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
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/02—Drugs for disorders of the nervous system for peripheral neuropathies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/14—Drugs for disorders of the nervous system for treating abnormal movements, e.g. chorea, dyskinesia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Definitions

  • the invention relates to a new combination of active substances for the more effective treatment of restless leg syndrome (RLS), consisting of an ⁇ 2 agonist and a further neuropsychopharmaceutical that reduces the symptoms of RLS as monotherapy.
  • RLS restless leg syndrome
  • Restless Leg Syndrome is a neurological disorder that mainly manifests itself in leg disorders such as tingling, pulling, tearing, itching, burning, cramps or pain and triggers the irresistible urge to move. These disorders frequently occur when the person concerned is resting. Especially at night when sleeping, these emotional disorders and the consequent urge to move lead to restlessness and sleep disorders.
  • the RLS occurs at all ages, with the frequency increasing in older age. The prevalence in the general population is around 5%. Because of the characteristics of the symptoms, RLS is one of the most common causes of sleep disorders. In 20-40 year olds the RLS in 7%, in 40-60 year olds in 18% and in the over 60 year olds in 33% cause sleep and sleep disorders.
  • L-DOPA levodopa
  • dopamine agonists The disadvantage of dopamine agonists is the occurrence of side effects such as nausea,
  • Benzodiazepines and opiates are also effective in RLS. However, due to the risk of dependency and the development of tolerance, these substances are only available for therapy to a limited extent.
  • Carbamazepine has only been tested in a few partially open studies in the indication RLS. It only leads to partial freedom from symptoms and is currently not considered a suitable means of treating the RLS.
  • clonidine 2- (2,6-dichloroanilino) -4,5-dihydroimidazole
  • the daily doses were between 0.1 and 0.9 mg.
  • the patients reported a decrease (statistically significant) in sensitive symptoms such as paresthesia, the urge to move and tiredness during the day.
  • the sleep latency was shortened, but the sleep quality, frequency of waking up or periodic leg movements during sleep (PLMS) were not influenced. Since more effective substances are available as monotherapy, clonidine is currently only conditionally recommended as an alternative form of therapy. Another disadvantage of most monotherapies is that the amount of the corresponding active ingredient has to be increased over time in order to ensure therapeutic success.
  • the present invention relates to a combination of active substances for the treatment of restless leg syndrome consisting of a 2-agonist and a further neuropsychopharmaceutical, which also leads to a reduction in RLS symptoms in monotherapy, the combination overcoming the disadvantages of the monotherapies known from the prior art ,
  • the advantage of the invention is, inter alia, that in this combination the ⁇ 2 agonist influences the effect of the other neuropsychopharmaceuticals known from RLS monotherapy synergistically (or vice versa) in terms of an increase in activity, so that even low doses of both active substances are sufficient to to improve the patient's condition without causing intolerable side effects.
  • the combined administration of these two active substances also leads to better responsiveness and a higher responder rate in patients with RLS.
  • Imidazole receptor agonists are preferred as the ⁇ 2 agonist. Further preferred are azepexol, brimonidine, clonidine, dexmedetomidine, lofexidine, medetomidine, moxomidine, rilmenidine, talipexol, tiamenidine, tizanidine, AGN-190837, AGN-193080, BAM 1110, BAM-1125, CHF-1035, MPV-295, MPV- 2426, S-18616, UK-1403.
  • brimonidines Preferred are: brimonidines, clonidine, dexmedetomidine, lofexidine, moxomidines, talipexol, AGN-193080, BAM-1125, MPV-2426.
  • Clonidine is particularly preferred.
  • the active ingredient can likewise be a pharmacologically acceptable salt or an ester or a prodrug form, for example an ester. The same applies to all of the active ingredients listed in the context of this invention.
  • the other neuropsychopharmaceutical is preferably opioids, benzodiazepines, dopamine agonists or the combination levodopa (L-DOPA) plus decarboxylase inhibitor.
  • L-DOPA Levodopa
  • benserazide L-DOPA plus carbidopa
  • Pramipexole and pramipexole hydrochloride are particularly preferred.
  • clonazepam is particularly preferred.
  • Clonidine with a dopamine agonist particularly preferred is the combination with pramipexole or a pharmacologically acceptable salt thereof.
  • Clonidine with a benzodiazepine particularly preferably with clonazepam.
  • Clonidine with an opioid particularly preferably with tilidine / naloxone
  • the active substance combination according to the invention can be formulated in accordance with the conventional pharmaceutical processes known from the prior art so that it can be administered orally, spinally, anal, intravenously, by inhalation, subcutaneously or transdermally. Oral and transdermal application forms are preferred.
  • Oral administration can take the form of a tablet, powder, powder in a capsule (e.g. hard gelatin capsule), solution or suspension.
  • the active substance combination according to the invention is given as a solution.
  • the anal application takes place via suppositories.
  • the active ingredient combination can be in the form of a powder, as an aqueous or aqueous-ethanolic solution or by means of a propellant gas formulation.
  • the active ingredient can be applied to the skin either as an ointment or cream, but is preferably administered via a plaster.
