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WO2011149110A1 - Novel composition for the prevention and/or treatment of thromboembolism - Google Patents

Novel composition for the prevention and/or treatment of thromboembolism Download PDF

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Publication number
WO2011149110A1
WO2011149110A1 PCT/JP2011/062645 JP2011062645W WO2011149110A1 WO 2011149110 A1 WO2011149110 A1 WO 2011149110A1 JP 2011062645 W JP2011062645 W JP 2011062645W WO 2011149110 A1 WO2011149110 A1 WO 2011149110A1
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WO
WIPO (PCT)
Prior art keywords
solvate
acceptable salt
pharmacologically acceptable
carbonyl
clopidogrel
Prior art date
Application number
PCT/JP2011/062645
Other languages
French (fr)
Inventor
Yoshiyuki Morishima
Original Assignee
Daiichi Sankyo Company, Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Daiichi Sankyo Company, Limited filed Critical Daiichi Sankyo Company, Limited
Publication of WO2011149110A1 publication Critical patent/WO2011149110A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/4353—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems
    • A61K31/4365—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom ortho- or peri-condensed with heterocyclic ring systems the heterocyclic ring system having sulfur as a ring hetero atom, e.g. ticlopidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/4427—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems
    • A61K31/444—Non condensed pyridines; Hydrogenated derivatives thereof containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring heteroatom, e.g. amrinone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P7/00—Drugs for disorders of the blood or the extracellular fluid
    • A61P7/02—Antithrombotic agents; Anticoagulants; Platelet aggregation inhibitors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P9/00—Drugs for disorders of the cardiovascular system
    • A61P9/10—Drugs for disorders of the cardiovascular system for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis

Definitions

  • the present invention relates to combined use of an antiplatelet agent clopidogrel and an anticoagulant edoxaban or a pharmacologically acceptable salt thereof, or a solvate thereof.
  • the present invention also relates to a pharmaceutical composition comprising an antiplatelet agent clopidogrel and an anticoagulant edoxaban or a pharmacologically acceptable salt thereof, or a solvate thereof, and a method for preventing and/or treating thrombosis and/or embolism using the pharmaceutical composition.
  • Antiplatelet agents and anticoagulants are known as preventive and/or therapeutic drugs for thrombosis and/or embolism.
  • pharmaceutical drugs such as ticlopidine, clopidogrel, prasugrel, aspirin, sarpogrelate, limaprost, or cilostazol are clinically used as antiplatelet agents, and are effective in the prevention and/or treatment of ischemic heart disease, cerebral infarction, and the like, caused by thrombosis or embolism.
  • anticoagulants there are known, for example, heparin, enoxaparin sodium, fondaparinux sodium, warfarin, rivaroxaban, dabigatran, and N 1 -(5- chloropyridin-2-yl)-N 2 -((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide (in the present specification, also referred to as compound I or edoxaban) represented by the following formula (I):
  • activated blood coagulation factor X in the present specification, also referred to as factor Xa or FXa
  • FXa inhibitor activated blood coagulation factor X inhibitor
  • Patent Literature 1 to 3 a preventive and/or therapeutic agent for thrombosis and/or embolism
  • Patent Literature 4 an antiplatelet agent and an anticoagulant
  • Patent Literature 5 or 6 combined use of an antiplatelet agent and an FXa inhibitor
  • PLT6 Japanese Patent Laid-Open No. 2006-52208
  • An object of the present invention is to find a novel pharmaceutical composition that is useful in the prevention and/or treatment of thrombosis and/or embolism.
  • the present inventor has conducted diligent studies on novel preventive and/or therapeutic agents for thrombosis and/or embolism, and consequently found that, surprisingly, the combination of clopidogrel and compound I or salt thereof, etc., among many other known antiplatelet agents and anticoagulants, exerts an antithrombotic effect equivalent to that observed by administering each of them in an amount required to exert sufficient effect in itself (in the present specification, this amount is also referred to as a usual dose and/or a clinically effective dose), without promoting the risk of bleeding.
  • the present invention relates to:
  • a pharmaceutical composition comprising compound L or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and a pharmaceutically acceptable carrier;
  • the pharmaceutical composition according to any one of [1] to [4], wherein the pharmaceutical composition is a kit comprising a preparation comprising the compound (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, a preparation comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, and an instruction which instructs an administration method of the two preparations;
  • a pharmaceutical drug comprising compound I or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof.
  • the present invention relates to:
  • a pharmaceutical composition comprising N 1 -(5-chloropyridin-2-yl)-N 2 -((1S,2R,4S)- 4-[(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide represented by the following formula (I):
  • composition comprising N 1 -(5-chloropyridin-2-yl)-N 2 -((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide represented by the following formula (I)
  • composition comprising clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
  • kits according to [2.] wherein the pharmaceutical composition comprising the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, and the pharmaceutical composition comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, are separately packaged;
  • prevention or treatment comprises administration of N 1 -(5-chloropyridin-2-yl)-N 2 -((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
  • clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and N 1 -(5-chloropyridin-2-yl)-N 2 - ((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4- c]pyridin-2-yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide represented by the following formula (I):
  • prevention or treatment comprises administration of N 1 -(5- chloropyridin-2-yl)-N 2 -((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2- ⁇ [(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino ⁇ cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
  • the present invention provides a novel pharmaceutical composition that is useful in the prevention and/or treatment of thrombosis and/or embolism.
  • Figure 1A represents the change in the amount of protein in thrombus (ordinate) caused by administering compound la to rats in a model of ferric chloride- induced arterial thrombosis.
  • Figure 1 B represents the FXa inhibitory activity (ordinate) of compound la in a rat model of ferric chloride-induced arterial thrombosis.
  • * P ⁇ 0.05 and "* P ⁇ 0.001 were compared with the control group (Dunnett test).
  • FIG. 2 represents the change in the amount of protein in thrombus (ordinate) caused by administering clopidogrel to rats in a model of ferric chloride-induced arterial thrombosis.
  • FIG. 3 represents the change in the amount of protein in thrombus (ordinate) caused by administering compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) to rats in a model of ferric chloride-induced arterial thrombosis.
  • ##P ⁇ 0.01 and ###P ⁇ 0.001 were compared with the control group (Student t test). $$$P ⁇ 0.001 was compared with the compound la group (Student t test). *** P ⁇ 0.001 was compared with the clopidogrel group (Student t test).
  • Figure 4 represents the change in bleeding time (ordinate) caused by administering compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) to rats in a model of tail bleeding.
  • ##P ⁇ 0.01 was compared with the control group (Wilcoxon test). $$$P ⁇ 0.001 was compared with the compound la group (Wilcoxon test).
  • Figure 5A represents the influence of compound la (1 mg/kg) and/or clopidogrel
  • Figure 5B represents the influence of compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) on platelet aggregation activity (ordinate) in rats.
  • ###P ⁇ 0.001 was compared with the control group (Student t test). $$$P ⁇ 0.001 was compared with the compound la group (Student t test). "* P ⁇ 0.001 was compared with the clopidogrel group (Student t test).
  • Compound I may be a solvate (including a hydrate), or may be a pharmacologically acceptable salt, or a solvate (including a hydrate) of the salt.
