# Patent

## Title
Compositions and methods of using (R)-pramipexole

## Abstract

Pharmaceutical compositions of (R)-pramipexole and methods and kits of using such compositions for the treatment of neurodegenerative diseases, or those related to mitochondrial dysfunction or increased oxidative stress are disclosed.

## Background
CROSS REFERENCE
This application claims the benefit of U.S. Provisional Application No. 60/870,009, filed Dec. 14, 2006, U.S. Provisional Application No. 60/894,835, filed Mar. 14, 2007, U.S. Provisional Application No. 60/894,829, filed Mar. 14, 2007, U.S. Provisional Application No. 60/894,799, filed on Mar. 14, 2007, and U.S. Provisional Application No. 60/979,049, filed Oct. 10, 2007, and is a continuation in part of U.S. application Ser. No. 11/733,642, filed Apr. 10, 2007, now abandoned, each of which is incorporated herein by reference in its entirety, which claims the benefit of U.S. Provisional Application No. 60/744,540, filed Apr. 10, 2006, U.S. Provisional Application No. 60/746,441, filed May 4, 2006, U.S. Provisional Application No. 60/747,317, filed May 16, 2006, U.S. Provisional Application No. 60/747,320, filed on May 16, 2006, U.S. Provisional Application No. 60/829,066, filed Oct. 11, 2006, U.S. Provisional Application No. 60/870,009, filed Dec. 14, 2006, U.S. Provisional Application No. 60/894,799, filed Mar. 14, 2007, U.S. Provisional Application No. 60/894,829, filed Mar. 14, 2007, and U.S. Provisional Application No. 60/894,835, filed Mar. 14, 2007. This application is also a continuation in part of U.S. application Ser. No. 11/749,497 filed May 16, 2007, now U.S. Pat. No. 8,017,598, issued Sep. 13, 2001, which is incorporated herein by reference in its entirety, which claims the benefit of U.S. Provisional Application No. 60/747,320, filed on May 16, 2006, U.S. Provisional Application No. 60/870,009, filed Dec. 14, 2006, U.S. Provisional Application No. 60/894,799, filed Mar. 14, 2007, U.S. Provisional Application No. 60/894,829, filed Mar. 14, 2007, U.S. Provisional Application No. 60/894,835, filed Mar. 14, 2007, and is a continuation in part of U.S. Application No. 11/733,642, filed Apr. 10, 2007, now abandoned.


GOVERNMENT INTERESTS
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PARTIES TO A JOINT RESEARCH AGREEMENT
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INCORPORATION BY REFERENCE OF MATERIAL SUBMITTED ON A COMPACT DISC
Not applicable
BACKGROUND
(R)-pramipexole is an enantiomer of the active pharmaceutical ingredient of the approved Parkinson's disease (PD) and restless legs syndrome (RLS) treatment Mirapex (pramipexole; (S)-pramipexole). Mirapex® is a high-affinity (low nM IC50) agonist at human and rodent recombinant dopamine D2 and D3 receptors, a property that is the pharmacological basis of its efficacy in these disorders. Both the (R)- and the (S)-enantiomers have been shown preclinically to possess neuroprotective properties that are independent of dopamine receptor affinity.
Neuroprotective properties of (S)-pramipexole have been recognized as potentially useful for the treatment of neurodegenerative disorders, but clinical experience with the drug for treatment of dopamine deficiency disorders, such as PD, have shown that dosing is limited both temporally, by the need for prolonged dose titration, and absolutely, in terms of maximum tolerated dose (MTD), due to dopamine agonist-related side effects. These dosing limitations are typical for dopamine receptor agonists of this class.
The maximum allowable single starting dose for Mirapex® is 0.125 mg, given three times a day (t.i.d.); and the maximum allowable dose for Mirapex is 1.5 mg t.i.d., providing a maximum daily dose of 4.5 mg of Mirapex® after 7-8 weeks of titration.
While these dose levels of Mirapex® are useful for treatment of the signs and symptoms of PD and RLS, in neuroprotective assays the potency of (S)-pramipexole as a neuroprotective is approximately 1000-fold lower than its potency as a dopamine agonist. This suggests the therapeutically useful neuroprotective doses cannot be reached using this enantiomer.
(R)-pramipexole possesses similar neuroprotective potency, but lower affinity for dopamine receptors. Accordingly, it has been advanced as a potentially more useful compound for treatment of neurodegenerative disorders. However, previously reported dopamine receptor affinity difference for the (R)-pramipexole compared to (S)-pramipexole would still impose clinically important dose limitations and would still require dose-titration and dose-limitations to avoid dopamine-related side effects. In previous reports utilizing (R)-pramipexole in amyotrophic lateral sclerosis (ALS), a rapidly progressing fatal neurodegenerative disorder, dosing of (R)-pramipexole was suggested to be limited and to require significant dose-titration in animal experiments. The assumed requirement for dose-titration-specifically, the requirement to start dosing at very low doses and increase the dose to a final therapeutically effective dose level over 7-8 weeks-severely limits the usefulness of the neuroprotective potential of the (R)-pramipexole enantiomer Additionally, the assumed MTD would severely limit the timely exploitation of the neuroprotective potential of the (R)-pramipexole enantiomer for both acute and chronic neurodegenerative disorders.
BRIEF SUMMARY OF THE INVENTION
The present invention unlocks the therapeutic potential of (R)-pramipexole by achieving clinically purified (R)-pramipexole and determining the actual in vitro and in vivo binding affinity and tolerance of a patient to purified (R)-pramipexole. In accordance with embodiments of the present invention, larger doses of (R)-pramipexole can be administered to a patient in need thereof.
The present invention further provides a method of treating neurodegenerative disease in a patient in need thereof, comprising administering to the patient a daily dose amount of about 25 mgs to about 5,000 mgs of (R)-pramipexole, more preferably about 500 mgs to about 2,100, most preferably above 500 mgs and less than 2,100 mgs of (R)-pramipexole on a daily basis.
In some embodiments, the disease to be treated is acute and in others it is chronic. In some embodiments, the chronic neurodegenerative disease is selected from primary neurodegenerative disease, Huntington's Chorea, metabolically induced neurological damage, senile dementia of Alzheimer's type, age associated cognitive dysfunction, vascular dementia, multi-infarct dementia, Lewy body dementia, neurodegenerative dementia, neurodegenerative movement disorder, ataxia, Friedreich's ataxia, multiple sclerosis, spinal muscular atrophy, primary lateral sclerosis, seizure disorders, motor neuron disorder or disease, inflammatory demyelinating disorder, Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, hepatic encephalopathy, and chronic encephalitis. In some embodiments, the chronic neurodegenerative disease is amyotrophic lateral sclerosis. In some embodiments, the patient is a naïve patient.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 depicts the mean plasma (R)-pramipexole concentrations after oral administration of single 50 mg, 150 mg, and 300 mg doses to healthy volunteers under fasted conditions.
FIG. 2 depicts mean plasma (R)-pramipexole concentrations after oral administration of single 150 mg doses to healthy volunteers under fasted and fed conditions.
FIG. 3 depicts mean plasma (R)-pramipexole concentrations on Days 1 and 7 during oral administration of 50 mg and 100 mg doses on Day 1, Q12H on Days 3 through 6, and a single dose on Day 7 to healthy volunteers under fasted conditions.
FIG. 4 depicts an exposure (AUC) vs. dose (mg/m2) for male and female rats and humans (both genders).
FIG. 5 depicts mean exposure (AUC) vs. dose (mg/m2) for male and female minipigs and humans (both genders).



