WO2007075896A2 - Inhibiteurs de cytokine heterocycliques - Google Patents

Inhibiteurs de cytokine heterocycliques Download PDF

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WO2007075896A2
WO2007075896A2 PCT/US2006/048803 US2006048803W WO2007075896A2 WO 2007075896 A2 WO2007075896 A2 WO 2007075896A2 US 2006048803 W US2006048803 W US 2006048803W WO 2007075896 A2 WO2007075896 A2 WO 2007075896A2
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compound
alkyl
substituted
group
disease
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WO2007075896A3 (fr
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Erik Boman
Antonio Garrido Montalban
Yazhong Pei
Christopher Larson
Zhijun Wang
Jan Urban
Nancy G. L. Delaet
Lubomir Sebo
Christopher Lum
Justin Ernst
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Kemia Inc
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Kemia Inc
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    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D413/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms
    • C07D413/02—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings
    • C07D413/12—Heterocyclic compounds containing two or more hetero rings, at least one ring having nitrogen and oxygen atoms as the only ring hetero atoms containing two hetero rings linked by a chain containing hetero atoms as chain links
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D231/00—Heterocyclic compounds containing 1,2-diazole or hydrogenated 1,2-diazole rings
    • C07D231/02—Heterocyclic compounds containing 1,2-diazole or hydrogenated 1,2-diazole rings not condensed with other rings
    • C07D231/10—Heterocyclic compounds containing 1,2-diazole or hydrogenated 1,2-diazole rings not condensed with other rings having two or three double bonds between ring members or between ring members and non-ring members
    • C07D231/14—Heterocyclic compounds containing 1,2-diazole or hydrogenated 1,2-diazole rings not condensed with other rings having two or three double bonds between ring members or between ring members and non-ring members with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D261/00—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings
    • C07D261/02—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings
    • C07D261/06—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members
    • C07D261/08—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members with only hydrogen atoms, hydrocarbon or substituted hydrocarbon radicals, directly attached to ring carbon atoms
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D261/00—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings
    • C07D261/02—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings
    • C07D261/06—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members
    • C07D261/10—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
    • C07D261/14—Nitrogen atoms
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D261/00—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings
    • C07D261/02—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings
    • C07D261/06—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members
    • C07D261/10—Heterocyclic compounds containing 1,2-oxazole or hydrogenated 1,2-oxazole rings not condensed with other rings having two or more double bonds between ring members or between ring members and non-ring members with hetero atoms or with carbon atoms having three bonds to hetero atoms with at the most one bond to halogen, e.g. ester or nitrile radicals, directly attached to ring carbon atoms
    • C07D261/18—Carbon atoms having three bonds to hetero atoms, with at the most one bond to halogen
    • C—CHEMISTRY; METALLURGY
    • C07—ORGANIC CHEMISTRY
    • C07D—HETEROCYCLIC COMPOUNDS
    • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
    • C07D405/02—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings
    • C07D405/12—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing two hetero rings linked by a chain containing hetero atoms as chain links

Definitions

  • the present invention relates to low molecular weight compounds and compositions thereof, useful, e.g., as cytokine inhibitors, and their preparation.
  • the invention further relates to methods of prevention and treatment of cytokine-mediated disorders.
  • cytokines The functioning of the immune system is finely balanced by the activities of 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 anti-inflammatory 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, 1 18: 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 at some point 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- ⁇ (TNF- a) and interleukin-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-o ⁇ s 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- ⁇ also referred to as TNFa
  • IL-Ib interleukin-1/3
  • the present invention provides low molecular weight compounds and pharmaceutical compositions thereof.
  • compounds of the invention are useful as cytokine release inhibitory agents.
  • methods for the preparation of such compounds and for the use of these compounds alone, in mixtures thereof, or in mixtures with other therapeutic agents in the preparation of medicaments for use in treating various disease states are provided.
  • methods for the use of compounds of the invention in the prevention and treatment of various disorders mediated by cytokines such as inflammatory disorders, cancer, pain, and others.
  • a targeting moiety 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 carbonyl of 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 a 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 a 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 mo
  • the compound is a cytokine inhibitor.
  • cytokine inhibitors have the structure
  • PEM-TM-OM-L-AM At a concentration of 10 ⁇ M, such compounds typically inhibit induced TNFa-release from a cell by about 50% or greater than 50%.
  • the targeting moiety can hydrogen bond to residues at the binding site of the target protein.
  • the targeting moiety is an amide group.
  • the pocket-expanding moiety is of sufficient size to force a conformational change in the target protein, resulting in an expanded binding pocket therein.
  • Such moieties include 6 membered aryl and heteroaryl groups, for example, phenyl, pyridyl, or the like, substituted by bulky moieties.
  • Bulky moieties fill a large volume of space in comparison to, for example, a methyl group, and include groups such as substituted or unsubstituted C 2 ⁇ alkyl groups, for example substituted or unsubstituted isopropyl, tert-butyl, isobutyl, or sec- butyl groups; substituted or unsubsituted € 3 .
  • cycloalkyl groups for example substituted or unsubstituted cyclohexyl or norbornyl groups; or substituted or unsubstituted heterocyclyl groups, such as substituted or unsubstituted morpholinyl, pyrrolidinyl, piperidyl, 8-oxa-3-aza- bicyclo[3.2.1]octan-3-yl, oxazepanyl, thiazolyl, or thiomorpholinyl groups.
  • the orienting moiety by binding to a hydrophobic pocket on the target protein, provides the proper orientation of the targeting moiety and pocket-expanding moiety for binding of the cytokine inhibitor to its target protein.
  • Such moieties include, for example, phenyl, pyridyl or pyridazinyl, substituted by small hydrophobic moieties, exemplified by halogens, methyl, trifluoromethyl, and the like.
  • the linker moiety, L 5 comprises an oxazolyl, isoxazolyl, pyrazolyl, imidazolyl, thiazolyl, isothiazolyl, oxadiazolyl, triazolyl or thiadiazolyl group.
  • the anchoring moiety is a hydrogen bond acceptor. In other embodiments, the anchoring bond moiety comprises both a hydrogen bond donor and acceptor.
  • the anchoring moiety may comprise a substituted or unsubstituted amide, hydrazide or urethane group, and may further comprise a substituted or unsubstituted alkyl, cycloalkyl, aryl or heterocyclyl group, such as substituted or unsubstituted phenyl, 2- pyridyl, 3-pyridyl, 4-pyridyl, tetrahydropyranyl, morpholinyl, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, adamantyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, isobutyl, or neopentyl group.
  • the invention provides compounds of Formula I
  • X and Y are each independently CH or N;
  • A is F, Cl, Br, I, NR 2 , or a Ci_ 3 alkyl or -O(Ci. 3 alkyl) group, wherein the alkyl group is optionally partially or fully halogenated;
  • B, D and E are each independently N, NR, O 5 S or CR; wherein B, D, and E are selected such that the ring containing B, D, and E is aromatic;
  • G is an aryl or heteroaryl group, wherein G is substituted by one or more R 1 , R 2 or R 3 ;
  • L 1 is -C(O)NH-
  • L 2 is -(CR' 2 ) n -C(OHCR' 2 )p-, -(CR' 2 ) n -NR-(CR' 2 ) p -, -(CR' 2 ) n -C(O)NR-(CR' 2 ) p -, -(CR' 2 ) n -C(O)NRNR-(CR' 2 ) P -, or -(CR' 2 ) n -O-C(O)NR-(CR' 2 ) p -;
  • Q is hydrogen, or a substituted or unsubstituted alkyl, cycloalkyl, aryl or heterocyclyl group; each R 1 is independently F, Cl, Br, I, -NR 2 , -CN, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, cycloalkenyl, aryl, heterocyclyl or heterocyclylalkyl group; each R 2 is independently F, Cl 5 Br, I, -CN, -NO 2 , a substituted or unsubstituted alkyl or heterocyclylalkyl group, -OR', -C(O)R', -C(O)OR', -C(O)NR' 2 , -NR' 2 , -NRC(O)R", -NR 5 C(O)OR", -NR 5 SO 2 R", -NR'C(O)NR' 2 , -NR'C(
  • compounds of Formula I are also cytokine inhibitors having the formula PEM-TM-OM-L-AM.
  • G is PEM
  • L 1 is TM
  • the 6-membered ring is OM
  • the 5-membered heteroaryl is L
  • -L 2 -Q is
  • the compound of Formula I is the compound of Formula II:
  • B is N.
  • D is NH, O or S.
  • E is CH or O.
  • A is F, — CH3, or -CFj.
  • G is a phenyl, pyrimidyl or pyridyl group. In other embodiments, G is a phenyl or pyridyl group. For example, G is
  • L 2 is -C(OMCR' 2 )p- 5 -(CH 2 ) n -C(O)NR-(CH 2 )p-, or -(CH 2 ) n -C(O)NRNR-(CH 2 )p-.
  • L 2 is -C(O) -, -C(O)CH 2 - -C(O)CH 2 CH 2 -, -C(O)CH 2 CH 2 CH 2 -, -C(O)NHNH-, -C(O)N(CH 3 )NH-, -C(O)N(CH 3 )NH-CH 2 -, -C(O)N(CH 3 )NH-CH 2 CH 2 -, -C(O)N(CH 3 )NH-CH 2 CH 2 CH 2 -, -C(O)NHNH-CH 2 -, -C(O)NHNH-CH 2 CH 2 - or -C(O)NHNH-CH 2 CH 2 CH 2 -, C(O)NH-, -C(O)N(CH 3 )-, -C(O)N(CH 3 )-CH 2 ⁇ , -C(O)N(CHa)-CH 2 CH 2 - -C(O)N(CH 2
  • Q is a substituted or unsubstituted alkyl, cycloalkyl, aryl or heterocyclyl group.
  • Q is H, or a substituted or unsubstituted alkyl, cycloalkyl, phenyl, pyridyl, pyrimidinyl, morpholinyl, thiomorpholinyl, 8-oxa-3-aza-bicyclo[3.2.1]octanyl, tetrahydropyranyl, tetrahydrofuranyl, pyrrolidinyl, piperidyl, or piperazinyl group.
  • Q is a substituted or unsubstituted phenyl, 2-pyridyl, 3-pyridyl, 4-pyridyl, tetrahydrofuranyl, tetrahydropyranyl, pyrrolidinyl, piperidyl, mo ⁇ holinyl, , 8-oxa-3-aza- bicyclo[3.2.1]octanyl, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, adamantyl, ethyl, n- propyl, isopropyl, n-butyl, sec-butyl, tert-butyl, isobutyl, or neopentyl group.
  • R 1 is F, -CN, -NR 2 , or a substituted or unsubstituted Q -4 alkyl, C 3 . 9 cycloalkyl, aryl, heterocyclyl, or heterocyclyl alkyl group.
  • R 1 is F, -CN, -N(Ci -3 alkyl) 2 wherein each Cj -3 alkyl group is independently substituted or unsubstituted, or a substituted or unsubstituted isopropyl, tert-butyl, isobutyl, sec-butyl, cyclohexyl, phenyl, 8-oxa-3-aza-bicyclo[3.2.1]octan-3-yl, thiazolyl, CH 2 -thiazolyl, CH 2 CH 2 -thiazolyl, pyrrolidinyl, CH 2 -pyrrolidinyl, CEbCHa-pyrrolidinyl, piperidyl, CH 2 -piperidyl, CH 2 CH 2 -piperidyl, morpholinyl, CH 2 -morpholinyl, CH 2 CH 2 -morpholinyl, thiomorpholinyl, CH 2 -thiomorpholinyl, CH
  • R 2 is a substituted or unsubstituted Ci -4 alkyl or heterocyclylalkyl group, F, Cl, -CN, -NO 2 , -OR', -C(O)OR', -C(O)NRZ 2 , -NRC(O)R", -NRC(O)OR", -NR 5 SO 2 R", -NR'C(O)NR' 2 , or -SO 2 NR' 2 .
  • the alkyl group is substituted with NRR.
  • the heterocyclylalkyl group is a substituted or unsubstituted -(Ci- 3 alkyl)-pyrrolidinyl, -(Ci -3 alkyl)-piperidyl, -(Ci -3 alkyl)-piperazinyl, or -(C1-3 alkyl)- morpholinyl group.
  • R 2 is F, -CF 3 , -CN, -NO2, -O(Ci_ 6 alkyl), -C(O)O(Ci -6 alkyl), -C(O)NH 2 , -C(O)NH(C, -6 alkyl), -C(O)NH(aryl), -C(O)N H(aralkyl), - NHC(O)(C 1-5 alkyl), -NHC(O)(aryl), -NHC(O)(aralkyl), -NHSO 2 (Ci -5 alkyl), -NHSO 2 (aryl), -NHSO 2 (aralkyl), -SO 2 NH(C 1-6 alkyl), -SO 2 NH(aryl), or -SO 2 NH(aralkyl), wherein each Ci -6 alkyl, aryl, or aralkyl group is substituted or unsubstituted.
  • R 3 is a substituted or unsubstituted Ci -4 alkyl or -0(Ci -4 alkyl) group, or is a partially or fully halogenated -Q(Ci -2 alkyl) group.
  • G is phenyl and R 1 is F, Cl, -CN, -N(Ci_3 alkyl)2 wherein each C1-3 alkyl group is independently substituted or unsubstituted, or a substituted or unsubstituted morpholinyl, thiomorpholinyl, 8-oxa-3-aza-bicyclo[3.2.1]octan-3-yl, pyrrolidinyl, piperidyl, oxazepanyl, isopropyl, tert-butyl, iso-butyl, sec-butyl, or cyclohexyl group.
  • R 1 is F, Cl, a substituted or unsubstituted morpholinyl, 8-oxa-3-aza-bicyclo[3.2.1]octan-3-yl, pyrrolidinyl, piperidyl, oxazepanyl, tert-butyl, or cyclohexyl group.
  • R 2 is a substituted or unsubstituted Q.
  • the alkyl group is substituted with NRR.
  • the heterocyclylalkyl group is a substituted or unsubstituted -(C 1 - 3 alkyl)-pyrrolidinyl, -(C
  • R 2 is F, -CF 3 , -CN, -C(O)NH 2 , -C(O)NH(C 1-6 alkyl), -NHSO 2 (C 6 alkyl), or -SO 2 NH(Ci -6 alkyl), wherein each Ci -6 alkyl is substituted or unsubstituted.
  • R 3 is a substituted or unsubstituted C 1-4 alkyl or -0(C 1-4 alkyl) group, or is a partially or fully halogenated -0(C 1-2 alkyl) group.
  • G is a phenyl or a pyridyl group.
  • Table 1 Exemplary combinations of the B, D 3 E containing aromatic ring and
  • Table 2 sets forth various combinations of substituents L 2 and Q of Formulas I and II.
  • combination 1692 describes those embodiments in which L 2 is -C(O)- and Q is t-butyl.
  • a combination of substituents is permissible only if such a combination results in a chemically stable compound, and that any combination from Table 1, describing the B, D, E containing ring and G, may be combined with any combination from Table 2, describing L 2 and Q.
  • combination 1047 from Table 1 and combination 1692 from Table 2 describe those embodiments of Formulas I and II in which the 5 membered B, D, E containing aromatic ring is pyrazol-3,5-diyl, G is phenyl, L is -C(O)- and Q is t-butyl.
  • Each G and Q in the tables is understood to be optionally substituted as described herein.
  • each value of A (-F, Cl, Br, I, NR 2 , or Cj -3 alkyl or— O(Ci- 3 )alkyl group) may be combined with any combination from Table 1 or Table 2 or any pair of combinations from the two tables.
  • combination 1692 describes those embodiments in which A is -F, L 2 is -C(O)- and Q is t-butyl, as well as those where A is — CH 3 , L 2 is -C(O)- and Q is t-butyl, etc.
  • Typical coupling agents include EDC, PyBOP, and the like.
  • the activating moiety is typically F, Cl, Br, I, N 3 , N-hydroxysuccinimido, 1 -oxybenzotriazole, pentafluorophenoxy, pentachlorophenoxy, para-nitrophenoxy, or -OC(O)-OR y , wherein R y is a substituted or unsubstituted Ci -6 alkyl group.
  • Suitable bases include sodium bicarbonate or a suitable organoamine, such as pyridine, N-methylmorpholine, diisopropylethylamine or triethylamine.
  • V is an alkyl or cycloalkyl group, optionally partially or fully halogenated;
  • T is -CN, -SO 2 NR' 2j -C(O)NR' 2) or -NR 5 SO 2 R";
  • U is-O(C,. 6 alkyl), and R' and R" are as defined herein.
  • K is a C 2-6 alkyl or a cycloalkyl group, optionally partially or fully halogenated;
  • J is -CN, -SC» 2 NR' 2 , or -NR'SO 2 R"; each R' is independently hydrogen, or a substituted or unsubstituted alkyl, aralkyl, heterocyclyl, or heterocyclylalkyl group; each R" is independently a substituted or unsubstituted alkyl, aryl, heterocyclyl, aralkyl or heterocyclylalkyl group; and R p is H or a substituted on unsubstituted alkyl, aralkyl or heterocyclalkyl group.
  • R n is hydrogen or a substituted or unsubstituted Ci -6 alkyl group; and m is 0, 1 or 2. In some embodiments, R n , is H.
  • the compound of Formula I at a concentration of 10 ⁇ M inhibits induced TNFa-release from a cell by about 50% or greater than 50%.
  • compositions comprising a compound as described herein and a pharmaceutically acceptable carrier.
  • the invention provides methods of treating disorders mediated by cytokines, including but not limited to inflammatory disorders, cardiovascular disorders, cancer and pain.
  • the methods include administering to a subject in need of such treatment a therapeutically effective amount of a compound as described herein.
  • the cytokine-mediated disorder is a p38 MAPK-mediated disease.
  • Such cytokine-mediated disorders include rheumatoid arthritis, osteoarthritis, Crohn's disease, ulcerative colitis, psoriatic arthritis, traumatic arthritis, rubella arthritis, inflammatory bowel disease, multiple sclerosis, graft versus host disease, systemic lupus erythematosus, toxic shock syndrome, irritable bowel syndrome, muscle degeneration, allograft rejections, pancreatitis, insulinitis, glomerulonephritis, diabetic nephropathy, renal fibrosis, chronic renal failure, gout, leprosy, acute synovitis, Reiter's syndrome, gouty arthritis, Behcet's disease, spondylitis, endometriosis, non-articular inflammatory conditions, such as intervertebral disk syndrome conditions, bursitis, tendonitis, tenosynovitis or fibromyalgic syndrome; and acute or chronic pain, including but not limited to neurological pain, neuropathies,
  • cytokine-mediated disorders are stroke, chronic heart failure, endotoxemia, reperfusion injury, ischemia reperfusion, myocardial ischemia, restenosis, thrombosis, angiogenesis, Coronary Heart Disease, Coronary Artery Disease, acute coronary syndrome, Takayasu arteritis, cardiac failure such as heart failure, cardiomyopathy, myocarditis, vasculitis, vascular restenosis, valvular disease or coronary artery bypass; hypercholesteremia, diseases or conditions related to blood coagulation or fibrinolysis, such as for example, acute venous thrombosis, pulmonary embolism, thrombosis during pregancy, hemorrhagic skin necrosis, acute or chronic disseminated intravascular coagulation (DIC), clot formation from surgery, long bed rest or long periods of immobilization, venous thrombosis, fulminant meningococcemia, acute thrombotic strokes, acute coronary o
  • Cytokine-mediated disorders further include allergic rhinitis, asthma, adult respiratory distress syndrome, chronic pulmonary inflammation, chronic obstructive pulmonary disease, obliterative bronchiolitis, emphysema, bronchitis, mucus hypersecretion, silicosis, SARS infection and respiratory tract inflammation. Also included are psoriasis, pemphigus, eczema, atopic dermatitis, contact dermatitis, or acne.
