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
  • A61K31/50—Pyridazines; Hydrogenated pyridazines
  • A61K31/501—Pyridazines; Hydrogenated pyridazines not condensed and containing further heterocyclic rings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
• • 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
  • A61P17/00—Drugs for dermatological disorders
• • 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
  • A61P3/00—Drugs for disorders of the metabolism
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P35/00—Antineoplastic agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P37/00—Drugs for immunological or allergic disorders
• • 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
• • Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
  • Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
  • Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
  • Y02A50/00—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE in human health protection, e.g. against extreme weather
  • Y02A50/30—Against vector-borne diseases, e.g. mosquito-borne, fly-borne, tick-borne or waterborne diseases whose impact is exacerbated by climate change

Definitions

• the present invention relates to methods of treating, preventing, modifying and managing cytokine-mediated disorders or related disorders, which comprise the administration of a compound, such as a cytokine inhibitor, alone or in combination with known therapeutics.
• the invention also relates to pharmaceutical compositions and dosing regimens using the disclosed compounds,
• the invention relates to the use of compounds as disclosed herein, optionally in conjunction with other therapies, for the treatment of autoimmune diseases, inflammatory diseases, cardiovascular diseases, and cancer.
• cytokines pro-inflammatory and anti-inflammatory mediators or cytokines.
• Some cytokines promote inflammation and are called pro-inflammatory cytokines, whereas other cytokines suppress the activity of pro-inflammatory cytokines and are referred to as antiinflammatory cytokines.
• IL-4, IL-10, and IL-13 are potent activators of B lymphocytes, but are also potent anti-inflammatory agents. They are anti-inflammatory cytokines by virtue of their ability to suppress genes for pro-inflammatory cytokines such as IL-I, TNF, and chemokines (CA. Dinarello, Chest. 2000, 118, 503-508).
• autoimmune diseases arise when immune system cells (lymphocytes, macrophages) become sensitized against the "self. Lymphocytes as well as macrophages are usually under control in this system. However, a misdirection of the system toward the body's own tissues may happen in response to still unexplained triggers.
• lymphocytes recognize an antigen which mimics the "self and a cascade of activation of different components of the immune system takes place, ultimately leading to tissue destruction. Genetic predisposition has also been postulated to be responsible for autoimmune disorders.
• Tumor necrosis factor-o; (TNF- en) and interlcukin-1 (IL-I) are proinflammatory cytokines that mediate inflammatory responses associated with infectious agents and other cellular stresses.
• Overproduction of cytokines such as IL-I and TNF- ⁇ is believed to underlie the progression of many inflammatory diseases including rheumatoid arthritis (RA), Crohn's disease, inflammatory bowel disease, multiple sclerosis, endotoxin shock, osteoporosis, Alzheimer's disease, congestive heart failure, and psoriasis among others (Dinarello, CA. et al., Rev. Infect. Diseases 1984, 6, 51 ; Salituro et al., Curr. Med.
• TNF-o also referred to as TNFa
• IL-Ib interleukin-1/3
• a method of treating a disorder mediated by one or more cytokines which comprises administering to a subject in need of such treatment a therapeutically effective amount of a compoundas described herein, for example, a cytokine inhibitor.
• the cytokine is selected from TNFa, IL-I, IL-6, IL-8, GM-CSF, and IFN-gamma, or a combination of any two or more thereof.
• the cytokine is TNFa or IL-I.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A), as described herein.
• the disorder is or results from abnormal bleeding, an abscess, actinic reticuloid syndrome, acute confusional migraine, acute confusional senile dementia, acute hepatocellular injury, acute tubular necrosis, adenohypophyseal diseases, adenovirus infections, adhesions, adhesive capsulitis, adnexitis, agammaglobulinemia, allergy, alopecia, fibrosing alveolitis, amyloidosis, angioplasty, angor pectoris, antiphospholipid syndrome, arteriosclerotic dementia, arteritis temporal, arthropod-bome encephalitis, asphyxia, atopic hypersensitivity, atrial fibrillation, beaver fever, biliary cirrhosis, bone loss, bronchiolitis, cancer of endocrine gland, cancer of larynx, candidiasis, small cell lung carcinoma, cardiac hypertrophy, cardiac surgery, cardiomega
• a cytokine inhibitor in another aspect of the invention, there are provided methods of reducing levels of a cytokine in a subject.
• the methods comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to reduce a level of a cytokine relative to the level prior to administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the reduction in cytokine levels is at least 10%, at least 30%, at least 50%, or at least 90%.
• the subject suffers from, or is at ⁇ sk for a cytokinc-mcdiated disorder, as described herein.
• the cytokine is selected from TNFa, IL-I, IL-6, IL-8, GM-CSF, IFN-gamma, or a combination of any two or more thereof.
• the cytokine is TNFa or IL-I.
• the cytokine level is measured in the subject or samples from the subject, e.g., tissue or bodily fluids such as the subject's blood.
• cytokine level is measured in the subject's synovium.
• the cytokine level is measured in the subject's skin.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A), as desc ⁇ bed herein.
• a cytokine released from a cell in response to a pro-inflammatory stimulus comprise exposing a cell to an amount of a compound, such as a cytokine inhibitor, effective to reduce the level of cytokine released from the cell in response to a pro-inflammatory stimulus relative to the level of released cytokine prior to contacting the cell with the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the reduction in cytokine levels is at least 10%, at least 30%, at least 50%, or at least 90%.
• the pro-inflammatory stimulus results from the presence of TNFa, IL-I, IL-6, IL-8, GM-CSF, IFN-gamma, LPS, or a combination of any two or more thereof.
• the cytokine level is the level of TNFa, IL- 1 , IL-6, IL-8, GM-CSF, IFN-gamma, or a combination of any two or more thereof.
• the method further includes exposing the cell to additional therapeutic ingredients (hereafter referred to as ingredient A), as described herein.
• methods of inhibiting p38 activity compose contacting p38 with an amount of a compound, such as a cytokine inhibitor, effective to inhibit p38 activity, the phosphorylation of p38, or both, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• a compound such as a cytokine inhibitor
• the inhibition of p38 activity or phosphorylation of p38 is at least 10%, at least 30%, at least 50%, or at least 90%.
• the p38 is in a subject.
• the subject suffers from, or is at ⁇ sk for, a cytokine- mediated disorder as described herein.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A) to the subject, as desc ⁇ bed herein.
• a pro-inflammatory mediator in another aspect of the invention, there are provided methods of reducing the activity of a pro-inflammatory mediator.
• the methods comp ⁇ se administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to reduce the activity of a pro-inflammatory mediator relative to the acthity p ⁇ or to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the reduction in pro-inflammatory mediator activity is at least 10%, at least 30%, at least 50%, or at least 90%.
• the subject suffers from or is at ⁇ sk for a cytokme-mediated disorder as described herein.
• the reduction in activity results from a decrease in circulating levels of a pro-inflammatory mediator relative to the circulating levels prior to administration of the compound
• the decrease in circulating pro-inflammatory mediator level is at least 10%, at least 30%, at least 50%, or at least 90%.
• the pro-inflammatory mediator is a prostaglandin or a leukotriene, or a combination of two or more thereof
• the reduction in activity results from an inhibition of the production of a pro-inflammatory mediator.
• the inhibition of proinflammatory mediator production is at least 10%, at least 30%, at least 50%, or at least 90%.
• the pro-inflammatory mediator is a prostaglandin, leukotriene, COX-2, NO-synthase, or a combination of any two or more thereof.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A), as desc ⁇ bed herein.
• a subject such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to reduce the circulating levels of C- Reactive Protein or Rheumatoid Factor, or both, in the subject's blood relative to the level prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the circulating C-Reactive Protein levels before administration are higher than about 2,87 mg/1.