DETAILED DESCRIPTION
The present invention provides evidence that the dopamine receptor affinity of (R)-pramipexole is actually much lower than that previously assumed, which greatly increases the clinical usefulness of the composition. It is also demonstrated herein that the functional affinity difference between the (S)-pramipexole and (R)-pramipexole enantiomers (e.g. 10,000-20,000 fold) is much greater than previously reported. These data demonstrate that (It)-pramipexole can be dosed at levels that can more fully and unexpectedly exploit the lower-potency neuroprotective potential of the compound without the theoretical limitation imposed by the assumptions about separation in dopamine receptor affinity between the enantiomers. This dosing may occur without the need for dose titration. These data also show that contamination of the composition of pure (R)-pramipexole with small amounts of (S)-pramipexole results in dramatic shifts in the off-target of the composition. The application presents methods for using chirally more pure compositions of (R)-pramipexole in acute and chronic neurodegenerative disorders previously thought to be inaccessible to this drug; at immediate full-strength; and/or without dose-titration.
In some embodiments, the present invention provides a pharmaceutical composition comprising (R)-pramipexole of sufficient doses to achieve neuroprotective, anti-oxidative, anti-apoptotic, or other beneficial cellular effects without simultaneously causing significant side effects. The ability to deliver clinically effective doses without dose limiting side effects is made possible by two basic discoveries: (i) the synthesis of (R)-pramipexole that is pure within limits of the detection discussed herein; and (ii) the discovery that (R)-pramipexole possesses substantially less affinity for dopamine receptors than previously reported. The pharmaceutical composition of the present invention may be dependent, in some embodiments, on either or both the optical purity of the (R)-pramipexole used in the composition or upon the limited dopaminergic activity of the chirally pure (R)-pramipexole used in the composition.
Before the present compositions and methods are described, it is to be understood that this invention is not limited to the particular processes, compositions, or methodologies described, as these may vary. It is also to be understood that the terminology used in the description is for the purpose of describing the particular versions or embodiments only, and is not intended to limit the scope of the present invention which will be limited only by the appended claims. All publications mentioned herein are incorporated by reference in their entirety to the extent to support the present invention.
The compound 2-amino-4,5,6,7-tetrahydro-6-(propylamino)benzothiazole is a synthetic aminobenzothiazole derivative, having two enantiomers with the structures shown below. The (S) enantiomer is a potent agonist of the 12 family of dopamine receptors, with particular affinity for the 13 receptor subtype. As a dopamine agonist, (S)-pramipexole activates dopamine receptors, thus mimicking the effects of the neurotransmitter dopamine. The (S)-pramipexole stereoisomer is a potent agonist of dopamine, with only small daily doses required and indeed tolerated by patients. Both enantiomers are thought to confer neuroprotective effects by their ability to accumulate in the brain, the spinal cord and mitochondria, and independent of the dopamine agonist activity, presumably through inhibition of lipid peroxidation, normalization of mitochondrial function and/or detoxification of oxygen radicals. As such, these compounds may have utility as inhibitors of the cell death cascades and loss of cell viability observed in neurodegenerative diseases.