  • the active ingredient or combination of active ingredients can either be delivered directly to the outer skin layer or it is embedded as a solution or as a gel, for example in a polymer matrix, using a transdermal patch, via micronade in or microcuts which the stratum corneum Skin penetrate directly into the deeper layers of skin.
  • a transdermal patch with micro-cutting edges or micro-spikes is disclosed, for example, in patent application WO 97/03718.
  • Patent application WO 91/07998 describes a method by means of which active ingredients can be applied transdermally in an improved manner by adjusting a certain pH value of the skin.
  • the delivery is controlled electronically, if necessary under the control of the blood plasma level by sensors or microsensors, which are integrated in the plaster or are in communication with it, so that the blood plasma level can be set according to the individual need and consequently a constant delivery is not absolutely necessary is.
  • the two active ingredients can be present in a separate formulation (for example, each in a capsule or in each case as a tablet), in a single formulation, but separated from one another (for example in a capsule with two chambers), or they are in a single formulation mixed before (eg in the form of a tablet or in a capsule with only one chamber).
  • the two active substances are each formulated independently of one another, it is not imperative that the two substances are administered via the same route of administration, but combinations of formulations can also be used in which the two active substances are administered via separate routes be administered.
  • clonidine / pramipexole combination for example, clonidine can be administered orally, while pramipexole is transdermal, e.g. is applied over the transdermal patch described above.
  • preferred formulations are those in which the two active compounds are administered via the same route of administration.
  • the two active ingredients are advantageously formulated together in one application form.
  • the two active substances can either be given in a separate patch, in a common patch, but both active substances are stored separately within the patch, or they are present as a mixture in one patch.
  • the active substance formulation according to the invention is prepared in accordance with the methods known from the prior art and can accordingly contain the formulation constituents which are known in the relevant field. In addition, it can contain other pharmacologically active substances or cosmetic additives.
  • the two active substances from the group of the ⁇ 2 agonists and the further neuropsychopharmaceuticals can be used both as a neutral compound or in the form of one of their pharmacologically acceptable salts.
  • the two active ingredients can equally be used both as neutral compounds, as two identical or two different salts or as a combination of a salt of one active ingredient and the neutral other active ingredient.
  • the different variants are influenced by the type of application. In cases in which the two active substances are present in a common formulation, it is preferably the neutral compound or the same salt (e.g. hydrochloride). The same applies preferably in the case when both active ingredients are taken orally as tablets or capsules.
  • an almost simultaneous or overlapping intake or administration is preferred.
  • oral administration for example, within 1 hour, preferably within 15 minutes.
  • the dose of the ⁇ 2 agonist corresponds to an oral application of 0.001-15 mg, preferably 0.001-10 mg, particularly preferably 0.01 to 5.0 mg and particularly preferably 0.01 mg-1 mg.
  • Azepexol 0.5 to 10.0 mg, preferably 3.0 to 7.0 mg, particularly preferably 4.5 to 5.5 mg,
  • Clonidine 0.01 to 1.0 mg, preferably from more than 0.01 to 0.5 mg and very particularly preferably from 0.05 to 0.3 mg,
  • Lofexidine 0.05 to 5.0 mg, preferably 0.05 to 3.0 mg, particularly preferably 0.1 to 2.0 mg,
  • Rilmenidine 0.05 to 5.0 mg, preferably 0.05 to 3.0 mg, particularly preferably 0.1 to 2.0 mg,
  • Tiamenidine 0.05 to 7.0 mg, preferably 0.1 to 5.0 mg, particularly preferably 0.5 to 3.5 mg.
  • L-DOPA in combination with benserazide 10 to 500 mg, preferably 50-200 mg and particularly preferably 100-200 mg L-DOPA and 1 - 100 mg, preferably 10-50 mg and particularly preferably 25-50 mg benserazide,
  • L-DOPA in combination with carbidopa 10 to 500 mg, preferably 10-300 mg and particularly preferably 50-200 mg L-DOPA and 1 - 100 mg, preferably 10 -50 mg and particularly preferably 12.5-50 mg carbidopa ;
  • Bromocriptine 1.25 - 20.0 mg, preferably 2.5 - 15.0 mg,
  • Cabergoline 0.05 - 5.0 mg, preferably 0.5 - 3.0 mg
  • ⁇ -dihydroergocryptine 5 - 60 mg, preferably 10 - 40 mg
  • Lisuride 0.1 - 5 mg, preferably 0.1 - 1.0 mg
  • Pergolide 0.05-1.0 mg, preferably 0.1-1.0 mg,
  • Pramipexole (HCl) 0.01-5.0 mg, preferably 0.1-1.5 mg, particularly preferably 0.125-1.0 mg
  • Ropinirole 0.2-10.0 mg, preferably 0.25-6.0 mg;
  • Codeine 10 to 100 mg, preferably 15 - 60 mg
  • Dihydrocodeine 10 to 100 mg, preferably 40 - 80 mg
  • Oxycodone 4,5-20mg
  • Tramadol 10 to 500 mg, preferably 25 to 200 mg and particularly preferably 50 to 100 mg,
  • Morphine 1 to 500 mg, preferably 1 to 200 mg and particularly preferably 10 to 100 mg,
  • Clonazepam 0.01-10 mg, preferably 0.1-5 mg and particularly preferably 0.25-2.0 mg,
  • Brotizolam 0.01-2 mg, preferably 0.05-0.5 mg and particularly preferably 0.1-0.3 mg.
  • the exact amount of the active ingredients can be determined simply
  • clonidine was also initially prescribed with a single dose of 0.075 mg two hours before bedtime and increased by 0.075 mg every 3 days.
  • the patient finally received 0.225 mg, the patient 0.45 mg clonidine hydrochloride as a single dose before sleep, whereby both patients stated that they hardly felt paraesthesia, the urge to move had also improved, but the quality of sleep and the number of waking up at night had not changed , Because of some intolerable side effects such as dry mouth, dizziness, constipation, both patients asked to stop taking the clonidine.

