ES2494015T3 - Composiciones para tratar nauseas y vómitos de origen central - Google Patents

Composiciones para tratar nauseas y vómitos de origen central Download PDF

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ES2494015T3
ES2494015T3 ES10805301.8T ES10805301T ES2494015T3 ES 2494015 T3 ES2494015 T3 ES 2494015T3 ES 10805301 T ES10805301 T ES 10805301T ES 2494015 T3 ES2494015 T3 ES 2494015T3
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vomiting
administered
nausea
patient
pharmaceutically acceptable
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Fabio Trento
Sergio Cantoreggi
Giorgia Rossi
Roberta Cannella
Daniele Bonadeo
Riccardo Braglia
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Helsinn Healthcare SA
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Helsinn Healthcare SA
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495Heterocyclic 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
    • A61K31/496Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/41Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/41641,3-Diazoles
    • A61K31/41781,3-Diazoles not condensed 1,3-diazoles and containing further heterocyclic rings, e.g. pilocarpine, nitrofurantoin
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/47Quinolines; Isoquinolines
    • A61K31/473Quinolines; Isoquinolines ortho- or peri-condensed with carbocyclic ring systems, e.g. acridines, phenanthridines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/56Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/57Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone
    • A61K31/573Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids substituted in position 17 beta by a chain of two carbon atoms, e.g. pregnane or progesterone substituted in position 21, e.g. cortisone, dexamethasone, prednisone or aldosterone
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/0012Galenical forms characterised by the site of application
    • A61K9/0053Mouth and digestive tract, i.e. intraoral and peroral administration
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/20Pills, tablets, discs, rods
    • A61K9/2004Excipients; Inactive ingredients
    • A61K9/2022Organic macromolecular compounds
    • A61K9/205Polysaccharides, e.g. alginate, gums; Cyclodextrin
    • A61K9/2054Cellulose; Cellulose derivatives, e.g. hydroxypropyl methylcellulose
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/48Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4808Preparations in capsules, e.g. of gelatin, of chocolate characterised by the form of the capsule or the structure of the filling; Capsules containing small tablets; Capsules with outer layer for immediate drug release
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/48Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4841Filling excipients; Inactive ingredients
    • A61K9/4858Organic compounds
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/48Preparations in capsules, e.g. of gelatin, of chocolate
    • A61K9/4841Filling excipients; Inactive ingredients
    • A61K9/4866Organic macromolecular compounds
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00Drugs for disorders of the alimentary tract or the digestive system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/08Drugs for disorders of the alimentary tract or the digestive system for nausea, cinetosis or vertigo; Antiemetics
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00Drugs for disorders of the endocrine system
    • A61P5/38Drugs for disorders of the endocrine system of the suprarenal hormones
    • A61P5/44Glucocorticosteroids; Drugs increasing or potentiating the activity of glucocorticosteroids

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Chemical & Material Sciences (AREA)
  • Medicinal Chemistry (AREA)
  • Pharmacology & Pharmacy (AREA)
  • Epidemiology (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Engineering & Computer Science (AREA)
  • General Chemical & Material Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Chemical Kinetics & Catalysis (AREA)
  • Organic Chemistry (AREA)
  • Nutrition Science (AREA)
  • Physiology (AREA)
  • Hospice & Palliative Care (AREA)
  • Otolaryngology (AREA)
  • Diabetes (AREA)
  • Endocrinology (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)
  • Paints Or Removers (AREA)
  • Medicines Containing Plant Substances (AREA)
  • Nitrogen Condensed Heterocyclic Rings (AREA)

Abstract

Una combinación de (i) netupitant o una sal farmacéuticamente aceptable del mismo, (ii) un antagonista de 5-HT3 o una sal farmacéuticamente aceptable del mismo, (iii) dexametasona, para su uso en el tratamiento de náuseas y vómitos durante cinco días consecutivos en un paciente que lo necesita, en la que: a) se administra dicho netupitant o una sal farmacéuticamente aceptable del mismo a dicho paciente el día uno, en una cantidad terapéuticamente eficaz que es eficaz para tratar náuseas y vómitos durante las fases aguda y tardía de emesis, y que entra en la circulación sistémica, cruza la barrera hematoencefálica y ocupa al menos el 70 % de receptores NK1 en el cuerpo estriado setenta y dos horas después de dicha administración; b) se administra el antagonista de 5-HT3 o una sal farmacéuticamente aceptable del mismo a dicho paciente el día uno, en una cantidad terapéuticamente eficaz, que es eficaz para tratar náuseas y vómitos durante las fases aguda y tardía; y c) se administra dexametasona a dicho paciente el día uno en una primera dosis que es ineficaz contra náuseas y vómitos cuando se administra sola, pero eficaz contra náuseas y vómitos cuando se administra en combinación con dicho netupitant, en la que la primera dosis comprende del 50 al 70 % de una dosis eficaz mínima cuando se administra sola.