• the reduction in circulating level is at least 10%, at least 30%, at least 50%, or at least 90%.
• the subject suffers from, or is at risk for a cytokine-mediated disorder as described herein.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A), as described herein, for example, the method further includes administration of methotrexate.
• the methods comprise administering to a subject exhibiting one or more indicia of rheumatoid arthritis, an amount of a compound, such as a cytokine inhibitor, effective to reduce at least one of the indicia to a level below that which exists prior to the administration of the compound, wherein the indicia are selected from erythrocyte sedimentation rate (ESR), number of painful and tender joints, level of joint pain, Ritchie articular index, duration of morning stiffness, joint immobility, joint swelling, and/or circulating C-reactive protein level, and wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the method further includes administration of additional therapeutic ingredients (hereafter referred to as ingredient A), as described herein.
• kits for reducing the number or severity of the clinical signs of psoriasis comprise administering to a subject exhibiting one or more clinical signs of psoriasis an amount of a compound, such as a cytokine inhibitor, effective to reduce the number or severity of clinical signs of psoriasis relative to those present in the subject prior to the administration of the compound, wherein the clinical signs of psoriasis are the percentage of total body surface area (BSA) affected by psoriasis, psoriasis plaque thickness, level of lymphocytes within psoriatic lesions, epidermal thickness, T-cell infiltration, pathological epidermal hyperplasia, cell-mediated immunity reactions, tetanus antibody response, lymphocyte subpopulations, or any two or more thereof, and wherein the cytokine inhibitor is as desc ⁇ bed herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt
• Combination therapy with other therapeutic ingredients A in the methods of the invention provides a beneficial therapeutic effect, particularly an additive or over- additive effect or an overall reduction of side effects of therapy.
• a beneficial therapeutic effect is desirable in the treatment of cytokine-mediated disorders and other methods as described herein.
• the invention provides methods that further include administering to a subject one or more, typically one, compound as desc ⁇ bed herein, for example a cytokine inhibitor, together with one or more, typically one, of the ingredients A desc ⁇ bed herein.
• the methods are for treating cytokme-mediated disorders or conditions.
• a combination of any two or more ingredients A are administered with a compound as desc ⁇ bed herein.
• An additive or over-additive (e g., synergistic) effect of the pharmaceutical combinations according to the invention provides for dose reduction, side-effect reduction and/or interval extension when compared to the individual compounds of the invention alone, or ingredient A alone.
• the effects mentioned above are observed both when the two substances are administered simultaneously in a single formulation and when they are administered successively in separate formulations.
• ingredient A being an injectable, especially a biological agent
• other benefits of adding a compound as desc ⁇ bed herein, e.g., a cytokine inhibitor may be seen, such as, for example, cost reduction by way of interval and/or dose reduction.
• a va ⁇ ety of ingredients A are contemplated for use in the combinations of the invention.
• non-steroidal anti-inflammatory drugs NSAIDs
• NSAIDs include acetaminophen, aspi ⁇ n, lbuprofen, choline magnesium salicylate, choline salicylate, diclofenac, diflumsal, etodolac, fenoprofen calcium, flurbiprofen, lndomethacm, ketoprofen, carprofen, mdoprofen, ketorolac tromethamine, magnesium salicylate, meclofenamate sodium, mefenamic acid, oxaprozin, piroxicam, sodium salicylate, sulmdac, tolmetin, meloxicam, rofecoxib, celecoxib, eto ⁇ coxib, val
• acetaminophen acetaminophen
• aspi ⁇ n
• Angiogenesis inhibitors may serve as ingredient A, such as VEGF inhibitors, taxol, pentoxyfylline and/or thalidomide.
• Biological agents shall be understood to mean any natural or artificial/synthetic biological molecule or fragment thereof as known in the art, such as antibodies, proteins, fusion proteins, receptors, nucleic acids, lipids, carbohydrates, and the like. Therefore, ingredient A includes biological agents, such as etanercept, infliximab, alefacept, adalimumab, efalizumab, anakinra, IL-IRA, alpha-interferon, interferon beta 1-B, CTLA-4, and other antibodies or receptor constructs directed against TNFa, IL1-6, LFA-I , or C5.
• biological agents such as etanercept, infliximab, alefacept, adalimumab, efalizumab, anakinra, IL-IRA, alpha-interferon, interferon beta 1-B, CTLA-4, and other antibodies or receptor constructs directed against TNFa, IL1-6, LFA-I , or C
• ingredient A is also within the scope of the invention for ingredient A are steroids, such as glucocorticoids, and vitamin D3 and analogs thereof (cholecalciferols), alone (the latter being used mostly for psoriasis) or in combination
• Steroids include budesonide, dexamethasone, fluocinonide, hydrocortisone, betamethasone, halobetasol (ulobctasol), methylprednisolone, prednisolone, prednisone, clobetasone, deflazacort, fluocinolone acetonide, fluticasone, triamcinolone acetonide, mometasone and diflucortolone.
• vitamin D3 derivatives are calcipotriol, tacalcitol, maxacalcitol, and tacalitol, the calciotropic hormones, l ⁇ ,2,5-dihydroxyvitamin D3, and parathyroid hormone-related peptide.
• cytokine inhibitors include hydroxychloroquine, D-penicillamine, sulfasalazine, auranofm, gold sodium thiomalate, minocycline, dapsone, chlorambucil, mercaptopurine, tacrolimus, sirolimus, pimecrolimus, mycophenolate mofetil, cyclosporine, leflunomide, methotrexate, azathioprine, cyclophosphamide, macrolides, ascomycin, hydroxyurea, 6- thioguanine, (Orfanos C E., 1999, Cutis 64(5), 347); alefacept, leflunomide, infliximab, etanercept, efalizumab, anti-CD4, anti-CD25, peptide T, LFA3TIP, alicafor
• agents or therapies which act on other targets or immune mediated products are suitable as the ingredient A.
• agents or therapies which act on other targets or immune mediated products are suitable as the ingredient A.
• PTKs protein tyrosine kinases
• EGFR epidermal growth factor receptor
• E-selectin inhibitors and therapies widely used for psoriasis such as anthralin, coal tar, phototherapies including ultraviolet B (UVB) or psoralens ultraviolet A (PUVA), photodynamic therapy and laser therapy.
• UVB ultraviolet B
• PUVA psoralens ultraviolet A
• Retinoid therapy can also be used as ingredient A.
• bexarotene, acitretin, etretinate, tazarotene, hydroxyurea, 6-thioguanine and phototherapies are suitable additional ingredients.
• Ingredients A useful in the invention further include small molecule inhibitors directed against enzymes involved in signal transduction pathways or to cell adhesion molecules like LFA-I or ICAM-I.
• Statins and HMG-CoA reductase inhibitors may also be employed as ingredients A including, e.g., atorvastatin (LIPITOR, TORVAST), fluvastatin (LESCOL), lovastatin (MEVACOR, ALTOCOR), mevastatin, pitavastatin (LIVALO, PITAVA), pravastatin (PRAVACHOL, SELEKTINE, LIPOSTAT), rosuvastatin (CRESTOR), or simvastatin (ZOCOR, LIPEX).
• atorvastatin LIPITOR, TORVAST
• fluvastatin LESCOL
• mevastatin mevastatin
• pitavastatin LIVALO, PITAVA
• pravastatin PRAVACHOL
• SELEKTINE SELEKTINE
• LIPOSTAT rosuvastatin
• ZOCOR simvastatin
• ingredients A contemplated for use in methods of the invention include fibrates, such as bezafibrate (e.g., BEZALIP), ciprofibrate (e.g., MODALIM), clofibrate, clinofibrate, gemfibrozil (e.g., LOPID), or fenofibrate; cholesterol absorption inhibitors, such as, ezetimibe (e.g., ZETIA); nicotinic acid; bile acid sequestrants, such as cholestyramine (QUESTRAN) and colestipol (COLESTID); and/or plant sterol-containing products and ⁇ 3 -fatty acids.