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  • Health & Medical Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Chemical & Material Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Medicinal Chemistry (AREA)
  • Animal Behavior & Ethology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Organic Chemistry (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
  • Neurology (AREA)
  • Biomedical Technology (AREA)
  • Neurosurgery (AREA)
  • Epidemiology (AREA)
  • Psychology (AREA)
  • Physical Education & Sports Medicine (AREA)
  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
  • Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
  • Medicinal Preparation (AREA)

Abstract

L'invention concerne une nouvelle combinaison d'agents actifs destinée à améliorer le traitement du syndrôme des jambes sans repos, composée d'un α2-agoniste et d'un autre agent neuropsycopharmaceutique réduisant les symptômes du syndrôme des jambes sans repos en tant que monothérapie.
EP00956413A 1999-08-19 2000-08-09 Traitement therapeutique du syndrome des jambes sans repos Withdrawn EP1210076A2 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE19938823 1999-08-19
DE19938823A DE19938823A1 (de) 1999-08-19 1999-08-19 Medikamentöse Behandlung des Restless Leg Syndroms
PCT/EP2000/007719 WO2001013903A2 (fr) 1999-08-19 2000-08-09 Traitement therapeutique du syndrome des jambes sans repos

Publications (1)

Publication Number Publication Date
EP1210076A2 true EP1210076A2 (fr) 2002-06-05

Family

ID=7918572

Family Applications (1)

Application Number Title Priority Date Filing Date
EP00956413A Withdrawn EP1210076A2 (fr) 1999-08-19 2000-08-09 Traitement therapeutique du syndrome des jambes sans repos

Country Status (21)

Country Link
US (1) US20010053777A1 (fr)
EP (1) EP1210076A2 (fr)
JP (1) JP2003513014A (fr)
KR (1) KR20020020273A (fr)
CN (1) CN1368878A (fr)
AR (1) AR025329A1 (fr)
AU (1) AU6836500A (fr)
BR (1) BR0013355A (fr)
CA (1) CA2382648A1 (fr)
CO (1) CO5190708A1 (fr)
CZ (1) CZ2002516A3 (fr)
DE (1) DE19938823A1 (fr)
IL (1) IL147643A0 (fr)
MX (1) MXPA02001295A (fr)
NO (1) NO20020792L (fr)
PE (1) PE20010738A1 (fr)
PL (1) PL364871A1 (fr)
SK (1) SK2452002A3 (fr)
TR (1) TR200200450T2 (fr)
UY (1) UY26296A1 (fr)
WO (1) WO2001013903A2 (fr)

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KR20020020273A (ko) 2002-03-14
PE20010738A1 (es) 2001-07-16
AU6836500A (en) 2001-03-19
US20010053777A1 (en) 2001-12-20
SK2452002A3 (en) 2002-06-04
NO20020792D0 (no) 2002-02-18
CN1368878A (zh) 2002-09-11
IL147643A0 (en) 2002-08-14
UY26296A1 (es) 2001-04-30
TR200200450T2 (tr) 2002-08-21
NO20020792L (no) 2002-02-18
BR0013355A (pt) 2002-04-30
CZ2002516A3 (cs) 2002-05-15
JP2003513014A (ja) 2003-04-08
WO2001013903A3 (fr) 2001-08-23
DE19938823A1 (de) 2001-02-22
PL364871A1 (en) 2004-12-27
MXPA02001295A (es) 2002-08-12
CA2382648A1 (fr) 2001-03-01
WO2001013903A2 (fr) 2001-03-01
CO5190708A1 (es) 2002-08-29
AR025329A1 (es) 2002-11-20

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