  • cytokine-mediated disorders are Guillain-Barre syndrome, Parkinson's disease, Huntingdon's disease, Alzheimer's disease, amyotrophic lateral sclerosis, multiple sclerosis and other demyelinating diseases, viral and bacterial meningitis, CNS trauma, spinal cord injury, seizures, convulsions, olivopontocerebellar atrophy, AIDS dementia complex, MERRF and MELAS syndromes, Leber's disease, Wernicke's encephalopathy, Rett syndrome, homocysteinuria, hyperprolinemia, hyperhomocysteinemia, nonketotic hyperglycinemia, hydroxybutyric aminoaciduria, sulfite oxidase deficiency, combined systems disease, lead encephalopathy, Tourett's syndrome, hepatic encephalopathy, drug addiction, drug tolerance, drug dependency, depression, anxiety, schizophrenia, aneurism, or epilepsy.
  • the cytokine-mediated disorders include bone resorption diseases such as osteopetrosis, osteoporosis, or osteoarthritis. Also included are diabetes, systemic cachexia, cachexia secondary to infection or malignancy, cachexia secondary to acquired immune deficiency syndrome (AIDS), obesity, anorexia or bulimia nervosa.
  • bone resorption diseases such as osteopetrosis, osteoporosis, or osteoarthritis.
  • diabetes systemic cachexia, cachexia secondary to infection or malignancy, cachexia secondary to acquired immune deficiency syndrome (AIDS), obesity, anorexia or bulimia nervosa.
  • the cytokine-mediated disease can be sepsis, HIV infection, HCV infection, malaria, infectious arthritis, leishmaniasis, Lyme disease, cancer, including but not limited to breast cancer, colon cancer, lung cancer, prostatic cancer, multiple myeloma, acute myelogenous leukemia, myelodysplastic syndrome, non-Hodgkins lymphoma, osteosarcoma or follicular lymphoma, Castleman's disease, or drug resistance.
  • the cytokine-mediated disorder is rheumatoid arthritis, osteoarthritis, Crohn's Disease, ulcerative colitis, inflammatory bowel disease, diabetes, psoriatic arthritis, psoriasis, pemphigus, chronic obstructive pulmonary disease, pain, atherosclerosis, ischemia reperfusion, restenosis, acute coronary syndrome, heart failure, multiple myeloma, follicular lymphoma or osteosarcoma.
  • the cytokine mediated disorder is a neutrophil-mediated disorder, such as, for example, bronchial asthma, rhinitis, influenza, stroke, myocardial infarction, thermal injury, adult respiratory distress syndrome (ARDS), multiple organ injury secondary to trauma, acute glomerulonephritis, dermatoses with acute inflammatory components, acute purulent meningitis, hemodialysis, leukopheresis, granulocyte transfusion associated syndromes, or necrotizing enterocolitis.
  • ARDS adult respiratory distress syndrome
  • 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 compound, 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 disorder is 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-borne encephalitis, asphyxia, atopic hypersensitivity, beaver fever, biliary cirrhosis, bone loss, bronchiolitis, cancer of endocrine gland, cancer of larynx, candidiasis, small cell lung carcinoma, cardiac hypertrophy, cardiac surgery, cardiomegaly, carditis, carotid angioplasty
  • 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 an amount of a cytokine inhibitor, effective to reduce a level of a cytokine relative to the level prior to administration of the cytokine inhibitor, wherein the cytokine inhibitor 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 a cytokine mediated disorder, as described herein.
  • the cytokine is selected from TNFa, IL- 1 , IL-6, IL-8, GM-CSF, IFN-gamma, or a combination of any two or more thereof. In others, the cytokine is TNFa or IL-I . In some embodiments, the cytokine level is measured in the subject or samples from the subject, e.g., a bodily fluid such as the subject's blood. In others, cytokine level is measured in the subject's synovium. In still others, the cytokine level is measured in the subject's skin.
  • cytokine levels are 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-I, IL-6, IL-8, GM-CSF, IFN-gamma, or a combination of any two or more thereof.
  • the methods comprise contacting p38 with an amount of a cytokine inhibitor effective to inhibit p38 activity, the phosphorylation of p38, or both, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 a cytokine mediated disorder as described herein.
  • a pro-inflammatory mediator comprising administering to a subject an amount of a cytokine inhibitor effective to reduce the activity of a pro-inflammatory mediator relative to the activity prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • the reduction in proinflammatory mediator activity is at least 10%, at least 30%, at least 50%, or at least 90%.
  • the subject suffers from a cytokine 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 cytokine inhibitor.
  • 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 pro-inflammatory 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 methods eomrise administering to a subject an amount of cytokine inhibitor effective to reduce the circulating levels of C-Reactive Protein or Rheumatoid Factor, or both, in blood relative to the level prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • the reduction in circulating level is at least 10%, at least 30%, at least 50%, or at least 90%.
  • the methods comprise administering to a subject exhibiting one or more indicia of rheumatoid arthritis, an amount of 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 cytokine inhibitor, wherein the indicia is selected from erythrocyte sedimentation rate (ESR), joint redness, joint pain, joint tenderness, Ritchie articular index, duration of morning stiffness, joint immobility, joint swelling, and/or circulating C-reactive protein level, and wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • ESR erythrocyte sedimentation rate
  • the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • kits for reducing the number or severity of clinical signs of psoriasis comprise administering to a subject exhibiting one or more clinical signs of psoriasis an amount of 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 cytokine inhibitor, 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 described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • BSA total body surface area
  • cytokine inhibitor effective to increase the HDL-level of the subject relative to the level prior to the administration of the cytokine inhibitor.
  • the cytokine inhibitor is a p38 inhibitor.
  • the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 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 cytokine inhibitor.
  • the subject is suffering from or is at risk of suffering from diabetes, insulin resistance, or Metabolic Syndrome.
  • the methods additionally comprise administration of Atorvastatin (Lipitor, Torvast), Fluvastatin (Lescol), Lovastatin (Mevacor, Altocor), Mevastatin, Pitavastatin (Livalo, Pitava), Pravastatin (Pravachol, Selektine, Lipostat), Rosuvastatin (Crestor), Simvastatin, gemfibrozil, fenofibrate, bezafibrate, ciprofibrate, clofibrate, clinofibrate, Cholestyramine (Questran), Colestipol (Colestid), Ezetimibe (Zetia), niacin, or combinations of two or more thereof.
  • the HDL level of the subject is increased by at least about 5%, by at least about 7%, or by at least about 10%.
  • the HDL level of the subject is increased by at least about 7%.
  • the methods comprise administering to a subject an amount of a cytokine inhibitor effective to decrease the triglyceride-level of the subject relative to the level prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 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 cytokine inhibitor.
  • the method additionally comprises administration of Atorvastatin (Lipitor, Torvast), Fluvastatin (Lescol), Lovastatin (Mevacor, Altocor), Mevastatin, Pitavastatin (Livalo, Pitava), Pravastatin (Pravachol, Selektine, Lipostat), Rosuvastatin (Crestor), Simvastatin, gemfibrozil, fenofibrate, bezafibrate, ciprofibrate, clofibrate, clinofibrate, Cholestyramine (Questran), Colestipol (Colestid), Ezetimibe (Zetia), niacin, or combinations of two or more thereof.
  • 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%.
  • methods of decreasing the fasting glucose-level in a subject comprise administering to a subject an amount of a cytokine inhibitor effective to decrease the fasting glucose-level in a subject relative to the level prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 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 cytokine inhibitor.
  • methods of decreasing the HbAIc value in a subject comprise administering to a subject an amount of a cytokine inhibitor effective to decrease the HbAIc value in the subject relative to the level prior to the administration of the cytokine inhibitor, 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 HbAl c level is decreased to between about 4% and about 6.5%.
  • 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 cytokine inhibitor.
  • methods for decreasing the insulin level in a subject comprise administering to a subject an amount of a cytokine inhibitor effective to decrease the insulin-level in the subject relative to the level prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 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 cytokine inhibitor.
  • the methods comprise administering to a subject an amount of a cytokine inhibitor effective to decrease the HOMA Insulin Resistance Index in the subject relative to the Index prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor is as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • 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 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 cytokine inhibitor.
  • the methods comprise administering to a subject an amount of a cytokine inhibitor effective to increase the indirect bilirubin level in the subject relative to the level prior to the administration of the cytokine inhibitor, wherein the cytokine inhibitor 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%.
  • the bilirubin level is increased without causing jaundice.
  • 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 cytokine inhibitor.
  • Combination therapy employing cytokine inhibitors of the invention in combination with additional ingredient(s) 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 as described herein, and in particular in the treatment of rheumatoid arthritis, Crohn's disease and psoriasis, and in the other methods described herein.
  • the invention provides methods that further include administering to a subject one or more, typically one, of the ingredients A described herein together with one or more, typically one, cytokine inhibitor of the invention.
  • 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 the cytokine inhibitor may be seen. For example, cost reduction by way of interval and/or dose reduction.
  • NSAIDs non-steroid anti-inflammatory drugs
  • NSAIDS include 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, oxaprozin, piroxicam, sodium salicylate, sulindac, tolmetin, meloxicam, rofecoxib, celecoxib, etoricoxib, valdecoxib, nabumetone, naproxen,
  • Angiogenesis inhibitors may serve as ingredient A, such as compounds directed against VEGF, 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 C5.
  • ingredient A 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 (ulobetasol), methylprednisolone, prednisolone, 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.
  • Many types of immunomodulatory, immunosuppressive or cytostatic drugs can be used in combination with cytokine inhibitors of the invention.
  • agents include hydroxychloroquine, D-penicillamine, sulfasalazine, auranofin, 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, alicaforsen, DAB 389 , CTLA-4Ig, anti-CD80, for example IDEC- 1 14 or ABX-IL8, DAB-IL
  • 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 and tazarotene, and 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).
  • Other ingredients A contemplated for use in methods of the invention include fibrates, such as Bezafibrate (e.g. Bezalip®), Ciprofibrate (e.g.
  • combinations comprising ingredient A and a cytokine inhibitor 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 ingredient(s) A and the cytokine inhibitor of the invention may further include the pharmaceutically acceptable derivatives thereof, and may be optionally combined with a conventional excipient, carrier, or combination thereof.
  • the pharmaceutical combinations of ingredient A and the cytokine inhibitor according to the invention may be administered in any conventional dosage form in any conventional manner, including any of the routes described herein.
  • 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 cytokine inhibitor according to the invention 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 cytokine inhibitor may therefore be physically combined with the conventional therapeutics or other adjuvants into a single pharmaceutical composition.
  • the ingredient A and/or the cytokine inhibitor may be used in the combination as a salt, solvate, tautomer and/or prodrug and as a single stereroisomer or mixtures of stereoisomers, including racemates.
  • the proportions in which the two components, ingredient A and the cytokine inhibitor, may be used in the combinations according to the invention are variable.
  • Ingredient A and the cytokine inhibitor 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 cytokine inhibitor, and are within the skill in the art.
  • UVB ultraviolet B
  • PUVA psoralens ultraviolet A
  • a typical combination for treating psoriasis is the cytokine inhibitor compound in combination with immunotherapy drugs which include cyclosporin, pimecrolimus, tacrolimus, ascomycine, anti-CD4, anti-CD25, peptide T, LFA3TIP, DAB 38 Q, CTLA-4Ig, E-selectin inhibitors, alefacept, infliximab, etanercept, efalizumab, and those disclosed in Griffiths, Christopher E. M., 1998 Hospital Medicine, VoI 59 No 7, and the obvious variants thereof.
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound with methotrexate (MTX).
  • MTX methotrexate
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound with cyclosporine, especially because of cyclosporine's efficiency for induction of remission.
  • Another embodiment of the invention comprises administration in the following sequence: induction with cytokine inhibitor and cyclosporine, followed by continuation with cytokine inhibitor after decrease of dosing and discontinuation of cyclosporine.
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound in combination with retinoids.
  • Retinoids provide minimal efficacy with potential Cyt P450 interactions and risk of teratogenicity, and this would be alleviated by continuation therapy with the cytokine inhibitor.
  • Yet another typical combination for treating psoriasis is the cytokine inhibitor compound, in combination with ingredients A selected from steroids, such as glucocortico steroids, vitamin D analogs, retinoids and dithranol. In some such combination treatments, the steroids and retinoids can be administered topically.
  • a more typical combination for treating psoriasis is a cytokine inhibitor compound with vitamin D derivatives, most typically calcipotriol or tacalcitol.
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound in combination with macrolides, most typically with ascomycin analogues, administered topically, and even more typically with those available orally such as pimecrolimus.
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound in combination with cell adhesion molecules inhibitors, such as anti LFA3, and/or anti LFAl. This includes adhesion molecule blockage by recombinant fusion proteins like alefacept, anti LFA3-IgCl, or by anti-CD 11 monoclonal antibodies, efalizumab, and the obvious variants thereof.
  • Cell adhesion molecules inhibitors appear to provide an acceptable response rate with limited tolerability problems.
  • Another embodiment of the invention comprises administration in the following sequence: induction with cytokine inhibitor and CAM inhibitors, followed by maintenance treatment with the cytokine inhibitor alone and retreatment with CAM inhibitors in case of significant relapse.
  • Another typical combination for treating psoriasis is the cytokine inhibitor compound 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 as alicaforsen, in combination with a cytokine inhibitor compound.
  • cytokine inhibitor compound with anti-CD4, anti-CD80 (IDEC-114 or ABX- IL8), DAB IL-2, DAB 389 IL-2, CTLA4-Ig, ILlO, the IL2 receptor inhibitors such as daclizumab (anti-TAC), or basiliximab.
  • DMARDs Disease Modifying Antirheumatic Drugs
  • SAARDs Slow Acting Antirheumatic Drugs
  • a typical combination for treating rheumatoid arthritis is the cytokine inhibitor compound combined with one or more of the following immunosuppressive, immunomodulatory, or cytostatic drugs, such as, for example, hydroxychloroquine, D- penicillamine, sulfasalazine, auranof ⁇ n, gold sodium thiomalate, minocycline, dapsone, chlorambucil, mercaptopurine, tacrolimus, sirolimus, mycophenolate mofetil, cyclosporine, leflunomide, methotrexate, azathioprine or cyclophosphamide.
  • immunosuppressive immunomodulatory
  • cytostatic drugs such as, for example, hydroxychloroquine, D- penicillamine, sulfasalazine, auranof ⁇ n, gold sodium thiomalate, minocycline, dapsone, chlorambucil, mercaptopurine, tacrolimus,
  • cytokine inhibitor compound Another typical combination for treating rheumatoid arthritis is the cytokine inhibitor compound 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.
  • cytokine inhibitor compound in combination with inhibitors of cell adhesion, such as inhibitors of LFA-I or inhibitors of ICAM-I.
  • Another typical combination for treating rheumatoid arthritis is the cytokine inhibitor compound 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.
  • the cytokine inhibitor is combined with infliximab and methotrexate.
  • Another typical combination for treating rheumatoid arthritis is the cytokine inhibitor compound in combination with IL-I receptor antagonists, such as Kineret.
  • cytokine inhibitor compound combined with NSAIDs, including acetaminophen, aspirin, ibuprofen, choline magnesium salicylate, choline salicylate, diclofenac, difiunisal, etodolac, fenoprofen calcium, flurbiprofen, indomethacin, ketoprofen, carprofen, indoprofen, ketorolac tromethamine, magnesium salicylate, meclofenamate sodium, mefenamic acid, oxaprozin, piroxicam, sodium salicylate, sulindac, tolmetin, meloxicam, rofecoxib, celecoxib, etoricoxib, valdecoxib, nabumetone, naproxen, lomoxicam, nimesulide, indoprofen, remifenzone, salsalate,
  • NSAIDs including acetaminophen, as
  • cytokine inhibitor compound Another typical combination for treating rheumatoid arthritis is the cytokine inhibitor compound 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.
  • the following groups of drugs combined with the cytokine inhibitor may be effective: steroids such as budesonide, 5-ASA drugs like mesalamine, immunosuppressants, biological agents and adhesion molecule inhibitors.
  • steroids such as
  • cytokine inhibitor compound 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.
  • the cytokine inhibitor is combined with infliximab and methotrexate. More typically, the cytokine inhibitor is combined with infliximab.
  • Another typical combination for treating Crohn's disease is the cytokine inhibitor compound combined with IL-IO, alicaforsen (anti ICAM 1), or Antegren (VCAM receptor antagonist).
  • 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 patient in need thereof a pharmaceutically effective amount of the cytokine inhibitor.
  • This administration may be of benefit given either prophylactically to patients at risk or therapeutically for patients who have developed complications related to these pathways.
  • cytokine inhibitor and 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, dipyrirnidamole, 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, dipyrirnidamole, aggrennox, ticlopidine
  • a method comprising administering to a subject a combination of a cytokine inhibitor as described herein 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 A is selected from agents useful in the treatment of obesity or an obesity-related condition or disorders.
  • the obesity-related disorder is selected from overeating, binge eating, bulimia, diabetes, elevated plasma insulin concentrations, insulin resistance, metabolic syndrome, dyslipidemias, hyperlipidemia, lypodystrpohy, osteoarthritis, arthritis deformans, lumbodynia, emmcniopathy, obstructive sleep apnea, cholelithiasis, gallstones, nonalcoholic steatohepatitis, heart disease, abnormal heart rhythms and abnormal heart arrythmias, 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
  • the subject desires to lose body weight relative to the subject's body weight prior to administration of the combination.
  • the method additionally comprises lipoplasty, gastric bypass, laparoscopic adjustable gastric binding, biliopancreatic diversion or vertical banded gastroplasty.
  • both the cytokine inhibitor and ingredient A are administered orally.
  • both the cytokine inhibitor and ingredient A are administered intravenously, subcutaneously or by inhalation.
  • the cytokine inhibitor is administered orally and the ingredient A is administered intravenously, subcutaneously, or by inhalation.
  • the cytokine inhibitor 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 disorders as ingredients A include an insulin sensitizer, an insulin or insulin mimetic, a sulfonyl urea, 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 sulfonyl urea, an of-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, radafaxine, orlistat, cetilistat, oxyntomodulin, or oleoyl-estrone.
  • Typical examples of ingredients A, and combinations of any 2 or more thereof, that may be combined with the cytokine inhibitors as described 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 y agonists
  • glitazones e.g.isaglitazone; pioglitazone; rosiglitazone; rivoglitazone, netoglitazone
  • naveglitazar farglitazar
  • metaglidasen GW6779542, CS038, MBX2044, AZD6610, PLX204, LBM642, AMG131 , AVE0847, AVE5376, ONO5129, TAK654, CLX0921, and the like
  • biguanides such as metformin and phenformin
  • insulin or insulin mimetics such as insulin aspart, insulin glulisine, insulin glargine, insulin lispro, insulin detemir, NN5401, NN9101, NN344, AT1391, DTYOOl, betaRx, insulin zinc suspension (lente and ultralente); insulintropin.
  • insulin is meant a polypeptide or its equivalent useful in regulation of blood glucose levels. A general description 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 derivatives of insulin exist and are useful in this invention.
  • Such compositions can be administered by any standard route, including oral, nasal, pulmonary, or transdermal administration.
