MXPA99012078A - Treatment of diabetes with thiazolidinedione and metformin - Google Patents

Abstract

A method for the treatment and/or prophylaxis of diabetes mellitus, conditions associated with diabetes mellitus and certain complications thereof, in a mammal which method comprises administering an effective non-toxic and pharmaceutically acceptable amount of an insulin sensitiser and a biguanide antihyperglycaemic agent, to a mammal in need thereof and a pharmaceutical composition comprising an insulin sensitiser and a biguanide antihyperglycaemic agent.

Description

TREATMENT OF DIABETES WITH TIAZOLIDINODIONA AND METFORMIN DESCRIPTIVE MEMORY This invention relates to a method of treatment, in particular to a method for the treatment of diabetes mellitus, especially non-insulin dependent diabetes (NIDDM) or type II diabetes and conditions associated with diabetes mellitus. Anti-hyperglycemic agents of biguanide are commonly used in the treatment of NIDDM (or type II diabetes). 1,1-dimethylbiguanidine (or metformin) is an example of an antihyperglycemic biguanide agent. The European patent application, no. 0,306,228 refers to certain thiazolidinedione derivatives having antihyperglycemic and hypolipidemic activity. A particular thiazolidinedione described in EP 0306228 is 5- [4- [2- (N-methyl-N- (2-pyridyl) amino) ethoxy] benzyl] thiazolidin-2,4-dione (from here hereinafter 'compound (I)'). WO94 / 05659 describes certain salts of compound (I) including the maleate salt in example 1 thereof. Compound (I) is an example of a class of antihyperglycemic agents known as 'insulin sensitizers'. In particular, the compound (I) is an insulin sensitizer of thiazolidinedione.

European patent applications, numbers: 0008203, 0139421, 0032128, 0428312, 0489663, 0155845, 0257781, 0208420, 0177353, 0319189, 0332331, 0332332, 0528734, 0508740; International patent applications, numbers 92/18501, 93/02079, 93/22445 and US Pat. No. 5104888 and 5478852, also disclose certain thiazolidinedione insulin sensitizers. Other series of compounds generally recognized to have insulin sensitizing activity are those compounds described in international patent applications, numbers WO93 / 21166 and WO94 / 01420. These compounds are referred to herein as 'acyclic insulin sensitizers'. Other examples of acyclic insulin sensitizers are those described in U.S. patent application number 5232945 and in international patent applications, numbers WO92 / 03425 and WO91 / 19702. Examples of other insulin sensitizers are those described in European patent application, number 0533933, Japanese patent application number 05271204 and United States patent number 5264451. The aforementioned applications are incorporated herein by reference. Surprisingly, it is indicated that compound (I) in combination with an antihyperglycaemic agent of biguanide provides a particularly beneficial effect on glycemic control without observation of adverse effects, said combination is particularly useful for the treatment of diabetes mellitus, especially type II diabetes and conditions associated with diabetes mellitus. Also, the invention provides a method for the treatment of diabetes mellitus, especially type II diabetes and conditions associated with diabetes mellitus in a mammal, such as a human, wherein said method comprises the administration of a non-toxic and pharmaceutically acceptable effective amount. of an insulin sensitizer, such as compound (I), and an antihyperglycemic agent of biguanide, to a mammal in need thereof. In another aspect of the invention there is provided an insulin sensitizer, such as compound (I), together with an antihyperglycemic biguanide agent, for use in a method for the treatment of diabetes mellitus, especially type II diabetes and conditions associated with Mellitus diabetes. The method comprises the co-administration of an insulin sensitizer, such as compound (I), and an antihyperglycemic agent of biguanide or the sequential administration thereof. Co-administration includes the administration of a formulation that includes both an insulin sensitizer, such as compound (I), and an antihyperglycemic biguanide agent or the essentially simultaneous administration of separate formulations of each agent.