  • Examples of the salt of compound I include hydrochloride, sulfate, hydrobromide, citrate, hydroiodide, phosphate, nitrate, benzoate, methanesulfonate, benzenesulfonate, 2-hydroxyethanesulfonate, p-toluenesulfonate, acetate, propionate, oxalate, malonate, succinate, glutarate, adipate, tartrate, maleate, fumarate, malate, and mandelate.
  • the salt of compound I is preferably hydrochloride, methanesulfonate, or p- toluenesulfonate, particularly preferably p-toluenesulfonate.
  • compound I or the pharmacologically acceptable salt thereof, or the solvate thereof can include the following compounds: N 1 -(5-chloropyridin-2-yl)-N 2 -(( ⁇
  • Compound I or the pharmacologically acceptable salt thereof, or the solvate thereof can be produced by a method described in Patent Literature 1 to 3 or a method equivalent thereto.
  • clopidogrel may be a solvate (including a hydrate), or may be a pharmacologically acceptable salt, or a solvate (including a hydrate) of the salt.
  • the clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, is also referred to in the present specification as clopidogrel or salt thereof, etc.
  • the present invention is not limited to clopidogrel sulfate and also encompasses pharmacologically acceptable salts of (+)-(S)-methyl 2-(2-chlorophenyl)-2-(4, 5,6,7- tetrah drothieno[3,2-c]pyridin-5-yl)acetate represented by the following formula (II):
  • Clopidogrel sulfate and clopidogrel hydrogen sulfate are preferred.
  • the present invention demonstrated that clopidogrel or salt thereof, etc. exerts excellent antithrombotic effect even at less than a usual dose without promoting bleeding by combined use with compound I or salt thereof, etc.
  • the usual dose refers to an amount required to exert sufficient effect in itself, that is, the dose required to show clinical effect (also referred to herein as a "clinically effective dose”).
  • the phrase "less than a usual dose” refers to a dose lower than the amount required to exert sufficient effect in itself, that is, a dose lower than the clinically effective dose.
  • the phrase "less than a usual dose” refers a dose lower than a dose recommended as a use to show the desired therapeutic effect when the ingredient is administered alone to a human.
  • the general-purpose dose of clopidogrel or salt thereof, etc. recommended as a use to show the desired therapeutic effect can be known readily by those skilled in the art and is 50 to 900 mg per day in an adult as of the filing of the present application. From such a viewpoint, the dose of the clopidogrel or salt thereof, etc. combined with the compound I or salt thereof, etc.
  • the dose of the clopidogrel or salt thereof, etc. combined with the compound I or salt thereof, etc. of the present application may be less than the ED50 of the clopidogrel or salt thereof, etc.
  • the present invention demonstrated that compound I or salt thereof, etc. exerts excellent antithrombotic effect even at less than a usual dose without promoting bleeding by combined use with clopidogrel or salt thereof, etc.
  • the usual dose refers to an amount required to exert sufficient effect in itself, that is, the dose required to show clinical effect (also referred to herein as a "clinically effective dose”).
  • the phrase “less than a usual dose” refers to a dose lower than the amount required to exert sufficient effect in itself, that is, a dose lower than the clinically effective dose.
  • the phrase “less than a usual dose” refers a dose less than a dose recommended as a use to show the desired therapeutic effect when the ingredient is administered alone to a human.
  • the dose of the compound I or salt thereof, etc. combined with the clopidogrel or salt thereof, etc. of the present application is, for example, 3 to 90 mg, 5 to 80 mg, 5 to 70 mg, 5 to 60 mg, 5 to 50 mg, 5 to 40 mg, 5 to 30 mg, 5 to 20 mg, or 5 to 10 mg per day in an adult.
  • the dose of the compound I or salt thereof, etc. combined with the clopidogrel or salt thereof, etc. of the present application may be less than the ED50 of the compound I or salt thereof, etc.
  • Certain embodiments of the present invention relate to a pharmaceutical composition comprising compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. as active ingredients, a pharmaceutical composition comprising compound I or salt thereof, etc. as an active ingredient, wherein the pharmaceutical composition is used in combination with clopidogrel or salt thereof, etc., or a pharmaceutical composition comprising clopidogrel or salt thereof, etc. as an active ingredient, wherein the pharmaceutical composition is used in combination with compound I or salt thereof, etc.
  • inventions of the present invention relate to a method for preventing and/or treating thrombosis and/or embolism, comprising administering compound I or salt thereof, etc. and clopidogrel or salt thereof, etc., a method for preventing and/or treating thrombosis and/or embolism, comprising administering compound I or salt thereof, etc. which is used in combination with clopidogrel or salt thereof, etc., or a method for preventing and/or treating thrombosis and/or embolism, comprising administering clopidogrel or salt thereof, etc. which is used in combination with compound I or salt thereof, etc.
  • each of the compound I or salt thereof, etc. and the clopidogrel or salt thereof, etc. can be administered at a dose lower than an amount required to exert sufficient effect in itself, or at less than a clinically effective dose of each single compound. Furthermore, each of the compound I or salt thereof, etc. and the clopidogrel or salt thereof, etc. may be administered at less than the ED50 of each single compound. Adverse reactions attributed to each active ingredient can be reduced by administering each active ingredient at a dose lower than an amount required to exert sufficient effect in itself.
  • the pharmaceutical compositions of the present invention may be administered orally or parenterally, and are preferably administered orally.
  • the oral dosage forms of the present invention can include tablets, fine granules, powders, granules, capsules, syrups, or suspensions.
  • the oral dosage form is preferably a tablet or a capsule.
  • the pharmaceutical compositions of the present invention may contain a pharmaceutically acceptable carrier, in addition to the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc.
  • Those skilled in the art can appropriately select and use the pharmaceutically acceptable carrier used in combination with the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc.
  • the pharmaceutically acceptable carrier include pharmaceutically acceptable additives described below.
  • the pharmaceutically acceptable additives include fillers, bulking agents, binders, disintegrants, dissolution promoters, wetting agents, and lubricants. These additives can be selected and used appropriately according to the need.
  • the pharmaceutical composition of the present invention when it is an orally administrable preparation, it may be a solid preparation or a nonsolid preparation, and is preferably a solid preparation.
  • the solid preparation include tablets, fine granules, powders, granules, and capsules.
  • the solid preparation is preferably a tablet or a capsule.
  • a well known method for producing solid preparations can be adopted as a production method thereof.
  • the pharmaceutical compositions of the present invention can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, a fluidizer, a lubricant, a coloring agent, and a lustering agent, and so on, according to the need, into the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc., together or separately, and subjecting the formulation to a method for producing solid preparations described in the General Rules for Preparations in the Japanese Pharmacopoeia.
  • the dosage form of the pharmaceutical composition of the present invention is granules
  • they can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, and other appropriate additives according to the need into the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, mixing them into a homogeneous mixture, and then granulating the mixture by an appropriate method to obtain granules.
  • the obtained granules may further be coated by spraying a suspension/dissolution ⁇ qf a coating agent using a fluidized-bed coating machine.
  • the dosage form of the pharmaceutical composition of the present invention is a powder
  • it can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, and other appropriate additives according to the need into the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, mixing them into a homogeneous mixture, and then pulverizing or microgranulating the mixture by an appropriate method to obtain a powder or fine particles.