• fibrates such as bezafibrate (e.g., BEZALIP), ciprofibrate (e.g., MODALIM), clofibrate, clinofibrate, gemfibrozil (e.g., LOPID), or fenofibrate
• Combination therapy with the above ingredients A is contemplated for use in any method of the invention including treatment of the cytokine-mediated disorders and conditions as well as in the methods described in the related applications, U.S. Application No. 10/939,324, International Application PCT/US2006/042679, International Application PCT/US2006/048803, and International Application No. PCT/US2006/006682, each of which is herein incorporated by reference in its entirety.
• combinations comprising ingredient A and one or more compounds, as described herein, for example, cytokine inhibitors, typically in therapeutically effective amounts, for use as pharmaceutical compositions with anti-cytokine activity.
• combinations comprising ingredient A and a compound as described herein can be used for preparing a pharmaceutical composition for the treatment and/or prevention of a cytokine-mediated disorder or condition.
• the pharmaceutical preparations, containing as the active substance one or more compound combinations comprising ⁇ ngredient(s) A and the compound(s) as described herein further include the pharmaceutically acceptable derivatives thereof, and may be optionally combined with a conventional excipient, carrier, or combination thereof.
• UVB ultraviolet B
• PUVA psoralens ultraviolet A
• a typical combination for reducing the number or seventy of the clinical signs of psoriasis includes a compound described herein in combination with immunotherapy drugs which include cyclospo ⁇ ne, pimecrolimus, tacrolimus, ascomycine, anti-CD4, anti-CD25, peptide T, LFA3T1P, DAB 389 , CTLA-41g, E-selectin inhibitors, alefacept, infliximab, etanercept, efahzumab, and those disclosed in Griffiths, Christopher E. M., 1998 Hospital Medicine, 59 No 7, and variants thereof.
• immunotherapy drugs which include cyclospo ⁇ ne, pimecrolimus, tacrolimus, ascomycine, anti-CD4, anti-CD25, peptide T, LFA3T1P, DAB 389 , CTLA-41g, E-selectin inhibitors, alefacept, infliximab, etanercept, ef
• Another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound as desc ⁇ bed herein with methotrexate (MTX). It is expected this combination will be effective because of the good tolerability of MTX in the short term and because of the acceptability if maintenance of remission is obtained with good quality of life
• Another typical combination for reducing the number or seventy of the clinical signs of pso ⁇ asis is a compound as desc ⁇ bed herein with cyclospo ⁇ nc, especially because of cyclosporin's efficiency for induction of remission.
• Another embodiment of the invention comp ⁇ ses administration in the following sequence induction with a compound described herein and cyclosporine, followed by continuation with the compound after decrease of dosing and discontinuation of cyclosporine.
• Another typical combination for treating psoriasis is a compound described herein in combination with retinoids. Retinoids provide minimal efficacy with potential Cyt P450 interactions and risk of teratogenicity , and this would be alleviated by continuation of therapy with the compound.
• Yet another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound described herein, in combination with ingredients A selected from steroids, such as glucocorticosteroids, vitamin D analogs, retinoids and dithranol.
• the steroids and retinoids can be administered topically.
• a more typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound as described herein with vitamin D derivatives, most typically calcipotriol or tacalcitol.
• Another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound described herein in combination with macro lides, most typically with ascomycin analogues, administered topically, and even more typically with those available orally such as pimecro ⁇ mus.
• Another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound described herein in combination with cell adhesion molecule inhibitors, such as anti LF A3, and/or anti LFAl.
• cell adhesion molecule inhibitors such as anti LF A3, and/or anti LFAl.
• Cell adhesion molecule inhibitors appear to provide an acceptable response rate with limited tolerability problems.
• Combination with a compound described herein could avoid the disadvantage of their injectable form, with CAM inhibitors being used intermittently.
• Another embodiment of the invention comprises administration in the following sequence: induction with compound as described herein and CAM inhibitors, followed by maintenance treatment with the compound alone and retreatment with CAM inhibitors in case of significant relapse.
• Another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound as described herein with another anti-TNFa ingredient.
• a typical embodiment is one wherein the other anti-TNFa ingredient is selected from infliximab or etanercept, typically infliximab.
• Infliximab is believed to have a higher rate of response for induction of remission, which recently was suggested to be maintained on the long term.
• topical or general antisense inhibitors of TNFa such alicaforsen in combination with a cytokine inhibitor compound.
• Another typical combination for reducing the number or severity of the clinical signs of psoriasis is a compound described herein with anti-CD4, anti-CD80 (IDEC-114 or ABX-IL8), DAB-IL-2, DAB 389 -IL-2, CTLA4-Ig, ILl O, the IL-2 receptor inhibitors such as daclizumab (anti-TAC), or basiliximab.
• DMARDs Disease Modifying Antirheumatic Drugs
• SAARDs Slow Acting Antirheumatic Drugs
• a typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein combined with one or more of the following immunosuppressive, immunomodulatory, or cytostatic drugs, such as, for example, hydroxychloroquine, D-penicillamine, sulfasalazine, auranofin, gold sodium thiomalate, minocycline, dapsonc, chlorambucil, mercaptopurinc, tacrolimus, sirolimus, mycophenolate mofetil, cyclosporine, leflunomide, methotrexate, azathioprinc or cyclophosphamide.
• immunosuppressive immunomodulatory
• cytostatic drugs such as, for example, hydroxychloroquine, D-penicillamine, sulfasalazine, auranofin, gold sodium thiomalate, minocycline, dapsonc, chlorambucil, mer
• Another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein combined with angiogenesis inhibitors, such as compounds directed against VEGF, taxol, pentoxyfylline, thalidomide, interferon beta-IB and alpha-interferon.
• angiogenesis inhibitors such as compounds directed against VEGF, taxol, pentoxyfylline, thalidomide, interferon beta-IB and alpha-interferon.
• Yet another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein in combination with inhibitors of cell adhesion, such as inhibitors of LFA-I or inhibitors of ICAM-I .
• Another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein combined with anti-TNFa antibodies or TNFa-receptor antagonists such as etanercept, infliximab, adalimumab (D2E7), or biological agents such as CTLA-4, or biological agents directed against targets such as CD-4, LFA-I, IL-6, ICAM-I, C5, or IL-I receptor.
• a compound as described herein is combined with infliximab alone or infliximab and methotrexate.
• Another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein in combination with IL-I receptor antagonists, such as anakinra (KINERET).
• IL-I receptor antagonists such as anakinra (KINERET).
• KINERET anakinra
• Yet another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein combined with NSAIDs, including acetaminophen, aspirin, ibuprofen, choline magnesium salicylate, choline salicylate, diclofenac, diflunisal, etodolac, fenoprofen calcium, flurbiprofen, indomethacin, ketoprofen, carprofen, indoprofen, ketorolac tromethamine, magnesium salicylate, meclofenamate sodium, mefenamic acid
• Another typical combination for reducing at least one of the indicia of rheumatoid arthritis is a compound as described herein combined with steroids, such as glucocorticosteroids, for example, betamethasone, dexamethasone, methylprednisolone, prednisolone, and deflazacort.
• steroids such as glucocorticosteroids, for example, betamethasone, dexamethasone, methylprednisolone, prednisolone, and deflazacort.