  • sulfonylureas such as acetohexamide; chlorpropamide; glibenclamide; glipizide; glyburide; glimepiride; gliclazide; glipentide; gliquidone; glisolamide; tolazamide; and tolbutamide;
  • cfc-glucosidase inhibitors such as alglucosidase alfa, voglibose, celgosivir, miglitol, acarbose, and the like;
  • 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, GFTl 4, PLX204, Kl 11, naveglitazar, LBM642, GW
  • PPAR ⁇ agonists such as GW677954, CS068, RWJ800025, GW501516, and CKD501;
  • CB cannabinoid
  • 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 cannabinoid
  • anti-obesity serotonergic agents such as fenfluramine, dexfenfluramine, phentermine, DOVl 02677, zimeldine, and sibutramine;
  • adrenoceptor agonists including j83-adrenoreceptor agonists, such as solabregon, YM 178, amibregon, tesofensince, fenfluramine, amphetamine, phenmetrazine, phentermine, and N5984;
  • pancreatic lipase inhibitors such as orlistat, cetilistat, and GT389255;
  • apo-A apolipoprotein-B secretion/microsomal triglyceride transfer protein
  • 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, GW5481 18., 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, ACl 62352, 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;
  • melanocortin (MC) agonists including MC4 agonists and MC4R agonists, such as Melanotan II, PTl 5, BL3020, AP1030, or those described in PCT Application Nos. WO 99/64002, WO 00/74679, WO 01/991752, WO 01/74844, WO 02/12166, WO 02/11715, 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;
  • MC melanocortin
  • ghrelin receptor antagonists such as NOXB 11 , CYT009GhrQb, TZP300,
  • 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, RC 1291, 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.
  • 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, fluvoxamine, escitalopram, sibutramine, venlafaxine, vilazodone, DOV21947, LUAA21004, BGC201259, NS2359, UK416244, DOV102677, SEP225289, OPC14523, SLV314, WLlOI l, WL1017, zimeldine, fluoxetine, paroxetine, fenfluramine, imipramine and sertraline, and those disclosed in U.S. Pat. No. 6,365,633, and PCT Application Nos. WO 01/27060 and WO 01/162341 ;
  • dopamine agonists for example dopamine D2 agonists, such as, ropinirole, bifeprunox, aripiprazole, pergolide, talipexole, ACPI 04, quinagolide, nolomirole, NHOOl , SLV308, piribedil, lisuride, bromocriptine, aplindore, tesofensine, and preclamol;
  • dopamine D2 agonists such as, ropinirole, bifeprunox, aripiprazole, pergolide, talipexole, ACPI 04, 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 acyl transferase
  • glucose transporter inhibitors for example, sodium glucose cotransporter
  • (SGLT) inhibitors such as, KGTl 251, 189075, AVE2268, and SGLOOlO;
  • CETP cholesterol ester transfer protein
  • glucocorticoid antagonists for example, mifepristone, Org34511 , and
  • PDE3B PDE3B inhibitors
  • tetomilast for example, tetomilast, tadalafil, atopik, vardenafil, tipelikast, HT0712, QADl 71 A, SK3530, oglemilast, acanafil, cilostazol, roflumilast, parogrelil, udenafil, EHT0202, dasantafil, MEM1414, SLx2101, CC10004, 256066, cilomilast, vinpocetine, ibudilast, pimobendan, ND7001, LAS37779, K123, UK357903, ND1251, tofimilast, UKl 69003, senazodan, trapidil, arofylline, theophylline, doxofylline, olprinone, pentoxifylline, zaprinast, sildenafil, amrin
  • antiplatelet agents such as, limaprost, clopidogrel, felbinac, eptifibatide,
  • angiotensin converting enzyme (ACE) inhibitors such as peridopril, enalapril, ramipril, fosinopril, quinapril, lisinopril, imidapril, benazepril, ilepatril, captopril, trandolapril, temcapil, cilazapril, MC4232, CHFl 521, 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, fimesartan, pratosartan, and saralasin;
  • thyroid hormone ⁇ agonists such as thyroid hormone, levothyroxine,
  • COX-2 inhibitors such as etoricoxib, G W4063 S 1 , meloxicam, lumiracoxib, diclofenac, valdecoxib, parecoxib, PMIOOl, 6444784,
  • 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
  • BDC03 BDC03, S2367, AOD9604, fluasterone, GT389255, QCBTl 6, 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 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 cytokine inhibitor 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 cytokine inhibitor as described herein 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 cytokine inhibitor 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.
  • a method of treating a cancer which comprises administering to a subject in need of such treatment a composition comprising a therapeutically effective amount of a cytokine inhibitor as described herein, or a pharmaceutically acceptable salt, solvate, or stereoisomer thereof.
  • the method of treating cancer further comprises treating the subject with surgery, radiation, cryotherapy, or one or more antiproliferative agents or a combination thereof.
  • the antiproliferative agent is an alkylating agent, platinum agent, antimetabolite, topoisomerase inhibitor, antitumor antibiotic, antimitotic agent, aromatase inhibitor, thymidylate synthase inhibitor, DNA antagonist, farnesyltransferase inhibitor, pump inhibitor, histone acctyltransferase inhibitor, metalloproteinase inhibitor, ribonucleoside reductase inhibitor, endothelin A receptor antagonist, retinoic acid receptor agonist, immunomodulator, hormonal or antihormonal agent, photodynamic agent, angiogenesis inhibitor, or a tyrosine kinase inhibitor.
  • the alkylating agent is busulfan, procarbazine, ifosfamide, altretamine, hexamethylmelamine, estramustine phosphate, thiotepa, mechlorethamine, dacarbazine, streptozocin, lomustine, temozolomide, cyclophosphamide, semustine, or chlorambucil.
  • platinum agents examples include spiroplatin, lobaplatin (Aeterna), tetraplatin, satraplatin (Johnson Matthey), ormaplatin, iproplatin, miriplatin (Sumitomo), nexplatin (AnorMED), polymer platinate (Access), oxaliplatin, or carboplatin.
  • the antimetabolite is azacytidine, trimetrexate, floxuridine, deoxycoformycin, 2-chlorodeoxyadenosine, pentostatin, 6-mercaptopurine, hydroxyurea, 6- thioguanine, decitabine (SuperGen), cytarabine, clofarabine (Bioenvision), 2-fluorodeoxy cytidine, irofulven (MGI Pharma), methotrexate, tomudex, ethynylcytidine (Taiho), fludarabine, gemcitabine, raltitrexed, or capecitabine.
  • the topoisomerase inhibitor is amsacrine, exatecan mesylate (Daiichi), epirubicin, quinamed (ChemGenex), etoposide, gimatecan (Sigma-Tau), teniposide, mitoxantrone, diflomotecan (Beaufour-Ipsen), 7-ethyl- 10-hydroxy-camptothecin, dexrazoxanet (TopoTarget), elsamitrucin (Spectrum), pixantrone (Novuspharma), edotecarin (Merck & Co), becatecarin (Exelixis), karenitecin (BioNumerik), BBR-3576 (Novuspharma), belotecan (Chong Kun Dang), rubitecan (SuperGen), irinotecan (CPT-1 1), or topotecan.
  • the antitumor antibiotic is dactinomycin (actinomycin D), azonafide, valrubicin, anthrapyrazole, daunorubicin (daunomycin), oxantrazole, therarubicin, losoxantrone, idarubicin, bleomycinic acid, rubidazone, sabarubicin (Menarini), plicamycinp, 13-deoxydoxorubicin hydrochloride (Gem Pharmaceuticals), porfiromycin, epirubicin, mitoxantrone (novantrone) or amonafide.
  • antimitotic agents are colchicines, ABT-751 (Abbott), vinblastine, xyotax (Cell Therapeutics), vindesine, IDN 5109 (Bayer), dolastatin 10 (NCI), A 105972 (Abbott), rhizoxin (Fujisawa), A 204197 (Abbott), mivobulin (Warner-Lambert), synthadotin (BASF), cemadotin (BASF), indibulin (ASTAMedica), RPR 109881 A (Aventis), TXD 258 (Aventis), combretastatin A4 (BMS) 5 epothilone B (Novartis), isohomohalichondrin-B (PharmaMar), T 900607 (Tularik), ZD 6126 (AstraZeneca), batabulin(Tularik), cryptophycin 52 (Eli Lilly), vinflum ' ne (Fabre), hydravin (Pre
  • the aromatase inhibitor is aminoglutethimide, atamestane (BioMedicines), formestane, fadrozole, letrozole, exemestane, or anastrazole.
  • the thymidylate synthase inhibitor is pemetrexed (Eli Lilly), nolatrexed (Eximias), ZD-9331 (BTG), doxifluridine (Nippon Roche), or 5,10-methylenetetrahydrofblate (BioKeys).
  • the DNA antagonist is trabectedin (PharmaMar), edotreotide (Novartis), glufosfamide (Baxter International), mafosfamide (Baxter International), apaziquone (Spectrum Pharmaceuticals), or thymectacin (NewBiotics).
  • the farnesyltransferase inhibitor is arglabin (NuOncology Labs), tipifarnib (Johnson & Johnson), lonafarnib (Schering-Plough), perillyl alcohol (DOR BioPharma), or sorafenib (Bayer).
  • Examples of pump inhibitors are zosuquidar trihydrochloride (Eli Lilly), tariquidar (Xenova), biricodar dicitrate (Vertex), or MS-209 (Schering AG).
  • Examples of histone acetyltransferase inhibitors include tacedinaline (Pfizer), pivaloyloxymethyl butyrate (Titan), AP-CANC-03 and AP-CANC-04 (Aton Pharma), depsipeptide (Fujisawa), or MS-275 (Schering AG).
  • the metalloproteinase inhibitor is neovastat (Aeterna Laboratories), metastat (CollaGenex), or marimastat (British Biotech).
  • the ribonucleoside reductase inhibitor is gallium maltolate (Titan), tezacitabine (Aventis), triapine (Vion), or didox (Molecules for Health).
  • the endothelin A receptor antagonist is atrasentan (Abbott), bosentan (Roche), ambrisentan (BASF), sitaxsentan (Encysive), clazosentan (Roche), darusentan (Knoll), and ZD-4054 (AstraZeneca).
  • the retinoic acid receptor agonist is fenretinide (Johnson & Johnson), alitretinoin (Ligand), tazarotene (Allergan), tetrinoin (Roche), isotretinoin (Roche), 13-cis-retinoic acid (UCSD), or LGD-1550 (Ligand).
  • the immuno-modulator is interferon, Roferon-A (Roche), dexosome therapy (Anosys), oncophage (Antigenics), pentrix (Australian Cancer Technology), GMK vaccine (Progenies), CD 154 cell therapy (Tragen), adenocarcinoma vaccine (Biomira), transvax (Intercell), avicine (AVI BioPharma), norelin (Biostar), IRX-2 (Immuno-Rx), BLP-25 liposome vaccine (Biomira), PEP-005 (Peplin Biotech), multiganglioside vaccine (Progenies), synchrovax vaccine (CTL Immuno), D-alethine (Dovetail), melanoma vaccine (CTL Immuno), vasocare (Vasogen), rituximab (Genentech/Biogen pou), or p21 RAS vaccine (GemVax).
  • the hormonal agent is an estrogen, dexamethasone, a conjugated estrogen, prednisone, ethinyl estradiol, methylprednisolone, chlortrianisen, prednisolone, idenestrol, aminoglutethimide, hydroxyprogesterone caproate, leuprolide, medroxyprogesterone, octreotide, testosterone, mitotane, testosterone propionate, fluoxymesterone, methyltestosterone, 2-methoxyestradiol (EntreMed), diethylstilbestrol, arzoxifene (Eli Lilly), megestrol, tamoxifen, bicalutamide, toremofme, flutamide, goserelin, nilutamide, or leuporelin.
  • the photodynamic agent is talaporfin (Light Sciences), Pd-bacteriopheophorbide (Yeda), theralux (Theratechnologies), lutetium texaphyrin (Pharmacyclics), motexafin, gadolinium (Pharmacyclics), or hypericin.
  • the angiogenesis inhibitor is neovastat (AEterna Zentaris), ATN-224 (Attenuon), sorafenib (Bayer), thalidomide, bevacizumab (Genentech), ranibizumab (Genentech), benefin (Lane Labs), L-6515S2 (Merck & Co), vatalanib (Novartis), or sutent (Sugen).
  • tyrosine kinase inhibitors include imatinib (Novartis), leflunomide (Sugen/Pharmacia), kahalide F (PharmaMar) iressa (AstraZeneca), lestaurtinib (Cephalon), erlotinib (Oncogene Science), canertinib (Pfizer), tandutinib (Millenium), squalamine (Genaera), midostaurin (Novartis), phenoxodiol, SU6668 (Pharmacia), cetuximab (ImClone), rhu-Mab (Genentech), ZD6474 (AstraZeneca), MDX- H210 (Medarex), vatalanib (Novartis), omnitarg (Genentech), lapatinib (GlaxoSmithKline), panitumumab (Abgenix), IMC-I CI l (No
  • the antiproliferative agent is melphalan, carmustine, cisplatin, 5-fluorouracil, mitomycin C, adriamycin (doxorubicin), bleomycin, or paclitaxel (Taxol ® ).
  • the cancer is osteosarcoma, Kaposi's sarcoma, colorectal cancer, brain cancer, epithelial cell-derived neoplasia (epithelial carcinoma), basal cell carcinoma, adenocarcinoma, gastrointestinal cancer, Hp cancer, mouth cancer, esophageal cancer, small bowel cancer, stomach cancer, gastric cancer, colon cancer, liver cancer, bladder cancer, pancreas cancer, ovarian cancer, cervical cancer, lung cancer, breast cancer, skin cancer, squamus cell cancer, basal cell cancer, prostate cancer, renal cell carcinoma; leukemia, lymphoma, erythroblastoma, glioblastoma, glioma, meningioma, astrocytoma, myoblastoma, multiple myeloma, acute myelogenous leukemia, myelodysplastic syndrome, non-Hodgkins lymphoma, or follicular lymphoma
  • the cancer is acral lentiginous melanoma, actinic keratoses, adenocarcinoma, adenoid cycstic carcinoma, adenomas, adenosarcoma, adenosquamous carcinoma, astrocytic tumors, bartholin gland carcinoma, basal cell carcinoma, bronchial gland carcinomas, capillary carcinoids, carcinoma, carcinosarcoma, cavernous, cholangiocarcinoma, chondosarcoma, choriod plexus papilloma/carcinoma, clear cell carcinoma, cystadenoma, endodermal sinus tumor, endometrial hyperplasia, endometrial stromal sarcoma, endometrioid adenocarcinoma, ependymal, epitheloid, Ewing's sarcoma, fibrolamellar, focal nodular hyperplasia, gas
  • the cancer is leukemia, erythroblastoma, multiple myeloma, acute myelogenous leukemia, myelodysplastic syndrome, non-hodgkin's lymphoma or follicular lymphoma. In some embodiments, the cancer is follicular lymphoma, acute myelogenous leukemia, multilple myeloma or non-hodgkin's lymphoma.
  • the cancer is brain cancer, glioblastoma, meningioma, astocytoma, medulloblastoma, neuroblastoma or retinoblastoma. In some such embodiments, the cancer is glioma or glioblastoma.
  • the cancer is osteosarcoma, Kaposi's sarcoma, chondosarcoma, Ewing's sarcoma or myoblastoma. In some such embodiments, the cancer is osteosarcoma bone cancer.
  • the cancer is breast, lung, kidney or prostate cancer metastasis.
  • the neoplasm is bone metastasis.
  • a method of treating, modifying or managing pain which comprises administering to a patient in need of such treatment, modification or management, a composition comprising a therapeutically effective amount of a cytokine inhibitor as described herein, or a pharmaceutically acceptable salt, solvate, or stereoisomer thereof.
  • the composition further comprises an antidepressant, antihypertensive, anxiolytic, calcium channel blocker, ⁇ -adrenergic receptor agonist, ⁇ -adrenergic receptor antagonist, ketamine, anesthetic, muscle relaxant, non-narcotic analgesic, opioid analgesic, NSAID, immunomodulatory agent, immunosuppressive agent, corticosteroid, anticonvulsant, hyperbaric oxygen, ⁇ 2 ⁇ ligand, NMDA receptor antagonist, or a combination of any two or more thereof.
  • an antidepressant antihypertensive, anxiolytic, calcium channel blocker, ⁇ -adrenergic receptor agonist, ⁇ -adrenergic receptor antagonist, ketamine, anesthetic, muscle relaxant, non-narcotic analgesic, opioid analgesic, NSAID, immunomodulatory agent, immunosuppressive agent, corticosteroid, anticonvulsant, hyperbaric oxygen, ⁇ 2 ⁇ ligand,
  • the antidepressant is nortriptyline, amitriptyline, imipramine, doxepin, clomipramine, fluoxetine, sertraline, nefazodone, venlafaxine, trazodone, or bupropion.
  • the anti-hypertensive is nifedipine, terazosin, prazosin, losartan, verapamil, telmisartan, fosinopril, bosentan, or olmesartan.
  • the anxiolytic is fluoxetine, paroxetine, sertraline, or venlafaxine.
  • Examples of calcium channel blockers include nifedipine, verapamil and clonidine.
  • the ⁇ -adrenergic receptor agonist is clonidine or midodrine.
  • the ot-adrenergic receptor antagonist is terazosin, prazosin, or doxasozin.
  • the anesthetic is procaine, lidocaine, mepivacaine, articaine, prilocaine, etidocaine, bupivacaine, or ropivacaine.
  • opioid analgesic include hydromorphone, oxycodone, morphine sulfate, meperidine, and fentanyl transdermal patch.
  • the NSAID is a COX-2 inhibitor, salicylic acid acetate, ibuprofen, ketoprofen, naproxen sodium, ketorolac, diclofenac, indometacin, or acetaminophen.
  • the COX-2 inhibitor is rofecoxib, celecoxib, or valdecoxib.
  • the corticosteroid is prednisone, dexamethasone or hydrocortisone.
  • the anticonvulsant is carbamazepine, oxcarbazepine, gabapentin, pregabalin, phenytoin, sodium valproate, clonazepam, topiramate, lamotrigine, zonisamide, tiagabine, famotodine, phenobarbital, diphenylhydantoin, mephenytoin, ethotoin, mephobarbital, primidone, ethosuximide, methsuximide, phensuximide, trirnethadione, benzodiazepine, phenacemide, acetazolamide, progabide, divalproex sodium, magnesium sulfate injection, metharbital, paramethadione, clobazam, sulthiame, dilantin, diphenylan, or L-5-hydroxytryptophan.
  • the NMDA receptor antagonist is dextromethorphan, dextrorphan, ketamine, memantine, amantadine, agmatine, aptiganel, gavestinel, selfotel, 7-chlorokynurate, remacemide, riluzole, pyrroloquinoline quinone or cis-4-(phosphonomethyl)-2-piperidinecarboxylic acid.
  • the ⁇ 2 ⁇ ligand is gabapentin, pregabalin, [(lR,5R,6S)-6-(Aminomethyl)bicyclo[3.2.0]hept-6- yl]acetic acid, S-O-Aminomethyl-cyclohexylmethyl ⁇ H-tl ⁇ -oxadiazol-S-one and C-[I- (1 H-Tetrazol-5-ylmethyl)-cycloheptyl]-methylamine, (3S,4S)-(1 -Aminomethyl-3,4-dimethyl- cyclopentyl)-acetic acid, (l ⁇ ,3 ⁇ ,5 ⁇ )(3-amino-methyl-bicyclo[3.2.0]hept-3-yl)-acetic acid, (3S,5R)-3-Aminomethyl-5-methyl-octanoic acid, (3S,5R)-3-amino-5-methyl-heptanoic acid, (3S,5R)-3-amino-5-methyl-
  • the composition further comprises acetylsalicylic acid, diclofenac, ibuprofen, indometacin, flufenamic acid, mefenamic acid, morphine, pethidine, methadone, fentanyl, buprenorphine, tramadol, gabapentin, pregabalin, carbamazepine, lamotrigin, topiramate, phenyloin, levitiracetam, procaine, lidocaine, mepivacaine, articaine, prilocaine, etidocaine, bupivacaine, ropivacaine, amitryptiline, paroxetine, citalopram, bupropione, duxoletine, ketamine, memantine, 2,3-benzodiazepines, or a combination of any two or more thereof.