  • the obtained powder or fine particles may further be coated by spraying a dissolution/suspension of a coating agent using a fluidized-bed coating machine.
  • the dosage form of the pharmaceutical composition of the present invention is a capsule, it can be produced by merely charging the granules or the powder into appropriate capsule shells.
  • the dosage form of the pharmaceutical composition of the present invention is a tablet
  • it may be produced by mixing pharmaceutically acceptable carriers such as an excipient, a disintegrant, and a binder with the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, and directly compression-molding the mixture
  • the tablet may be produced by granulating a mixed powder by fluidized-bed granulation, stirring granulation, or the like, and then compression-molding the obtained granules.
  • the pharmaceutical composition of the present invention may be a combination drug of clopidogrel or salt thereof, etc. and compound I or salt thereof, etc.
  • a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof, etc. may be packaged separately.
  • a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof, etc. is packaged separately, one combined dose of these two agents may be packaged in a clear configuration or instructed clearly.
  • the pharmaceutical composition of the present invention may be a kit for prevention and/or treatment comprising a set of a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof. etc.
  • a combination drug may be administered, or compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. may be administered separately, as shown in the package form.
  • the daily dose of the preventive and/or therapeutic agent of the present invention may be administered in one to three portions.
  • each drug may be administered at least within 24 hours, at least within 12 hours, at least within 6 hours, at least within 1 hour, or at least within 30 minutes from the administration of the other drug.
  • these drugs may be administered sequentially without intervals.
  • the order in which they are administered may be first administration of clopidogrel or salt thereof, etc. or may be first administration of compound I or salt thereof, etc.
  • the time interval between administration of each dose may be about 24 hours, about 12 hours * or about 8 hours, and is preferably about 24 hours.
  • the pharmaceutical compositions of the present invention are useful as preventive and/or therapeutic agents for thrombosis and/or embolism.
  • the pharmaceutical compositions of the present invention are useful as pharmaceutical drugs for mammals including humans, as antiplatelet agents, as factor Xa inhibitors, as anticoagulant agents, as preventive and/or therapeutic agents for thrombosis and/or embolism, as preventive and/or therapeutic agents for thrombotic disease, and as preventive agents and/or therapeutic agents for cerebral infarction, cerebral embolism, pulmonary infarction, pulmonary embolism, myocardial infarction, angina pectoris, thrombosis and/or embolism accompanying nonvalvular atrial fibrillation (NVAF), deep vein thrombosis, deep vein thrombosis after surgical operation, thrombosis after prosthetic valve/joint replacement, thromboembolism after total hip replacement (THR), thromboembolism after total knee replacement (TKR), thromboembolism after hip fracture surgery (HF
  • MC solution 0.5% methylcellulose
  • thrombus was collected from the abdominal aorta, and the amount of protein in the thrombus was measured.
  • blood was collected with
  • Amount of protein in thrombus 0.1 N aqueous sodium hydroxide solution containing 2% sodium carbonate was added to the thrombus and boiled for approximately 30 minutes to solubilize protein. The amount of protein in this thrombus lysate was quantified by the Bradford method. The rate of inhibition of thrombosis was calculated according to the following calculation formula:
  • Rate of inhibition of thrombosis (1 - the amount of protein in the thrombus in each individual of test substance-administered rats/an average of the amounts of protein in the thrombus in the rats in the control group) ⁇ 100.
  • FXa inhibitory activity in plasma the S-2222 degradation reaction (change in absorbance at 405 nm for 10 minutes) of human FXa was assayed using a spectrophotometer, and the FXa inhibitory activity in the plasma was calculated according to the following calculation formula using the calculated reaction rate
  • FXa inhibitory activity in plasma (1 - the reaction rate in the plasma of each individual of test substance-administered rats/an average of the reaction rates in the plasma of the rats in the control group) ⁇ 100.
  • clopidogrel inhibited thrombosis by 30%, 34%, and 75% at doses of 3 mg/kg, 10 mg/kg, and 30 mg/kg, respectively ( Figure 2).
  • Clopidogrel exerted a dose-dependent antithrombotic effect.
  • the ED50 value of the thrombosis inhibitory effect of clopidogrel was 12 mg/kg.
  • clopidogrel (10 mg/kg) or a 0.5% MC solution was orally administered.
  • compound la (1 mg/kg) or a 0.5% MC solution was orally administered thereto.
  • each rat was anesthetized with thiopental sodium. Fifteen minutes after the anesthesia, an incision of 1 mm in depth was made in the arterial portion at a position of 4 cm from the tip of the tail using a blade. Blood was blotted every 15 seconds with filter paper. Cessation of bleeding was confirmed as the absence of any detectable blood stain on the opposite side of the filter paper, which touched the wound for 30 seconds. The bleeding time was defined as the interval from the incision to the last detectable blood stain. When the bleeding did not stop within 30 minutes, the bleeding time was defined as 30 minutes.
  • Ratio of prolongation of bleeding time compared with the control the bleeding time of each individual of test substance-administered rats/an average of the bleeding times of the rats in the control group.
  • the control group and the group administered with compound la alone did not differ in bleeding time ( Figure 4).
  • the group administered with clopidogrel alone and the group administered with the combination of compound la + clopidogrel had almost the same ratio of prolongation of bleeding time compared with the control (2.1 times and 2.0 times, respectively).
  • the bleeding time observed in the group administered with clopidogrel alone was not prolonged by the addition of compound la.
  • clopidogrel (10 mg/kg) or a 0.5% MC solution was orally administered.
  • compound la (1 mg/kg) or a 0.5% MC solution was orally administered thereto.
  • each rat was anesthetized with thiopental sodium, and blood was collected with 3.13% trisodium citrate dihydrate as an anticoagulant from the jugular vein and the abdominal aorta.
  • PPP platelet rich plasma
  • PPP platelet poor plasma
  • the light transmittance of PPP was defined as an aggregation value of 100%, and the rate of platelet aggregation in PRP induced by adenosine diphosphate (ADP, final concentration: 3 ⁇ ) was determined.
  • ADP adenosine diphosphate
  • Rate of inhibition of platelet aggregation (1 - the maximum platelet aggregation in each individual of test substance-administered rats/an average of the maximum rates of platelet aggregations in the rats in the control group) ⁇ 100.
  • Plasma was separated from the blood collected from the jugular vein, and the FXa inhibitory activity in the plasma was determined in the same way as in Example 1 (1 ).
  • the group administered with compound la alone had the maximum rate of platelet aggregation equivalent to that of the control group.
  • Significant platelet aggregation inhibitory activity was observed in the group administered with clopidogrel alone and the group administered with the combination of compound la + clopidogrel, and the activity did not differ between the two groups.

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Abstract

An object of the present invention is to find a novel pharmaceutical drug combination that does not promote the risk of bleeding as adverse reaction and is useful in the prevention and/or treatment of thrombus and/or embolism. The present invention provides a pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I): or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof. The present invention also provides a kit comprising: a pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2- ((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof; and a pharmaceutical composition comprising clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof; which may be packaged separately.