The degree to which dosing of a molecule has demonstrable phenotypic activity resulting from affinity to particular receptors or other pharmaco-effective proteins, even when the activity results from affinities to unknown targets, can be operationally defined in terms of whether this activity contributes in a positive way (‘on-target’ activity) or a negative way (‘off-target’ activity) to a specific and desired therapeutic effect. For any given molecule, a number of ‘off-target’ activities can theoretically be identified, but ‘on-target’ activity is restricted to the desired therapeutic effect. To the extent that these activities can be measured and quantified, or comparisons be made with known standards, an index of activity can be generated for each of these categories (the ‘activity equivalent’, or AE), and one or more ratios generated to compare ‘off-target’ to ‘on-target’ activities, useful to compare potential risk-benefit ratios between molecules.
In the case of (R)-pramipexole, two activities can be defined in this context. The first, which is agonist activity at a subset of human dopamine receptors and the resulting behavioral/toxicological phenotype, is ‘off-target’ activity for most neurodegenerative disorders. This activity results in dose-limiting side effects due to dopamine receptor agonist activity, and for the purposes of the current discussion can be defined to be the dopamine activity equivalent, or DAE. Throughout the application, the term “dopaminergic activity equivalent” (DAE) will be referred to which means the measure of activity at the dopamine receptors equivalent to the activity of 1 mg of (S)-pramipexole at the dopamine receptors. For example, a dosage of (R)-pramipexole having a DAE of 0.01 would have activity at the dopamine receptors which is equivalent to the activity of 0.01 mg of (S)-pramipexole. The DAE can also be related to a variety of pharmaceutical terms, including maximum tolerated dose (MTD), no observable adverse effect level (NOAEL), and non-effective dose amount for the sake of clarity. For example, the NOAEL dose amount for (S)-pramipexole is most preferably below 0.05 mg. This, in turn, corresponds to a DAE of below 0.05. A dose amount of (R)-pramipexole having a DAE of 0.01 would, therefore, be below the DAE for the most preferable (S)-pramipexole NOAEL dose amount of 0.05 mg. In some embodiments, DAE is determined by measuring the binding affinity (IC50) or activity (EC50) at the D2 and/or D3 receptors relative to the same parameter for 1 mg of (S)-pramipexole. In some embodiments, DAE is determined by the binding affinity or activity at the D2 receptor. In some embodiments, DAE is determined by the binding affinity or activity at the D3 receptor. In some embodiments, DAE is determined by the binding affinity at the D2 receptor. In some embodiments, DAE is determined by the binding affinity at the D3 receptor. In some embodiments, DAE is determined by a suitable in vitro assay such as an IC50 binding affinity assay for the D2 or D3 receptor such as those described by Schneider, C. S.; Mierau, J., “Dopamine Autoreceptor Agonists: Resolution and Pharmacological Activity of 2,6-Diaminotetrahydrobenzothiazole and an Aminothiazole Analogue of Apomorphine”, (1987). J. Med. Chem. 30:494-498; or Wong, S. K.-F.; Shrikhande, A. V., S. K.-F. Wong, “Activation of Extracellular Signal-Regulated Kinase by Dopamine D2 and D3 Receptors”, (2003) Society for Neuroscience Abstracts. This ‘off-target’ activity for (R)-pramipexole in neurodegenerative disorders (other than Parkinson's disease) would be the ‘on-target’ activity for its enantiomer (S)-pramipexole, used to treat PD and restless legs syndrome.
Our studies suggest that the DAE for (R)-pramipexole is much lower than may have been previously appreciated. For example, our studies have shown that the binding affinity for (R)-pramipexole to the D2 and D3 dopamine receptors is about 290 and 649 times lower than (S)-pramipexole, respectively, when using high chiral purity (R)-pramipexole. By comparison, the literature reports that the binding affinity for the (R)-pramipexole to the D2 dopamine receptor is about 9-21 times lower than (S)-pramipexole, while the binding affinity for the (R)-pramipexole to the D3 dopamine receptor is about 50 times lower than (S)-pramipexole.
Even more striking, our studies in beagle dogs indicate that the MTD dose ratio of (R)-pramipexole to (S)-pramipexole is 10,000, while the NOAEL dose ratio of (R)-pramipexole to (S)-pramipexole is 20,000. As a biological assay, the MTD and NOAEL in dogs reveal in vivo tolerance heretofore entirely unpredictable. Because of limitations on standard and quantitative analysis, the in vivo MTD and NOAEL in dogs may actually suggest even the slightest impurity of 0.005% could, in fact be responsible for the dopamine agonist-related side effects. These comparative studies suggest that the DAE for (R)-pramipexole is much lower than may previously been appreciated.
The other activity of (R)-pramipexole and (S)-pramipexole is neuroprotection. Neuroprotection is a phenomenon independent of mechanism, and hence qualifies as a category of activity. This ‘on-target’ activity of (R)-pramipexole for the treatment of neurodegenerative disorders is measurable and approximately equivalent in both enantiomers, and can be defined in relative terms as the neuroprotective activity equivalent or NAE. The neuroprotective activity equivalent (NAP) refers to the neuroprotective activity inherent in 1 mg of (S)-pramipexole. Unlike the DAE, NAE has been shown to be equal in both pramipexole enantiomers in a number of in vitro tests. In this example, the DAE is seen as a unit measure of the potential for adverse effects, while the NAE is seen as a unit measure of the potential for therapeutic benefit. For this example, the NAEs of both (R)-pramipexole and Mirapex® may be determined from the concentrations needed to produce neuroprotection in in vitro assays.
In some embodiments, NAP can be determined by measuring the neuroprotective activity in a standard in vitro neuroprotective assay relative to the activity of 1 mg of (S)-pramipexole. In some embodiments, the neuroprotective activity is determined by measuring cell death in the presence of MPP+ and/or rotenone in dopaminergic and/or non-dopaminergic cells (as a non-limiting example, see the assay in M. Gu, Journal of Neurochemistry, 91:11075-1081 (2004)).
A preferred intent of the present invention is to maximize the NAEs delivered to a patient, while minimizing the number of activity equivalents suggestive of adverse events, in this case the DAE.
(S)-pramipexole has a high DAE/NAE ratio, due to the high dopamine affinity, while the corresponding ratio for (R)-pramipexole is significantly lower. In practical terms the embodiments of the present invention provide significantly greater NAE levels and greater NAB/DAE levels than previously believed, maximizing the probability that a therapeutically effective dose amount of the neuroprotectant can be administered to a patient in need. The NAB and the DAE may be useful in terms of a ratio, particularly as a ratio of beneficial to adverse effects, and useful to define a range over which a particular composition may be administered.
Dosages of (S)-pramipexole, however, are limited by the dopaminergic activity of the (S) enantiomer, which can lead to adverse side effects at dosages above the “No Observable Adverse Effect Level” (NOAEL dose amount). A NOAEL dose as used herein refers to an amount of active compound or pharmaceutical agent that produces no statistically or biologically significant increases in the frequency or severity of adverse effects between an exposed population and its appropriate control; some effects may be produced at this level, but they are not considered as adverse, or as precursors to adverse effects. The exposed population may be a system, tissue, animal, individual or human that is being treated by a researcher, veterinarian, medical doctor or other clinician. With respect to (S)-pramipexole, exemplary adverse events are dizziness, hallucination, nausea, hypotension, somnolence, constipation, headache, tremor, back pain, postural hypotension, hypertonia, depression, abdominal pain, anxiety, dyspepsia, flatulence, diarrhea, rash, ataxia, dry mouth, extrapyramidal syndrome, leg cramps, twitching, pharyngitis, sinusitis, sweating, rhinitis, urinary tract infection, vasodilatation, flu syndrome, increased saliva, tooth disease, dyspnea, increased cough, gait abnormalities, urinary frequency, vomiting, allergic reaction, hypertension, pruritis, hypokinesia, nervousness, dream abnormalities, chest pain, neck pain, paresthesia, tachycardia, vertigo, voice alteration, conjunctivitis, paralysis, tinnitus, lacrimation, mydriasis and diplopia.
For example, a dose of 1.5 mg of (S)-pramipexole has been shown to cause somnolence in human subjects (Public Statement on Mirapex®, Sudden Onset of Sleep from the European Agency for the Evaluation of Medicinal Products; Boehringer Ingelheim product insert for Mirapex® which indicates that the drug is administered as three doses per day). Further, studies performed in dogs, as presented herein, (see Examples and results shown in Table 11) indicate that the NOAEL dose may be as low as 0.00125 mg/kg, which is equivalent to a human dose of 0.0007 mg/kg or 0.05 mg for a 70 kg individual. Thus, with reference to (S)-pramipexole, a NOAEL dose amount may be an amount below 1.5 mg, below 0.50 mg, or more preferably below 0.05 mg. With reference to DAE as defined herein, a NOAEL dose may have a DAE of below 1.5, below 0.5, or more preferably below 0.05.
Generally, an amount larger than the non-effective dose amount of (S)-pramipexole is necessary to have a therapeutic effect in treating diseases alleviated by dopamine agonist activity. This amount, however, may not be desired when a neuroprotective effect is sought, as it may lead to the described adverse side effects. A “non-effective dose amount” as used herein refers to an amount of active compound or pharmaceutical agent that elicits a biological or medicinal response similar to the biological or medicinal response of a placebo as observed in a tissue, system, animal, individual or human that is being treated by a researcher, veterinarian, medical doctor or other clinician. A “non-effective dose amount” may therefore elicit no discernable difference from placebo in positive effects as observed in a tissue, system, animal, individual or human that is being treated by a researcher, veterinarian, medical doctor or other clinician. As such, the “non-effective dose amount” is not expected to (1) prevent a disease; for example, preventing a disease, condition or disorder in an individual that may be predisposed to the disease, condition or disorder but does not yet experience or display the pathology or symptomatology of the disease; (2) inhibit the disease; for example, inhibiting a disease, condition or disorder in an individual that is experiencing or displaying the pathology or symptomatology of the disease, condition or disorder (i.e., arresting or slowing further development of the pathology and/or symptomatology), or (3) ameliorate the disease; for example, ameliorating a disease, condition or disorder in an individual that is experiencing or displaying the pathology or symptomatology of the disease, condition or disorder (i.e., reversing or reducing the pathology and/or symptomatology).
As an example, in monkeys treated with MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine), a known dopaminergic neurotoxin, (S)-pramipexole has been shown to antagonize motor deficits and Parkinson-like symptoms in a dose-dependent manner, with the lowest effective oral dose being 0.053 mg/kg (see Scientific Discussion at http://www.emea.europa.euhumandocs/PDFs/EPAR/Sifrol/059197EN6.pdf). This would be equivalent to a human dose of 0.017 mg/kg, or 1.2 mg for a 70 kg individual. In human trials, the lowest effective oral dose of (S)-pramipexole with a significant effect versus placebo in the treatment of Parkinson's disease was found to be 1.1 mg/day. Individual patients may need doses higher than 1.1 mg/day to gain a sufficient effect above the placebo effect (Initial Scientific Discussion for the Approval of Mirapex from the European Agency for the Evaluation of Medicinal Products). In human trials, the lowest effective dose with a significant effect versus placebo in the treatment of restless legs syndrome was found to be 0.25 mg/day (Boehringer Ingelheim product insert for Mirapex®). Therefore, with reference to (S)-pramipexole, a non-effective dose amount may be an amount below 1.0 mg/day, below 0.75 mg/day, below 0.5 mg/day, below 0.25 mg/day, or preferably below 0.125 mg/day. With reference to DAE, a non-effective dose amount per day may have a DAE per day below 1.0, below 0.75, below 0.5, below 0.25, or preferably below 0.125.
Other limits on the amount of (S)-pramipexole which can be administered to a patient also include the maximum recommended therapeutic dose and the maximum tolerated dose. A “maximum recommended therapeutic dose” (MRTD) refers to the dosages compiled by the FDA's Center for Drug Evaluation and Research, Office of Pharmaceutical Science, Informatics and Computational Safety Analysis Staff's Maximum Recommended Therapeutic Dose and as described in Matthews, et al., “Assessment of the Health Effects of Chemicals in Humans: I. QSAR Estimation of the Maximum Recommended Therapeutic Dose (MRTD) and No Effect Level (NOEL) of Organic Chemicals Based on Clinical Trial Data,”, Current Drug Discovery Technologies, 2004, 1:61-76). The FDA's MRTD database cites a MRTD for S-pramipexole of 0.1 mg/kg/day or 7.0 mg/day for a 70 lb. person. Matthews, in turn, estimates that a NOEL (no adverse effect level) usually is about one-tenth of the MRTD, which corresponds to 0.01 ng/kg or about 0.7 mg/day for a 70 lb. person.
Because of its adverse impact on naïve patients (S)-pramipexole must be titrated over the course of weeks to reach these dosages without dose limiting adverse effects (such as that documented in Boehringer Ingelheim product insert for Mirapex®). For example, for restless leg syndrome, the recommended starting daily dose amount of Mirapex® is 0.125 mg taken once daily 2-3 hours before bedtime. For patients requiring additional symptomatic relief the daily dose may be increased to 0.25 mg over 4 to 7 day period and then to 0.5 mg over a second 4 to 7 day period. For the treatment of Parkinson's disease, the package insert recommends the following titration schedule for Mirapex®:












Week
Dosage (mg)
Total daily dose (mg)

















1
0.125 tid 
0.375


2
0.25 tid
0.75


3
 0.5 tid
1.5


4
0.75 tid
2.25


5
 1.0 tid
3.0


6
1.25 tid
3.75


7
 1.5 tid
4.5









A “maximum tolerated dose” (MTD) as used herein refers to an amount of active compound or pharmaceutical agent which elicits significant toxicity in a tissue, system, animal, individual or human that is being treated by a researcher, veterinarian, medical doctor or other clinician. Single dose toxicity of (S)-pramipexole after oral administration has been studied in rodents, dogs, monkeys and human. In rodents, deaths occurred at doses of 70-105 mg/kg and above (Initial Scientific Discussion for the Approval of Mirapex from the European Agency for the Evaluation of Medicinal Products). This is equivalent to a human dose of 7-12 mg/kg, or approximately 500-850 mg for a 70 kg individual. In human subjects, a starting daily dose of (S)-pramipexole of greater than 0.20 mg was not tolerated when administered to a naïve patient. In dogs, vomiting occurred at 0.0007 mg/kg and above while monkeys displayed major excitation at 3.5 mg/kg. Further, the product insert for Mirapex® sets the maximally tolerated dose for humans at 4.5 mg/day, administered as three 1.5 mg single dosages. However, the 4.5 mg/day dosage is not administered to a naïve patient, but, instead, reached after a titration regimen (such as that documented in the product insert for Mirapex®). Generally, the starting daily dosage for administration to a naïve patient is a 0.125 mg dose administered three times per day and a seven-week titration schedule is recommended to reach a 1.5 mg dose administered three times daily. All species showed signs of toxicity related to exaggerated pharmacodynamic responses to (S)-pramipexole. For example, behavioral changes including hyperactivity were common and led to a number of secondary effects, such as reduced body weight and other stress-induced symptoms. In minipigs and monkeys, (S)-pramipexole moderately affected cardiovascular parameters. In rats, the potent prolactin-inhibitory effect of pramipexole affected reproductive organs (e.g. enlarged corpora lutea, pyometra), and showed a dose-related retinal degeneration during long-term exposure (Initial Scientific Discussion for the Approval of Mirapex from the European Agency for the Evaluation of Medicinal Products). Studies in dogs indicate a MTD amount of (S)-pramipexole for a human subject may be an amount below 4.5 mg/day, preferably below 1.5 mg/day. Further, the MTD amount for a human subject may be an amount below 0.3 mg/dose based on results of studies disclosed herein, and preferably below 0.2 mg/dose (see Table 11). With reference to DAE, the MTD amount may have a DAE of below 1.5, below 0.3, or below 0.2.
Given the limits on the amount of (S)-pramipexole that can be administered to a patient, the use of the embodiments of the present invention presents a clinically important alternative for the development of new neuroprotective therapies. The literature previously reported that the binding affinity of (R)-pramipexole at the D2 receptor was approximately 9 to 21 times less than about that of (S)-pramipexole, while the binding affinity of (R)-pramipexole at the D3 receptor was approximately 50 times less than about that of (S)-pramipexole (Table 10). These literature derived comparative binding affinity ratios suggest that (R)-pramipexole can be administered only at somewhat higher dosages than (S)-pramipexole. This limitation may occur because the exquisite sensitivity of tissues, systems, animals, and human subjects to the effects of dopamine agonism would preclude the use of (R)-pramipexole at doses that exceed tolerated doses of (S)-pramipexole by a factor greater than the literature derived comparative binding affinity ratios of the two enantiomers.
The seeming preclusion of higher doses of (R)-pramipexole can be demonstrated by reference to a theoretical 50 mg tablet. Assuming a 9 times difference in binding affinities, a 50 mg tablet which is 99.95% pure would have approximately 5.575 DAE (5.55 DAE from the (R)-pramipexole and 0.025 DAE from the (S)-pramipexole). Similarly, a 25 mg tablet would be expected to exhibit a DAE of 2.79 (2.78 from the (It)-pramipexole and 0.0125 DAE from the (S)-pramipexole). The MTD of (S)-pramipexole after a seven week titration regimen is 4.5 mg, or 1.5 mg three times a day, which is equivalent to a 4.5 DAE in a day or 1.5 DAE in a single dose. Further, the NOAEL dose amount for (S)-pramipexole is below 1.5 mg, preferably below 0.50 mg, or more preferably below 0.05 mg, which are each equivalent to 1.5 DAE, 0.5 DAE and 0.05 DAE, respectively. Given that the single dose MTD) for (S)-pramipexole has 1.5 DAE and the NOAEL of (S)-pramipexole has less than about 1.5 DAE, a single dosage of 50 mg with a DAE of 5.55 and a single dosage of 25 mg with a DAE of 2.79 would be precluded when referring solely to the literature derived comparative binding affinity ratios. Further, use of a high chiral purity of 99.95% as used in these theoretical dosages, would result in unacceptably high DAEs of 5.55 and 2.79 beyond the single dosage MTD DAE of 1.5 mg, and far beyond the preferable NOAELs of 0.5 DAE and 0.05 DAE.
To the contrary, in some embodiments, an aspect of the present invention involves unexpectedly high chiral purities that have been attained. These purities have led to MTDs or NOAELs for (R)-pramipexole which are higher than previously appreciated based on the literature derived comparative binding affinities. In some embodiments, the present invention provides pharmaceutical compositions, starting doses, method of treatment, and kits comprising (R)-pramipexole of high chiral purity. Pursuant the discussion above, a 25 mg dosage with a similar chiral purity of 99.95% would be predicted to be well above the MTD or NOAEL for (S)-pramipexole and, therefore, result in observable adverse side effects. Studies in dogs, however, suggest that the high chiral purity (R)-pramipexole results in NOAEL dose amounts unexpectedly than those that may have been appreciated (Table 10). Incredibly, a 25 mg/kg dosage of (R)-pramipexole with no detectable amount of (S)-pramipexole (0.05% limit of detection) resulted in no observable effects in dogs, which is unexpected based on the literature binding affinity data.
Further, the studies in dogs demonstrate the high (approaching absolute) chiral purity of the pramipexole compositions for the (R)-enantiomer. (R)-pramipexole is administered in high dose levels in the studies disclosed herein (equivalent to human doses of 1.000 mg to 3,000 mg; see Examples), so that even the smallest amount of (S)-pramipexole would contribute to the observed NOAEL and MTD. For example, with reference to human equivalence doses based on data obtained in dogs, the MTP for the (R)-enantiomer has been shown to be equivalent to about 3,000 mg for a 70 kg human subject, while the equivalent MTD for the (S)-enantiomer would be equivalent to only 0.30 mg for that same subject (Table II). That is a difference of 10,000-fold. The NOAEL dose for the (R)-enantiomer is 20,000-fold greater than for the (S)-enantiomer (Table 11). Thus, the (R)-pramipexole compositions used in these studies must be at least 99.99% pure if one were to assume that the observed side effects stemmed only from contamination by the (S)-enantiomer. On the other hand, these data demonstrate the high dose levels of the (R)-enantiomer of pramipexole that may be administered safely. This data highlights the usefulness of the high chiral purity for the (R)-enantiomer of pramipexole in various embodiments of the present invention.
The present invention further provides pharmaceutical compositions, starting doses, methods, and kits comprising (R)-pramipexole with higher dosages and higher chiral purities. As discussed above, the literature previously suggested that the comparative binding affinity ratios at the D2 and D3 receptors were approximately 9 to 21, and 50, respectively (See Example 1 and Table 10 below). It has been unexpectedly found that the comparative binding affinity ratios of S:R at the D2 and D3 receptors are approximately 290 and 649, when using high chiral purity (R)-pramipexole.
As is discussed in greater detail below this suggests that the comparative binding affinity ratios are about 13 to 32 times the comparative binding affinity ratios reported in the literature. The literature is replete with discussion of the adverse impact of (S)-pramipexole. Although the in vitro data and binding affinity is presented in support of the present invention is compelling, the importance of an economical and efficient synthesis becomes apparent when comparing the in vitro and in vivo data presented herein. The in vivo clinical observations in beagle dogs indicate that the MTD dose ratio of (R)-pramipexole to (S)-pramipexole is 10,000, while the NOAEL dose ratio of (R)-pramipexole to (S)-pramipexole is 20,000. The absolute MTD dose ratio may be higher because the chiral purities reported herein are limited to level of detection (See Example 2 and Table 11). Based on the chiral purity and the in vitro comparative binding affinity ratios, clinical NOAEL dose ratios, or clinical MTD dose ratios (herein “comparative ratios”), it is now possible to predict the DAE for a given dosage of (R)-pramipexole. Table 1 shows the DAE for a 25 mg dose of (R)-pramipexole as a function of comparative ratio and chiral purity. These data show that a much lower DAE can unexpectedly result from a 25 mg dosage form of (R)-pramipexole than may have been previously appreciated, due to the lower comparative ratios described herein when compared to the literature derived comparative ratios.