  • the pain is acute pain, chronic pain, pain resulting from soft tissue and peripheral damage from acute trauma; neuropathic pain; post-stroke pain; postherpetic neuralgia, occipital neuralgia, trigeminal neuralgia, segmental or intercostal neuralgia and other neuralgias; pain associated with osteoarthritis and rheumatoid arthritis; musculo-skeletal pain; spinal pain, central nervous system pain; lower back pain, sciatica, dental pain, myofascial pain syndromes, episiotomy pain, gout pain, and pain resulting from burns; deep and visceral pain; muscle pain, eye pain, inflammatory pain, orofacial pain; abdominal pain, and gynecological pain; somatogenic pain; pain associated with nerve and root damage; pain associated with limb amputation, tic douloureux, neuroma, or vasculitis; diabetic neuropathy, chemotherapy-induced-neuropathy, acute
  • the musculo-skeletal pain is pain associated with strains, sprains or broken bones.
  • the central nervous system pain is pain due to spinal cord or brain stem damage.
  • the deep and visceral pain is heart pain.
  • the orofacial pain is odontalgia.
  • the gynecological pain is dysmenorrhoea, labour pain and pain associated with endometriosis.
  • the pain associated with nerve and root damage is pain associated with peripheral nerve disorders.
  • the peripheral nerve disorder is nerve entrapment or brachial plexus avulsions.
  • the headache is migraine with aura, migraine without aura, vascular headaches, acute or chronic tension headache, sinus headache or cluster headache.
  • the chronic non-neuropathic pain is pain associated with HIV, anthralgia, vasculitis or fibromyalgia.
  • the complex regional pain syndrome is type I or type II.
  • the pain is nociceptive pain or neuropathic pain.
  • the nociceptive pain is associated with chemical or thermal burn, cut of the skin, contusion of the skin, osteoarthritis, rheumatoid arthritis, systemic lupus erthrematosis (SLE) tendonitis, or myofascial pain.
  • SLE systemic lupus erthrematosis
  • the neuropathic pain is diabetic neuropathy, post herpetic neuralgia, trigeminal neuralgia, post-stroke pain, complex regional pain syndrome, sympathetic maintained pain syndrome, reflex sympathetic dystrophy, reflex neurovascular dystrophy, reflex dystrophy, spinal cord injury pain, Sudeck atrophy of bone, algoneurodystrophy, shoulder hand syndrome, post-traumatic dystrophy, pain related to cancer or metastases, phantom limb pain, fibromyalgia, chronic fatigue syndrome, radiculopathy, luetic neuropathy, or painful neuropathic condition induced by a drug.
  • the cancer is osteosarcoma, colorectal cancer, brain cancer, epithelial call-derived neoplasia (epithelial carcinoma), basal cell carcinoma, adenocarcinoma, gastrointestinal cancer, lip cancer, mouth cancer, esophageal cancer, small bowel cancer, stomach cancer, colon cancer, liver cancer, bladder cancer, pancreas cancer, ovarian cancer, cervical cancer, lung cancer, breast cancer, skin cancer, squamus cell and/or basal cell cancers, prostate cancer, renal cell carcinoma, and other known cancers that affect epithelial cells throughout the body; leukemia; lymphoma; or angiogenesis including neoplasia.
  • the metastases are breast, lung, kidney or prostate cancer metastases.
  • a method of treating pemphigus which comprises administering to a subject in need of such treatment a composition comprising a therapeutically effective amount of a cytokine inhibitor as described herein, or a stereoisomer, tautomer, solvate, prodrug, or pharmaceutically acceptable salt thereof.
  • the pemphigus is pemphigus vulgaris, pemphigus vegetans, pemphigus foliaceus, pemphigus erythematosus, bullous pemphigoid, paraneoplastic pemphigus, or cicatricial pemphigoid.
  • methods comprising administering to a subject in need thereof a combination of (i) an effective amount of a cytokine inhibitor of the invention and (ii) an effective amount of one or more therapeutic Ingredients A useful in the treatment of pemphigus as described herein, wherein the effective amount of Ingredients A is less than the effective amount of Ingredient A when used alone.
  • kits comprising administering to a subject exhibiting one or more clinical indicia of pemphigus an amount of a cytokine inhibitor of the invention effective to reduce the number and/or severity of clinical indicia of pemphigus relative to those present in the subject prior to the administration of the cytokine inhibitor, wherein the clinical indicia of pemphigus include the percentage of total body surface area (BSA) affected by pemphigus, pemphigus lesion thickness, the number of new pemphigus lesions, the number of active pemphigus lesions (including blisters and erosions), the healing time of active lesions (for example, time to 80% healing), serum anti-desmoglein-1 (DSGl) antibody levels, serum anti-DSG3 antibody levels, serum TNFa-levels, serum IL6 levels, skin TNFa-mRNA levels, skin IL6 mRNA levels, or any two or more thereof.
  • BSA total body surface area
  • DSGl serum anti-desmoglein-1
  • the methods additionally comprise administering to the subject an effective amount of one or more Ingredients A, useful in the treatment of pemphigus, as described herein.
  • the effective amount of Ingredients A is less than the effective amount of Ingredient A when used alone.
  • the methods further comprise administering to the subject an Ingredient A, wherein the Ingredient A is an anti- inflammatory agent, an immunosuppressant, an anti-infective, an antibiotic, a gold salt, an alkylating agent, an immunoglobulin, or a combination of two or more thereof.
  • the Ingredient A is an anti- inflammatory agent, an immunosuppressant, an anti-infective, an antibiotic, a gold salt, an alkylating agent, an immunoglobulin, or a combination of two or more thereof.
  • the anti-inflammatory may be a corticosteroid, a COX-2 inhibitor, a non-steroidal antiinflammatory drug (NSAID), a TNFa antagonist, or an IL-I antagonist.
  • the corticosteroid can be prednisone, prednisolone, or methylprednisolone.
  • Corticosteroids such as these may also be administered with either chlorambusil or mycophenylate mofetil.
  • the TNFa antagonist is infliximab, etanercept, or adalimumab.
  • the IL-I antagonist is anakinra.
  • the immunosuppressant is mycophenylate mofetil, cyclosporin, azathioprine, methotrexate, alefacept, rituximab, anti -interferon gamma, or cyclophosphamide.
  • the anti-infective is dapsone, or hydroxychloroquine.
  • the gold salt is myochrysine, or solganal.
  • the alkylating agent is lukeran.
  • the antibiotic is tetracycline, minocycline, or doxycycline.
  • the method further comprises administration of nicotinamide, or niacinamide.
  • the methods of the invention further comprise administering plasmapheresis therapy or photophoresis therapy to the subject.
  • Ingredient A is reduced by from about 10% to about 90% in comparison to the dosage used to achieve the same therapeutic effect with Ingredient A alone. In some embodiments, the dosage is reduced by at least about 10%, about 20%, about 30%, about 40%, about 50%, or about 60%.
  • Ingredient A is a corticosteroid, for example, prednisone or prednisolone. In some other embodiments, Ingredient A comprises a corticosteroid and either chlorambusil or mycophenylate mofetil. In some embodiments, the dosage of prednisone is reduced to less than about 10 mg/day, less than about 15 mg per day, less than about 20 mg/day, less than about 30 mg/day, less than about 50 mg/day or less than about 70 mg/day.
  • the cytokine inhibitor is administered orally or topically.
  • Ingredient A is a corticosteroid or antibiotic and is administered orally, topically, in a mouthwash or in a mouth spray.
  • references to a certain element such as hydrogen or H is meant to include all isotopes of that element.
  • an R group is defined to include hydrogen or H, it also includes deuterium and tritium.
  • isotopically labeled compounds are within the scope of the invention.
  • substituted refers to an organic group as defined below (e.g., an alkyl group) in which one or more bonds to a hydrogen atom contained therein are replaced by a bond to non-hydrogen or non-carbon atoms.
  • Substituted groups also include groups in which one or more bonds to a carbon(s) or hydrogen(s) atom are replaced by one or more bonds, including double or triple bonds, to a heteroatom.
  • a substituted group will be substituted with one or more substituents, unless otherwise specified.
  • a substituted group is substituted with 1, 2, 3, 4, 5, or 6 substituents.
  • substituent groups include: halogens (i.e., F, Cl, Br, and I); hydroxyls; alkoxy, alkenoxy, alkynoxy, aryloxy, aralkyloxy, heterocyclyloxy, and heterocyclylalkoxy groups; carbonyls (oxo); carboxyls; esters; urethanes; oximes; hydroxylamines; alkoxyamines; aralkoxyamines; thiols; sulfides; sulfoxides; sulfones; sulfonyls; sulfonamides; amines; N-oxides; hydrazines; hydrazides; hydrazones; azides; amides; ureas; amidines; guanidines; enamines; imides; isocyanates; isothiocyanates; cyanates; thiocyanates; imines; nitro groups; nitriles (i.
  • Substituted ring groups such as substituted cycloalkyl, aryl, heterocyclyl and heteroaryl groups also include rings and fused ring systems in which a bond to a hydrogen atom is replaced with a bond to a carbon atom. Therefore, substituted cycloalkyl, aryl, heterocyclyl and heteroaryl groups may also be substituted with substituted or unsubstituted alkyl, alkenyl, and alkynyl groups as defined below.
  • Alkyl groups include straight chain and branched alkyl groups having from 1 to about 20 carbon atoms, and typically from 1 to 12 carbons or, in some embodiments, from 1 to 8, 1 to 6, or 1 to 4 carbon atoms. Alkyl groups further include cycloalkyl groups as defined below. Examples of straight chain alkyl groups include those with from 1 to 8 carbon atoms such as methyl, ethyl, n-propyl, n-butyl, n-pentyl, n-hexyl, n-heptyl, and n- octyl groups.
  • branched alkyl groups include, but are not limited to, isopropyl, iso-butyl, sec-butyl, tert-butyl, neopentyl, isopentyl, and 2,2-dimethylpropyl groups.
  • Representative substituted alkyl groups may be substituted one or more times with substituents such as those listed above.
  • Cycloalkyl groups are cyclic alkyl groups such as, but not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, and cyclooctyl groups.
  • the cycloalkyl group has 3 to 8 ring members, whereas in other embodiments the number of ring carbon atoms range from 3 to 5, 3 to 6, or 3 to 7.
  • Cycloalkyl groups further include mono-, bicyclic and polycyclic ring systems, such as, for example bridged cycloalkyl groups as described below, and fused rings, such as, but not limited to, decalinyl, and the like.
  • polycyclic cycloalkyl groups have three rings. Substituted cycloalkyl groups may be substituted one or more times with, non- hydrogen and non-carbon groups as defined above. However, substituted cycloalkyl groups also include rings that are substituted with straight or branched chain alkyl groups as defined above. Representative substituted cycloalkyl groups may be mono-substituted or substituted more than once, such as, but not limited to, 2,2-, 2,3-, 2,4- 2,5- or 2,6-disubstituted cyclohexyl groups, which may be substituted with substituents such as those listed above.
  • Bridged cycloalkyl groups are cycloalkyl groups in which two or more hydrogen atoms are replaced by an alkylene bridge, wherein the bridge can contain 2 to 6 carbon atoms if two hydrogen atoms are located on the same carbon atom, or 1 to 5 carbon atoms, if the two hydrogen atoms are located on adjacent carbon atoms, or 2 to 4 carbon atoms if the two hydrogen atoms are located on carbon atoms separated by 1 or 2 carbon atoms.
  • Bridged cycloalkyl groups can be bicyclic, such as, for example bicyclo[2.1.l]hexane, or tricyclic, such as, for example, adamantyl.
  • Representative bridged cycloalkyl groups include bicyclo[2.1.1]hexyl, bicyclo[2.2.1]heptyl, bicyclo[3.2.1]octyl, bicyclo[2.2.2]octyl, bicyclo[3.2.2]nonyl, bicyclo[3.3.1]nonyl, bicyclo[3.3.2]decanyl, adamantyl, noradamantyl, bornyl, or norbornyl groups.
  • Substituted bridged cycloalkyl groups may be substituted one or more times with non-hydrogen and non-carbon groups as defined above.
  • Representative substituted bridged cycloalkyl groups may be mono-substituted or substituted more than once, such as, but not limited to, mono-, di- or tri-substituted adamantyl groups, which may be substituted with substituents such as those listed above.
  • Cycloalkylalkyl groups are alkyl groups as defined above in which a hydrogen or carbon bond of an alkyl group is replaced with a bond to a cycloalkyl group as defined above.
  • cycloalkylalkyl groups have from 4 to 20 carbon atoms, 4 to 16 carbon atoms, and typically 4 to 10 carbon atoms.
  • Substituted cycloalkylalkyl groups may be substituted at the alkyl, the cycloalkyl or both the alkyl and cycloalkyl portions of the group.
  • Representative substituted cycloalkylalkyl groups may be mono-substituted or substituted more than once, such as, but not limited to, mono-, di- or tri-substituted with substituents such as those listed above.
  • Alkenyl groups include straight and branched chain and cycloalkyl groups as defined above, except that at least one double bond exists between two carbon atoms.
  • alkenyl groups have from 2 to about 20 carbon atoms, and typically from 2 to 12 carbons or, in some embodiments, from 2 to 8, 2 to 6, or 2 to 4 carbon atoms.
  • alkenyl groups include cycloalkenyl groups having from 4 to 20 carbon atoms, 5 to 20 carbon atoms, 5 to 10 carbon atoms, or even 5, 6, 7, or 8 carbon atoms.
  • Representative substituted alkenyl groups may be mono- substituted or substituted more than once, such as, but not limited to, mono-, di- or tri- substituted with substituents such as those listed above.
  • Cycloalkenylalkyl groups are alkyl groups as defined above in which a hydrogen or carbon bond of the alkyl group is replaced with a bond to a cycloalkenyl group as defined above. Substituted cycloalkylalkenyl groups may be substituted at the alkyl, the cycloalkenyl or both the alkyl and cycloalkenyl portions of the group. Representative substituted cycloalkenylalkyl groups may be substituted one or more times with substituents such as those listed above.
  • Alkynyl groups include straight and branched chain alkyl groups, except that at least one triple bond exists between two carbon atoms.
  • Representative substituted alkynyl groups may be mono-substituted or substituted more than once, such as, but not limited to, mono-, di- or tri-substituted with substituents such as those listed above.
  • Aryl groups are cyclic aromatic hydrocarbons that do not contain heteroatoms.
  • Aryl groups include monocyclic, bicyclic and polycyclic ring systems.
  • aryl groups include, but are not limited to, phenyl, azulenyl, heptalenyl, biphenylenyl, indacenyl, fluorenyl, phenanthrenyl, triphenylenyl, pyrenyl, naphthacenyl, chrysenyl, biphenyl, anthracenyl, indenyl, indanyl, pentalenyl, and naphthyl groups.
  • aryl groups contain 6-14 carbons, and in others from 6 to 12 or even 6-10 carbon atoms in the ring portions of the groups.
  • aryl groups includes groups containing fused rings, such as fused aromatic-aliphatic ring systems (e.g., indanyl, tetrahydronaphthyl, and the like), it does not include aryl groups that have other groups, such as alkyl or halo groups, bonded to one of the ring members. Rather, groups such as tolyl are referred to as substituted aryl groups.
  • Representative substituted aryl groups may be mono-substituted or substituted more than once.
  • monosubstituted aryl groups include, but are not limited to, 2-, 3-, 4-, 5-, or 6-substituted phenyl or naphthyl groups, which may be substituted with substituents such as those listed above.
  • Aralkyl groups are alkyl groups as defined above in which a hydrogen or carbon bond of an alkyl group is replaced with a bond to an aryl group as defined above.
  • aralkyl groups contain 7 to 20 carbon atoms, 7 to 14 carbon atoms or 7 to 10 carbon atoms.
  • Substituted aralkyl groups may be substituted at the alkyl, the aryl or both the alkyl and aryl portions of the group.
  • Representative aralkyl groups include but are not limited to benzyl and phenethyl groups and fused (cycloalkylaryl)alkyl groups such as 4- ethyl-indanyl.
  • Representative substituted aralkyl groups may be substituted one or more times with substituents such as those listed above.
  • Heterocyclyl groups include aromatic (also referred to as heteroaryl) and non- aromatic ring compounds containing 3 or more ring members, of which one or more is a heteroatom such as, but not limited to, N, O, and S.
  • heterocyclyl groups include 3 to 20 ring members, whereas other such groups have 3 to 6, 3 to 10, 3 to 12, or 3 to 15 ring members.
  • Heterocyclyl groups encompass unsaturated, partially saturated and saturated ring systems, such as, for example, imidazolyl, imidazolinyl and imidazolidinyl groups.
  • heterocyclyl group includes fused ring species including those comprising fused aromatic and non-aromatic groups, such as, for example, benzotriazolyl, 2,3-dihydrobenzo[l,4]dioxinyl, and benzo[l,3]dioxolyl.
  • the phrase also includes bridged polycyclic ring systems containing a heteroatom such as, but not limited to, quinuclidyl.
  • the phrase does not include heterocyclyl groups that have other groups, such as alkyl, oxo or halo groups, bonded to one of the ring members. Rather, these are referred to as "substituted heterocyclyl groups".
  • Heterocyclyl groups include, but are not limited to, aziridinyl, azetidinyl, pyrrolidinyl, imidazolidinyl, pyrazolidinyl, thiazolidinyl, tetrahydrothiophenyl, tetrahydrofuranyl, dioxolyl, furanyl, thiophenyl, pyrrolyl, pyrrolinyl, imidazolyl, imidazolinyl, pyrazolyl, pyrazolinyl, triazolyl, tetrazolyl, oxazolyl, isoxazolyl, thiazolyl, thiazolinyl, isothiazolyl, thiadiazolyl, oxadiazolyl, piperidyl, piperazinyl, morpholinyl, thiomorpholinyl, tetrahydropyranyl, tetrahydrothiopyranyl,
  • substituted heterocyclyl groups may be mono- substituted or substituted more than once, such as, but not limited to, pyridyl or morpholinyl groups, which are 2-, 3-, A-, 5-, or 6-substituted, or disubstituted with various substituents such as those listed above.
  • Heteroaryl groups are aromatic ring compounds containing 5 or more ring members, of which, one or more is a heteroatom such as, but not limited to, N, O, and S.
  • Heteroaryl groups include, but are not limited to, groups such as pyrrolyl, pyrazolyl, triazolyl, tetrazolyl, oxazolyl, isoxazolyl, thiazolyl, pyridyl, pyridazinyl, pyrimidinyl, pyrazinyl, thiophenyl, benzothiophenyl, furanyl, benzofuranyl, indolyl, azaindolyl (pyrrolopyridyl), indazolyl, benzimidazolyl, imidazopyridyl (azabenzimidazolyl), pyrazolopyridyl, triazolopyridyl, benzotriazolyl, benzoxazolyl, benzothi
  • heteroaryl groups includes fused ring compounds such as indolyl and 2,3-dihydro indolyl, the phrase does not include heteroaryl groups that have other groups bonded to one of the ring members, such as alkyl groups. Rather, heteroaryl groups with. such substitution are referred to as "substituted heteroaryl groups.” Representative substituted heteroaryl groups may be substituted one or more times with various substiruents such as those listed above. [00193] Heterocyclylalkyl groups are alkyl groups as defined above in which a hydrogen or carbon bond of an alkyl group is replaced with a bond to a heterocyclyl group as defined above.
  • Substituted heterocyclylalkyl groups may be substituted at the alkyl, the heterocyclyl or both the alkyl and heterocyclyl portions of the group.