Description

DESCRIPTION
Title of Invention
NOVEL COMPOSITION FOR THE PREVENTION AND/OR TREATMENT OF THROMBOEMBOLISM
Technical Field
The present invention relates to combined use of an antiplatelet agent clopidogrel and an anticoagulant edoxaban or a pharmacologically acceptable salt thereof, or a solvate thereof. The present invention also relates to a pharmaceutical composition comprising an antiplatelet agent clopidogrel and an anticoagulant edoxaban or a pharmacologically acceptable salt thereof, or a solvate thereof, and a method for preventing and/or treating thrombosis and/or embolism using the pharmaceutical composition.
Background Art
Antiplatelet agents and anticoagulants are known as preventive and/or therapeutic drugs for thrombosis and/or embolism. For example, pharmaceutical drugs such as ticlopidine, clopidogrel, prasugrel, aspirin, sarpogrelate, limaprost, or cilostazol are clinically used as antiplatelet agents, and are effective in the prevention and/or treatment of ischemic heart disease, cerebral infarction, and the like, caused by thrombosis or embolism. As anticoagulants, there are known, for example, heparin, enoxaparin sodium, fondaparinux sodium, warfarin, rivaroxaban, dabigatran, and N1-(5- chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide (in the present specification, also referred to as compound I or edoxaban) represented by the following formula (I):
Figure imgf000002_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof (in the present specification, these are also referred to as compound I or salt thereof, etc.). For example, N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4- [(d i methyla m i no )ca rbo nyl]-2-{[(5-^
yl)carbonyl]amino}cyclohexyl)ethanediamide p-toluenesulfonate monohydrate (in the present specification, also referred to as compound la) represented by the following formula (la):
Figure imgf000003_0001
is known as a pharmacologically acceptable salt and solvate of compound I.
It is known that edoxaban or salt thereof, etc. exerts a strong inhibitory effect on activated blood coagulation factor X (in the present specification, also referred to as factor Xa or FXa), and is useful as a pharmaceutical drug, particularly, as an activated blood coagulation factor X inhibitor (in the present specification, also referred to as factor Xa inhibitor or FXa inhibitor) and/or as a preventive and/or therapeutic agent for thrombosis and/or embolism (Patent Literature 1 to 3).
However, for further enhancing the preventive/therapeutic effects on thrombosis or embolism, it is required to develop novel drugs or to devise drug administration methods, and so on. Combined use of an antiplatelet agent and an anticoagulant (Patent Literature 4) or combined use of an antiplatelet agent and an FXa inhibitor (Patent Literature 5 or 6) is known as a strategy for the method of drug administration. Citation List
Patent Literature
PLT1 : WO2003/000657
PLT2: WO2003/000680
PLT3: WO2003/016302
PLT4: U.S. Patent No. 6103705
PLT5: W098-56365
PLT6: Japanese Patent Laid-Open No. 2006-52208
Summary of Invention
Technical Problem An object of the present invention is to find a novel pharmaceutical composition that is useful in the prevention and/or treatment of thrombosis and/or embolism.
Solution to Problem
The present inventor has conducted diligent studies on novel preventive and/or therapeutic agents for thrombosis and/or embolism, and consequently found that, surprisingly, the combination of clopidogrel and compound I or salt thereof, etc., among many other known antiplatelet agents and anticoagulants, exerts an antithrombotic effect equivalent to that observed by administering each of them in an amount required to exert sufficient effect in itself (in the present specification, this amount is also referred to as a usual dose and/or a clinically effective dose), without promoting the risk of bleeding.
Specifically, the present invention relates to:
[1] a pharmaceutical composition comprising compound L or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and a pharmaceutically acceptable carrier;
[2] the pharmaceutical composition according to [1], wherein the pharmaceutical composition is a preventive and/or therapeutic agent for thrombosis and/or embolism;
[3] the pharmaceutical composition according to [1] or [2], wherein the pharmaceutical composition is used in the prevention and/or treatment of cerebral infarction, cerebral embolism, pulmonary infarction, pulmonary embolism, myocardial infarction, angina pectoris, thrombosis and/or embolism accompanying nonvalvular atrial fibrillation (NVAF), deep vein thrombosis, deep vein thrombosis after surgical operation, thrombosis after prosthetic valve/joint replacement, thromboembolism after total hip replacement (THR), thromboembolism after total knee replacement (TKR), thromboembolism after hip fracture surgery (HFS), thrombosis and/or reocclusion after revascularization, Buerger's disease, disseminated intravascular coagulation syndrome, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), thrombosis at the time of extracorporeal circulation, blood coagulation at the time of blood collection, cerebrovascular disorder, relapse after ischemic cerebrovascular disorder, acute coronary syndrome, acute coronary syndrome to which percutaneous coronary intervention (PCI) is applied, unstable angina, and/or non-ST segment elevation myocardial infarction;
[4] the pharmaceutical composition according to any one of [1] to [3], wherein the preparation comprising the compound (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, and the preparation comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, are separately packaged.
[5] the pharmaceutical composition according to any one of [1] to [4], wherein the pharmaceutical composition is a kit comprising a preparation comprising the compound (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, a preparation comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, and an instruction which instructs an administration method of the two preparations;
[6] the pharmaceutical composition according to any one of [1] to [3], wherein the preparation is a combination drug of the compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, and the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof;
[7] the pharmaceutical composition according to any one of [1] to [6], wherein the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, is administered at a dose lower than an amount required for the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, to exert sufficient effect in itself;
[8] the pharmaceutical composition according to any one of [1] to [7], wherein the compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, is administered at a dose lower than an amount required for the compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, to exert sufficient effect in itself;
[9] the pharmaceutical composition according to any one of [1] to [8], wherein the compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, is compound la; and
[10] a pharmaceutical drug comprising compound I or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof. According to other embodiments, the present invention relates to:
[1.] a pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)- 4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000006_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, , or a solvate thereof, and a pharmaceutically acceptable carrier;
[2.] a kit comprising:
a pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I)
Figure imgf000006_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof,
and
a pharmaceutical composition comprising clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
[3.] a kit according to [2.], wherein the pharmaceutical composition comprising the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, and the pharmaceutical composition comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, are separately packaged;
[4.] a kit according to [3.], further comprising an instruction which instructs an administration method of the two pharmaceutical compositions; [5.] the pharmaceutical composition according to [1 .], or the kit according to any one of [2.] to [4.], wherein the pharmaceutical composition or kit is a preventive and/or therapeutic agent for thrombus and/or embolism; [6.] the pharmaceutical composition according to [1.], or the kit according to any one of [2.] to [4.], wherein the pharmaceutical composition or kit is for use in the prevention and/or treatment of cerebral infarction, cerebral embolism, pulmonary infarction, pulmonary embolism, myocardial infarction, angina pectoris, thrombosis and/or embolism accompanying nonvalvular atrial fibrillation, deep vein thrombosis, deep vein thrombosis after surgical operation, thrombosis after prosthetic valve/joint replacement, thromboembolism after total hip replacement, thromboembolism after total knee replacement, thromboembolism after hip fracture surgery, thrombosis and/or reocclusion after revascularization, Buerger's disease, disseminated intravascular coagulation syndrome, systemic inflammatory response syndrome, multiple organ dysfunction syndrome, thrombosis at the time of extracorporeal circulation, blood coagulation at the time of blood collection, cerebrovascular disorder, relapse after ischemic cerebrovascular disorder, acute coronary syndrome, acute coronary syndrome to which percutaneous coronary intervention is applied, unstable angina, and/or non-ST segment elevation myocardial infarction;
[7.] the pharmaceutical composition according to [1.], or the kit according to any one of [2.] to [4.], wherein the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof is for administration at a dose lower than a clinically effective dose of the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof;
[8.] the pharmaceutical composition according to [ .], or the kit according to any one of [2.] to [4.], wherein the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof is for administration at a dose lower than a clinically effective dose of the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof;
[9.] the pharmaceutical composition according to [1.], or the kit according to any one of [2.] to [4.], wherein the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof is N1-(5-chloropyridin- 2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethaned p- toluenesulfonate monohydrate represented by the following formula (la):
Figure imgf000008_0001
[10.] a method for prevention and/or treatment of thrombus and/or embolism, comprising administering N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-
[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000008_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
[11.] N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5- methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000008_0003
or a pharmacologically acceptable salt thereof, or a solvate thereof, for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
[12.] clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and N1-(5-chloropyridin-2-yl)-N2- ((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4- c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000009_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof;
[13.] use of N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5- methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
( I )
Figure imgf000009_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of N1-(5- chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof;
[14.] use of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-
[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000010_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof; and
[15.] use of N -(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5- methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000010_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism. Advantageous Effects of Invention
The present invention provides a novel pharmaceutical composition that is useful in the prevention and/or treatment of thrombosis and/or embolism.