TABLE 1







DAE for a 25 mg dose of (R)-pramipexole as a function of % chiral purity and the


comparative ratio













Percent








Chiral
20,000
10,000
5,000
2,400
100
10


Purity for
comparative
comparative
comparative
comparative
comparative
comparative


R PPX
ratio
ratio
ratio
ratio
ratio
ratio
















99.9967
0.0020749
0.0033249
0.0058248
0.0112413
0.2508168
2.5007425


99.9958
0.0022999
0.0035498
0.0060498
0.0114662
0.2510395
2.5009450


99.9950
0.0024999
0.0037499
0.0062498
0.0116661
0.2512375
2.5011250


99.9933
0.0029249
0.0041783
0.0066747
0.0120909
0.2516583
2.5015075


99.9900
0.0037499
0.0049998
0.0074995
0.0129156
0.2524750
2.5022500


99.9833
0.0054248
0.0066746
0.0091742
0.0145899
0.2531333
2.5037575


99.9800
0.0062498
0.0074995
0.0099990
0.0154158
0.2549500
2.5045000


99.9750
0.0074997
0.0087494
0.0112488
0.0166641
0.2561875
2.5056250


99.9667
0.0095746
0.0108242
0.0133233
0.0187382
0.2582418
2.5074925


99.9583
0.0116745
0.0129239
0.0154229
0.0208373
0.2603208
2.5093825


99.9500
0.0137494
0.0149988
0.0174975
0.0229115
0.2623750
2.5112500


99.9333
0.0179242
0.0191733
0.0216717
0.0270847
0.2665083
2.5150075


99.9000
0.0262488
0.0274975
0.0299950
0.0354063
0.2747500
2.5225000


99.8333
0.0429229
0.0441798
0.0466666
0.0520743
0.2912583
2.5375075


99.8000
0.0512475
0.0524950
0.0549900
0.0603958
0.2995000
2.5450000


99.7500
0.0637469
0.0649938
0.0674875
0.0728906
0.3118750
2.5562500


99.6667
0.0845708
0.0858167
0.0883093
0.0937065
0.3324918
2.5749925


99.5800
0.1062448
0.1074895
0.1099790
0.1153729
0.3539500
2.5945000


99.5000
0.1262438
0.1274875
0.1299750
0.1353656
0.3737500
2.6125000


99.3333
0.1679167
0.1691583
0.1764167
0.1770222
0.4150083
2.6500075


99.0000
0.2512375
0.2524750
0.2549500
0.2603125
0.4975000
2.7250000


98.3300
0.4187291
0.4199583
0.4224165
0.4277427
0.6633250
2.8757500


98.0000
0.5102250
0.5024500
0.5049000
0.5102083
0.7450000
2.9500000


97.5000
0.62621875
0.6274375
0.629875
0.6351563
0.86875
3.0625









Table 1 attempts to illustrate the importance of both purity and affinity on even a 25 mg single oral dosage. Assumptions regarding dopaminergic activity of the (R)-pramipexole at the dopamine receptors would seemingly preclude even a high purity (even 100% pure) 25 mg (R)-pramipexole tablet. Based upon the disclosure of the present invention one can immediately envisage numerous tables to illustrate the point. Tables 1A and 1B below are intended to illustrate the importance of purity for a single oral dosage form of (R)-pramipexole by illustrating the impact of even the smallest contamination of the composition by (S)-pramipexole







TABLE 1A







“NOAEL” dosages of (R)-pramipexole


compositions (based on DAE < 0.05)














50 mg
100 mg
150 mg
200 mg
250 mg
500 mg
















(R)-purity %
99.9000
99.9500
99.9667
99.9750
99.9800
99.9900


(S)-impurity %
0.1000
0.0500
0.0333
0.0250
0.0200
0.0100


(S)-impurity
0.05
0.05
0.05
0.05
0.05
0.05


DAE
















TABLE 1B







“Non-effective” dosages of (R)-pramipexole


compositions (based on DAE < 0.125)














50 mg
100 mg
150 mg
200 mg
250 mg
500 mg
















(R)-purity %
99.7500
99.8750
99.9170
99.9380
99.9500
99.9750


(S)-impurity %
0.2500
0.1250
0.0830
0.0620
0.0500
0.0250


(S)-impurity
0.125
0.125
0.125
0.125
0.125
0.125


DAE









No one has appreciated or articulated that synthetic methodology was necessary to achieve purities that exceed typical detection limits. Further, no one has suggested this single dosage must be 99.95% or greater in purity to be suitable for its intended purpose.
Based on the comparative ratios for binding affinity, NOAEL and MTD values, it is then possible to predict the amount of (R)-pramipexole that could be administered which would be equivalent to a non-effective dose amount of the (S)-pramipexole. Table 2 shows DAE as a function of a dosage of (R)-pramipexole (left hand column) and the comparative ratio (top row). With reference to Table 2, a unit dose can be chosen which allows for an amount of (R)-pramipexole having DAE which is equal to the non-effective amount of (S)-pramipexole. Indeed, unless a dual DAE/NAE effect is desired, a DAE would be avoided or minimized in a pharmaceutical composition. Thus, any single dose greater than 25 milligrams would not be expected to avoid off-target activity and would be expressly avoided by one skilled in the art. This is not true if as in present invention, the comparative ratios exceed 200. This is best illustrated by Table 2.







TABLE 2







DAE as a function of (R)-pramipexole and comparative ratio (assuming 100% chiral


purity of (R)-pramipexole)











A DAE equivalent to a preferred non-effective dose amount of the (S)-pramipexole may be below 1.0 mg; more preferably below 0.5 mg, and more preferably below 0.125 mg.






Similarly, one can ascertain the amount of (R)-pramipexole that could be administered which would be equivalent to a no observable adverse effect level dose amount of the (S)-pramipexole. Table 3 shows DAE as a function of a dosage of (R)-pramipexole (left hand column) and the comparative ratio (top row). With reference to Table 3, a unit dose can be chosen which allows for an amount of (R)-pramipexole having a DAE equal to the NOAEL dose amount of (S)-pramipexole. While 0.125 avoids unwanted effects, less than 0.05 avoids NOAEL. The difference in literature report and actual results is even more striking in Table 3.