• ком ⁇ онентs in Crohn's disease, the following groups of drags combined with a compound as described herein may be effective: steroids such as budesonide, 5-ASA drugs like mesalamine, immunosuppressants, biological agents and adhesion molecule inhibitors.
• steroids such as budesonide, 5-ASA drugs like mesalamine, immunosuppressants, biological agents and adhesion molecule inhibitors.
• a typical combination for treating Crohn's disease is a compound as described herein with one or more of the following: steroids including all those listed herein, 5- ASA, methotrexate and azathioprine.
• Another typical combination for treating Crohn's disease is a compound described herein combined with IL-I receptor antagonists, such as anakinra (KINERET).
• Yet another typical combination for treating Crohn's disease is a compound described herein with anti-TNFa antibodies or TNFa-receptor antagonists, such as etanercept, infliximab, adalimumab (D2E7), or biological agents such as CTLA- 4, or biological agents directed against targets such as CD-4, LFA-I , IL-6, ICAM-I , or C5,
• a compound described herein is combined with infliximab and methotrexate. More typically, the compound is a cytokine inhibitor and is combined with infliximab.
• Another typical combination for treating Crohn's disease is a compound described herein combined with IL-IO, alicaforscn (anti ICAM 1), or antegren (VCAM receptor antagonist).
• methods of increasing HDL-levels of a subject comprise administering to a subject an amount of a compound, such as a cytokine inhibitor, effective to increase the HDL-level of the subject relative to the level prior to the administration of the compound, wherein the compound is as described herein or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the compound is a p38 inhibitor.
• the subject suffers from or is at risk for a cytokine- mediated disorder as described herein.
• the HDL level prior to administration is less than about 70 mg/dl, less than about 65 mg/ml, less than about 60 mg/dl, less than about 55 mg/dl, less than about 50 mg/dl, less than about 45 mg/dl or less than about 40 mg/dl.
• the HDL level prior to administration is less than about 55 mg/dl.
• the HDL is HDL 2 , while in others it is HDL 3 .
• the subject has an LDL level less than about 150 mg/ml.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• the subject is suffering from or is at risk of suffering from diabetes, insulin resistance, or metabolic syndrome.
• the methods of increasing HDL-levels in a subject additionally comprise administration of statins or HMG-CoA reductase inhibitors, such as, atorvastatin (LIPITOR, TORVAST), fluvastatin (LESCOL), lovastatin (MEVACOR, ALTOCOR), mevastatin, pravastatin (LIVALO, PITAVA), pravastatin (PRAVACHOL, SELEKTINE, LIPOSTAT), rosuvastatin (CRESTOR), or simvastatin (ZOCOR, LIPEX); fibrates, such as, gemfibrozil, fenofibrate, bezafibrate, ciprofibrate, clofibrate, or clinofibrate; bile acid sequestrants, such as, cholestyramine (QUESTRAN); cholesterol absorption inhibitors, such as colestipol (COLESTID), or ezetimibe (ZETIA); niacin
• methods of increasing Apo-Al-levels of a subject comprise administering to a subject an amount of a compound, such as a cytokine inhibitor, effective to increase the Apo-Al -level of the subject relative to the level prior to the administration of the compound, wherein the compound is as described herein or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• a compound such as a cytokine inhibitor
• the Apo-Al -level is increased by at least about 5% or by at least about 10%.
• the subject's HDL level prior to administration is less than about 70 mg/dl, less than about 65 mg/dl, less than about 60 mg/dl, less than about 55 mg/dl, less than about 50 mg/dl, less than about 45 mg/dl or less than about 40 mg/dl. In other embodiments, the HDL level prior to administration is less than about 55 mg/dl; or the subject's LDL level prior to administration is less than about 150 me/ml.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event can be a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the cytokine inhibitor.
• the subject is suffering from or is at risk of suffering from diabetes, insulin resistance, or metabolic syndrome.
• the HDL level of the subject is increased by at least about 5%, by at least about 7%, by at least about 10%, or by at least about 15%.
• the HDL level of the subject is increased by at least about 12%.
• methods of decreasing or preventing from increasing the systolic or diastolic blood pressure of a subject in need thereof comprise administering to a subject an amount of a compound effective to decrease or to prevent from increasing the systolic or diastolic blood pressure of the subject relative to the blood pressure prior to the administration of the compound, wherein the compound is as described herein or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the blood pressure is the systolic blood pressure. In others, the blood pressure is the diastolic blood pressure.
• the subject's systolic blood pressure prior to administration is above 140 mm Hg, and the diastolic blood pressure prior to administration of the compound is above 90 mm Hg. In others, the diastolic blood pressure prior to administration of the compound is higher than 85 mm Hg. In some embodiments, the decrease in systolic or diastolic blood pressure, or both, is at least about 5 mm Hg, at least about 3 mm Hg or at least about 2 mm Hg.
• the subject's HDL level prior to administration is less than about 70 mg/dl, less than about 65 mg/dl, less than about 60 mg/dl, less than about 55 mg/dl, less than about 50 mg/dl, less than about 45 mg/dl or less than about 40 mg/dl. In other embodiments, the HDL level prior to administration is less than about 55 mg/dl; or the subject's LDL level prior to administration is less than about 150 mg/ml.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• a vascular event for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event may be a cardiovascular event or a cerebrovascular event.
• the present methods produce a reduction of the occurrence or severity of the vascular event in the subject, relative to a subject who is at risk of a vascular event who has not been administered a compound described herein.
• the subject is suffering from or is at risk of suffering from diabetes, insulin resistance, or metabolic syndrome.
• the HDL level of the subject may be increased by at least about 5%, by at least about 7%, by at least about 10%, or by at least about 15%.
• the HDL level of the subject is increased by at least about 12%.
• the HDL level of the subject may be increased by about 5% to about 20%.
• Compounds disclosed herein may be used in combination therapy with one or more anti-hypertensive agents, for example, ACE inhibitors, calcium channel blockers, aldosterone antagonists, angiotensin II antagonists, diuretics, benzothiazepine derivatives, beta blocking agents, dihydropyridine derivatives, potassium-sparing agents, urologicals, sulfonamides, or thiazides.
• anti-hypertensive agents for example, ACE inhibitors, calcium channel blockers, aldosterone antagonists, angiotensin II antagonists, diuretics, benzothiazepine derivatives, beta blocking agents, dihydropyridine derivatives, potassium-sparing agents, urologicals, sulfonamides, or thiazides.
• Examples include benazepril, , enalapril, lisinopril, quinapril, captopril, ramipril, spironolactone, olmesartan, valsartan, , telmisartan, valsartan, losartan, irbesartan, diltiazem, verapamil, trandolapril, , atenolol, bisoprolol, metoprolol, toprol, tenoretic, amlodipine, nifedipine, felodipine, nisoldipine, triamterene, furosemide, lasix, prazosin, propanolol, hydrochlorothiazide, or combinations of two or more thereof.
• methods of decreasing or preventing an elevation in PAI-I levels comprise administering to a subject at risk for increased PAI-I levels (for example in a subject suffering from, or at risk of obesity, metabolic syndrome or inflammatory conditions) an amount of a compound effective to decrease or prevent an elevation in the PAI-I -level of the subject relative to the level in the untreated subject, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• methods of decreasing or preventing an elevation in VEGF-levels comprise administering to a subject at risk of increased VEGF levels (for example in a subject suffering from, or at risk for cancer or inflammation) an amount of a compound effective to decrease or prevent an elevation in the VEGF-level of the subject relative to the level in an untreated subject, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• methods of decreasing the triglyceride-level of a subject are provided.
• the methods comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to decrease the triglyceride-level of the subject relative to the level prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof,
• a compound such as a cytokine inhibitor
• the triglyceride-level prior to administration is above 500 mg/dl, above 200 mg/dl, or above 150 mg/dl.