  • Representative heterocyclyl alkyl groups include, but are not limited to, 4-ethyl-morpholinyl, 4-propylmorpholinyl, furan-2-yl methyl, furan-3-yl methyl, pyridine-3-yl methyl, tetrahydrofuran-2-yl ethyl, and indol-2-yl propyl.
  • Representative substituted heterocyclylalkyl groups may be substituted one or more times with substituents such as those listed above.
  • Heteroaralkyl groups are alkyl groups as defined above in which a hydrogen or carbon bond of an alkyl group is replaced with a bond to a heteroaryl group as defined above. Substituted heteroaralkyl groups may be substituted at the alkyl, the heteroaryl or both the alkyl and heteroaryl portions of the group. Representative substituted heteroaralkyl groups may be substituted one or more times with substituents such as those listed above.
  • Groups described herein having two or more points of attachment i.e., divalent, trivalent, or polyvalent
  • divalent alkyl groups are alkylene groups
  • divalent aryl groups are arylene groups
  • divalent heteroaryl groups are divalent heteroarylene groups
  • Substituted groups having a single point of attachment to the compound of the invention are not referred to using the "ene" designation.
  • chloroethyl is not referred to herein as chloroethylene.
  • Alkoxy groups are hydroxyl groups (-OH) in which the bond to the hydrogen atom is replaced by a bond to a carbon atom of a substituted or unsubstituted alkyl group as defined above.
  • linear alkoxy groups include but are not limited to methoxy, ethoxy, propoxy, butoxy, pentoxy, hexoxy, and the like.
  • branched alkoxy groups include but are not limited to isopropoxy, sec-butoxy, tert-butoxy, isopentoxy, isohexoxy, and the like.
  • cycloalkoxy groups include but are not limited to cyclopropyloxy, cyclobutyloxy, cyclopentyloxy, cyclohexyloxy, and the like.
  • Representative substituted alkoxy groups may be substituted one or more times with substituents such as those listed above.
  • aryloxy and arylalkoxy refer to, respectively, a substituted or unsubstituted aryl group bonded to an oxygen atom and a substituted or unsubstituted aralkyl group bonded to the oxygen atom at the alkyl. Examples include but are not limited to phenoxy, naphthyloxy, and benzyloxy. Representative substituted aryloxy and arylalkoxy groups may be substituted one or more times with substituents such as those listed above.
  • carboxylate refers to a -COOH group.
  • R 30 is a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl, aralkyl, heterocyclylalkyl or heterocyclyl group as defined herein.
  • amide (or “amido”) includes C- and N-amide groups, i.e.,
  • R 31 and R 32 are independently hydrogen, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, aryl, aralkyl, heterocyclylalkyl or heterocyclyl group as defined herein.
  • Amido groups therefore include but are not limited to carbamoyl groups (-C(O)NH 2 ) and formamide groups (-NHC(O)H).
  • Urethane groups include N- and O-urethane groups, i.e., -NR 33 C(O)OR 34 and
  • R 33 and R 34 are independently hydrogen, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, aryl, aralkyl, heterocyclylalkyl, or heterocyclyl group as defined herein.
  • amine refers to -NHR 35 and -NR 36 R 37 groups, wherein R 35 , R 36 and R 37 are independently hydrogen, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, aryl, aralkyl, heterocyclylalkyl or heterocyclyl group as defined herein.
  • the amine is NH 2 , methylamino, dimethylamino, ethylamino, diethylamino, propylamino, isopropylamino, phenylamino, or benzylamino.
  • sulfonamido includes S- and N-sulfonamide groups, i.e.,
  • R 38 and R 39 are independently hydrogen, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, aryl, aralkyl, heterocyclylalkyl, or heterocyclyl group as defined herein.
  • Sulfonamido groups therefore include but are not limited to sulfamoyl groups (-SO 2 NH 2 ).
  • thiol refers to -SH groups
  • sulfides include -SR 40 groups
  • sulfoxides include -S(O)R 41 groups
  • sulfones include -SO 2 R 42 groups
  • sulfonyls include -SO 2 OR 43 .
  • R 40 , R 41 , R 42 , and R 43 are each independently a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein.
  • urea refers to -NR 44 -C(O)-NR 45 R 46 groups.
  • R 44 , R 45 , and R 46 groups are independently hydrogen, or a substituted or unsubstituted alkyl, alkenyl, alkynyl, cycloalkyl, aryl, aralkyl, heterocyclyl, or heterocyclylalkyl group as defined herein.
  • amidine refers to -C(NR 47 )NR 48 R 49 and -NR 47 C(NR 48 )R 49 , wherein R 47 , R 48 , and R 49 are each independently hydrogen, or a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein.
  • guanidine refers to -NR 50 C(NR 51 JNR 52 R 53 , wherein R 50 , R 51 , R 52 and R 53 are each independently hydrogen, or a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein.
  • R 54 , R 55 , R 56 and R 57 are each independently hydrogen, a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein.
  • ⁇ mide refers to -C(O)NR 58 C(O)R 59 , wherein R 58 and R 59 are each independently hydrogen, or a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein.
  • the term "imine” refers to -CR 60 (NR 61 ) and -N(CR 60 R 61 ) groups, wherein R 60 and R 61 are each independently hydrogen or a substituted or unsubstituted alkyl, cycloalkyl, alkenyl, alkynyl, aryl aralkyl, heterocyclyl or heterocyclylalkyl group as defined herein, with the proviso that R 60 and R 61 are not both simultaneously hydrogen.
  • protected with respect to hydroxyl groups, amine groups, carboxy groups, and sulfhydryl groups refers to forms of these functionalities which are protected from undesirable reaction by means of protecting groups.
  • Protecting groups are known to those skilled in the art and can be added or removed using well-known procedures such as those set forth in Protective Groups in Organic Synthesis, Greene, T. W.; Wuts, P. G. M., John Wiley & Sons, New York, NY, (3rd Edition, 1999).
  • Examples of protected hydroxyl groups include, but are not limited to, silyl ethers such as those obtained by reaction of a hydroxyl group with a reagent such as, but not limited to, t-butyldimethyl-chlorosilane, trimethylchlorosilane, triisopropylchlorosilane, tri ethyl chlorosilane; substituted methyl and ethyl ethers such as, but not limited to methoxymethyl ether, methythiomethyl ether, benzyloxymethyl ether, t-butoxymethyl ether, 2-methoxyethoxymethyl ether, tetrahydropyranyl ethers, 1 -ethoxyethyl ether, allyl ether, benzyl ether; esters such as, but not limited to, benzoylformate, formate, acetate, trichloroacetate, and trifluoracetate.
  • a reagent such as, but not
  • N-Protecting groups comprise acyl groups such as formyl, acetyl, propionyl, pivaloyl, t-butylacetyl, 2-chloroacetyl, 2-bromoacetyl, trifluoroacetyl, trichloroacetyl, phthalyl, o-nitrophenoxyacetyl, a-chlorobutyryl, benzoyl, 4-chlorobenzoyl, 4-bromobenzoyl, 4-nitrobenzoyl, and the like; sulfonyl groups such as benzenesulfonyl, p-toluenesulfonyl and the like; carbamate forming groups such as benzyloxycarbonyl, p-chlorobenzyloxycarbonyl, p-methoxybenzyloxycarbonyl, p-nitrobenzyloxycarbonyl, 2-nitrobenzyloxycarbonyl, p-bro
  • N-protecting groups are formyl, acetyl, benzoyl, pivaloyl, t-butylacetyl, phenylsulfonyl, benzyl, 9-fluorenylmethyloxycarbonyl (Fmoc), t-butyloxycarbonyl (Boc) and benzyloxycarbonyl (Cbz).
  • Examples of protected sulfhydryl groups include, but are not limited to, thioethers such as S-benzyl thioether, S-t-butylthioether, and S-4-picolyl thioether; substituted S-methyl derivatives such as hemithio, dithio and aminothio acetals; and others.
  • thioethers such as S-benzyl thioether, S-t-butylthioether, and S-4-picolyl thioether
  • substituted S-methyl derivatives such as hemithio, dithio and aminothio acetals
  • Representative carboxy protecting groups are Cj to C 8 alkyl (e.g., methyl, ethyl or tertiary butyl and the like); haloalkyl; alkenyl; cycloalkyl and substituted derivatives thereof such as cyclohexyl, cyclopentyl and the like; cycloalkylalkyl and substituted derivatives thereof such as cyclohexylmethyl, cyclopentylmethyl and the like; arylalkyl, for example, phenethyl or benzyl and substituted derivatives thereof such as alkoxybenzyl or nitrobenzyl groups and the like; arylalkenyl, for example, phenylethenyl and the like; aryl and substituted derivatives thereof, for example, 5-indanyl and the like; dialkylaminoalkyl (e.g., dimethylaminoethyl and the like); alkanoyloxyalkyl groups such as
  • Tautomers refers to isomeric forms of a compound that are in equilibrium with each other.
  • concentrations of the isomeric forms will depend on the environment the compound is found in and may be different depending upon, for example, whether the compound is a solid or is in an organic or aqueous solution.
  • pyrazoles may exhibit the following isomeric forms, which are referred to as tautomers of each other:
  • Stereoisomers of compounds include all chiral, diastereomeric, and racemic forms of a structure, unless the specific stereochemistry is expressly indicated.
  • compounds used in the present invention include enriched or resolved optical isomers at any or all asymmetric atoms as are apparent from the depictions.
  • racemic and diastereomeric mixtures, as well as the individual optical isomers can be isolated or synthesized so as to be substantially free of their enantiomeric or diastereomeric partners, and these are all within the scope of the invention.
  • an aprotic solvent such as, for example DCM, ether, or toluene
  • L' when L' contains a urethane or carbonyl moiety, L' can be L 2 -Q, wherein L 2 is -(CH 2 ) n -OC(O)NR-(CH 2 )p- or -C(O)- respectively, and Q is as defined herein.
  • L' when L' contains a protected carboxylate group (e.g. ester), this group is deprotected under basic or acidic conditions (for example, NaOH or TFA respectively), followed by coupling with HNR-(CH 2 ) P -Q to form compound b, wherein L 2 is -(CH 2 ) ⁇ -C(O)NR-(CH 2 ) q -.
  • Coupling with the amine-containing moiety may be effected, for example, by the use of typical amide-bond-forming reagents such as EDC, PyBOP, and the like, or by introduction of an activating moiety.
  • the activating moiety is typically F, Cl, Br, I, N 3 , N-hydroxysuccinimide, 1 -hydroxybenzotriazole, pentafluorophenol, pentachlorophenol, para- nitrophenol, or OC(O)-OR y , wherein R y is a Ci-6 alkyl group.
  • Suitable bases include sodium bicarbonate or a suitable organoamine, such as pyridine, N-methylmorpholine, diisopropylethylamine or tri ethyl amine.
  • a suitable organoamine such as pyridine, N-methylmorpholine, diisopropylethylamine or tri ethyl amine.
  • any suitable amide-bond forming procedure may be used, such as those described in Bodanszky, M. and Bodanszky, A., Tke Practice of Peptide Synthesis, Springer- Verlag (1984); or Jones, J. Amino Acid and Peptide Synthesis Ed. Steven G. Davies, Oxford Science (1992).
  • L' when L' contains a protected amine, it can be similarly deprotected and coupled with Q-(CH 2 ) n -COOH by the methods described above, leading to compounds b, wherein L 2 is -(CH 2 ) n -C(O)NR-(CH 2 ) q -.
  • the nitro group of compound b is reduced to the amine, for example via hydrogenation in a solvent such as MeOH, EtOH, or the like, using Raney nickel or Pd/C as a catalyst, or reaction with SnCl 2 in a solvent such as DMF at room temperature.
  • Target compounds of Formula IA are finally obtained by coupling with a G-COOH moiety, by one of the coupling methods described above.
  • the nitro group in compound a is reduced first, followed by coupling with G-COOH, and finally conversion of L' to L 2 -Q, using the methods described above.
  • Scheme 2 depicts an alternative route to the aryl-isoxazole derivatives.
  • a suitably derivatized phenyl, pyridine or pyridazine, bearing an acetylene and amine moiety, is coupled to G-COOH by the methods described above to form compound d.
  • the aryl-isoxazole derivative e wherein L' is COOR/, is formed by reaction with phenyl isocyanate and alkyl nitroacetate (NO 2 CH 2 COOR y ), or an oxime derivative (L 'C(NOH)H) as above.
  • the ester can be deprotected and the resulting acid coupled with NH 2 (CH 2 VQ to provide L 2 -Q, wherein L 2 is -C(O)NH(CH 2 ) q -.
  • the alcohol is oxidized to the aldehyde moiety via Dess-Martin oxidation.
  • This intermediate can then be further derivatized as described above to generate the target compounds.
  • the nitro group of intermediate f is selectively reduced by treatment with hydrogen gas in the presence of Raney nickel or Pd/C.
  • the amine is coupled to G-COOH as described above.
  • the ester moiety can be reduced to the aldehyde directly via DIBAL reduction, or converted into the aldehyde via the alcohol, using LiAlHU reduction followed by Dess-Martin oxidation as before.
  • the compound thus obtained can be subjected to the reactions described above for aryl-isoxazole formation and futher derivatization.
  • aryl-pyrazole derivatives (Scheme 4), can be obtained from intermediate a, by ring opening via for example, reduction with hydrogen using Pd/C, followed by recyclization with hydrazine to form the target pyrazole intermediate. Futher derivatization proceeds as described above for the isoxazole derivatives.
  • ester can be deprotected and the resulting acid coupled with NH 2 (CH 2 ) q -Q to provide L 2 -Q, wherein L 2 is -C(O)NH(CH 2 ) q -.
  • Intermediate f can also be reacted with ammonia to form amide derivative g, which is converted to the nitrile and reacted with hydroxylamine, to generate the cyclization precursor h.
  • Cyclization to the aryl- oxadiazole derivative can be achieved by treatment with ethyl 2-chloro-2-oxoacetate (J. Med. Chem., 1995, 38, 1355; J. Med.
  • intermediate g can be reacted with chlorocarbonylsulfenyl chloride in the presence of ethyl carbonocyanidate (J. Chem. Soc, Perkin Trans. I 3 1987, 2339) to afford the arylthiadiazole intermediates, wherein L' is COOEt, which can be further derivatized as before.
  • Scheme 6 shows an exemplary synthesis route towards aryl-thiazole derivatives.
  • the aldehyde function of a suitably derivatized aryl precursor is converted into the epoxide moiety, which upon treatment with bromide anion (generated from NaBr, KBr and other bromide salts) and oxidation of the resulting ⁇ -bromohydrin yields the ⁇ - bromoketone derivative i.
  • Treatment of this intermediate with ethyl 2-amino-2-thioxoacetate yields the ester containing aryl-thiazole intermediate (J.Med. Chem., 2002, 45, 3865), which can be derivatized further as before.
  • pyridine precursors for the alternate orientations of L 1 can be prepared by reported methods (see for example, J. Med. Chem., 1974, 17, 172; J. Org. Chem., 1984, 49, 193; J. Am. Chem. Soc, 1953, 75, 737; J. Med. Chem., 1977, 20, 129; J. Am. Chem. Soc, 1961, 26, 3420; J. Am. Chem. Soc, 1947, 69, 2574; J. Med. Chem., 1978, 21, 194; J. Med. Chem., 1993, 36, 2676; J. Med. Chem., 1990, 33, 1859; Synthesis, 1986, 400), or by modification or extension of those methods.
  • a "cytokine inhibitor" within the context of this invention is a compound which at a concentration of 10 ⁇ M inhibits induced cytokine release from a cell by about 50% or greater than 50%.
  • induction of TNFa release can be achieved by, but not limited to, treatment of a cell or cell line with lipopolysaccharide (LPS) or IL-Ib and is inhibited by compounds described herein.
  • LPS lipopolysaccharide
  • IL-Ib IL-Ib
  • Lipoproteins are complexes which contain both a lipid and protein. Most of the lipids in plasma are present as lipoproteins and are transported as such. Lipoproteins are characterized by their flotation constants (e.g., densities). Various classes of lipoproteins exist and include high density lipoproteins (HDL) and low density lipoproteins (LDL). LDLs are particularly rich in cholesterol esters. Traditionally, high levels of LDL and/or low levels of HDL are associated with coronary artery disease. Epidemiological studies have shown that high concentrations of HDL (over 60 mg/dl) have protective value against cardiovascular diseases.
  • HDL high density lipoproteins
  • LDL low density lipoproteins
  • Low concentrations of HDL (below 40 mg/dl for men, below 50 mg/dl for women) are a positive risk factor for atherosclerotic diseases.
  • a near optimal level of LDL is considered to be between 100 to 129 mg/dl, with levels below 100 mg/dl considered optimal, while very high LDL levels (above 190 mg/dl) correspond to the highest increased risk of heart disease.
  • Glucose or "blood sugar" is normally present in humans at concentrations of about 80-120 mg/dl and is the principal source of carbohydrate energy for man and many other organisms. Excess glucose is stored in the body (especially in the liver and muscles) as glycogen, a starch-like substance which is, essentially, polymerized glucose. Glycogen is metabolized into glucose as needed to meet bodily requirements.
  • Glucose normally stimulates both the secretion and biosynthesis of insulin.
  • basal insulin secretion namely the biological process by which insulin is released into the circulation in the absence of stimulation by levels of glucose, or other agents that promote insulin secretion, that are elevated above their "fasting" or non-fed levels.
  • the values for fasting and postprandial (after a meal) insulin are about 14 to 145 pmol/1, and 100 to 300 pmol/1 respectively in healthy people, with perhaps 3-to 4-fold higher levels in insulin-resistant people.
  • HgAIc is a form of hemoglobin used primarily to identify the plasma glucose concentration over time.
  • the normal range that found in healthy subjects
  • People with diabetes mellitus often have higher levels of HbAl c.
  • diabetic subject treatment goals vary, many include a target range of HbAIc values.
  • a diabetic with good glucose control has a HbAIc level that is close to or within the reference range.
  • the International Diabetes Federation and American College of Endocrinology recommends HbAIc values below 6.5%, while the range recommended by the American Diabetes Association extends to 7%.
  • a very high HbAl c represents poor glucose control.
  • Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Insulin
  • Metabolic syndrome also known as Syndrome X, Metabolic Syndrome X, insulin resistance syndrome, is a combination of medical disorders, having at least three of the following symptoms and features: fasting hyperglycemia (including diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance or insulin resistance), high blood pressure, central obesity (also known as visceral adiposity), decreased HDL cholesterol, and elevated triglycerides.
  • Insulin resistance can be detected by the following indications: as an increased level of blood insulin, increased blood level of glucose in response to oral glucose tolerance test (OGTT), decreased level of phosphorylated protein kinase B (AKT) in response to insulin administration, and the like. Insulin resistance may be caused by decreased sensitivity of the insulin receptor-related signaling system in cells and/or by loss of beta cells in the pancreas through apoptosis. There is also evidence that insulin resistance can be characterized as having an underlying inflammatory component.
  • OGTT oral glucose tolerance test
  • AKT phosphorylated protein kinase B
  • Bilirubin is formed when red blood cells die and their hemoglobin is broken down within the macrophages to heme and globins. The heme is further degraded to Fe 2+ , carbon monoxide and bilirubin via the intermediate compound biliverdin. Since bilirubin is poorly soluble in water, it is carried to the liver and bound to albumin. Bilirubin is made water-soluble in the liver by conjugation with glucuronic acid. Conjugated bilirubin, or bilirubinglucuronide, moves into the bile canaliculi of the liver and then to the gall bladder.
  • Bilirubin is found in blood either in the conjugated form (also called direct bilirubin), or in the unconjugated form (also called indirect bilirubin).