Brief Description of Drawings
[Fig. 1] Figure 1A represents the change in the amount of protein in thrombus (ordinate) caused by administering compound la to rats in a model of ferric chloride- induced arterial thrombosis. Figure 1 B represents the FXa inhibitory activity (ordinate) of compound la in a rat model of ferric chloride-induced arterial thrombosis. In each diagram, the open circles denote values of individual data; the filled circle and the bars denote the mean ± SE (N=6); and each value within parentheses denotes % inhibition. *P<0.05 and "*P<0.001 were compared with the control group (Dunnett test).
[Fig. 2] Figure 2 represents the change in the amount of protein in thrombus (ordinate) caused by administering clopidogrel to rats in a model of ferric chloride-induced arterial thrombosis. The open circles denote values of individual data; the filled circle and the bars denote the mean ± SE (N=6); and each value within parentheses denotes % inhibition. "*P<0.001 was compared with the control group (Dunnett test).
[Fig. 3] Figure 3 represents the change in the amount of protein in thrombus (ordinate) caused by administering compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) to rats in a model of ferric chloride-induced arterial thrombosis. The open circles denote values of individual data; the filled circle and the bars denote the mean ± SE (N=6); and each value within parentheses denotes % inhibition. ##P<0.01 and ###P<0.001 were compared with the control group (Student t test). $$$P<0.001 was compared with the compound la group (Student t test). ***P<0.001 was compared with the clopidogrel group (Student t test).
[Fig. 4] Figure 4 represents the change in bleeding time (ordinate) caused by administering compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) to rats in a model of tail bleeding. The open circles denote values of individual data; the filled circle and the bars denote the mean + SE (N=8); and each value within parentheses denotes the ratio of prolongation of bleeding time compared with the control. ##P<0.01 was compared with the control group (Wilcoxon test). $$$P<0.001 was compared with the compound la group (Wilcoxon test).
[Fig. 5] Figure 5A represents the influence of compound la (1 mg/kg) and/or clopidogrel
(10 mg/kg) on FXa activity (ordinate). Figure 5B represents the influence of compound la (1 mg/kg) and/or clopidogrel (10 mg/kg) on platelet aggregation activity (ordinate) in rats. The open circles denote values of individual data; the filled circle and the bars denote the mean ± SE (N=4); and each value within parentheses denotes % inhibition. ###P<0.001 was compared with the control group (Student t test). $$$P<0.001 was compared with the compound la group (Student t test). "*P<0.001 was compared with the clopidogrel group (Student t test).
Description of Embodiments
N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5- methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000012_0001
is identified by the International Nonproprietary Name (INN) of edoxaban, (N-(5- chloropyridin-2-yl)-N'-[(1S,2R,4S)-4-(N,N-dimethylcarbamoyl)-2-(5-methyl-4,5,6,7- tetrahydro[1 ,3]thiazolo[5,4-c]pyridine-2-carboxamido)cyclohexyl]oxamide).
Compound I may be a solvate (including a hydrate), or may be a pharmacologically acceptable salt, or a solvate (including a hydrate) of the salt.
Examples of the salt of compound I include hydrochloride, sulfate, hydrobromide, citrate, hydroiodide, phosphate, nitrate, benzoate, methanesulfonate, benzenesulfonate, 2-hydroxyethanesulfonate, p-toluenesulfonate, acetate, propionate, oxalate, malonate, succinate, glutarate, adipate, tartrate, maleate, fumarate, malate, and mandelate.
The salt of compound I is preferably hydrochloride, methanesulfonate, or p- toluenesulfonate, particularly preferably p-toluenesulfonate.
Preferable examples of compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, can include the following compounds: N1-(5-chloropyridin-2-yl)-N2-((^
4,5,67-tetrahydrothiazolo[5,4-c]pyridin-^
N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{^
4,5,67-tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethan hydrochloride;
N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl- 4,5,67-tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediarnide p-toluenesulfonate; and
N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl- 4i5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide p-toluenesulfonate monohydrate represented by the following formula (la):
Figure imgf000013_0001
Compound I or the pharmacologically acceptable salt thereof, or the solvate thereof, can be produced by a method described in Patent Literature 1 to 3 or a method equivalent thereto.
In the present specification, clopidogrel may be a solvate (including a hydrate), or may be a pharmacologically acceptable salt, or a solvate (including a hydrate) of the salt. The clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, is also referred to in the present specification as clopidogrel or salt thereof, etc. The present invention is not limited to clopidogrel sulfate and also encompasses pharmacologically acceptable salts of (+)-(S)-methyl 2-(2-chlorophenyl)-2-(4, 5,6,7- tetrah drothieno[3,2-c]pyridin-5-yl)acetate represented by the following formula (II):
Figure imgf000013_0002
or solvates thereof (including hydrates). Clopidogrel sulfate and clopidogrel hydrogen sulfate are preferred. The present invention demonstrated that clopidogrel or salt thereof, etc. exerts excellent antithrombotic effect even at less than a usual dose without promoting bleeding by combined use with compound I or salt thereof, etc. In this context, the usual dose refers to an amount required to exert sufficient effect in itself, that is, the dose required to show clinical effect (also referred to herein as a "clinically effective dose"). Moreover, the phrase "less than a usual dose" refers to a dose lower than the amount required to exert sufficient effect in itself, that is, a dose lower than the clinically effective dose. In other words, the phrase "less than a usual dose" refers a dose lower than a dose recommended as a use to show the desired therapeutic effect when the ingredient is administered alone to a human. The general-purpose dose of clopidogrel or salt thereof, etc. recommended as a use to show the desired therapeutic effect can be known readily by those skilled in the art and is 50 to 900 mg per day in an adult as of the filing of the present application. From such a viewpoint, the dose of the clopidogrel or salt thereof, etc. combined with the compound I or salt thereof, etc. of the present application is, for example, 10 to 800 mg, 10 to 700 mg, 10 to 600 mg, 10 to 500 mg, 10 to 450 mg, 10 to 400 mg, 10 to 300 mg, 10 to 200 mg, 10 to 150 mg, 10 to 100 mg, or 10 to 50 mg per day in an adult. According to the present invention, the dose of the clopidogrel or salt thereof, etc. combined with the compound I or salt thereof, etc. of the present application may be less than the ED50 of the clopidogrel or salt thereof, etc.