In another aspect the invention provides the use of an insulin sensitizer, such as compound (I), and a biguanide antihyperglycaemic agent, for use in the preparation of a composition for the treatment of diabetes mellitus, especially type II diabetes and conditions associated with diabetes mellitus. A suitable antihyperglycemic agent of biguanide is metformin, buformin or phenformin, especially metformin. A suitable thiazolidinedione insulin sensitizer is compound (I). Other suitable thiazolidinedione insulin sensitizers include (+) - 5 - [[4 - [(3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-1-benzopyran-2-yl) methoxy] phenyl] methyl] -2,4-thiazolidinedione (or troglitazone), 5- [4 - [(1-methyl-cyclohexyl) methoxy] benzyl] thiazolidino-2,4-dione (or ciglitazone), 5- [4 - [2- (5-ethylpyridin-2-yl) ethoxy] benzyl] thiazole-2,4-dione (or pioglitazone) or 5 - [(2-benzyl-2,3-dihydrobenzopyran) -5-ylmethyl) thiazolidino-2,4-dione (or englitazone). In a particular aspect, the method comprises the administration of 2 to 12 mg of the compound (I), especially when administered per day. Particularly, the method comprises the administration of 2 to 4, 4 to 8 or 8 to 12 mg of compound (I) per day. Particularly, the method comprises the administration of 2 to 4 mg of the compound (I), especially when administered per day. In particular, the method comprises the administration of 4 to 8 mg of compound (I), especially when administered per day.

Particularly, the method comprises the administration of 8 to 12 mg of the compound (I), especially when administered per day. Preferably, the method comprises administration of 2 mg of compound (I), especially when administered per day. Preferably, the method comprises the administration of 4 mg of compound (I), especially when administered per day. Preferably, the method comprises administration of 8 mg of compound (I), especially when administered per day. It should be understood that the insulin sensitizer, such as compound (I) and the antihyperglycemic agent of biguanide are administered in a pharmaceutically acceptable form, including pharmaceutically acceptable derivatives such as pharmaceutically acceptable salts, esters and solvates thereof, as appropriate pharmaceutically active agent in question. In some cases the names used for the biguanide in question can refer to a particular pharmaceutical form of the active agent in question: it should be understood that this invention comprises all pharmaceutically acceptable forms of the active agents per se. Suitable pharmaceutically acceptable forms of insulin sensitizers include those described in the aforementioned applications. Suitable pharmaceutically acceptable forms of compound (I) include those described in EP 0306228 and WO94 / 05659, especially pharmaceutically acceptable salt forms. A preferred pharmaceutically acceptable salt is a maleate. Suitable pharmaceutically acceptable solvated forms of the compound (I) include those described in EP 0306228 and WO94 / 05659, in particular hydrates. Suitable pharmaceutically acceptable forms of the antihyperglycemic agent of biguanide depend on the agent used in particular, but include known pharmaceutically acceptable forms of the particular compound chosen. Such derivatives are described or mentioned in standard reference texts, such as British and US Pharmacopoeias, Remington's Pharmaceutical Sciences (Mack Publish Co.), The Extra Pharmacopoeia (London, The Pharmaceutical Press) (for example, see the 31st edition page 341 and pages cited therein). A suitable pharmaceutically acceptable form of metformin is an acid addition salt, such as a hydrochloride. The compound (I) or a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable solvate thereof, can be prepared using known methods, for example those described in EP 0306228 and WO94 / 05659. The descriptions of EP 0306228 and WO94 / 05659 are incorporated herein by reference. The compound (I) can exist in one of several tautomeric forms, which are comprised by the term "compound (I)" as individual tautomeric forms or as mixtures of the same. The compound (I) contains a chiral carbon atom, and therefore can exist in up to two stereoisomeric forms, the compound term (I) includes all these isomeric forms either as individual isomers or as mixtures of isomers, including racemates. The insulin sensitizer or the selected biguanide antihyperglycaemic agent is prepared by known methods, said methods are mentioned or shown in standard reference texts, such as British and US Pharmacopoeias, Remington's Pharmaceutical Sciences (Mack Publish Co.), Martindale The Extra Pharmacopoeia (London, The Pharmaceutical Press) (for example, see the 31st edition page 341 and pages cited therein) or as described in the publications mentioned above. When used herein the term "conditions associated with diabetes" includes those conditions associated with the pre-diabetic condition, conditions associated with diabetes mellitus itself, and complications associated with diabetes mellitus. When the term "conditions associated with the pre-diabetic state" is used herein, it includes conditions such as insulin resistance, including hereditary insulin resistance, impaired glucose tolerance and hyperinsulinemia. "Conditions associated with diabetes mellitus itself" include insulin resistance, hyperglycemia, including acquired insulin resistance and obesity. Additional conditions associated with own Diabetes mellitus include hypertension and cardiovascular disease, especially atherosclerosis, and conditions associated with insulin resistance. Conditions associated with insulin resistance include polycystic ovarian syndrome and steroid-induced insulin resistance and gestational diabetes. "Complications associated with diabetes mellitus" include kidney diseases, especially kidney diseases associated with type II diabetes, neuropathy and retinopathy. Renal diseases associated with type II diabetes include diabetic nephropathy, glomerulonephritis, glomerular sclerosis, nephrotic syndrome, hypertensive nephrosclerosis, and end-stage renal disease. As used herein the term "pharmaceutically acceptable" includes both veterinary and human use: for example the term "pharmaceutically acceptable" includes a veterinarily acceptable compound. For the avoidance of doubt, when reference is made to scalar amounts, including amounts in mg, of the compound (I) in a pharmaceutically acceptable form, the scalar amount referred to is made with respect to the compound (I) per se: example 2 mg of compound (I) in the maleate salt form is the amount of maleate salt containing 2 mg of compound (I). Diabetes mellitus is preferably type II diabetes.