  • the reference range for total bilirubin is 0.3 - 1.0 mg/dl.
  • For direct bilirubin it is 0.1 - 0.3 mg/dl, while for indirect bilirubin it is 0.2 - 0.7 mg/dl.
  • the concentration of total bilirubin in the blood must exceed 2-3 mg/dl for the coloration to be easily visible.
  • Treating within the context of the instant invention, means an alleviation, in whole or in part, of symptoms associated with a disorder or disease, or slowing or halting of further progression or worsening of those symptoms, or prevention or prophylaxis of the disease or disorder in a subject at risk for developing the disease or disorder.
  • successful treatment may include an alleviation of symptoms or slowing or halting the progression of the disease, as measured by a reduction in the growth rate of a tumor, a halt in the growth of the tumor, a reduction in the size of a tumor, partial or complete remission of the cancer, or increased survival rate or clinical benefit.
  • a "therapeutically effective amount" of a compound of the invention refers to an amount of the compound that alleviates, in whole or in part, symptoms associated with a disorder or disease, or slows or halts of further progression or worsening of those symptoms, or prevents or provides prophylaxis for the disease or disorder in a subject at risk for developing the disease or disorder.
  • a subject is any animal that can benefit from the administration of a cytokine inhibitor, hi some embodiments, the subject is a mammal, for example, a human, a primate, a dog, a cat, a horse, a cow, a pig, a rodent, such as for example a rat or mouse.
  • the mammal is a human.
  • Subjects who are at risk for a cardiovascular and/or cerebrovascular event are also subjects who manifest at least one symptom indicative of a vascular disorder/event.
  • Symptoms that are indicative of a coronary-related vascular event include chest pain, abnormal electrocardiograms, elevated levels of ischemic markers, necrosis markers, or thrombin/fibrin generation markers.
  • Such markers include, but are not limited to, Creatine Kinase with Muscle and/or Brain subunits (CKMB), D-Dimer, F 1.2, thrombin anti-thrombin (TAT), soluble fibrin monomer (SFM), fibrin peptide A (FPA), myoglobin, thrombin precursor protein (TPP), platelet monocyte aggregate (PMA) and troponin (cTn).
  • Subjects who are at risk also include subjects having a history of a thrombotic event (e.g. disorder), including Coronary Heart Disease (CHD), stroke, or transient ischemic attacks (TIA).
  • a thrombotic event e.g. disorder
  • CHD Coronary Heart Disease
  • TIA transient ischemic attacks
  • a history of CHD can include, for example, a history of MI, coronary revascularization procedure, angina with ischemic changes, or a positive coronary angiogram (e.g., showing greater than about 50% stenosis of at least one major coronary artery).
  • Treatment may also include administering the compounds or pharmaceutical formulations of the present invention in combination with other therapies.
  • Combinations of the invention may be administered simultaneously, separately or sequentially.
  • the compounds and pharmaceutical formulations of the present invention maybe administered before, during, or after surgical procedure and/or radiation therapy.
  • the compounds of the invention can also be administered in conjunction with other anti -inflammatory agents, anticancer agents and other agents described herein.
  • many types of immunomodulatory, immunosuppressive or cytostatic drugs, as described herein, can be used in combination with the cytokine inhibitors.
  • carcinomas Malignancies of epithelial glandular tissue such as are found in the breast, prostate, and colon, are known as adenocarcinomas.
  • Malignant growths of connective tissue e.g., muscle, cartilage, lymph tissue, and bone, are called sarcomas. Lymphomas and leukemias are malignancies arising among the white blood cells.
  • prevention or chemoprevention includes either preventing the onset of clinically evident neoplasia altogether or preventing the onset of a preclinically evident stage of neoplasia in individuals at risk. Also intended to be encompassed by this definition is the prevention of transformation into malignant cells or to arrest or reverse the progression of premalignant cells to malignant cells. This includes prophylactic treatment of those at risk of developing the neoplasia.
  • nociceptive pain includes, but is not limited to, pain associated with chemical or thermal burns, cuts of the skin, contusions of the skin, osteoarthritis, rheumatoid arthritis, tendonitis, and myofascial pain.
  • neuroopathic pain includes, but is not limited to, CRPS (Complex
  • RSD reflex sympathetic dystrophy
  • reflex sympathetic dystrophy 5 reflex neurovascular dystrophy, reflex sympathetic dystrophy, reflex neurovascular dystrophy, reflex dystrophy, sympathetically maintained pain syndrome, causalgia, Sudeck atrophy of bone, algoneurodystrophy, shoulder hand syndrome, post-traumatic dystrophy, trigeminal neuralgia, post herpetic neuralgia, cancer and metastases related pain, phantom limb pain, fibromyalgia, chronic fatigue syndrome, spinal cord injury pain, central post-stroke pain, radiculopathy, diabetic neuropathy, post-stroke pain, luetic neuropathy, and other painful neuropathic conditions such as those induced by drugs such as vincristine, velcade and thalidomide.
  • the neuropathic pain can result from a mononeuropathy, polyneuropathy, complex regional pain syndromes or deafferentation.
  • neuropathy includes, but is not limited to, a functional disturbance or pathological change in the nervous system, especially in the peripheral nervous system, and is characterized clinically by sensory or motor neuron abnormalities.
  • mononeuropathy indicates that a single nerve is affected, while the term polyneuropathy indicates that several nerves are affected.
  • Deafferentation indicates a loss of the sensory input from a portion of the body, and can be caused by interruption of either peripheral sensory fibers or nerves from the central nervous system.
  • the etiology of a neuropathy can be known or unknown.
  • Known etiologies include complications of a disease or toxic state such as diabetes, which is the most common metabolic disorder causing neuropathy, or irradiation, ischemia or vasculitis. It is understood that the methods of the invention can be used to treat chronic pain of these or other chronic neuropathies of known or unknown etiology.
  • the specific amount of the additional active agent will depend on the specific agent used, the type of condition being treated or managed, the severity and stage of the condition, and the amount(s) of compounds and any optional additional active agents concurrently administered to the subject.
  • one or more compounds of the invention and an additional active agent are administered to a subject, more typically a human, in a sequence and within a time interval such that the compound can act together with the other agent to provide an enhanced benefit relative to the benefits obtained if they were administered otherwise.
  • the additional active agents can be coadminstered by coformulation, administered at the same time or administered sequentially in any order at different points in time; however, if not administered at the same time, they should be administered sufficiently close in time so as to provide the desired therapeutic or prophylactic effect.
  • the compound and the additional active agents exert their effects at times which overlap.
  • Each additional active agent can be administered separately, in any appropriate form and by any suitable route.
  • the compound is administered before, concurrently or after administration of the additional active agents.
  • the compound and the additional active agents are administered less than about 1 hour apart, at about 1 hour apart, at about 1 hour to about 2 hours apart, at about 2 hours to about 3 hours apart, at about 3 hours to about 4 hours apart, at about 4 hours to about 5 hours apart, at about 5 hours to about 6 hours apart, at about 6 hours to about 7 hours apart, at about 7 hours to about 8 hours apart, at about 8 hours to about 9 hours apart, at about 9 hours to about 10 hours apart, at about 10 hours to about 1 1 hours apart, at about 11 hours to about 12 hours apart, no more than 24 hours apart or no more than 48 hours apart.
  • the compound and the additional active agents are administered concurrently.
  • the compound and the additional active agents are administered concurrently by coformulation.
  • the compound and the additional active agents are administered at about 2 to 4 days apart, at about 4 to 6 days apart, at about 1 week part, at about 1 to 2 weeks apart, or more than 2 weeks apart.
  • the inventive compound and optionally the additional active agents are cyclically administered to a subject.
  • Cycling therapy involves the administration of a first agent for a period of time, followed by the administration of a second agent and/or third agent for a period of time and repeating this sequential administration. Cycling therapy can provide a variety of benefits, e.g., reduce the development of resistance to one or more of the therapies, avoid or reduce the side effects of one or more of the therapies, and/or improve the efficacy of the treatment.
  • the inventive compound and optionally the additional active agent are administered in a cycle of less than about 3 weeks, about once every two weeks, about once every 10 days or about once every week.
  • One cycle can comprise the administration of an inventive compound and optionally the second active agent by infusion over about 90 minutes every cycle, about 1 hour every cycle, about 45 minutes every cycle, about 30 minutes every cycle or about 15 minutes every cycle.
  • Each cycle can comprise at least 1 week of rest, at least 2 weeks of rest, at least 3 weeks of rest.
  • the number of cycles administered is from about 1 to about 12 cycles, more typically from about 2 to about 10 cycles, and more typically from about 2 to about 8 cycles.
  • Courses of treatment can be administered concurrently to a subject, i.e., individual doses of the additional active agents are administered separately yet within a time interval such that the inventive compound can work together with the additional active agents.
  • one component can be administered once per week in combination with the other components that can be administered once every two weeks or once every three weeks.
  • the dosing regimens are carried out concurrently even if the therapeutics are not administered simultaneously or during the same day.
  • the additional active agents can act additively or, more typically, synergistically with the inventive compound.
  • the inventive compound is administered concurrently with one or more second active agents in the same pharmaceutical composition.
  • the inventive compound is administered concurrently with one or more second active agents in separate pharmaceutical compositions.
  • the inventive compound is administered prior to or subsequent to administration of a second active agent.
  • the invention contemplates administration of an inventive compound and a second active agent by the same or different routes of administration, e.g., oral and parenteral.
  • the inventive compound when administered concurrently with a second active agent that potentially produces adverse side effects including, but not limited to, toxicity, the second active agent can advantageously be administered at a dose that falls below the threshold that the adverse side effect is elicited.
  • the instant invention also provides for pharmaceutical compositions and medicaments which may be prepared by mixing one or more compounds of the invention, prodrugs thereof, pharmaceutically acceptable salts thereof, stereoisomers thereof, tautomers thereof, or solvates thereof, with pharmaceutically acceptable carriers, excipients, binders, diluents or the like to prevent and treat disorders associated with excess cytokine production.
  • the compounds and compositions of the invention may be used to prepare formulations and medicaments that prevent or treat a variety of disorders associated with excess cytokine production as disclosed herein, e.g., diseases and pathological conditions involving inflammation, pain, cancer, etc.
  • compositions can be in the form of, for example, granules, powders, tablets, capsules, syrup, suppositories, injections, emulsions, elixirs, suspensions or solutions.
  • the instant compositions can be formulated for various routes of administration, for example, by oral, parenteral, topical, rectal, nasal, vaginal administration, or via implanted reservoir.
  • Parenteral or systemic administration includes, but is not limited to, subcutaneous, intravenous, intraperitoneally, intramuscular, intra-articular, intrasynovial, intrasternal, intrathecal, intralesional and intracranial injections.
  • the following dosage forms are given by way of example and should not be construed as limiting the instant invention.
  • compositions are considered within the scope of the present invention.
  • pharmaceutically acceptable salts can be formed with inorganic acids (such as hydrochloric acid, hydroboric acid, nitric acid, sulfuric acid, and phosphoric acid), organic acids (e.g.
  • the compound of the invention can form salts with metals, such as alkali and earth alkali metals (e.g.
  • organic amines e.g.trimethylamine, triethylamine, pyridine, picoline, ethanolamine, diethanolamine, triethanolamine
  • basic amino acids e.g. arginine, lysine and ornithine
  • prodrugs Certain compounds within the scope of the invention are derivatives referred to as prodrugs.
  • the expression "prodrug” denotes a derivative of a known direct acting drug, e.g. esters and amides, which derivative has enhanced delivery characteristics and therapeutic value as compared to the drug, and is transformed into the active drug by an enzymatic or chemical process; see Notari, R.E., "Theory and Practice of Prodrug Kinetics," Methods in Enzymology 7/2:309-323 (1985); Bodor, N., “Novel Approaches in Prodrug Design," Drugs of the Future 6:165-182 (1981); and Bundgaard, H., “Design of Prodrugs: Bioreversible- Derivatives for Various Functional Groups and Chemical Entities,” in Design of Prodrugs (H.
  • powders, suspensions, granules, tablets, pills, capsules, gelcaps, and caplets are acceptable as solid dosage forms. These can be prepared, for example, by mixing one or more compounds of the instant invention, or pharmaceutically acceptable salts or tautomers thereof, with at least one additive such as a starch or other additive.
  • Suitable additives are sucrose, lactose, cellulose sugar, mannitol, maltitol, dextran, starch, agar, alginates, chitins, chitosans, pectins, tragacanth gum, gum arabic, gelatins, collagens, casein, albumin, synthetic or semi-synthetic polymers or glycerides.
  • oral dosage forms can contain other ingredients to aid in administration, such as an inactive diluent, or lubricants such as magnesium stearate, or preservatives such as paraben or sorbic acid, or anti-oxidants such as ascorbic acid, tocopherol or cysteine, a disintegrating agent, binders, thickeners, buffers, sweeteners, flavoring agents or perfuming agents. Tablets and pills may be further treated with suitable coating materials known in the art.
  • suitable coating materials known in the art.
  • Liquid dosage forms for oral administration may be in the form of pharmaceutically acceptable emulsions, syrups, elixirs, suspensions, and solutions, which may contain an inactive diluent, such as water.
  • Pharmaceutical formulations and medicaments may be prepared as liquid suspensions or solutions using a sterile liquid, such as, but not limited to, an oil, water, an alcohol, and combinations of these.
  • Pharmaceutically suitable surfactants, suspending agents, emulsifying agents may be added for oral or parenteral administration.
  • suspensions may include oils.
  • oils include, but are not limited to, peanut oil, sesame oil, cottonseed oil, corn oil and olive oil.
  • Suspension preparation may also contain esters of fatty acids such as ethyl oleate, isopropyl myristate, fatty acid glycerides and acetylated fatty acid glycerides.
  • Suspension formulations may include alcohols, such as, but not limited to, ethanol, isopropyl alcohol, hexadecyl alcohol, glycerol and propylene glycol.
  • Injectable dosage forms generally include aqueous suspensions or oil suspensions which may be prepared using a suitable dispersant or wetting agent and a suspending agent. Injectable forms may be in solution phase or in the form of a suspension, which is prepared with a solvent or diluent. Acceptable solvents or vehicles include sterilized water, Ringer's solution, or an isotonic aqueous saline solution. Alternatively, sterile oils may be employed as solvents or suspending agents. Typically, the oil or fatty acid is nonvolatile, including natural or synthetic oils, fatty acids, mono-, di- or tri-glycerides.
  • the pharmaceutical formulation and/or medicament may be a powder suitable for reconstitution with an appropriate solution as described above.
  • these include, but are not limited to, freeze dried, rotary dried or spray dried powders, amorphous powders, granules, precipitates, or particulates.
  • the formulations may optionally contain stabilizers, pH modifiers, surfactants, bioavailability modifiers and combinations of these.
  • the pharmaceutical formulations and medicaments may be in the form of a suppository, an ointment, an enema, a tablet or a cream for release of compound in the intestines, sigmoid flexure and/or rectum.
  • Rectal suppositories are prepared by mixing one or more compounds of the instant invention, or pharmaceutically acceptable salts or tautomers of the compound, with acceptable vehicles, for example, cocoa butter or polyethylene glycol, which is present in a solid phase at normal storing temperatures, and present in a liquid phase at those temperatures suitable to release a drug inside the body, such as in the rectum.
  • Oils may also be employed in the preparation of formulations of the soft gelatin type and suppositories.
  • Water, saline, aqueous dextrose and related sugar solutions, and glycerols may be employed in the preparation of suspension formulations which may also contain suspending agents such as pectins, carbomers, methyl cellulose, hydroxypropyl cellulose or carboxymethyl cellulose, as well as buffers and preservatives.
  • Compounds of the invention may be administered to the lungs by inhalation through the nose or mouth.
  • suitable pharmaceutical formulations for inhalation include solutions, sprays, dry powders, or aerosols containing any appropriate solvents and optionally other compounds such as, but not limited to, stabilizers, antimicrobial agents, antioxidants, pH modifiers, surfactants, bioavailability modifiers and combinations of these.
  • Formulations for inhalation administration contain as excipients, for example, lactose, ⁇ olyoxyethylene-9- lauryl ether, glycocholate and deoxycholate.
  • Aqueous and nonaquous aerosols are typically used for delivery of inventive compounds by inhalation.
  • an aqueous aerosol is made by formulating an aqueous solution or suspension of the compound together with conventional pharmaceutically acceptable carriers and stabilizers.
  • the carriers and stabilizers vary with the requirements of the particular compound, but typically include nonionic surfactants (Tweens, Pluronics, or polyethylene glycol), innocuous proteins like serum albumin, sorbitan esters, oleic acid, lecithin, amino acids such as glycine, buffers, salts, sugars or sugar alcohols.
  • Aerosols generally are prepared from isotonic solutions.
  • a nonaqueous suspension e.g., in a fluorocarbon propellant
  • Aerosols containing compounds for use according to the present invention are conveniently delivered using an inhaler, atomizer, pressurized pack or a nebulizer and a suitable propellant, e.g., without limitation, pressurized dichlorodifiuoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, nitrogen, air, or carbon dioxide.
  • a suitable propellant e.g., without limitation, pressurized dichlorodifiuoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, nitrogen, air, or carbon dioxide.
  • the dosage unit may be controlled by providing a valve to deliver a metered amount.
  • Capsules and cartridges of, for example, gelatin for use in an inhaler or insufflator may be formulated containing a powder mix of the compound and a suitable powder base such as lactose or starch. Delivery of aerosols of the present invention using sonic nebulizers is advantageous because nebulizers minimize exposure of the agent to shear, which can result in degradation of the compound.
  • the pharmaceutical formulations and medicaments may be a spray, nasal drops or aerosol containing an appropriate solvent(s) and optionally other compounds such as, but not limited to, stabilizers, antimicrobial agents, antioxidants, pH modifiers, surfactants, bioavailability modifiers and combinations of these.
  • the compounds may be formulated in oily solutions or as a gel.
  • any suitable propellant may be used including compressed air, nitrogen, carbon dioxide, or a hydrocarbon based low boiling solvent.
  • Dosage forms for the topical (including buccal and sublingual) or transdermal administration of compounds of the invention include powders, sprays, ointments, pastes, creams, lotions, gels, solutions, and patches.
  • the active component may be mixed under sterile conditions with a pharmaceutically-acceptable carrier or excipient, and with any preservatives, or buffers, which may be required.
  • Powders and sprays can be prepared, for example, with excipients such as lactose, talc, silicic acid, aluminum hydroxide, calcium silicates and polyamide powder, or mixtures of these substances.
  • the ointments, pastes, creams and gels may also contain excipients such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
  • excipients such as animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
  • Transdermal patches have the added advantage of providing controlled delivery of a compound of the invention to the body.
  • dosage forms can be made by dissolving or dispersing the agent in the proper medium.
  • Absorption enhancers can also be used to increase the flux of the inventive compound across the skin. The rate of such flux can be controlled by either providing a rate controlling membrane or dispersing the compound in a polymer matrix or gel.
  • Ophthalmic formulations eye ointments, powders, solutions and the like, are also contemplated as being within the scope of this invention.
  • the compounds of this invention can be incorporated into various types of ophthalmic formulations for delivery to the eye (e.g., topically, intracamerally, or via an implant).
  • the compounds are typically incorporated into topical ophthalmic formulations for delivery to the eye.
  • the compounds may be combined with one or more ophthalmologically acceptable preservatives, viscosity enhancers, penetration enhancers, buffers, sodium chloride, and water to form an aqueous, sterile ophthalmic suspension or solution.
  • Ophthalmic solution formulations may be prepared by dissolving a compound in a physiologically acceptable isotonic aqueous buffer.
  • the ophthalmic solution may include an ophthalmologically acceptable surfactant to assist in dissolving the compound.