Moreover, the present invention demonstrated that compound I or salt thereof, etc. exerts excellent antithrombotic effect even at less than a usual dose without promoting bleeding by combined use with clopidogrel or salt thereof, etc. In this context, the usual dose refers to an amount required to exert sufficient effect in itself, that is, the dose required to show clinical effect (also referred to herein as a "clinically effective dose"). Moreover, the phrase "less than a usual dose" refers to a dose lower than the amount required to exert sufficient effect in itself, that is, a dose lower than the clinically effective dose. In other words, the phrase "less than a usual dose" refers a dose less than a dose recommended as a use to show the desired therapeutic effect when the ingredient is administered alone to a human. When used alone, compound I or salt thereof, etc. probably shows the desired therapeutic effect usually at approximately 5 to approximately 100 mg in an adult. From such a viewpoint, the dose of the compound I or salt thereof, etc. combined with the clopidogrel or salt thereof, etc. of the present application is, for example, 3 to 90 mg, 5 to 80 mg, 5 to 70 mg, 5 to 60 mg, 5 to 50 mg, 5 to 40 mg, 5 to 30 mg, 5 to 20 mg, or 5 to 10 mg per day in an adult. According to the present invention, the dose of the compound I or salt thereof, etc. combined with the clopidogrel or salt thereof, etc. of the present application may be less than the ED50 of the compound I or salt thereof, etc.
Certain embodiments of the present invention relate to a pharmaceutical composition comprising compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. as active ingredients, a pharmaceutical composition comprising compound I or salt thereof, etc. as an active ingredient, wherein the pharmaceutical composition is used in combination with clopidogrel or salt thereof, etc., or a pharmaceutical composition comprising clopidogrel or salt thereof, etc. as an active ingredient, wherein the pharmaceutical composition is used in combination with compound I or salt thereof, etc.
Other embodiments of the present invention relate to a method for preventing and/or treating thrombosis and/or embolism, comprising administering compound I or salt thereof, etc. and clopidogrel or salt thereof, etc., a method for preventing and/or treating thrombosis and/or embolism, comprising administering compound I or salt thereof, etc. which is used in combination with clopidogrel or salt thereof, etc., or a method for preventing and/or treating thrombosis and/or embolism, comprising administering clopidogrel or salt thereof, etc. which is used in combination with compound I or salt thereof, etc.
In the pharmaceutical compositions of the present invention, each of the compound I or salt thereof, etc. and the clopidogrel or salt thereof, etc. can be administered at a dose lower than an amount required to exert sufficient effect in itself, or at less than a clinically effective dose of each single compound. Furthermore, each of the compound I or salt thereof, etc. and the clopidogrel or salt thereof, etc. may be administered at less than the ED50 of each single compound. Adverse reactions attributed to each active ingredient can be reduced by administering each active ingredient at a dose lower than an amount required to exert sufficient effect in itself.
The pharmaceutical compositions of the present invention may be administered orally or parenterally, and are preferably administered orally. Examples of the oral dosage forms of the present invention can include tablets, fine granules, powders, granules, capsules, syrups, or suspensions. The oral dosage form is preferably a tablet or a capsule. The pharmaceutical compositions of the present invention may contain a pharmaceutically acceptable carrier, in addition to the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. Those skilled in the art can appropriately select and use the pharmaceutically acceptable carrier used in combination with the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. Examples of the pharmaceutically acceptable carrier include pharmaceutically acceptable additives described below. Examples of the pharmaceutically acceptable additives include fillers, bulking agents, binders, disintegrants, dissolution promoters, wetting agents, and lubricants. These additives can be selected and used appropriately according to the need.
When the pharmaceutical composition of the present invention is an orally administrable preparation, it may be a solid preparation or a nonsolid preparation, and is preferably a solid preparation. Examples of the solid preparation include tablets, fine granules, powders, granules, and capsules. The solid preparation is preferably a tablet or a capsule. Moreover, a well known method for producing solid preparations can be adopted as a production method thereof. For example, the pharmaceutical compositions of the present invention can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, a fluidizer, a lubricant, a coloring agent, and a lustering agent, and so on, according to the need, into the compound I or salt thereof, etc. and clopidogrel or salt thereof, etc., together or separately, and subjecting the formulation to a method for producing solid preparations described in the General Rules for Preparations in the Japanese Pharmacopoeia.
When the dosage form of the pharmaceutical composition of the present invention is granules, they can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, and other appropriate additives according to the need into the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, mixing them into a homogeneous mixture, and then granulating the mixture by an appropriate method to obtain granules. The obtained granules may further be coated by spraying a suspension/dissolution^qf a coating agent using a fluidized-bed coating machine.
When the dosage form of the pharmaceutical composition of the present invention is a powder, it can be produced, for example, by formulating each of an excipient, a disintegrant, a binder, and other appropriate additives according to the need into the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, mixing them into a homogeneous mixture, and then pulverizing or microgranulating the mixture by an appropriate method to obtain a powder or fine particles. The obtained powder or fine particles may further be coated by spraying a dissolution/suspension of a coating agent using a fluidized-bed coating machine.
When the dosage form of the pharmaceutical composition of the present invention is a capsule, it can be produced by merely charging the granules or the powder into appropriate capsule shells.
When the dosage form of the pharmaceutical composition of the present invention is a tablet, it may be produced by mixing pharmaceutically acceptable carriers such as an excipient, a disintegrant, and a binder with the compound I or salt thereof, etc. and/or clopidogrel or salt thereof, etc., together or separately, and directly compression-molding the mixture, or the tablet may be produced by granulating a mixed powder by fluidized-bed granulation, stirring granulation, or the like, and then compression-molding the obtained granules.
The pharmaceutical composition of the present invention may be a combination drug of clopidogrel or salt thereof, etc. and compound I or salt thereof, etc. Alternatively, a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof, etc. may be packaged separately. When a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof, etc. is packaged separately, one combined dose of these two agents may be packaged in a clear configuration or instructed clearly. For example, the pharmaceutical composition of the present invention may be a kit for prevention and/or treatment comprising a set of a preparation comprising clopidogrel or salt thereof, etc. and a preparation comprising compound I or salt thereof. etc.