• the triglyceride-level prior to administration is above 200 mg/dl.
• the subject suffers from or is at risk for a cytokine-mediated disorder as described herein.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• the method additionally comprises administration of statins or HMG-CoA reductase inhibitors, such as, atorvastatin (LIPlTOR, TORVAST), fluvastatin (LESCOL), lovastatin (MEVACOR, ALTOCOR), mevastatin, pitavastatin (LlVALO, PITAVA), pravastatin (PRAVACHOL, SELEKTINE, LIPOSTAT), rosuvastatin (CRESTOR), or simvastatin (ZOCOR, LIPEX); fibrates, such as, gemfibrozil, fenofibrate, bezafibrate, ciprofibrate, clofibrate, or clinofibrate; bile acid sequestrants, such as, cholestyramine (QUESTRAN); cholesterol absorption inhibitors, such as colestipol (COLESTID), or ezetimibe (ZETIA); niacin; plant sterol-containing products; ⁇
• the subject is suffering from, or is at risk of suffering from diabetes, insulin resistance, or metabolic syndrome.
• the subject is a primate, particularly a human.
• the triglyceride level of the subject is reduced by at least about 10%. In others, the triglyceride level of the subject is reduced by at least about 20%.
• the methods comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to decrease the fasting glucose-level in a subject relative to the level prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• a compound such as a cytokine inhibitor
• the glucose level prior to the administration is above about 130 mg/dl.
• the glucose level is decreased by about 5%, about 10%, about 20% or about 30%.
• the subject suffers from, or is at risk for a cytokine-mediated disorder as described herein.
• the subject suffers from, or is at risk of suffering from diabetes, insulin resistance, or metabolic syndrome.
• the method further comprises administration of tolbutamide, acetohexamide, tolazamide, chlorpropamide, glipizide, glyburide, glimepiride, gliclazide, repaglinide, nateglinide, metformin, miglitol, acarbose, exendin, pramlintide, insulin, or combinations of two or more thereof.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• methods of decreasing the HbAIc value in a subject comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to decrease the HbAIc value in the subject relative to the level prior to the administration of the compound, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the subject has a HbAIc value above about 8%, above about 7.5%, or above about 7%.
• the HbAIc level is decreased to between about 4% and about 6.5%.
• the subject suffers from, or is at risk for a cytokine-mediated disorder as described herein. In other embodiments, the subject suffers from, or is at risk of suffering from, diabetes, insulin resistance or metabolic syndrome.
• the method further comprises administration of tolbutamide, acetohexamide, tolazamide, chlorpropamide, glipizide, glyburide, glimepiride, gliclazide, repaglinide, nateglinide, metformin, miglitol, acarbose, exendin, pramlintide, insulin, or combinations of two or more thereof.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• methods for decreasing the insulin level in a subject comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to decrease the insulin-level in the subject relative to the level prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• a compound such as a cytokine inhibitor
• the subject has a fasting insulin level prior to administration of above about 100 pmol/1, above about 150 pmol/1, above about 200 pmol/1, above about 250 pmol/1, above about 300 pmol/1, above about 350 pmol/1, above about 400 pmol/1, or above about 500 pmol/1.
• the subject has a postprandial insulin level of above about 400 pmol/1, above about 500 pmol/1, above about 600 pmol/1, above about 700 pmol/1, or above about 800 pmol/1.
• the insulin level is reduced by about 10%, about 20%, about 30%, or about 40%.
• the subject suffers from, or is at risk for a cytokine-mediated disorder as described herein. In yet other embodiments, the subject suffers from, or is at risk of suffering from diabetes, insulin resistance or metabolic syndrome.
• the method further comprises administration of tolbutamide, acetohexamide, tolazamide, chlorpropamide, glipizide, glyburide, glimepiride, gliclazide, repaglinide, nateglinide, metformin, miglitol, acarbose, exendin, pramlintide, insulin, or a combination of two or more thereof.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• the methods comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to decrease the HOMA Insulin Resistance Index in the subject relative to the Index prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• a compound such as a cytokine inhibitor
• the Insulin Resistance Index is reduced to below about 2.5, below about 2.0, or below about 1.8.
• the Insulin Resistance Index is reduced by about 10%, about 20%, or about 30%.
• the subject is in need of a decreased HOMA Insulin Resistance Index because, e.g., the subject suffers from, or is at risk for a cytokine- mediated disorder as described herein. Li others, the subject suffers from, or is at risk of suffering from diabetes, insulin resistance or metabolic syndrome.
• the method further comprises administration of tolbutamide, acetohexamide, tolazamide, chlorpropamide, glipizide, glyburide, glimepiride, gliclazide, repaglinide, nateglinide, metformin, miglitol, acarbose, exendin, pramlintide, insulin, or a combination of two or more thereof.
• the subject is at risk of a vascular event, for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis, hi some such embodiments, the vascular event is a cardiovascular event or a cerebrovascular event. In some embodiments, a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• a vascular event for example, one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and/or a disorder in which at least one major coronary artery exhibits greater than 50% stenosis
• the vascular event is a cardiovascular event or
• the methods comprise administering to a subject, such as a subject in need thereof, an amount of a compound, such as a cytokine inhibitor, effective to increase the indirect bilirubin-level in the subject relative to the level prior to the administration of the compound, wherein the compound is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the indirect bilirubin level is increased to about 0.4 mg/dl, to about 0.5 mg/dl, to about 0.6 mg/dl, or to about 0.7 mg/dl.
• the indirect bilirubin level is increased by about 10%, about 20%, or about 30%. In other embodiments, the bilirubin level is increased without causing jaundice. In certain embodiments, the subject is in need of increased indirect bilirubin-level because, e.g., the subject suffers from, or is at risk for a cytokine-mediated disorder as described herein.
• the subject is at risk of a vascular event
• the vascular event is one or more of thrombotic disorder, myocardial infarction, angina, stroke, transient ischemic attack, thrombotic re-occlusion subsequent to a coronary intervention procedure and a disorder in which at least one major coronary artery exhibits greater than 50% stenosis.
• the vascular event is a cardiovascular event or a cerebrovascular event.
• a reduction of the occurrence or severity of the vascular event occurs, relative to a subject who is at risk of a vascular event who has not been administered the compound.
• compounds described herein possess inhibitory effects on the procoagulant and profibrinolytic responses during human endotoxemia.
• the invention therefore also provides a method of anticoagulant and fibrinolytic therapy for a disease or condition relating to blood coagulation or fibrinolysis, comprising administering to a subject in need thereof a pharmaceutically effective amount of a compound as described herein, for example, a cytokine inhibitor.
• This administration may be of benefit given either prophylactically to subjects at risk or therapeutically to subjects who have developed complications related to these pathways.
• Compounds disclosed hei'ein may be used in combination therapy with one or more other anticoagulant or fibrinolytic agents.
• these include recombinant tissue plasminogen activator (rtPA), streptokinase (SK), urokinase (UK), proUK, heparin, enoxoparin, dalteparin, coumarin anticoagulants, aspirin, dipyrimidamole, aggrennox, ticlopidine, clopidogrel (Plavix), abciximab, RheoPro, integrilin, aggrestat, and the like.
• rtPA tissue plasminogen activator
• SK streptokinase
• UK urokinase
• proUK proUK
• heparin heparin
• enoxoparin dalteparin
• coumarin anticoagulants aspirin, dipyrimidamole, aggrennox, ticlopidine
• a method comprising administering to a subject a combination of a compound, as described herein, for example, a cytokine inhibitor, and one or more ingredients A, in an amount effective to control, treat or prevent obesity or obesity-related conditions or disorders in a subject in need thereof, wherein ingredient A is selected from agents useful in the treatment of obesity or an obesity-related condition or disorder.