  • the ophthalmic solution may contain an agent to increase viscosity, such as hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, methylcellulose, polyvinylpyrrolidone, or the like, to improve the retention of the formulation in the conjunctival sac.
  • Gelling agents can also be used, including, but not limited to, gellan and xanthan gum.
  • sterile ophthalmic ointment formulations the compound of the invention is combined with a preservative in an appropriate vehicle, such as, mineral oil, liquid lanolin, or white petrolatum.
  • a preservative in an appropriate vehicle, such as, mineral oil, liquid lanolin, or white petrolatum.
  • Sterile ophthalmic gel formulations may be prepared by suspending the invention compound in a hydrophilic base prepared from the combination of, for example, carbopol-974, or the like, according to the published formulations for analogous ophthalmic preparations. Preservatives and tonicity agents can be optionally incorporated.
  • Intrathecal administration via bolus dosage or constant infusion, allows the local administration of a compound to a region of the spinal cord, such as the dorsal horn regions, delivering the compound directly to the subarachnoid space containing the CSF (cerebrospinal fluid).
  • a region of the spinal cord such as the dorsal horn regions
  • Central delivery to the spinal cord regions can also be performed by epidural injection to a region of the spinal cord exterior to the arachnoid membrane.
  • Enhancing permeation of the active compound through meningeal membranes may be achieved by using hypertonic dosing solutions that increase permeability of meningeal membranes, or by addition of permeation enhancers, such as, but not limited to, liposomal encapsulation, surfactants, or ion-pairing agents.
  • excipients and carriers are generally known to those skilled in the art and are thus included in the instant invention. Such excipients and carriers are described, for example, in "Remingtons Pharmaceutical Sciences” Mack Pub. Co., New Jersey (1991), which is incorporated herein by reference.
  • the formulations of the invention may be designed to be short-acting, fast- releasing, long-acting, and sustained-releasing as described below.
  • the pharmaceutical formulations may also be formulated for controlled release or for slow release.
  • compositions may also comprise, for example, micelles or liposomes, or some other encapsulated form, or may be administered in an extended release form to provide a prolonged storage and/or delivery effect. Therefore, the pharmaceutical formulations and medicaments may be compressed into pellets or cylinders and implanted intramuscularly or subcutaneously as depot injections or as implants such as stents. Such implants may employ known inert materials such as silicones and biodegradable polymers.
  • the present disclosure also provides medical devices incorporating the cytokine inhibitors as described herein.
  • a representative device includes a vascular stent coated or impregnated with the cytokine inhibitors as described herein. The device can be configured to be inserted into a blood vessel where it can release the cytokine inhibitors as described herein to help reduce or prevent vascular inflammation, for example vascular inflammation.
  • cytokine inhibitors as described herein, or a combination of the cytokine inhibitors with additional ingredients A, as described herein.
  • the cytokine inhibitors as described herein can be coated on the surface of the medical device or the device can be saturated with the cytokine inhibitors such that the cytokine inhibitors are released from the device, for example over a period of time.
  • Exemplary medical devices including the cytokine inhibitors as disclosed herein include, but are not limited to, vascular medical devices such as vascular stents.
  • Stents and methods for making and using stents coated or impregnated with therapeutic agents are well-known in the art: see, e.g., U.S. Application No. US20050181977 and U.S. Application No. US20050129729.
  • Specific dosages may be adjusted depending on conditions of disease, the age, body weight, general health conditions, sex, and diet of the subject, dose intervals, administration routes, excretion rate, and combinations of drugs. Any of the above dosage forms containing effective amounts are well within the bounds of routine experimentation and therefore, well within the scope of the instant invention.
  • a therapeutically effective amount of a compound of the present invention may vary depending upon the route of administration and dosage form. Effective amounts of invention compounds typically fall in the range of about 0.001 up to 100 mg/kg/day, and more typically in the range of about 0.05 up to 10 mg/kg/day. Typically, the compound or compounds of the instant invention are selected to provide a formulation that exhibits a high therapeutic index.
  • the therapeutic index is the dose ratio between toxic and therapeutic effects which can be expressed as the ratio between LD 50 and ED 50 .
  • the LD 50 is the dose lethal to 50% of the population and the ED 50 is the dose therapeutically effective in 50% of the population.
  • the LD 50 and ED 50 are determined by standard pharmaceutical procedures in animal cell cultures or experimental animals.
  • the cytokine inhibitors can be used in the methods and compositions of the invention either alone or together with additional treatments or active ingredients or a combination thereof. Additional treatments comprise treatment by surgery, radiation, or cryotherapy, while treatment with additional active ingredients comprises the use of anti-proliferative agents. Combinations of drugs are administered in an attempt to obtain a synergistic cytotoxic effect on most cancers, e.g., carcinomas, melanomas, lymphomas and sarcomas, and to reduce or eliminate emergence of drug-resistant cells and to reduce side effects to each drug.
  • Additional treatments comprise treatment by surgery, radiation, or cryotherapy
  • additional active ingredients comprises the use of anti-proliferative agents.
  • Combinations of drugs are administered in an attempt to obtain a synergistic cytotoxic effect on most cancers, e.g., carcinomas, melanomas, lymphomas and sarcomas, and to reduce or eliminate emergence of drug-resistant cells and to reduce side effects to each drug.
  • the additional active agent will depend on the specific agent used, the type of cancer being treated or managed, the severity and stage of the cancer, and the amount(s) of cytokine inhibitors and any optional additional active agents concurrently administered to the subject.
  • the additional active ingredients that can be used in combination with the cytokine inhibitors of the present invention are used at dosages well known in the art.
  • antiproliferative agents includes agents that prevent the development, maturation, or spread of cells, by acting directly on the cell, e.g., by cytostatic or cytocidal effects, and not indirectly through mechanisms such as biological response modification.
  • cytostatic or cytocidal effects e.g., by cytostatic or cytocidal effects
  • biological response modification e.g., by cytostatic or cytocidal effects
  • Typical antiproliferative agents can be categorized as alkylating agents, platinum agents, antimetabolites, topoisomerase inhibitors, antitumor antibiotics, antimitotic agents, aromatase inhibitors, thymidylate synthase inhibitors, DNA antagonists, farnesyltransferase inhibitors, pump inhibitors, histone acetyl transferase inhibitors, metalloproteinase inhibitors, ribonucleoside reductase inhibitors, endothelin A receptor antagonists, retinoic acid receptor agonists, immunomodulators, hormonal or antihormonal agents, photodynamic agents, angiogenesis inhibitors, tyrosine kinase inhibitors, and the like. Some antiproliferative agents operate through multiple or unknown mechanisms and can thus be classified into more than one category.
  • a family of antiproliferative agents which may be used in combination with the present invention includes alkylating-type agents.
  • the alkylating agents are believed to act by alkylating and cross-linking guanine and possibly other bases in DNA, arresting cell division.
  • Typical alkylating agents include nitrogen mustards, ethyleneimine compounds, alkyl sulfates, cisplatin, and various nitrosoureas.
  • a disadvantage with these compounds is that they not only attack malignant cells, but also other cells which are naturally dividing, such as those of bone marrow, skin, gastro-intestinal mucosa, and fetal tissue.
  • Suitable alkylating-type agents include, but are not limited to, busulfan, procarbazine, ifosfamide, altretamine, hexamethylmelamine, estramustine phosphate, thiotepa, mechlorethamine, dacarbazine, streptozocin, lomustine, temozolomide, cyclophosphamide, semustine, and chlorambucil.
  • a family of antiproliferative agents which may be used in combination with the present invention includes platinum agents.
  • Suitable platinum agents that may be used in the present invention include, but are not limited to spiroplatin, lobaplatin (Aeterna), tetraplatin, satraplatin (Johnson Matthey), ormaplatin, iproplatin, miriplatin (Sumitomo), nexplatin (AnorMED), polymer platinate (Access), oxaliplatin, or carboplatin.
  • An additional family of antiproliferative agents which may be used in combination with the present invention includes antimetabolite-type agents.
  • Antimetabolites are typically reversible or irreversible enzyme inhibitors, or compounds that otherwise interfere with the replication, translation or transcription of nucleic acids.
  • Suitable antimetabolite agents include, but are not limited to azacytidine, trimetrexate, floxuridine, deoxycoformycin, 2-chlorodeoxyadenosine, pentostatin, 6-mercaptopurine, hydroxyurea, 6-thioguanine, decitabine (SuperGen), cytarabine, clofarabine (Bioenvision), 2-fluorodeoxy cytidine, irofulven (MGI Pharma), methotrexate, tomudex, ethynylcytidine (Taiho), fludarabine, gemcitabine, raltitrexed, or capecitabine.
  • azacytidine trimetrexate, floxuridine, deoxycoformycin, 2-chlorodeoxyadenosine, pentostatin, 6-mercaptopurine, hydroxyurea, 6-thioguanine, decitabine (SuperGen), cytarabine, clofarabine (Bioenvision
  • topoisomerase inhibitors Another family of antiproliferative agents which may be used in combination with the present invention includes topoisomerase inhibitors.
  • Suitable topoisomerase agents include, but are not limited to amsacrine, exatecan mesylate (Daiichi), epirubicin, quinamed (ChemGenex), etoposide, gimatecan (Sigma-Tau), teniposide, mitoxantrone, diflomotecan (Beaufour-Ipsen), 7-ethyl-lO-hydroxy-camptothecin, dexrazoxanet (TopoTarget), elsamitrucin (Spectrum), pixantrone (Novuspharma), edotecarin (Merck & Co), becatecarin (Exelixis), karenitecin (BioNumerik), BBR-3576 (Novuspharma), belotecan (Chong Kun Dang), rubitecan (
  • antibiotic-type antiproliferative agents include antibiotic-type antiproliferative agents.
  • Suitable antibiotic-type antiproliferative agents include, but are not limited to dactinomycin (actinomycin D), azonafide, valrubicin, anthrapyrazole, daunorubicin (daunomycin), oxantrazole, therarubicin, losoxantrone, idarubicin, bleomycinic acid, rubidazone, sabarubicin (Menarini), plicamycinp, 13-deoxydoxorubicin hydrochloride (Gem Pharmaceuticals), porfiromycin, epirubicin, mitoxantrone (novantrone) or amonafide.
  • antiproliferative agents Another family of antiproliferative agents which may be used in combination with the present invention includes antimitotic agents.
  • Suitable antimitotic antiproliferative agents that may be used in the present invention include, but are not limited to colchicines, ABT-751 (Abbott), vinblastine, xyotax (Cell Therapeutics), vindesine, IDN 5109 (Bayer), dolastatin 10 (NCI), A 105972 (Abbott), rhizoxin (Fujisawa), A 204197 (Abbott), mivobulin (Warner-Lambert), synthadotin (BASF), cemadotin (BASF), indibulin (ASTAMedica), RPR 109881A (Aventis), TXD 258 (Aventis), combretastatin A4 (BMS) 5 epothilone B (Novartis), isohomohalichondrin-B (PharmaMar), T 900607 (Tula
  • aromatase inhibitors include, but are not limited to aminoglutethimide, atamestane (BioMedicines), formestane, fadrozole, letrozole, exemestane, or anastrazole.
  • An additional family of antiproliferative agents which may be used in combination with the present invention includes the thymidylate synthase inhibitors.
  • Suitable thymidylate synthase inhibitors that may be used in the present invention include, but are not limited to, pemetrexed (Eli Lilly), nolatrexed (Eximias), ZD-9331 (BTG), doxifluridine (Nippon Roche), or 5,10-methylenetetrahydrofolate (BioKeys).
  • DNA antagonists include, but are not limited to trabectedin (PharmaMar), edotreotide (Novartis), glufosfamide (Baxter International), mafosfamide (Baxter International), apaziquone (Spectrum Pharmaceuticals), or thymectacin (NewBiotics).
  • Another family of antiproliferative agents which may be used in combination with the present invention includes farnesyltransferase inhibitors.
  • Suitable farnesyltransferase inhibitors include, but are not limited to arglabin (NuOncology Labs), tipifarnib (Johnson & Johnson), lonafarnib (Schering-Plough), perillyl alcohol (DOR BioPharma), or sorafenib (Bayer).
  • An additional family of antiproliferative agents which may be used in combination with the present invention includes pump inhibitors.
  • Suitable pump inhibitors that may be used in the present invention include, but are not limited to zosuquidar trihydrochloride (Eli Lilly), tariquidar (Xenova), biricodar dicitrate (Vertex), or MS-209 (Schering AG).
  • An alternative family of antiproliferative agents which may be used in combination with the present invention includes histone acetyltransferase inhibitors.
  • Suitable histone acetyltransferase inhibitors include, but are not limited to tacedinaline (Pfizer), pivaloyloxymethyl butyrate (Titan), AP-CANC-03 and AP-CANC-04 (Aton Pharma), depsipeptide (Fujisawa), or MS-275 (Schering AG).
  • Another family of antiproliferative agents which may be used in combination with the present invention includes metalloproteinase inhibitors.
  • Suitable metal loproteinase inhibitors that may be used in the present invention include, but are not limited to neovastat (Aeterna Laboratories), ⁇ etastat (CollaGenex), or marimastat (British Biotech).
  • the family of antiproliferative agents which may be used in combination with the present invention includes ribonucleoside reductase inhibitors.
  • ribonucleoside reductase inhibitors include, but are not limited to gallium maltolate (Titan), tezacitabine (Aventis), triapine (Vion), or didox (Molecules for Health).
  • Another family of antiproliferative agents which may be used in combination with the present invention includes endothelin A receptor antagonists.
  • Suitable endothelin A receptor antagonists include, but are not limited to atrasentan (Abbott), bosentan (Roche), ambrisentan (BASF), sitaxsentan (Encysive), clazosentan (Roche), darusentan (Knoll), and ZD-4054 (AstraZeneca).
  • retinoic acid receptor agonists include compounds which are natural and synthetic analogues of retinol (Vitamin A).
  • the retinoids bind to one or more retinoic acid receptors to initiate diverse processes such as reproduction, development, bone formation, cellular proliferation and differentiation, apoptosis, hematopoiesis, immune function and vision.
  • Retinoids are required to maintain normal differentiation and proliferation of almost all cells and have been shown to reverse/suppress carcinogenesis in a variety of in vitro and in vivo experimental models of cancer, see (Moon et al., Ch.
  • Suitable retinoic acid receptor agonists that may be used in the present invention include, but are not limited to fenretinide (Johnson & Johnson), alitretinoin (Ligand), tazarotene (Allergan), tetrinoin (Roche), isotretinoin (Roche), 13-cis-retinoic acid (UCSD), or LGD-1550 (Ligand).
  • immunomodulators include, but are not limited to interferon, Roferon-A (Roche), dexosome therapy (Anosys), oncophage (Antigenics), pentrix (Australian Cancer Technology), GMK vaccine (Progenies), CDl 54 cell therapy (Tragen), adenocarcinoma vaccine (Biomira), transvax (Intercell), avicine (AVI BioPharma), norelin (Biostar), IRX-2 (Immuno-Rx), BLP-25 liposome vaccine (Biomira), PEP-005 (Peplin Biotech), multiganglioside vaccine (Progenies), synchrovax vaccine (CTL Immuno),
  • hormonal agents include, but are not limited to an estrogen, dexamethasone, a conjugated estrogen, prednisone, ethinyl estradiol, methylprednisolone, chlortrianisen, prednisolone, idenestrol, aminoglutethimide, hydroxyprogesterone caproate, leuprolide, medroxyprogesterone, octreotide, testosterone, mitotane, testosterone propionate, fluoxymesterone, methyltestosterone, 2-methoxyestradiol (EntreMed), diethylstilbestrol, arzoxifene (Eli Lilly), megestrol, tamoxifen, bicalutamide, toremofine, flutamide, goserelin, nilutamide, or leuporelin.
  • photodynamic agents include, but are not limited to talaporfin (Light Sciences), Pd-bacteriopheophorbide (Yeda), theralux (Theratechnologies), lutetium texaphyrin (Pharmacyclics), motexafin, gadolinium (Pharmacyclics), or hypericin.
  • angiogenesis inhibitors include, but are not limited to neovastat (AEterna Zentaris), ATN-224 (Attenuon), sorafenib (Bayer), thalidomide, bevacizumab (Genentech), ranibizumab (Genentech), benefin (Lane Labs), L-651582 (Merck & Co), vatalanib (Novartis), or sutent (Sugen).
  • Tyrosine Kinase Inhibitors Another family of antiproliferative agents which may be used in combination with the present invention includes Tyrosine Kinase Inhibitors.
  • Suitable Tyrosine Kinase Inhibitors include, but are not limited to imatinib (Novartis), leflunomide (Sugen/Pharmacia), kahalide F (PharmaMar) iressa (AstraZeneca), lestaurtinib (Cephalon), erlotinib (Oncogene Science), canertinib (Pfizer), tandutinib (Millenium), squalamine (Genaera), midostaurin (Novartis), phenoxodiol, SU6668 (Pharmacia), cetuximab (ImClone), rhu-Mab (Genentech), ZD6474 (AstraZeneca), MDX- H210 (Medarex), vatalanib (
  • Additional anti-proliferative agents which may be used in combination with the present invention include melphalan, carmustine, cisplatin, 5-fluorouracil, mitomycin C, adriamycin (doxorubicin), bleomycin, paclitaxel (Taxol ® ), and the like.
  • the cytokine inhibitors of the invention can be used in methods and compositions together with additional active ingredients or agents.
  • the additional active agents are capable of relieving pain, inhibiting inflammatory reactions, providing a sedative effect or an antineuralgic effect, or ensuring patient comfort.
  • additional active agents include, but are not limited to, opioid analgesics, non-narcotic analgesics, anti-inflammatories, cox-2 inhibitors, ⁇ -adrenergic receptor agonists or antagonists, ketamine, anesthetic agents, NMDA antagonists, ⁇ 2 ⁇ ligands, immunomodulatory agents, immunosuppressive agents, antidepressants, anticonvulsants, antihypertensives, anxiolytics, calcium channel blockers, muscle relaxants, corticosteroids, hyperbaric oxygen, other therapeutics known to relieve pain, and pharmaceutically acceptable salts, solvates, hydrates, stereoisomers, prodrugs and pharmacologically active metabolites thereof,
  • Opioids can be used to treat severe pain.
  • opioid analgesics include, but are not limited to, oxycodone (OxyContinTM), morphine sulfate (MS ContinTM, DuramorphTM, AstramorphTM), meperidine (DemerolTM), and fentanyl transdermal patch (DuragesicTM) and other known conventional medications (See, e.g., Physicians' Desk Reference, 594-595, 2851 and 2991 (57 th ed., 2003)).
  • Oxycodone (OxyContinTM) is a long- acting form of an opioid and may be used usually in initial and later stages of CRPS.
  • Morphine sulfate may be used for analgesia due to reliable and predictable effects, safety profile, and ease of reversibility with naloxone. Morphine sulfate is sold in the United States under the trade name MS ContinTM, DuramorphTM, or AstramorphTM (See, e.g., Physicians' Desk Reference, 594-595 (57 lh ed., 2003)). Fentanyl transdermal patch (DuragesicTM) is a potent narcotic analgesic with much shorter half-life than morphine sulfate. Meperidine (DemerolTM) and hydromorphone (DilaudidTM) may also be used for pain management (See, e.g., Physicians' Desk Reference, 2991 (57 th ed., 2003)).
  • Non-narcotic analgesics and antiinflammatories are preferably used for treatment of pain during pregnancy and breastfeeding.
  • Antiinflammatories such as nonsteroidal anti -inflammatory drugs (NSAIDs) and cox-2 inhibitors typically inhibit inflammatory reactions and pain by decreasing the activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis.