The particularly beneficial effect on glycemic control provided by the treatment of the invention indicates that it is a synergistic effect relative to the expected control for the sum of the effects of the individual active agents. Glycemic control can be characterized by conventional methods, for example by measuring a commonly used glycemic control index such as fasting plasma glucose or glucose hemoglobin (Hb A1 c). These indices are determined using standard methodology, for example those described in: Tuescher A., Richterich, P., Schweiz. med. Wschr. 101 (1971), 345 and 390 and Frank P., "Monitoring the Diabetic Patient with Glycosolated Hemoglobin Measurements", Clinical Products 1988. In a preferred aspect, the dosage level of each of the active agents when used in accordance with the treatment of the invention will be less than that which would have been required in a purely additive effect with respect to glycemic control. It is also indicated that the treatment of the invention will effect an increase, related to individual agents, in the levels of advanced glycosylation end products (AGEs), leptin and serum lipids including total cholesterol, HDL-cholesterol, LDL-cholesterol including increases in their ratios, in particularly an increase in serum lipids including total cholesterol, cholesterol-HDL, cholesterol-LDL including increases in the same relationships. In the method of the invention, the active medicaments are preferably administered in the form of a pharmaceutical composition. As indicated above, said compositions may include both medications or only one of the medications. Also, in one aspect of the invention there is provided a pharmaceutical composition comprising an insulin sensitizer, such as compound (I) especially from 2 mg to 12 mg thereof, the anti-hyperglycemic agent of biguanide and a pharmaceutically acceptable carrier thereof. Said compositions can be prepared by mixing an insulin sensitizer, such as compound (I) especially from 2 mg to 12 mg thereof, the antihyperglycemic agent of biguanide and a pharmaceutically acceptable carrier thereof. Usually the compositions are preferably adapted for oral administration. However, they can also be adapted for other modes of administration, for example parenteral, sublingual or transdermal administration. The compositions may be in the form of tablets, capsules, powders, granules, lozenges, suppositories, reconstitutable powders, or liquid preparations such as sterile oral or parenteral solutions or suspensions.

In order to obtain consistency of administration it is preferable that the composition of the invention be in the form of a unit dose. The forms of presentation of the unit doses for oral administration can be tablets and capsules and can comprise conventional excipients such as binding agents, for example syrup, acacia, gelatin, sorbitol, tragacanth, or polyvinylpyrrolidone; fillers, for example lactose, sugar, corn starch, calcium phosphate, sorbitol or glycine; tabletting lubricants, for example magnesium stearate; disintegrators, for example starch, polyvinyl pyrrolidone; sodium starch glycolate or microcrystalline cellulose; or pharmaceutically acceptable wetting agents such as sodium lauryl sulfate. The compositions of the invention are preferably in unit dosage form in an amount appropriate for the daily dose. Suitable unit doses comprise 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, or 12 mg of compound (I). The composition of the invention can be administered 1 to 6 times a day, but preferably 1 to 2 times a day. Particular doses of compound (I) are 2 mg / day, 4 mg / day, including 2 mg twice daily, and 8 mg / day, including 4 mg twice daily.