• a compound as described herein, for example, a cytokine inhibitor, and one or more ingredients A
• the obesity-related disorder is selected from overeating, binge eating, bulimia, diabetes, elevated plasma insulin concentrations, insulin resistance, metabolic syndrome, dyslipidemias, hyperlipidemia, lipodystrophy, osteoarthritis, arthritis deformans, lumbodynia, emmeniopathy, obstructive sleep apnea, cholelithiasis, gallstones, nonalcoholic steatohepatitis, heart disease, abnormal heart rhythms and abnormal heart arrhythmias, myocardial infarction, congestive heart failure, coronary heart disease, coronary artery disease, angina pectoris, hypertension, sudden death, stroke, cerebral infarction, cerebral thrombosis, transient ischemic attack, polycystic ovary disease, craniopharyngioma, Pickwickian syndrome, fatty liver, Prader-Willi Syndrome, Frohlich's syndrome, GH-deficiency, normal variant short stature, Turner's syndrome, pediatric
• the subject desires to lose body weight relative to the subject's body weight prior to administration of the combination.
• the method additionally comprises treatment of the subject with lipoplasty, gastric bypass, laparoscopic adjustable gastric binding, biliopancreatic diversion or vertical banded gastroplasty.
• both compound(s) as described herein and ingredient A are administered orally.
• both compound and ingredient A are administered intravenously, subcutaneously or by inhalation.
• compound is administered orally and the ingredient A is administered intravenously, subcutaneously, or by inhalation.
• compound may be administered intravenously, subcutaneously, or by inhalation and the ingredient(s) A may be administered orally.
• agents useful in the treatment of obesity or an obesity-related condition or disorder as ingredients A include an insulin sensitizer, an insulin or insulin mimetic, a sulfonylurea, an ⁇ -glucosidase inhibitor, a cholesterol lowering agent, a PPAR ⁇ agonist, a CB receptor ligand, a serotonergic agent, an adrenoceptor agonist, a pancreatic lipase inhibitor, an ApoB/MTP inhibitor, a MCH receptor antagonist, an amylin and/or calcitonin receptor agonist, an NPY antagonist, an orexin antagonist, a GLP-I agonist, an MC agonist, a ghrelin antagonist, a leptin agonist, a CCK agonist, a PYY agonist, a CNTF, a GH secretagogue, a GH secretagogue receptor modulator, a DP- IV inhibitor, a H3 antagonist or inverse
• ingredient A is an insulin sensitizer, an insulin or insulin mimetic, a sulfonylurea, an ⁇ -glucosidase inhibitor, or a glucose transporter inhibitor.
• ingredient A is a cholesterol lowering agent, or a PPAR ⁇ agonist.
• ingredient A is a CB receptor ligand, a serotonergic agent, an adrenoceptor agonist, a pancreatic lipase inhibitor, an ApoB/MTP inhibitor, a DP-IV inhibitor, a H3 antagonist or inverse agonist, a 5HT agonist, a serotonin transport or reuptake inhibitor, a dopamine agonist, a NE transport inhibitor, a CETP inhibitor, a squalene synthase inhibitor, a PDE inhibitor, or an acyl-estrogen
• ingredient A is a MCH receptor antagonist, an NPY antagonist, an orexin antagonist, a GLP-I agonist, an MC agonist, a ghrelin antagonist, a leptin agonist, a CCK agonist, a PYY agonist, a CNTF, a GH secretagogue, or a GH secretagogue receptor modulator.
• ingredient A is rimonabant, sibutramine, fluoxetine, phentermine, bupropion, radafaxme, orlistat, cetihstat, oxyntomodulin, or oleoyl-estrone.
• ingredients A and combinations of any two or more thereof, that may be combined with compounds desc ⁇ bed herein, for the treatment or prevention of obesity, diabetes and/or obesity-related disorders, either administered separately or in the same pharmaceutical compositions, include, but are not limited to:
• insulin sensitizers including (i) peroxisome proliferator activated receptors (PPAR) ⁇ agonists, such as glitazones (e.g.isaghtazone; pioglitazone; rosightazone; ⁇ voglitazone, netoglitazone), naveglitazar, farghtazar, metaglidasen, GW6779542, CS038, MBX2044, AZD6610, PLX204, LBM642, AMG131, AVE0847, AVE5376, ONO5129, TAK654, CLX0921, and the like); (ii) biguanides such as metformin and phenformm;
• PPAR peroxisome proliferator activated receptors
• insulin or insulin mimetics such as insulin aspart, insulin glulisine, insulin glargme, insulin lispro, insulin detemir, NN5401, NN9101, NN344, AT1391, DTYOOl, betaRx, insulin zinc suspension (lente and ultralente); insuhntropm (by "msulm” is meant a polypeptide or its equivalent useful in regulation of blood glucose levels.
• msulm is meant a polypeptide or its equivalent useful in regulation of blood glucose levels.
• a general desc ⁇ ption of such insulins is provided in Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th Ed., Pergamon Press (1990).
• Such insulins can be fast acting, intermediate acting, or long acting.
• Various de ⁇ vatives of msulm exist and are useful in this invention.
• Such compositions can be administered by any standard route, including oral, nasal, pulmonary, or transdermal administration.
• Coenzyme A HMG-CoA reductase inhibitors (atorvastatin, pitavastatin, fluvastatin, rosuvastatin, pravastatin, simvastatin, lovastatin and other statins); (ii) bile acid absorbers/sequestrants, such as colesevelam, colestipol, cholestyramine, dialkylaminoalcyl derivatives of a cross-inked dextran, and the like; (ii) nicotinyl alcohol, nicotinic acid or a salt thereof; (iii) PPAR ⁇ agonists such as fenofibric acid derivatives (ciprofibrate, gemfibrozil, clofibrate, fenofibrate and benzafibrate), GW677954, CS038, ABT335, LY674, GFT14, PLX204, Kl 11 , naveglitazar, LBM642,
• PPAR ⁇ agonists such as GW677954, CS068, RWJ800025,
• CB receptor ligands such as CB-I receptor antagonists or inverse agonists, for example rimonabant, surinabant,, AVEl 625, CP945598, and SLV-319, and those disclosed in U.S. Pat. Nos. 6,344,474, 6,028,084, 5,747,524, 5,596,106, 5,532,237, 4,973,587, 5,013,837, 5,081,122, 5,112,820, 5,292,736, 5,624,941, PCT Application Nos.
• CB-I receptor antagonists or inverse agonists for example rimonabant, surinabant,, AVEl 625, CP945598, and SLV-319, and those disclosed in U.S. Pat. Nos. 6,344,474, 6,028,084, 5,747,524, 5,596,106, 5,532,237, 4,973,587, 5,013,837, 5,081,122, 5,112,820, 5,292,736, 5,
• anti-obesity serotonergic agents such as fenfluramine, dexfenfluramine, phentermine, DOVl 02677, zimeldine, and sibutramine
• adrenoceptor agonists including /33-adrenoreceptor agonists, such as solabregon, YMl 78, amibregon, tesofensince, fenfluramine, amphetamine, phenmetrazine, phentermine, and N5984;
• pancreatic lipase inhibitors such as orlistat, cetilistat, and GT389255;
• (apo-B/MTP) inhibitors such as ISIS301012, ISIS301012, JTT130, and SLx4090;
• MCH melanin-concentrating hormone
• MCHlR and MCH2R antagonists for example, 856464, and AMG076, and those described in U.S. Patent Application Publication Nos. 2005/0009815, 2005/0026915, 2004/0152742, 2004/0209865; PCT Patent Application Publication Nos. WO 01/82925, WO 01/87834, WO 02/06245, WO 02/04433, and WO 02/51809; and Japanese Patent Application No. JP 13226269;
• neuropeptide Y (NPY) antagonists such as NPYl antagonists, for example, BIBP3226, Jl 15814, BIBO3304, LY357897, CP671906, GI264879A, and those disclosed in U.S. Pat. No. 6,001 ,836 and PCT Application Nos.