TABLE 3







DAE as a function of dosages of (R)-pramipexole and comparative ratio (assuming


100% chiral purity of (R)-pramipexole)











A DAE equivalent to a preferred no observable adverse effect level (NOAEL) dose amount of the (S)-pramipexole may be below 0.5 mg, preferably below 0.05 mg.






Further, Table 4 shows DAE as a function of a dosage of (R)-pramipexole (left hand column) and the comparative ratio (top row). With reference to Table 4, a unit dose can be chosen which allows a dose amount of (R)-pramipexole having a particular DAE.







TABLE 4







DAE as a function of dosages of (R)-pramipexole and comparative ration (assuming


100% chiral purity of (R)-pramipexole)











DAE below 0.2, or below 5.






The higher comparative ratios described herein further suggest that a given dose of (R)-pramipexole can contain a certain amount of (S)-pramipexole impurity before exceeding the acceptable DAE. For example, Table 3 shows that a 25 mg dose of (R)-pramipexole results in 0.00125 DAE at a comparative ratio of 20,000 as suggested by the NOAEL ratio of (R)-pramipexole to (S)-pramipexole in the dog studies, assuming a 100% chiral purity of (R)-pramipexole. Theoretically an additional 1.4 mg of (S)-pramipexole could be added without exceeding the DAE for a single dose MTD of (S)-pramipexole, while an additional 0.045 mg of (S)-pramipexole could be added before exceeding the preferable NOAEL dose amount of (S)-pramipexole. These compositions would be 96% pure and 99.8% pure. By contrast, a 25 mg of 100% pure (R)-pramipexole would result in 2.78 DAE, using the comparative binding affinity ratio of 9 from the literature, suggesting that even 100% purity would be insufficient to avoid adverse side effects. Hence, the present invention further provides particular doses of (R)-pramipexole which unexpectedly tolerate small amounts of (S)-pramipexole impurities.
Further Definitions
It must also be noted that as used herein and in the appended claims the singular forms “a”, “an”, and “the” include plural reference unless the context clearly dictates otherwise. Thus, for example, reference to a “salt” is a reference to one or more organic solvents and equivalents thereof known to those skilled in the art, and so forth.
As used herein, the term “about” means plus or minus 10% of the numerical value of the number with which it is being used. Therefore, about 50% means in the range of 45%-55%. Unless defined otherwise, all technical and scientific terms used herein have the same meanings as commonly understood by one of ordinary skill in the art.
As used herein, the term “comparative binding affinity ratio” refers to the binding affinity at the D2 or D3 dopamine receptors (IC50 value) of (R)-pramipexole divided by the binding affinity at the D2 or D3 dopamine receptors (IC50 value) of (S)-pramipexole. In some embodiments, the comparative binding affinity ratio refers to the ratio of the IC50 values at the D2 receptor. In some embodiments, the comparative binding affinity ratio refers to the ratio of the IC50 values at the D3 receptor.
As used herein, the term “comparative ratio” refers one of the following: 1) the ratio of the IC50 values at the D2 or D3 receptors for (R)-pramipexole to (S)-pramipexole; 2); the ratio of MTD amounts for (R)-pramipexole to (S)-pramipexole; or 3) the ratio of NOAEL dose amounts for (R)-pramipexole to (S)-pramipexole.
As used herein, the term “daily dose amount” refers to the amount of pramipexole per day that is administered or prescribed to a patient. This amount can be administered in multiple unit doses or in a single unit dose, in a single time during the day or at multiple times during the day.
As used herein, the term “dopaminergic activity equivalent” (DAE) refers to the measure of activity at the dopamine receptors which is equivalent to the activity of 1 mg of (S)-pramipexole at the dopamine receptors.
A “dose amount” as used herein, is generally equal to the dosage of the active ingredient which may be administered once per day, or may be administered several times a day (e.g. the unit dose is a fraction of the desired daily dose). For example, a non-effective dose amount of 0.5 mg/day of (S)-pramipexole may be administered as 1 dose of 0.5 mg, 2 doses of 0.25 mg each or 4 doses of 0.125 mg. The term “unit dose” as used herein may be taken to indicate a discrete amount of the therapeutic composition which comprises a predetermined amount of the active compound. The amount of the active ingredient is generally equal to the dosage of the active ingredient which may be administered once per day, or may be administered several times a day (e.g. the unit dose is a fraction of the desired daily dose). The unit dose may also be taken to indicate the total daily dose, which may be administered once per day or may be administered as a convenient fraction of such a dose (e.g. the unit dose is the total daily dose which may be given in fractional increments, such as, for example, one-half or one-third the dosage).
As used herein, the terms “enantiomers”, “stereoisomers” and “optical isomers” may be used interchangeably, and refer to molecules which contain an asymmetric or chiral center and are non-superimposable mirror images of one another. As used herein, the term “chirally pure” or “enantiomerically pure” may be taken to indicate that the compound contains at least 99.95% of a single optical isomer. The term “enantiomerically enriched”, unless a number is mentioned, may be taken to indicate that at least 51% of the material is a single enantiomer. The term “enantiomeric enrichment” as used herein refers to an increase in the amount of one enantiomer as compared to the other. A “racemic” mixture is a mixture of equal amounts of (R)- and (S)-enantiomers of a chiral molecule.
As used herein, a “kit” refers to one or more pharmaceutical compositions and instructions for administration or prescription of the one or more compositions. The instructions may consist of product insert, instructions on a package of one or more pharmaceutical compositions, or any other instruction.
As used herein, the term “Mirapex®” refers to tablets containing (S)-pramipexole dihydrochloride, which has the chemical name, (S)-2-amino-4,5,6,7-tetrahydro-6-(propylamino)benzothiazole dihydrochloride monohydrate.
As used herein, the term “naïve patient” refers to a patient that has not previously received pramipexole treatment (either (R)-pramipexole or (S)-pramipexole) or who has not received a titration regimen of pramipexole previous to receiving a starting dose of pramipexole.
As used herein, the term “neuroprotectant” refers to any agent that may prevent or slow the progression of neuronal degeneration and/or may prevent neuronal cell death.
The term “patient” and “subject” are interchangeable and may be taken to mean any living organism which may be treated with compounds of the present invention. As such, the terms “patient” and “subject” may include, but is not limited to, any non-human mammal, primate or human. In some embodiments, the “patient” or “subject” is a mammal, such as mice, rats, other rodents, rabbits, dogs, cats, swine, cattle, sheep, horses, primates, or humans. In some embodiments, the patient or subject is an adult, child or infant. In some embodiments, the patient or subject is a human.
As used herein, the term “pharmaceutically acceptable salt” is meant to indicate those salts which are, within the scope of sound medical judgment, suitable for use in contact with the tissues of humans and lower animals without undue toxicity, irritation, allergic response and the like, and are commensurate with a reasonable benefit/risk ratio. Pharmaceutically acceptable salts are well known in the art. For example, Berge et al. (1977) J. Pharm. Sciences, Vol 6. 1-19, describes pharmaceutically acceptable salts in detail.
The term “pharmaceutical composition” shall mean a composition comprising at least one active ingredient, whereby the composition is amenable to investigation for a specified, efficacious outcome in a mammal (for example, without limitation, a human). Those of ordinary skill in the art will understand and appreciate the techniques appropriate for determining whether an active ingredient has a desired efficacious outcome based upon the needs of the artisan.
As used herein, the term “(R)-pramipexole” refers the (R)-enantiomer of pramipexole, or its pharmaceutically acceptable salt thereof, preferably the R(+) enantiomer of pramipexole, or pharmaceutically acceptable salt thereof. “(R)-pramipexole” can also include the hydrate of the (R)-enantiomer of pramipexole, or pharmaceutically acceptable salt thereof. In some embodiments, (R)-pramipexole is (R)-pramipexole dihydrochloride monohydrate.
As used herein, the term “(S)-pramipexole” refers to the (S)-enantiomer of pramipexole, or pharmaceutically acceptable salt thereof; preferably the S(−) enantiomer of pramipexole or pharmaceutically acceptable salt thereof “(S)-pramipexole” can also include the hydrate of the (S)-enantiomer of pramipexole, or pharmaceutically acceptable salt thereof.
As used herein, the term “salt” of the (R)-pramipexole as used herein is any acid addition salt, preferably a pharmaceutically acceptable acid addition salt, including but not limited to, halogenic acid salts such as, for example, hydrobromic, hydrochloric, hydrolluoric and hydroiodic acid salt; an inorganic acid salt such as, for example, nitric, perchloric, sulfuric and phosphoric acid salt; an organic acid salt such as, for example, sulfonic acid salts (methanesulfonic, trilluoromethan sulfonic, ethanesulfonic, benzenesulfonic or p-toluenesulfonic), acetic, malic, fumaric, succinic, citric, benzoic, gluconic, lactic, mandelic, mucic, pamoic, pantothenic, oxalic and maleic acid salts; and an amino acid salt such as aspartic or glutamic acid salt. The acid addition salt may be a mono- or di-acid addition salt, such as a di-hydrohalogenic, di-sulfuric, di-phosphoric or di-organic acid salt. In all cases, the acid addition salt is used as an achiral reagent which is not selected on the basis of any expected or known preference for interaction with or precipitation of a specific optical isomer of the products of this invention (e.g. as opposed to the specific use of D(+) tartaric acid in the prior art, which may preferentially precipitate the (R)-pramipexole).
As used herein, the term “starting daily dose amount” refers to the amount of pramipexole per day that is administered or prescribed to a patient beginning pramipexole treatment, who has not previously been subjected to a titration regimen of pramipexole. This amount can be administered in multiple unit doses or in a single unit dose, in a single time during the day or at multiple times during the day.