In actual administration, a combination drug may be administered, or compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. may be administered separately, as shown in the package form. Moreover, the daily dose of the preventive and/or therapeutic agent of the present invention may be administered in one to three portions. When compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. are separately administered, each drug may be administered at least within 24 hours, at least within 12 hours, at least within 6 hours, at least within 1 hour, or at least within 30 minutes from the administration of the other drug. Alternatively, these drugs may be administered sequentially without intervals. When compound I or salt thereof, etc. and clopidogrel or salt thereof, etc. are separately administered, the order in which they are administered may be first administration of clopidogrel or salt thereof, etc. or may be first administration of compound I or salt thereof, etc.
In actual administration, the time interval between administration of each dose (whether of the drug combination together or of each drug administered separately), may be about 24 hours, about 12 hours* or about 8 hours, and is preferably about 24 hours.
The pharmaceutical compositions of the present invention are useful as preventive and/or therapeutic agents for thrombosis and/or embolism. The pharmaceutical compositions of the present invention are useful as pharmaceutical drugs for mammals including humans, as antiplatelet agents, as factor Xa inhibitors, as anticoagulant agents, as preventive and/or therapeutic agents for thrombosis and/or embolism, as preventive and/or therapeutic agents for thrombotic disease, and as preventive agents and/or therapeutic agents for cerebral infarction, cerebral embolism, pulmonary infarction, pulmonary embolism, myocardial infarction, angina pectoris, thrombosis and/or embolism accompanying nonvalvular atrial fibrillation (NVAF), deep vein thrombosis, deep vein thrombosis after surgical operation, thrombosis after prosthetic valve/joint replacement, thromboembolism after total hip replacement (THR), thromboembolism after total knee replacement (TKR), thromboembolism after hip fracture surgery (HFS), thrombosis and/or reocclusion after revascularization, Buerger's disease, disseminated intravascular coagulation syndrome, systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), thrombosis at the time of extracorporeal circulation, blood coagulation at the time of blood collection, cerebrovascular disorder, relapse after ischemic cerebrovascular disorder, acute coronary syndrome, acute coronary syndrome to which percutaneous coronary intervention (PCI) is applied, unstable angina, and/or non-ST segment elevation myocardial infarction. In the present specification, prevention encompasses secondary prevention.
Hereinafter, the present invention will be described specifically with reference to Examples. However, the present invention is not intended to be limited to these Examples.
Examples
Example 1
Evaluation using a rat model of ferric chloride-induced arterial thrombosis
(1 ) Antithrombotic effects of compound la (Figure 1) and clopidogrel (Figure 2) To rats fasted overnight, compound la (0.3 mg/kg, 1 mg/kg, or 3 mg/kg; in the present Examples, the dose of compound la is indicated as a converted value in terms of the weight of compound I contained in the compound la - hence the dose is the dose of the free form, not the dose of the p-toluenesulfonate monohydrate) or clopidogrel sulfate (hereinafter, referred to as clopidogrel in the present Examples) (3 mg/kg, 10 mg/kg, or 30 mg/kg) was orally administered 30 minutes or 2 hours, respectively, before ferric chloride treatment. Compound la and clopidogrel were dissolved in 0.5% methylcellulose (hereinafter, referred to as an MC solution). To a control group, a solvent (MC solution) was orally administered. Fifteen minutes after the administration of compound la or 1.75 hours after the administration of clopidogrel, each rat was anesthetized with thiopental sodium (100 mg/kg, i.p.). Fifteen minutes after the anesthesia, a median incision was cut in the abdomen, and a filter paper (2x8 mm) to which a 50% ferric chloride solution had been applied was placed on the abdominal aorta to induce thrombosis. Ten minutes later, the filter paper was removed.
Twenty minutes after the ferric chloride treatment, thrombus was collected from the abdominal aorta, and the amount of protein in the thrombus was measured. For the evaluation of the FXa inhibitory activity of compound la, blood was collected with
3.13% trisodium citrate dihydrate as an anticoagulant from the jugular vein immediately before thrombus collection. After plasma separation, the FXa inhibitory activity in the plasma was determined.
Each parameter was measured as follows.
Amount of protein in thrombus: 0.1 N aqueous sodium hydroxide solution containing 2% sodium carbonate was added to the thrombus and boiled for approximately 30 minutes to solubilize protein. The amount of protein in this thrombus lysate was quantified by the Bradford method. The rate of inhibition of thrombosis was calculated according to the following calculation formula:
Rate of inhibition of thrombosis (%) = (1 - the amount of protein in the thrombus in each individual of test substance-administered rats/an average of the amounts of protein in the thrombus in the rats in the control group) χ 100.
FXa inhibitory activity in plasma: the S-2222 degradation reaction (change in absorbance at 405 nm for 10 minutes) of human FXa was assayed using a spectrophotometer, and the FXa inhibitory activity in the plasma was calculated according to the following calculation formula using the calculated reaction rate
(AO.D./min):
FXa inhibitory activity in plasma (%) = (1 - the reaction rate in the plasma of each individual of test substance-administered rats/an average of the reaction rates in the plasma of the rats in the control group) χ 100.
The results are shown in Figures 1 A, 1 B, and 2.
In the rat model of ferric chloride-induced arterial thrombosis in the abdominal aorta, compound la inhibited thrombosis by 11 %, 42%, and 82% at doses of 0.3 mg/kg, 1 mg/kg, and 3 mg/kg, respectively (Figure 1A). Compound la exerted a dose- dependent antithrombotic effect. The ED50 value of the thrombosis inhibitory effect of compound la was 1.1 mg/kg. Furthermore, dose-dependent and significant FXa inhibitory activity was observed in the plasma after oral administration of compound la (Figure 1 B).
In the rat model of ferric chloride-induced arterial thrombosis in the abdominal aorta, clopidogrel inhibited thrombosis by 30%, 34%, and 75% at doses of 3 mg/kg, 10 mg/kg, and 30 mg/kg, respectively (Figure 2). Clopidogrel exerted a dose-dependent antithrombotic effect. The ED50 value of the thrombosis inhibitory effect of clopidogrel was 12 mg/kg.
(2) Antithrombotic effect of combined use of compound la and clopidogrel (Figure 3)
The effect of combined use of compound la (1 mg/kg) and clopidogrel (10 mg/kg) at doses less than the ED50 was evaluated in the rat model of ferric chloride- induced arterial thrombosis in the abdominal aorta.
To rats fasted overnight, clopidogrel (10 mg/kg) or a 0.5% MG solution was orally administered. Ninety minutes thereafter, compound la (1 mg/kg) or a 0.5% C solution was orally administered thereto. Fifteen minutes later, each rat was anesthetized with thiopental sodium, and the antithrombotic effect was evaluated in the same way as in paragraph (1 ).
The results are shown in Figure 3.
In the groups administered with 1 mg/kg compound la alone and 10 mg/kg clopidogrel alone, the rate of inhibition of thrombosis was 52% and 34%, respectively (Figure 3). In the group administered with the combination of compound la + clopidogrel, the rate of inhibition of thrombosis was 86%, demonstrating significant potentiating effect compared with both the single-compound administered groups. Example 2
Effect of combined use of compound la and clopidogrel on rat tail bleeding time
To rats fasted overnight, clopidogrel (10 mg/kg) or a 0.5% MC solution was orally administered. Ninety minutes thereafter, compound la (1 mg/kg) or a 0.5% MC solution was orally administered thereto.