• NPY5 antagonists for example, S2367, FMS586, GW569180A, GW594884A, GW587081 , GW548118., FR226928, FR240662, FR252384, 1229U91, GI264879A, CGP71683A, LY377897, PD160170, SR120562A, SR120819A and JCF104, and those disclosed in U.S. Pat. Nos.
• WO 97/19682 WO 97/20820, WO 97/20821, WO 97/20822, WO 97/20823, WO 98/27063, WO 00/64880, WO 00/68197, WO 00/69849, WO 01/09120, WO 01/14376, WO 01/85714, WO 01/85730, WO 01/07409, WO 01/02379, WO 01/23388, WO 01/23389, WO 01/44201, WO 01/62737, WO 01/62738, WO 01 ⁇ 09120, WO 02/22592, WO 0248152, and WO 02/49648;
• peptide YY (PYY) agonists such as PYY, PYY 3-36, peptide YY analogs, and PYY agonists, for example, AC162352, N-Acetyl [Leu(28,31)]NPY 24-36, and PYY(3-36)NH 2 , cyclo-(28/32)-Ac-[Lys28- Glu32]-(25-36)-pNPY, TASP-V, pancreatic peptide (PP), 122U91, and those disclosed in U.S. Pat. Publication No. 2002/0141985 and PCT Application Publication No. WO 2005/077094, WO 03/026591, WO 03/057235, and WO 03/027637;
• orexin antagonists such as orexin-1 receptor antagonists, for example
• GLP-I glucagon-like peptide (GLP)-I agonists including GLP-I, GLP-I analogs and derivatives, such as exenatide, exenatide-LAR, liraglutide, CJCl 134PC, LY548806, 716155, and AVEOOlO;
• MC mclanocortin
• MC4 agonists include MC4 agonists and MC4R agonists, such as Melanotan II, PTl 5, BL3020, AP 1030, or those described in PCT Application Nos. WO 99/64002, WO 00/74679, WO 01/991752, WO 01/74844, WO 02/12166, WO 02/1 1715, WO 02/12178, WO 03/007949, WO 02/068388, WO 02/068387, WO 02/067869, WO 03/040117, WO 03/066587, WO 03/068738, WO 03/094918, and WO 03/031410;
• ghrelin receptor antagonists such as NOXBl 1, CYT009GhrQb,
• leptin agonists including recombinant human leptin and recombinant methionyl human leptin, and leptin derivatives, such as OB3, and those disclosed in U.S. Pat. Nos. 5,552,524, 5,552,523, 5,552,522, 5,521,283, 6,777,388 and 6,936,439, and PCT Application Nos.
• cholecystokinin (CCK) agonists such as ARR15849, GI181771 ,
• ciliary neurotrophic factors including CNTF, CNTF modulators, and CNTF derivatives, such as Axokine and NT501, and those disclosed in U.S. Pat. Nos. 6,680,291 and 6,767,894 and in PCT Application Nos. WO 94/09134, WO 98/22128, and WO 99/43813;
• growth hormone (GH) secretagogues growth hormone secretagogues, growth hormone secretagogue receptor modulators, such as SUNl 1031, RC1291, tesamorelin, sermorelin, examorelin, NN703, hexarelin, MK677, SM-130686, CP-424,391, L-692,429 and L-163,255;
• dipeptidyl peptidase IV (DP-IV or DPP-IV) inhibitors such as denagliptin, sitagliptin, SYR322, RO0730699, TS021, ALS20426, vidagliptin, GRC8200, MP513, PHXl 149, PSN9301, TA6666, saxagliptin, SSR162369, R1438, KRP104, 825964, and the compounds disclosed in PCT Application Nos.
• WO 03/004498 WO 03/004496; EP 1 258 476; WO 02/083128; WO 02/062764; WO 03/000250; WO 03/002530; WO 03/002531; WO 03/002553; WO 03/002593; WO 03/000180; and WO 03/000181 ;
• H3 histamine receptor-3 (H3) antagonists/inverse agonists, such as
• 5HT 5-hydroxytryptamine
• 5HT2C serotonin receptor 2C
• lorcaserin vabicaserin
• APD356 5-hydroxytryptamine receptor 2C
• 5HT6 agonists such as PRX07034
• PRX07034 5-hydroxytryptamine agonists
• serotonin transport or serotonin reuptake inhibitors such as nefazodone, citalopram, dapoxetine, duloxetine, desvenlafaxine, fiuvoxamine, escitalopram, sibutramine, venlafaxine, vilazodone, DOV21947, LUAA21004, BGC201259, NS2359, UK416244, DOV102677, SEP225289, OPC14523, SLV314, WLlOl 1, WLl 017, zimeldine, fluoxetine, paroxetine, fenfluramine, imipramine and sertraline, and those disclosed in U.S. Pat. No.
• dopamine agonists for example dopamine D2 agonists, such as, ropinirole, bifeprunox, aripiprazole, pergolide, talipexole, ACP 104, quinagolide, nolomirole, NHOOl, SLV308, piribedil, lisuride, bromocriptine, aplindore, tesofensine, and preclamol;
• norepinephrine (NE) transport inhibitors such as lisdexamfetamine, atomoxetine, duloxetine, SLE381, desvenlafaxine, amfebutamone, sibutramine, venlafaxine, DOC21947, radafaxine, bupropion, DOV216303, reboxetine, AD337, NS2359, DOV102677, SEP225289, Xen2174, indeloxazine, protriptyline, and S33005;
• DAG diacylglycerol acyltransferase
• glucose transporter inhibitors for example, sodium glucose cotransporter (SGLT) inhibitors, such as, KGT1251, 189075, AVE2268, and SGLOOlO;
• SGLT sodium glucose cotransporter
• CETP cholesterol ester transfer protein
• glucocorticoid antagonists for example, mifepristone, Org34517, and
• PDE3B PDE3B inhibitors
• tetomilast for example, tetomilast, tadalafil, atopik, vardenafil, tipelikast, HT0712, QAD171A, SK3530, oglemilast, acanafil, cilostazol, roflumilast, parogrelil, udenafil, EHT0202, dasantafil, MEM1414, SLx2101, CC10004, 256066, cilomilast, vinpocetine, ibudilast, pimobendan, ND7001, LAS37779, K123, UK357903, ND1251, tofimilasL UKl 69003, senazodan, trapidil, arofylline, theophylline, doxofylline, olprinone, pentoxifylline, zaprinast, sildenafil, amrin
• antiplatelet agents such as, limaprost, clopidogrel, felbinac, cptifibatide, NCX4016, ticagrelor, tirofiban, abcixmab, sarpogrelade, DA697B, argatroban, SCH530348, cilostazol, YSPSL, parogrelil, asasantin, DG041, prasugrel, ramatroban, cangrelor, epoprostenol, beraprost, aspirin, Kl 34, triflusal, YY280, xemilofiban, ozagrel, alprostadil alfadex, TP9201, procainamide, AT1015, Z335, BGC728, glyrofam, EF5077, SH529, and ME3229;
• antiplatelet agents such as, limaprost, clopidogrel, felbinac, cpt
• angiotensin converting enzyme (ACE) inhibitors such as peridopril, enalapril, ramipril, fosinopril, quinapril, lisinopril, imidapril, benazepril, ilepatril, captopril, trandolapril, temcapil, cilazapril, MC4232, CHF 1521, omapatrilat, spirapril, moexipril, zofenopril, delapril, alacepril, S5590, and fasidotril;
• ACE angiotensin converting enzyme
• angiotensin II (All) receptor antagonists for example, losartan, candesartan, temisartan, coaprovel, imidapril, azilsartan, valsartan, irbesartan, olmesartan, CYT006AngQb, TAK491, eprosartan, VNP489, CGP63170, f ⁇ mesartan, pratosartan, and saralasin;
• thyroid hormone ⁇ agonists such as thyroid hormone, levothyroxine,
• cyclo-oxygenase (COX)-2 inhibitors such as etoricoxib, GW406381 , meloxicam, lumiracoxib, diclofenac, valdecoxib, parecoxib, PMIOOl, 6444784, SVT2016, nimesulfide, CS706, cimicoxib, LR3001, LAS34475, P54, rofecoxib, celecoxib, and arcoxia;
• metabotropic glutamate 5 (mGlu5) receptor antagonists such as
• acyl-estrogens such as oleoyl-estrone, disclosed in del Mar-Grasa, M. et al., Obesity Research, 9:202-9 (2001);
• FAS fatty acid synthase
• PTP-IB protein tyrosine phosphatase- IB
• urocortin binding protein antagonists and urocortin ligands such as urocortin II;
• IDI lOl BDC03, S2367, AOD9604, fluasterone, GT389255, QCBT16, MK0916, MK0493, MK0364, PD6735, c2735, and adiponectin,
• Obesity and weight loss treatments also include surgery. Typically the weight loss surgical procedure is liposuction or lipoplasty. Surgical obesity treatments include gastric bypass, laparoscopic adjustable gastric binding, biliopancreatic diversion or vertical banded gastroplasty.