Description

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E10805301
12-08-2014
• Gravedad de las náuseas para la fase global, aguda y tardía; • Satisfacción global del paciente con el tratamiento antiemético por medio de VAS para cada intervalo de 24 horas.
Las tasas de respuesta completa se resumen en la tabla 5. El porcentaje de pacientes con respuesta completa sobre 0-120 horas después del inicio de la administración de cisplatino fue del 76,5 % en el grupo de palonosetrón solo y del 87,4 %, 87,6 %, y del 89,6 % en los grupos de netupitant 100 mg, 200 mg, y 300 mg, respectivamente. Las diferencias de palonosetrón solo fueron mayores del 10 % (del 10,9 % al 13,2 %). Todas las dosis de netupitant fueron estadísticamente superiores a palonosetrón solo (valor p = 0,004 para el grupo de combinación de netupitant 300 mg).
Tabla 5: Tasa de respuesta completa para la fase global, aguda y tardía: Población MFAS
Criterio de valoración de eficacia
Palo solo (n=136) Palo + Netu 100 mg (n=135) Palo + Netu 200 mg (n=137) Palo + Netu 300 mg (n=135) Régimen de aprepitant (N=134)
RC, fase global, 0-120 h
Porcentaje de pacientes
76,5 87,4 87,6 89,6 86,6
Diferencia de Palo solo (%)
10,9 11,1 13,2 10,1
Valor p (*)
0,018 0,017 0,004 0,027
RC, fase aguda, 0-24 h
Porcentaje de pacientes
89,7 93,3 92,7 98,5 94,8
Diferencia de Palo solo (%)
3,6 3,0 8,8 5,1
Valor p (*)
0,278 0,383 0,007 0,114
RC, fase tardía, 25-120 h
Porcentaje de pacientes
80,1 90,4 91,2 90,4 88,8
Diferencia de Palo solo (%)
10,2 11,1 10,2 8,7
Valor p (*)
0,018 0,010 0,018 0,043
(*) valor p del análisis de regresión logística, valor p de aprepitant del análisis de regresión logística a posteriori.
10 La tabla 6 resume los principales criterios de valoración secundarios. En la fase global, el 76,5 % de los pacientes en el grupo de palonosetrón solo no experimentó emesis, mientras que el 87,4, 87,6, y 91,1 % de los pacientes no experimentó emesis en los grupos de combinación de netupitant 100 mg, 200 mg y 300 mg, respectivamente (p<0,05 para todas las dosis).
Tabla 6: Resumen de los resultados de eficacia secundaria: porcentaje de pacientes. Población MFAS
Criterio de valoración de eficacia
Palo solo (n=136) Palo + Netu 100 mg (n=135) Palo + Netu 200 mg (n=137) Palo + Netu 300 mg (n=135) Régimen de aprepitant (N=134) Palo + Aprep 285 mg (N=41) **
Sin emesis
Global
76,5 87,4* 87,6* 91,1* 87,3*
Aguda
89,7 93,3 92,7 98,5* 94,8
Tardía
80,1 90,4* 91,2* 91,9* 89,6*
Sin rescate
Global
95,6 97,8 100 98,5 97,8
Aguda
97,8 99,3 100 100 100
Tardía
97,1 97,8 100 98,5 97,8
Sin náuseas
Global
50,7 54,8 62,0 61,5 58,2 32
Aguda
75,0 72,6 77,4 80,0 77,6 59
Tardía
53,7 59,3 65,0 68,1* 60,4 41
Sin náuseas significativas
Global
79,4 80,0 86,1 89,6* 85,8 56
Aguda
93,4 94,1 94,2 98,5* 94,0 79
Tardía
80,9 81,5 89,8* 90,4* 88,1 59
Control total
Global
50,0 54,8 61,3 59,3 56,0
Aguda
71,3 71,9 76,6 80,0 74,6
Tardía
52,2 59,3 65,0* 65,9* 58,2
Protección completa
Global
69,9 76,3 80,3* 83,0* 78,4 51
Aguda
87,5 89,6 88,3 97,0* 89,6 76
14
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Claims (1)

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ES10805301.8T 2009-11-18 2010-11-18 Composiciones para tratar nauseas y vómitos de origen central Active ES2494015T3 (es)

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US26247009P 2009-11-18 2009-11-18
US262470P 2009-11-18
US38270910P 2010-09-14 2010-09-14
US382709P 2010-09-14
PCT/IB2010/003106 WO2011061622A1 (en) 2009-11-18 2010-11-18 Compositions for treating centrally mediated nausea and vomiting

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ES2494015T3 true ES2494015T3 (es) 2014-09-12

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ES14151678.1T Active ES2623503T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar náuseas y vómitos mediados centralmente
ES14151676.5T Active ES2559475T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar náuseas y vómitos de origen central
ES10805301.8T Active ES2494015T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar nauseas y vómitos de origen central
ES14151683.1T Active ES2595077T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar náuseas y vómitos mediados centralmente

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ES14151678.1T Active ES2623503T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar náuseas y vómitos mediados centralmente
ES14151676.5T Active ES2559475T3 (es) 2009-11-18 2010-11-18 Composiciones para tratar náuseas y vómitos de origen central

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EP (3) EP2727590B1 (es)
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