Suitable unit doses of the insulin sensitizer or biguanide antihyperglycemic agent, such as metformin, include the known doses for these compounds as described or mentioned in reference texts, for example British and US Pharmacopoeias, Remington's Pharmaceutical Sciences ( Mack Publish Co.), Martindale The Extra Pharmacopoeia (London, The Pharmaceutical Press) (for example, see the 31st edition page 341 and pages cited therein) or the publications mentioned above. Suitable doses of metformin include up to 3000 mg per day, in unit doses of 500 mg (for example two or three times a day) or 850 mg (for example twice a day), an example of a dose for metformin is 500 mg one to five times a day. Therefore, an example of the method comprises the administration of 4 or 8 mg of compound (I) (2 mg twice a day or 4 mg twice daily respectively) and 1000 mg or 2500 mg of metformin (500 mg twice daily or 500 mg five times a day respectively). Oral solid compositions can be prepared by conventional mixing, filling or tabletting methods. It is possible to use mixing operations as many times as necessary to distribute the active agent through the compositions using large amounts of fillers. Said operations are of course conventional in the art. The tablets may be coated according to good methods known in normal pharmaceutical practice, in particular with an enteric coating. The liquid oral preparations may be in the form of for example, emulsions, syrups, or elixirs, or presented in the form of a dry product to be reconstituted with water or other suitable vehicle before use. Said liquid preparations may comprise conventional additives such as suspending agents, for example sorbitol, syrup, methylcellulose, gelatin, hydroxyethylcellulose, carboxymethylcellulose, aluminum stearate gel, edible hydrogenated fats; emulsifying agents, for example lecithin, sorbitan monooleate, or acacia; non-aqueous vehicles (which may include edible oils), for example almond oil, fractionated coconut oil, fatty esters such as glycerin esters, propylene glycol, or ethyl alcohol; preservatives, for example methyl or propyl p-h idroxy benzoate, or sorbic acid; and if so desired conventional flavoring or coloring agents. For parenteral administration, fluid unit dosage forms are prepared using the active compound and a sterile vehicle, and, depending on the concentration used, they can be suspended or dissolved in the vehicle. In preparing the solutions for parenteral administration the composition of the invention can be dissolved in water for injection and sterilized by filter before filling into a suitable container or vial and sealed. Advantageously, auxiliaries such as local anesthetics, a preservative and pH regulating agents can dissolve in the vehicle. To increase stability, the composition can be frozen after filling in the container and the water removed under vacuum. Parenteral suspensions are prepared in substantially the same manner, except that the active compound is suspended in the vehicle instead of being dissolved, and sterilization can not be completed by filtration. The compound can be sterilized by exposure to ethylene oxide before suspending it in the sterile vehicle. Advantageously, a surfactant or wetting agent is included in the composition to facilitate uniform distribution of the compound. The compositions of the invention may contain 0.1% a 99% by weight, preferably 10-60% by weight, of the active material, depending on the method of administration. The compositions may, if desired, be in the form of a package accompanied by written or printed instructions for use. The compositions of the invention can be formulated according to conventional methods, such as those described in standard reference texts, for example British and US Pharmacopoeias, Remington's Pharmaceutical Sciences (Mack Publish Co.), Martindale The Extra Pharmacopoeia (London, The Pharmaceutical Press) (for example, see the 31st edition page 341 and pages cited therein) and Harry's Cosmeticology (Leonard Hill Books). In another aspect, the present invention also provides a pharmaceutical composition comprising an insulin sensitizer such as compound (I) especially from 2 to 12 mg thereof, an antihyperglycemic biguanide agent and a pharmaceutically acceptable carrier thereof, for use as an active therapeutic substance. In particular, the present invention provides a pharmaceutical composition comprising an insulin sensitizer such as compound (I) especially from 2 to 12 mg thereof, a biguanide antihyperglycemic agent and a pharmaceutically acceptable carrier thereof, for use in the treatment of diabetes mellitus, especially type II diabetes, and conditions associated with diabetes mellitus. A scale of 2 to 4 mg includes a scale of 2.1 to 4, 2.2 to 4, 2. 3 to 4, 2.4 to 4, 2.5 to 4, 2.6 to 4, 2.7 to 4, 2.8 to 4, 2.9 to 4 or 3 to 4 mg. A scale of 4 to 8 mg includes a scale of 4.1 to 8, 4.2 to 8, 4.3 to 8, 4.4 to 8, 4.5 to 8, 4.6 to 8, 4.7 to 8, 4.8 to 8, 4.9 to 8, 5 to 8 , 6 to 8 or 7 to 8 mg. A scale of 8 to 12 mg includes a scale of 8.1 to 12, 8.2 a 12, 8.3 to 12, 8.4 to 12, 8.5 to 12, 8.6 to 12, 8.7 to 12, 8.8 to 12, 8.8 to 12, 8.9 to 12, 9 to 12, 10 to 12 or 11 to 12 mg. No toxicological effects have been established for the compositions or methods of the invention in the mentioned dose scales. The following examples illustrate the invention but do not limit it in any way.