Fifteen minutes after the administration of compound la, each rat was anesthetized with thiopental sodium. Fifteen minutes after the anesthesia, an incision of 1 mm in depth was made in the arterial portion at a position of 4 cm from the tip of the tail using a blade. Blood was blotted every 15 seconds with filter paper. Cessation of bleeding was confirmed as the absence of any detectable blood stain on the opposite side of the filter paper, which touched the wound for 30 seconds. The bleeding time was defined as the interval from the incision to the last detectable blood stain. When the bleeding did not stop within 30 minutes, the bleeding time was defined as 30 minutes. The ratio of prolongation of bleeding time compared with the control was calculated according to the following calculation formula: Ratio of prolongation of bleeding time compared with the control = the bleeding time of each individual of test substance-administered rats/an average of the bleeding times of the rats in the control group.
The results are shown in Figure 4.
The control group and the group administered with compound la alone did not differ in bleeding time (Figure 4). The group administered with clopidogrel alone and the group administered with the combination of compound la + clopidogrel had almost the same ratio of prolongation of bleeding time compared with the control (2.1 times and 2.0 times, respectively). The bleeding time observed in the group administered with clopidogrel alone was not prolonged by the addition of compound la.
Example 3
Pharmacodynamic test of compound la and clopidogrel in rats (Figure 5)
To rats fasted overnight, clopidogrel (10 mg/kg) or a 0.5% MC solution was orally administered. Ninety minutes thereafter, compound la (1 mg/kg) or a 0.5% MC solution was orally administered thereto. Fifteen minutes later, each rat was anesthetized with thiopental sodium, and blood was collected with 3.13% trisodium citrate dihydrate as an anticoagulant from the jugular vein and the abdominal aorta.
From the blood collected from the abdominal aorta, platelet rich plasma (PRP) was prepared. From the residue after the PRP collection, platelet poor plasma (PPP) was prepared. The light transmittance of PPP was defined as an aggregation value of 100%, and the rate of platelet aggregation in PRP induced by adenosine diphosphate (ADP, final concentration: 3 μΜ) was determined. The rate of inhibition of platelet aggregation in the test substance-administered rats was calculated according to the following formula:
Rate of inhibition of platelet aggregation (%) = (1 - the maximum platelet aggregation in each individual of test substance-administered rats/an average of the maximum rates of platelet aggregations in the rats in the control group) χ 100.
Plasma was separated from the blood collected from the jugular vein, and the FXa inhibitory activity in the plasma was determined in the same way as in Example 1 (1 ).
The results are shown in Figures 5A and 5B.
Significant FXa inhibitory activity in the plasma was observed in the group administered with compound la alone and the group administered with the combination of compound la + clopidogrel, and the activity did not differ between the two groups (Figure 5A). No FXa inhibitory activity in the plasma was observed in the group administered with clopidogrel alone and the control group.
The group administered with compound la alone had the maximum rate of platelet aggregation equivalent to that of the control group. Significant platelet aggregation inhibitory activity was observed in the group administered with clopidogrel alone and the group administered with the combination of compound la + clopidogrel, and the activity did not differ between the two groups.

Claims

1. A pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2- ((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4- c]pyridin-2-yl)carb0nyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000023_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and a pharmaceutically acceptable carrier.
2. A kit comprising:
a pharmaceutical composition comprising N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I)
Figure imgf000023_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof,
and
a pharmaceutical composition comprising clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof.
A kit according to claim 2, wherein the pharmaceutical composition comprising compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof, and the pharmaceutical composition comprising the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof, are separately packaged.
4. A kit according to claim 3, further comprising an instruction which instructs an administration method of the two pharmaceutical compositions.
5. The pharmaceutical composition according to claim 1 , or the kit according to any one of claims 2 to 4, wherein the pharmaceutical composition or kit is a preventive and/or therapeutic agent for thrombus and/or embolism.
6. The pharmaceutical composition according to claim 1 or the kit according to any one of claims 2 to 4, wherein the pharmaceutical composition or kit is for use in the prevention and/or treatment of cerebral infarction, cerebral embolism, pulmonary infarction, pulmonary embolism, myocardial infarction, angina pectoris, thrombosis and/or embolism accompanying nonvalvular atrial fibrillation, deep vein thrombosis, deep vein thrombosis after surgical operation, thrombosis after prosthetic valve/joint replacement, thromboembolism after total hip replacement, thromboembolism after total knee replacement, thromboembolism after hip fracture surgery, thrombosis and/or reocclusion after revascularization, Buerger's disease, disseminated intravascular coagulation syndrome, systemic inflammatory response syndrome, multiple organ dysfunction syndrome, thrombosis at the time of extracorporeal circulation, blood coagulation at the time of blood collection, cerebrovascular disorder, relapse after ischemic cerebrovascular disorder, acute coronary syndrome, acute coronary syndrome to which percutaneous coronary intervention is applied, unstable angina, and/or non-ST segment elevation myocardial infarction.
7. The pharmaceutical composition according to claim 1 or the kit according to any one of claims 2 to 4, wherein the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof is for administration at a dose lower than a clinically effective dose of the clopidogrel or the pharmacologically acceptable salt thereof, or the solvate thereof.
8. The pharmaceutical composition according to claim 1 or the kit according to any one of claims 2 to 4, wherein the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof is for administration at a dose lower than a clinically effective dose of the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof.
9. The pharmaceutical composition according to claim 1 or the kit according to any one of claims 2 to 4, wherein the compound represented by the formula (I) or the pharmacologically acceptable salt thereof, or the solvate thereof is N1-(5-chloropyridin- 2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide p- toluenesulfonate monohydrate represented by the following formula (la):
CH,
Figure imgf000025_0001
10. A method for prevention and/or treatment of thrombus and/or embolism, comprising administering N1-(5-chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-
[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000025_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof.
1 1. N -(5-Chloropyridin-2-yl)-N2-((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5- methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000026_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof, for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of N1-(5-chloropyridin-2-yl)-N -((1 S,2R,4S)-4- [(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof.
12. Clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and N1-(5-chloropyridin-2-yl)-N2- ((1 S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4- c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000026_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof.
13. Use of N -(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2- {[(5^methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000027_0001
or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of N1-(5- chloropyridin-2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7- tetrahydrothiazolo[5,4-c]pyridin-2-yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the formula (I) or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof.
14. Use of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism, wherein said prevention or treatment comprises administration of clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, and N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-
[(dimethylamino)carbonyl]-2-{[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I):
Figure imgf000027_0002
or a pharmacologically acceptable salt thereof, or a solvate thereof.
15. Use of N1-(5-chloropyridin-2-yl)-N2-((1S,2R,4S)-4-[(dimethylamino)carbonyl]-2- {[(5-methyl-4,5,6,7-tetrahydrothiazolo[5,4-c]pyridin-2- yl)carbonyl]amino}cyclohexyl)ethanediamide represented by the following formula (I): H3C-N N H HNYANAJ
O H
or a pharmacologically acceptable salt thereof, or a solvate thereof, and clopidogrel or a pharmacologically acceptable salt thereof, or a solvate thereof, in the preparation of a medicament for use in the prevention and/or treatment of thrombus and/or embolism.
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