  • NSAIDs may provide pain relief in the early stage of pain syndrome.
  • anti-inflammatories include, but are not limited to, salicylic acid acetate (AspirinTM), ibuprofen (MotrinTM, AdvilTM), ketoprofen (OruvailTM), rofecoxib (VioxxTM), naproxen sodium (AnaproxTM, NaprelanTM, NaprosynTM), ketorolac (AcularTM), and other known conventional medications.
  • a specific cox-2 inhibitor is celecoxib (CelebrexTM) (See, e.g., Physicians' Desk Reference, 1990, 1910-1914 and 2891 (57 th ed., 2003); Physicians' Desk Reference for Nonprescription Drugs and Dietary Supplements, 511, 667 and 773 (23 rd ed., 2002)).
  • CelebrexTM celecoxib
  • Antidepressants increase the synaptic concentration of serotonin and/or norepinephrine in the CNS by inhibiting their reuptake by presynaptic neuronal membrane. Some antidepressants also have sodium channel blocking ability to reduce the firing rate of injured peripheral afferent fibers.
  • antidepressants include, but are not limited to, nortriptyline (PamelorTM), amitriptyline (ElavilTM), imipramine (Tofranill), doxepin (SinequanTM), clomipramine (AnafranilTM), fluoxetine (ProzacTM), sertraline (ZoloftTM), nefazodone (SerzoneTM), venlafaxine (EffexorTM), trazodone (DesyrelTM), bupropion (WellbutrinTM) and other known conventional medications (See, e.g., Physicians' Desk Reference, 329, 1417, 1831 and 3270 (57 th ed., 2003)).
  • Anticonvulsant drugs may also be used in embodiments of the invention.
  • anticonvulsants include, but are not limited to, carbamazepine, oxcarbazepine, gabapentin (NeurontinTM), phenytoin, sodium valproate, clonazepam, topiramate, lamotrigine, zonisamide, and tiagabine (See, e.g., Physicians' Desk Reference, 2563 (57 th ed., 2003)).
  • Corticosteroids e.g., prednisone, dexamethasone or hydrocortisone
  • orally active class Ib anti-arrhythmic agents e.g., mexiletine
  • calcium channel blockers e.g., nifedipine
  • beta-blockers e.g., propranolol
  • ⁇ -blockers e.g., phenoxybenzamine
  • ⁇ 2- adrenergic agonists e.g., clonidine
  • cytokine inhibitor See, e.g., Physicians' Desk Reference, 1979, 2006 and 2190 (57 th ed., 2003)).
  • the specific amount of the additional active agent will depend on the specific agent used, the type of pain being treated or managed, the severity and stage of pain, and the amount(s) of cytokine inhibitors and any optional additional active agents concurrently administered to the subject.
  • Hydromorphone (DilaudidTM) is typically administered in an initial dose of about 2 mg orally, or about 1 mg intravenously to manage moderate to severe pain (See, e.g., Physicians' Desk Reference, 2991 (57 th ed., 2003)).
  • Morphine sulphate (DuramorphTM, AstramorphTM, MS ContinTM) is typically administered in an initial dose of about 2 mg IV/SC/IM, depending on whether a subject has already taken narcotic analgesics (See, e.g., Physicians' Desk Reference, 594-595 (57 th ed., 2003)).
  • Oxycodone is a long-acting form of an opioid and may be used in initial and later stages of pain syndrome.
  • Oxycodone (OxyContinTM) is usually administered in an amount of about 10-160 mg twice a day (See, e.g., Physicians' Desk Reference, 2851 (57 th ed., 2003)].
  • Meperidine (DemerolTM) is typically administered in an amount of about 50-150 mg PO/IV/IM/SC every 3-4 hours.
  • a typical pediatric dose of meperidine (DemerolTM) is 1-1.8 mg/kg (0.5-0.8 mg/lb) PO/IV/IM/SC every 3-4 hours (See, e.g., Physicians' Desk Reference, 2991 (57 th ed., 2003)].
  • Fentanyl transdermal patch (Duragesic ) is available as a transdermal dosage form.
  • a typical adult dose is about 25 mcg/h (10 cm 2 ), 50 mcg/h (20 cm 2 ), 75 mcg/h (75 cm 2 ), or 100 mcg/h (100 cm 2 ) (See, e.g., Physicians' Desk Reference, 1775 (57 th ed., 2003)].
  • Non-narcotic analgesics and antiinflammatories such as NSAIDs and cox-2 inhibitors may be used to treat subjects suffering from mild to moderate pain.
  • Ibuprofen MotrinTM, AdvilTM
  • Naproxen sodium may also be used for relief of mild to moderate pain in an amount of about 275 mg thrice a day or about 550 mg twice a day (See, e.g., Physicians' Desk Reference, 1417,2193 and 2891 (57 th ed., 2003)].
  • Antidepressants e.g., nortriptyline (PamelorTM) may also be used in the invention to treat subjects suffering from chronic and/or neuropathic pain.
  • the oral adult dose is typically in an amount of about 25-100 mg, and usually does not exceed 200 mg/d.
  • a typical pediatric dose is about 0.1 mg/kg PO as initial dose, increasing, as tolerated, up to about 0.5-2 mg/d.
  • Amitriptyline (EtrafonTM) is typically used for neuropathic pain in an adult dose of about 25-100 mg PO (See, e.g., Physicians' Desk Reference, 1417 and 2193 (57 th ed., 2003)].
  • Anticonvulsants such as gabapentin (NeurontinTM) may also be used to treat subjects suffering from chronic and neuropathic pain.
  • gabapentin is orally administered in an amount of about 100-1,200 mg three times a day (See, e.g., Physicians' Desk Reference, 2563 (57 th ed., 2003)].
  • Carbamazepine (TegretolTM) is used to treat pain associated with true trigeminal neuralgia.
  • the oral adult dose is typically in an amount of about 100 mg twice a day as initial dose, increasing, as tolerated, up to about 2,400 mg/d (See, e.g., Physicians' Desk Reference, 2323-25 (57 th ed., 2003)].
  • agents which may be used in combination with the novel compounds of the invention include, but are not limited to, antiinflammatory agents, immunosuppressants, anti-infectives, antibiotics, gold salts, alkylating agents, immunoglobulins, or a combination of two or more thereof.
  • antiinflammatory agents include corticosteroids, COX-2 inhibitors, non-steroidal antiinflammatory drugs (NSAID), TNFa antagonists, and IL-I antagonists.
  • the corticosteroid can be prednisone, prednisolone, or methylprednisolone. Corticosteroids such as these may also be administered with either chlorambusil or mycophenylate mofetil.
  • TNFa antagonists examples include infliximab, etanercept, and adalimumab.
  • An example of an IL-I antagonist is anakinra.
  • immunosuppressants are mycophenylate mofetil, cyclosporin, azathioprine, methotrexate, alefacept, rituximab, anti-interferon gamma, and cyclophosphamide, while anti -infectives include dapsone and hydroxychloroquine.
  • the gold salt can be myochrysine, or solganal.
  • An example of an alkylating agent is lukeran.
  • Antibiotics useful in combinations are tetracycline, minocycline, and doxycycline, sometimes in combination with nicotinamide, or niacinamide.
  • Treatment of pemphigus can also include plasmapherisis therapy or photophoresis therapy to the subject.
  • BTNAP 2,2'-Bis(diphenylphosphino)- 1 , 1 '-binaphthyl
  • DIBAL Diisobutylaluminium hydride
  • EDC or EDCI l-(3-Dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride
  • IC50 value The concentration of an inhibitor that causes a 50 % reduction in a measured activity.
  • LPS Lipopolysaccharide
  • NBS N- bromosuccinimide
  • Chemdraw Ultra (CambridgeSoft), which generates systematic names for chemical structures, with support for the Cahn-Ingold-Prelog rules for stereochemistry, or using the naming program Autonom2000 (Elsevier MDL, San Leandro, CA).
  • Step 1 To a suspension of 3-bromo-4-hydroxybenzoic acid a_(2.86 g, 13.2 mmol) in DCM (80 ml) was added oxalyl chloride (2.9 ml, 2.5 eq.) and DMF (50 ⁇ l). The mixture was stirred overnight until it became homogeneous. The solvents were evaporated to give 3- bromo-4-hydroxybenzoyl chloride.
  • Step 2 The compound obtained above was dissolved in EtOH, the mixture was heated for 1.5 hr and the solvent was evaporated to yield ethyl 3-bromo-4- hydroxybenzoate (3.24 g, 100%).
  • Step 3 The compound obtained above (3.23, 13.2 mmol) was dissolved in acetone (50 ml), 3-chloro-2-methylprop-l-ene (1.6 ml, 1.25 eq.) and K 2 CO 3 (2.73 g, 1.5 eq.) were added, and the mixture was refluxed overnight. After cooling, the solids were filtered and the solution was evaporated. The residue was dissolved in DCM and the organic layer was washed with water, dried over MgSO 4 and evaporated to give 1.75 g (44%) of ethyl 3- bromo-4-(2-methylallyloxy)benzoate.
  • Step 4 A solution of ethyl 3 -bromo-4-(2 -methyl allyloxy)benzoate (305 mg,
  • Step 5 Ethyl 3,3-dimethyl-2,3-dihydrobenzofuran-5-carboxylate (130 mg, 59 mmol) was dissolved in MeOH (3 ml) and 1 M aq. NaOH (1.2 ml) was added. The solution was heated for 3 hr at 70 0 C. The MeOH was evaporated and the solution was acidified with 1 M HCl (1.4 ml). The precipitate was filtered off and washed with water. After drying the product 3,3-dimethyl-2,3-dihydrobenzofuran-5-carboxylic acid B was obtained (90 mg, 79%).
  • Method B Ethyl 3-isopropyIbenzoate (C-b). To a solution of l-bromo-3- isopropylbenzene (2.43 g, 12.5 mmol) in THF (18 ml) was added magnesium wire (0.296 g, 1 eq.). The mixture was heated to 50 to 60 0 C until the magnesium was dissolved. To this was added a THF solution of ethyl chloro formate (1.3 ml, 1.1 eq.) at -78°C and the mixture was allowed to warm up to room temperature . The reaction mixture was diluted with IM aq. HCl. The product was extracted into DCM, the organic layer was dried over MgSO 4 and evaporated.
  • Intermediate C-b can be easily converted into intermediate C-a by standard methods, using alkaline hydrolysis with aqueous NaOH in MeOH.
  • the mixture of esters was hydrolyzed by dissolving the residue in MeOH (5 ml), adding 1 M aq. NaOH (3 ml) and heating for 2 hr at 100 0 C. The MeOH was evaporated, and the remaining solution was acidified with 1 M HCl (4 ml). The product was extracted into DCM, the organic layer was dried over MgSO 4 and evaporated. The mixture of acids was used as such in subsequent reactions and the products obtained were separated by chromatography.
  • Step 1 A solution of ethyl 3-isopropylbenzoate C-b (236 mg, 1.23 mmol) NBS (250 mg, 1.14 eq.) and dibenzoylperoxide (22 mg, 0.07 eq.) in tetrachloromethane was heated to 80 0 C for 3 hr. The solvent was evaporated to yield the target compound.
  • Step 2 Ethyl 3-(2-bromopropan-2-yl)benzoate was dissolved in MeOH and the mixture was heated to 55°C for 2 hr. To the methanolic solution was added 1 M aq. NaOH (2 ml). The resulting mixture was heated overnight to 55°C. The MeOH was evaporated, and the resulting solution was acidified with 1 M HCl (4 ml). The product was extracted into DCM, the organic layer was dried over MgSO-*, and the solvent was evaporated. The product F-a was used without purification in subsequent reactions.
  • Step 2 The amide was dissolved in 6 N aq. HCl (3 ml) and heated to 120 0 C for
  • the compound was dissolved in toluene (12 ml) and excess sodium azide (600 mg, 9.2 mmol), catalytic tetrabutylammonium chloride (20 mg, 0.09 mmol), and water (3 ml) were added and the mixture was vigorously stirred. Progress of the reaction was followed by IR 3 by tracking of the disappearance of the COCl carbonyl stretch at 1752 cm "1 . Typically the reaction took less then 60 min to completion. The aqueous layer was removed, the toluene layer was washed with water and dried with MgSO 4 . This toluene solution of the intermediate azide was heated to 105 0 C until the evolving of gas seized.
  • the reaction mixture was allowed to cool to rt, 6 N aq. HCl was added (15 ml) and the mixture was heated at 125°C for 3 hr. After cooling to rt the reaction mixture was diluted with water (50 ml) and the pH was adjusted to 2 using aq.
  • Step 2 A solution of tert-butyl 2-chloroisonicotinate (427 mg, 2 mmol) and morpholine (5.2 ml, 60 mmol) in DMSO (1 ml) was heated at 80 0 C for 60 hr. Morpholine was evaporated and the residue was dissolved in EtOAc/ aqueous NaHCO 3 . The aqueous phase was extracted with EtOAc. The combined organic phase was washed with water, and dried over Na 2 SO -J . After evaporation the crude product was subjected to silica gel column chromatography (40 g silica gel column) using DCM/EtOAc as eluents.
  • Step 2 Methyl 3-cyano-S-morpholinobenzoate.
  • Methyl 3-carbamoyl-5- morpholinobenzoate (257 mg, 0.97 mmol) was dissolved in DCM (15 ml) in a 100 ml round- bottomed flask. Pyridine (851 ⁇ l, 9.7 mmol) and phosphorous oxychloride (445 ⁇ l, 4.9 mmol) were added and the solution was allowed to sit at room temperature for lhr.
  • Step 3 S-Cyano-S-morpholinobenzoic acid.
  • Methyl 3-cyano-5- morpholinobenzoate (197 mg, 0.8 mmol) was dissolved in MeOH (7 ml) and THF (7 ml).
  • a NaOH solution (2M, 0.60 ml) was added and the solution was heated to 50 0 C for 1 h 15 min.
  • the solvent was removed and the residue suspended in THF.
  • 2M HCl (0.60 ml) was added and the solvent was removed.
  • the residue was suspended in THF, the solution was filtered and the solvent was removed in vacuo to afford 281 mg of the acid, which contained some sodium chloride (CaIc. mass: 232, obs. mass: 233). It was used in subsequent reactions without further purification.
  • Step 2 To a solution of 5-tert-butyl-2-methoxy-3-bromobenzoic acid methyl ester (0.15 g, 0.5 mmol) in a 1:1 DMF/dioxane (5 ml) mixture, KCN (65 mg, 1 mmol), Pd(OAc) 2 (12 mg, 10 mol%), CsCO 3 (0.49 g, 1.5 mmol) and BINAP (62 mg, 20 mol%) were added. The mixture was stirred at 15O 0 C for 40 tnin. in the microwave, filtered over Celite, and the solids were washed with DCM.
  • Step 3 To a solution of 5-tert-butyl-2-methoxy-3-cyanobenzoic acid methyl ester (40 mg, 0.16 mmol) in 1 :1 THF/MeOH (1 ml) mixture, 2N NaOH (0.35 ml) was added. The mixture was stirred at room temperature for 1 hr, neutralized with IN HCl and extracted with approx. 20 ml of EtOAc. The organic layer was dried over MgSO 4 and concentrated to give intermediate N (quantitative) as a white solid which was used in the next step without further purification.
  • Step 3 Methyl 5-tert-butyl-2-methoxy-3-methyIsulfonamido)-benzoate.
  • Step 4 5-tert-butyl-2-methoxy-3-(methyIsulfonamido)benzoic acid.
  • a suspension of the compound obtained in step 3 (1.1 g, 3.5 mmol) in 6 N HCl (50 ml) was heated at 80 0 C for 72 hr. The mixture was allowed to cool, the precipitate collected under suction, washed with H 2 O and dried to give intermediate O (0.83 g, 79%) as a white solid.
  • the organic fractions were dried over MgSO 4 .
  • the drying agent was removed by filtration, and the filtrate was concentrated under vacuum to give the benzyl alcohol intermediate.
  • the intermediate was taken up into a THF/DCM mixture (50 ml of a 3:1 mixture) and was cooled to 0 0 C.
  • phosphorous tribromide (2.12 ml of a 1.0 M solution in DCM) was added and the reaction was stirred at 0 0 C for 1 hr and then at room temperature for 4 hr.
  • the mixture was added to 200 ml of water and was extracted with DCM.
  • the organic fractions were dried with MgSO 4 .
  • the drying agent was removed by filtration, and the filtrate was concentrated under vacuum.
  • Step 2 3-(Bromomethyl)-5-tert-butylbenzoic acid.
  • boron tribromide 0.5 ml of a 1.0 M solution in DCM
  • the mixture was then added to 20 ml of water.
  • the mixture was extracted with DCM.
  • the organic fractions were dried with MgSO 4 .
  • the drying agent was removed by filtration, and the filtrate was concentrated under vacuum to give the title compound as a clear oil (0.088 g).
  • Step 2 In a 250 ml round-bottomed flask in an ice bath were placed the compound obtained above (1.55 g, 5.08 mmol), THF (10 ml) and MeOH (10 ml). To this stirred mixture was added 2M NaOH (2.80 ml, 5.59 mmol). After 30 min 2M HCl (1.53 ml) was added and the solvent was removed in vacuo. The residue was diluted in THF (100 ml) and further 2M HCl (1.27 ml) was added. The solvent was concentrated so that only water remained.
  • Step 3 In a 50 ml round-bottomed flask were placed methyl 5-tert-butyl-3- cyano-2-(2-hydroxyethoxy)benzoate (364 mg, 1.31 mmol) and DCM (3 ml). To this reaction was added Dess-Martin reagent (668 mg, 1.58 mmol). The reaction was capped and stirred at rt for 25 min. The reaction mixture was treated with saturated NaHCO 3 (5 ml) and IM NaZS 2 O 3 (5 ml) and stirred for 15 min. The reaction was diluted with DCM (20 ml) and extracted with DCM. The combined organic layers were dried over Na 2 SO 4 . The solvents were removed and concentrated to ⁇ 8 ml.
  • Step 4 In a 50 ml round-bottomed flask in an ice bath were placed methyl 5- tert-butyl-3-cyano-2-(2-(4-methylpiperazin-l-yl)ethoxy)benzoate (76 mg, 0.21 mmol) and MeOH (3 ml), followed by 2 M NaOH (189 ⁇ l, 0.38 mmol). After stirring 2.5 hr in an ice bath the reaction was heated to 60 0 C for 1.5hr during which time the solvent evaporated.
  • the crude product was purified on a silica gel column using 3% EtOAc in Hex to give the target compound (white soft solid, 1.44 g) and tert-butyl 3-(2- methyl-5-nitrophenyl)isoxazole-4-carboxylate (yellow oil, 0.74 g).
  • Method b To a solution of W (0.08 mmol, crude product from the reaction above) in DMF (0.3 ml) was added carboxylic acid R 3 CO 2 H (0.08 mmol), BOP (0.05 g, 0.12 mmol), and NMM (0.02 ml, 0.2 mmol). The mixture was stirred at 50 0 C until the reaction was complete (typically 30 to 90 min.). The reaction mixture was diluted with MeOH and purified by RP-HPLC using AcN and water as eluents to give the target compound as a white solid.

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Abstract

La présente invention concerne des composés de faible poids moléculaire utiles en tant qu'inhibiteurs de cytokine, et des compositions de ceux-ci. En particulier, les composés de l'invention sont utiles en tant qu'agents anti-inflammatoires, antidouleur ou anticancéreux. La présente invention concerne en outre des procédés pour la préparation de tels agents et leur utilisation dans la prévention ou le traitement de pathologies véhiculées par des cytokines.
PCT/US2006/048803 2005-12-22 2006-12-20 Inhibiteurs de cytokine heterocycliques Ceased WO2007075896A2 (fr)

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