EXAMPLE This study evaluated the pharmacokinetics (PK) of compound (I) and metformin (M) administered alone or in combination. Sixteen male volunteers, aged between 22 and 55 years, received compound (I) oral (2 mg Q12h), M (500 mg Q12h), or combination, for 4 days. The plasma collected on day 4 of each regimen was tested for the concentrations of compound (I) and M. The oral doses of compound (I) and M, alone or in combination, were safe and well tolerated. There were no episodes of hypoglycemia and the co-administration did not result in an increase in the concentration of lactic acid in the blood.

Comb. = Co-administration of Compound (I) + M The co-administration of compound (I) and M did not affect the stable-state pharmacokinetics (AUC (0-12), Cmax, Tmax, or T1 / 2) of either drug. Because the plasma concentrations in M were not affected, the co-administration of compound (I) did not accentuate the toxicities dependent on the concentration of M.

COMPOSITIONS OF THE COMPOUND í \) A. Preparation of concentrate Approximately two thirds of lactose monohydrate pass through a suitable screen and mix with the crushed maleate salt of compound (I). Sodium starch glycolate, hydroxypropyl methylcellulose, microcrystalline cellulose and the remaining lactose pass through a suitable sieve and are added to the mixture. It continues mixing. The resulting mixture is wet granulated with purified water. The wet granules are sieved, dried on a fluidized bed dryer and the dried granules pass through an additional screen and are finally homogenized.

% COMPOSITION OF THE GRANULAR CONCENTRATE Ingredient Amount (%) Compound (I) crushed as salt of 13.25 (salt of pure maleate) maleate Sodium starch glycolate 5.00 Hydroxypropyl Methylcellulose 2910 5.00 Microcrystalline Cellulose 20.00 Lactose Monohydrate, regular grade at 100 * R Purified water B. Formulation of the concentrate in tablets The granules of the previous process are placed in a mixer. Approximately two thirds of lactose is sieved and added to the mixer. The microcrystalline cellulose, sodium starch glycolate, magnesium stearate and remaining lactose are sieved and added to the blender and the mixture is stirred together. The resulting mixture is compressed in a rotary tablet press at a target weight of 150 mg for tablets of 1, 2 and 4 mg and a target weight of 300 mg for tablets of 8 mg. The tablet centers are transferred to a tablet coating machine, preheated with warm air (approximately 65 ° C) and film coated until the weight of the tablet has increased by 2.0% to 3.5%.

Amount (mg per tablet) Concentration of the tablet 1.0 mg 2.0 mg 4.0 mg 8.0 mg Active ingredient 10.00 20.00 40.00 80.00 Granules of the maleate concentrate of compound (I) Other ingredients: Sodium starch glycolate 6.96 6.46 5.46 10.92 Microcrystalline Cellulose 27.85 25.85 21.85 43.70 Lactose monohydrate 104.44 96.94 81.94 163.88 Magnesium stearate 0.75 0.75 0.75 1.50 Total weight of the center 150.0 150.0 150.0 300.0 tablet coating material 4.5 4.5 4.5 9.0 water film Total weight of the tablet 154.5 154.5 154.5 309.0 film-coated

Claims (22)

NOVELTY OF THE INVENTION CLAIMS

1. The use of a non-toxic and pharmaceutically acceptable effective amount of an insulin sensitizer in combination with an anti-hyperglycemic agent of biguanide, to prepare a medicament for the treatment of diabetes mellitus and conditions associated with diabetes mellitus in a mammal.