“Therapeutically effective amount” as used herein refers to the amount of active compound or pharmaceutical agent that elicits a biological or medicinal response in a tissue, system, animal, individual or human that is being sought by a researcher, veterinarian, medical doctor or other clinician, which includes one or more of the following: (1) preventing the disease; for example, preventing a disease, condition or disorder in an individual that may be predisposed to the disease, condition or disorder but does not yet experience or display the pathology or symptomatology of the disease, (2) inhibiting the disease; for example, inhibiting a disease, condition or disorder in an individual that is experiencing or displaying the pathology or symptomatology of the disease, condition or disorder (i.e., arresting or slowing further development of the pathology and/or symptomatology), and (3) ameliorating the disease; for example, ameliorating a disease, condition or disorder in an individual that is experiencing or displaying the pathology or symptomatology of the disease, condition or disorder (i.e., reversing or reducing the pathology and/or symptomatology).
The term “treating” may be taken to mean prophylaxis of a specific disorder, disease or condition, alleviation of the symptoms associated with a specific disorder, disease or condition and/or prevention of the symptoms associated with a specific disorder, disease or condition. In some embodiments, the term refers to slowing the progression of the disorder, disease or condition or alleviating the symptoms associated with the specific disorder, disease or condition. In some embodiments, the term refers to slowing the progression of the disorder, disease or condition. In some embodiments, the term refers to alleviating the symptoms associated with the specific disorder, disease or condition. In some embodiments, the term refers to restoring function which was impaired or lost due to a specific disorder, disease or condition.
The term “trituration” may be taken to indicate a method of solidifying a chemical compound. Trituration involves agitating the compound by stirring, beating or a method of the like until the chemical compound forms a crystalline solid or precipitate. This solid may act to seed the remaining chemical compound in solution, causing it to precipitate or crystallize from solution.
Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of embodiments of the present invention, the preferred methods, devices, and materials are now described.
Pharmaceutical Compositions
The high chiral purity of the pramipexole used herein, (R)-pramipexole, allows for therapeutic compositions that may have a wide individual and daily dose range. As such, in a first aspect, the present invention provides a composition comprising (R)-pramipexole. The composition may further comprise a pharmaceutically acceptable carrier.
In some embodiments, the amount of (R)-pramipexole may be from about 0.1 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/g/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the amount of (R)-pramipexole may be from about 3 mg/g/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The amount of (R)-pramipexole in the compositions may preferably be about 25 mg to about 5,000 mg, about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses, preferably two or three doses per day. In some embodiments, the amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the amount of (R)-pramipexole is from about 500 mg to about 1000 mg. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the composition is a capsule. In some embodiments, the composition is a tablet.
The embodiments for amounts of (R)-pramipexole in the composition, chiral purity, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In another aspect, the present invention relates to compositions comprising pramipexole which is chirally pure for (R)-pramipexole. In some embodiments, the amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. In some embodiments, the compositions are administered in doses of from about 50 mg to about 5,000 mg, from about 1100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, or from about 500 mg to about 1,000 mg of (R)-pramipexole. In some embodiments, the compositions are administered in doses of from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg of (R)-pramipexole. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day. These doses of pramipexole preferably are in preparations which have a chemical purity of 97% or greater and a chiral purity for (R)-pramipexole, of 99.6% or greater, 99.7% or greater, 99.8% or greater, 99.9% or greater, preferably 99.95% or greater and more preferably 99.99% or greater. In a preferred embodiment, the compositions comprising pramipexole may have a chiral purity for (R)-pramipexole of 100%. The compositions may further comprise a carrier. The compositions of the present invention may be administered orally, preferably as a solid oral dose, and more preferably as a solid oral dose that may be a capsule or tablet. In preferred embodiments, the compositions of the present invention may be formulated as tablets for oral administration.
In another aspect, the present invention further provides a composition comprising a therapeutically effective amount of (R)-pramipexole. The composition may further comprise a pharmaceutically acceptable carrier.
In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the therapeutically effective amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The therapeutically effective amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 500 mg to about 1000 mg. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the composition is a capsule. In some embodiments, the composition is a tablet.
The embodiments for amounts of (R)-pramipexole in the composition, chiral purity, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In an additional aspect, the present invention provides a composition consisting essentially of a therapeutically effective amount of (R)-pramipexole, wherein the chiral purity for the (R)-pramipexole is 99.9%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.95% or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.99% or greater. In some embodiments, the chiral purity for (R)-pramipexole is 100%.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the composition is a capsule. In some embodiments, the composition is a tablet.
In a further aspect, the present invention further provides a composition comprising a therapeutically effective amount of (R)-pramipexole and a non-effective dose amount of (S)-pramipexole. The composition may further comprise a pharmaceutically acceptable carrier.
In some embodiments, the amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day. In some embodiments, the amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the amount of (R)-pramipexole is from about 500 mg to about 1000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
In embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed about 1.0 mg. In more preferred embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed about 0.75 mg, about 0.5 mg, about 0.25 mg, or about 0.125 mg. In some embodiments, the non-effective dose amount of (S)-pramipexole is less than about 0.125 mg.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the composition is a capsule. In some embodiments, the composition is a tablet.
The embodiments for amounts of (R)-pramipexole in the composition, chiral purity, non-effective dose amount, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In another aspect, the present invention provides a pharmaceutical composition comprising a therapeutically effective amount of (R)-pramipexole and a non-effective dose amount of (S)-pramipexole administered in a unit dose form. Preferable unit dose forms include those suitable for oral administration, including but not limited to, capsules, tablets and the like. Table 5 shows various exemplary embodiments. Shown in each column of Table 5 is the amount of (S)-pramipexole that may be co-administered in a non-effective dose amount as a function of the chiral purity of the composition for the (R)-enantiomer of pramipexole. The therapeutically effective amount of (R)-pramipexole may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, therapeutically effective amount of (R)-pramipexole may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
The non-effective dose amount of (S)-pramipexole may be preferably below 1.0 mg/day, below 0.5 mg/day, and below 0.125 mg/day. Thus, as a non-limiting example. a dose of 500 mg/day administered to a patient as a single unit dose may have a chiral purity for the R(+) enantiomer of pramipexole of at least about 99.80% so that the non-effective dose amount of (S)-pramipexole may remain below 1.0 mg/day, more preferably about 99.90% so that the non-effective dose amount of (S)-pramipexole may remain below 0.5 mg/day, and more preferably about 99.975% so that the non-effective dose amount of (S)-pramipexole may remain below 0.125 mg/day. The embodiments for the therapeutically effective amount of (R)-pramipexole, the non-effective dose amount of (S)-pramipexole, and the chiral purity embodiments listed herein may be combined in any suitable combination. With reference to Table 5, any combination of chiral purity and unit dose may be used which allows for the desired combination of a therapeutically effective amount of (R)-pramipexole and a non-effective dose amount of (S)-pramipexole as stated herein.
In some embodiments, the pharmaceutical composition is suitable for oral administration and comprises an amount of (R)-pramipexole greater than 100 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.125 mg. Another preferred embodiment is a pharmaceutical composition suitable for oral administration comprising an amount of (R)-pramipexole greater than 250 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.125 mg. Yet another preferred embodiment of the invention is a pharmaceutical composition suitable for oral administration comprising an amount of (R)-pramipexole greater than 500 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.125 mg. Preferred pharmaceutical compositions for oral administration include tablets, capsules and the like.
In some embodiments, the pharmaceutical composition is formulated as a tablet suitable for oral administration and comprises an amount of (R)-pramipexole greater than 50 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.50 mg, preferably an amount of (R)-pramipexole greater than 100 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.50 mg, and more preferably an amount of (R)-pramipexole greater than 250 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.50 mg. Another preferred embodiment is a pharmaceutical composition formulated as a tablet suitable for oral administration comprising an amount of (R)-pramipexole greater than 500 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.50 mg.