• a method comprising administering a compound, such as a cytokine inhibitor, and one or more ingredients A to a subject in need thereof, in an amount effective to increase or enhance the effectiveness of the ingredient A when used alone, wherein ingredient A is selected from agents useful in the treatment of obesity or an obesity-related condition or disorder, and wherein the compound is as described herein, or is a mixture of any two or more thereof and/or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
• the effectiveness enhancement is obtained by allowing administration of lower dosages of one or more of the ingredient A used in combination as relative to the use of either agent alone.
• a method comprising administering to a subject a compound as described herein, for example, a cytokine inhibitor, and an ingredient A, in an amount effective to reduce the risk of metabolic disorders in a subject in need thereof relative to the subject's risk prior to administration of the compound and ingredient A, wherein ingredient A is selected from agents useful in the treatment of obesity or an obesity-related condition or disorder.
• the reduction in risk of metabolic disorders is obtained by reducing the body weight of the subject, relative to the subject's body weight prior to administration of the combination of the cytokine inhibitor and ingredient(s) A.
• routes of administration include, but are not limited to, intravenous, intramuscular, subcutaneous, intrasynovial, by infusion, sublingual, transdermal, oral, topical and by inhalation.
• routes of administration include, but are not limited to, intravenous, intramuscular, subcutaneous, intrasynovial, by infusion, sublingual, transdermal, oral, topical and by inhalation.
• Typical modes of administration are oral, topical or intravenous.
• the pharmaceutical combinations of ingredient A and the compound as described herein may be administered separately, or in a combination formulation with other ingredients or adjuvants that enhance stability of the inhibitors, facilitate administration of pharmaceutical compositions containing them, provide increased dissolution or dispersion, increase inhibitory activity, provide adjunct therapy, or provide like advantages.
• Such combination therapies typically utilize lower dosages of the conventional therapeutics, and avoid the possible toxicity and adverse side effects incurred when those agents are used as monotherapies.
• Pharmaceutical combinations of ingredient A and the compound may therefore be physically combined with the conventional therapeutics or other adjuvants into a single pharmaceutical composition.
• the ingredient A and/or the compound may be used in the combination as a salt, solvate, tautomer and/ or prodrug and as a single stereoisomer or mixtures of stereoisomers, including racemates.
• ingredient A and the compound as described herein may be used in the combinations according to the invention are variable.
• Ingredient A and the compound are optionally present in the form of their solvates or hydrates.
• the weight ratios which may be used within the scope of the present invention vary on the basis of the different molecular weights of the various compounds and their different potencies. Determination of ratios by weight is dependent on the particular ingredient A and the compound, and are within the skill in the art.
• TM comprising at least an amide group having an amide NH, the targeting moiety capable of forming one or more hydrogen bonds with a target protein, and wherein the targeting moiety is not a urea group;
• a pocket-expanding moiety PEM directly attached to the targeting moiety, the pocket-expanding moiety comprising a planar moiety attached to a bulky non-planar hydrophobic moiety, said non-planar moiety forming hydrophobic interactions with the target protein;
• an orienting moiety comprising a planar hydrophobic moiety and attached to a different atom of the targeting moiety than the pocket-expanding moiety, said orienting moiety capable of forming a ⁇ - ⁇ or edge-to-face aromatic interaction with the target protein;
• the compound is optionally a cytokine inhibitor.
• Yet other compounds useful in the methods of the invention comprise: a targeting moiety, TM, comprising an amide group having an amide NH and carbonyl, the targeting moiety capable of forming one or more hydrogen bonds with a target protein; a pocket-expanding moiety, PEM, directly attached to the targeting moiety, the pocket-expanding moiety comprising a planar moiety attached to a bulky non- planar hydrophobic moiety, wherein the non-planar moiety is capable of forming hydrophobic interactions with the target protein; an orienting moiety, OM, comprising a pyridyl ring and attached to a different atom of the targeting moiety than the pocket-expanding moiety, wherein the orienting moiety is capable of forming hydrophobic interactions with the target protein; and an anchoring moiety, AM, indirectly attached to the orienting moiety by a linker moiety, L, such as, for example, a benzamide or pyridylamide,
• the compound is optionally a cytokine inhibitor.
• Additional compounds useful in the invention comprise: a targeting moiety, TM, comprising an amide NH and carbonyl, the targeting moiety capable of forming one or more hydrogen bonds with a target protein; a pocket-expanding moiety, PEM, directly attached to the targeting moiety, the pocket-expanding moiety comprising a planar moiety attached to a bulky non- planar hydrophobic moiety, wherein the non-planar moiety is capable of forming hydrophobic interactions with the target protein; an orienting moiety, OM, comprising a 6-membered aryl or heteroaryl ring and attached to the NH of the targeting moiety, wherein the orienting moiety is capable of forming hydrophobic interactions with the target protein; a linker moiety, L, attached to a different atom of the orienting moiety than the targeting moiety, wherein the linker moiety comprises a 5-membered heteroaryl moiety and the attachment point on the heteroaryl moiety is a carbon
• the compounds have the structure
• Compounds contemplated in the methods of the invention include representative examples of Formulas I, II, III and IV, as set forth in List I.
• Ethanesulfonic acid (5-tert-butyl-2-methoxy-3- ⁇ 3-[4-(2-morpholin-4-yl-ethoxy)- naphthalen-l-yl]-2,5-dioxo-2,5-dihydro-pyrrol-l-yl ⁇ -phenyl)-amide;

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• 2007
  • 2007-06-06 EP EP07798190A patent/EP2035005A4/de not_active Withdrawn
  • 2007-06-06 CA CA2691214A patent/CA2691214A1/en not_active Abandoned
  • 2007-06-06 AU AU2007257959A patent/AU2007257959A1/en not_active Abandoned
  • 2007-06-06 WO PCT/US2007/070547 patent/WO2007146712A2/en not_active Ceased
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