2. The use according to claim 1, wherein the antihyperglycemic agent of biguanide is metformin.

3. The use according to claim 1, wherein the anti-hyperglycemic agent of biguanide is metformin hydrochloride.

4. The use according to any of claims 1 to 3, wherein the insulin sensitizer is 5- [4- [2- (N-methyl-N- (2-pyridyl) amino) ethoxy] benzyl] thiazole Dino-2,4-dione (compound (I)).

5. The use according to any of claims 1 to 4, wherein the medicament provides 2 to 12 mg of compound (I) to the mammal.

6. The use according to any of the claims 1 to 5, wherein the medicament provides from 2 to 4 mg, 4 to 8 or 8 to 12 mg of compound (I) to the mammal.

7. - The use according to any of claims 1 to 6, wherein the medicament provides 2 to 4 mg of compound (I) to the mammal.

8. The use according to any of claims 1 to 6, wherein the medicament provides 4 to 8 mg of compound (I) to the mammal.

9. The use according to any of claims 1 to 6, wherein the medicament provides 8 to 12 mg of compound (I) to the mammal.

10. The use according to any of claims 1 to 6, wherein the medicament provides 2 mg of compound (I) to the mammal.

11. The use according to any of claims 1 to 6, wherein the medicament provides 4 mg of compound (I) to the mammal.

12. The use according to any of claims 1 to 6, wherein the medicament provides 8 mg of compound (I) to the mammal.

13. The use according to claim 1, wherein the insulin sensitizer is (+) - 5 - [[4 - [(3,4-dihydro-6-hydroxy-2,5,7,8- tetramethyl-2H-1-benzopyran-2-yl) methoxy] phenyl] methyl] -2,4-thiazolidinedione (or troglitazone), 5- [4 - [(1-methylcyclohexyl) methoxy] benzyl] thiazolidino-2,4- DONONE (or CLOLITAZONE), 5- [4- [2- (5-Ethyl-2-yl) ethoxy] benzyl] thiazole-2,4-dione (or pioglitazone) or 5 - [(2- benzyl-2,3-dihydrobenzopyran) -5-ylmethyl) thiazolidino-2,4-dione (or englitazone); or a pharmaceutically acceptable form thereof.

14. A pharmaceutical composition comprising an insulin sensitizer, an antihyperglycemic agent of biguanide and a pharmaceutically acceptable carrier thereof.

15. A composition according to claim 14, further characterized in that the anti-hyperglycemic agent of biguanide is metformin.

16. A composition according to claim 14, further characterized in that the anti-hyperglycemic agent of biguanide is metformin hydrochloride.

17. A composition according to any of claims 14 to 16, further characterized in that it comprises 500 mg or 850 mg of metformin.

18. A composition according to any of claims 14 to 17, further characterized in that the insulin sensitizer is compound (I).

19. A composition according to any of claims 14 to 18, further characterized in that it comprises from 2 to 12 mg of compound (I).

20. A pharmaceutical composition comprising an insulin sensitizer, an antihyperglycemic agent of biguanide and a pharmaceutically acceptable carrier thereof, for use as an active therapeutic substance.

21. A pharmaceutical composition comprising an insulin sensitizer, a biguanide antihyperglycemic agent and a pharmaceutically acceptable carrier thereof, for use in the treatment of diabetes mellitus and conditions associated with diabetes mellitus.

22. A composition according to any of claims 14, 20 or 21, further characterized because the insulin sensitizer is (+) - 5 - [[4 - [(3,4-dihydro-6-hydroxy-2,5,7,8-tetramethyl-2H-1-benzopyran -2-yl) methoxy] phenyl] methyl] -2,4-thiazolidinedione (or troglitazone), 5- [4 - [(1-methylcyclohexyl) methoxy] benzyl] thiazolidino-2,4-dione (or ciglitazone), - [4- [2- (5-ethylpyridin-2-yl) ethoxy] benzyl] thiazolidino-2,4-dione (or pioglitazone) or 5 - [(2-benzyl-2,3-dihydrobenzopyran) -5-ylmethyl ) thiazolidino-2,4-dione (or englitazone); or a pharmaceutically acceptable form thereof.