TABLE 5







Preferred non-effective dose amounts of (S)-pramipexole


based on the chiral purity of the composition for (R)-pramipexole











A preferred non-effective dose amount of the (S)-pramipexole may be below 1.0 mg; more preferably below 0.5 mg, and more preferably below 0.125 mg.






The embodiments for amounts of (R)-pramipexole in the composition, chiral purity, non-effective dose amount, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
Another embodiment of the invention is a pharmaceutical composition formulated as a tablet suitable for oral administration comprising an amount of (R)-pramipexole greater than 50 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.25 mg, preferably an amount of (R)-pramipexole greater than 100 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.25 mg, and more preferably an amount of (R)-pramipexole greater than 250 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.25 mg. Another preferred embodiment is a pharmaceutical composition formulated as a tablet suitable for oral administration comprising an amount of (R)-pramipexole greater than 500 mg and a non-effective dose amount of (S)-pramipexole that is less than about 0.25 mg.
In another aspect, the present invention provides a composition comprising a therapeutically effective amount of (R)-pramipexole and a no observable adverse effect level (NOAEL) dose amount of (S)-pramipexole. The therapeutic composition may further comprise a pharmaceutically acceptable carrier.
In some embodiments, the amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 11500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1'000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day. In some embodiments, the amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the amount of (R)-pramipexole is from about 500 mg to about 1000 mg. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
In some embodiments, the no observable adverse effect level dose amount of (S)-pramipexole is less than about 1.50 mg. In some embodiments, the no observable adverse effect level amount of (S)-pramipexole is less than about 0.5 mg. In some embodiments, the no observable adverse effect level amount of (S)-pramipexole is less than about 0.05 mg.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the composition is a capsule. In some embodiments, the composition is a tablet.
The embodiments for amounts of (R)-pramipexole in the composition, chiral purity, no observable adverse effect level dose amount, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In an additional aspect, the present invention provides a pharmaceutical composition comprising a therapeutically effective amount of (R)-pramipexole and a NOAEL dose amount of (S)-pramipexole administered in a unit dose form. Preferable unit dose forms include those suitable for oral administration, including but not limited to, capsules, tablets and the like. Table 6 shows various exemplary embodiments. Shown in each column of Table 6 is the amount of (S)-pramipexole that may be co-administered in a NOAEL dose amount as a function of the chiral purity of the composition for the R(+) enantiomer of pramipexole. The therapeutically effective amount of (R)-pramipexole may preferably be about 50 mg to about 5,000 mg, preferably from about 100 mg to about 3,000 mg, preferably from about 300 mg to about 1,500 mg, more preferably from about 500 mg to about 1,000 mg. In some embodiments, therapeutically effective amount of (R)-pramipexole may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
The NOAEL dose of (S)-pramipexole may be preferably below 1.5 mg, preferably below 0.5 mg, or more preferably below 0.05 mg. Thus, as a non-limiting example, an embodiment of the invention may be a dose of 1,500 mg/day administered to a patient as a single unit dose which may have a chiral purity for the R(+) enantiomer of pramipexole that is at least about 99.967% so that the non-adverse dose of (S)-pramipexole may remain below 0.50 mg/dose. Alternatively, a dose of 1,500 mg/day administered to a patient as three individual doses of 500 mg may have a chiral purity of the (R)-pramipexole that is at least about 99.90% so that the non-adverse dose of (S)-pramipexole may remain below 0.50 mg/dose or 1.5 mg/day. The embodiments for the therapeutically effective amount of (R)-pramipexole, the NOAEL dose amount of (S)-pramipexole, and the chiral purity embodiments listed herein may be combined in any suitable combination. With reference to Table 6, any combination of chiral purity and unit dose may be used which allows for the desired combination of a therapeutically effective amount of (R)-pramipexole and a non-adverse effect dose amount of (S)-pramipexole as stated herein.
In some embodiments, the pharmaceutical composition is formulated as a tablet suitable for oral administration and comprises an amount of (R)-pramipexole greater than 50 mg and a NOAEL dose amount of (S)-pramipexole that is less than about 0.05 mg, preferably an amount of (R)-pramipexole greater than 100 mg and a NOAEL dose amount of (S)-pramipexole that is less than about 0.05 mg, and more preferably an amount of (R)-pramipexole greater than 250 mg and a NOAEL dose amount of (S)-pramipexole that is less than about 0.05 mg. In some embodiments, the pharmaceutical composition is formulated as a tablet suitable for oral administration and comprises an amount of (R)-pramipexole greater than 500 mg and a NOAEL dose amount of (S)-pramipexole that is less than about 0.05 mg.







TABLE 6







Preferred no observable adverse effect level doses of (S)-pramipexole


based on the chiral purity of the composition for (R)-pramipexole











A preferred no observable adverse effect level (NOAEL) dose amount of the (S)-pramipexole may be below 0.5 mg, preferably below 0.05 mg.






In some embodiments, the present invention provides a composition for use as a neuroprotectant comprising a therapeutically effective amount of (R)-pramipexole and a therapeutically effective amount of (S)-pramipexole. The composition may further comprise a pharmaceutically acceptable carrier. The composition may be useful in the treatment of diseases which may be alleviated by the action of a neuroprotectant. An additional embodiment of the invention is a therapeutic composition for use as a neuroprotectant comprising a therapeutically effective amount of (R)-pramipexole and a therapeutically effective amount of (S)-pramipexole. The composition may further comprise a pharmaceutically acceptable carrier. The therapeutic composition may be useful in the treatment of diseases related to neuronal degeneration or neuronal cell death.
In one embodiment, the compositions of (R)-pramipexole may be used to restore or improve neuronal, retinal and muscle function in adults and children. Further, the compositions of (R)-pramipexole may be used to treat neurodegenerative diseases, or other diseases associated with mitochondrial dysfunction or increased oxidative stress. In some embodiments, the compositions of (R)-pramipexole may treat neurodegenerative dementias, neurodegenerative movement disorders and ataxias, seizure disorders, motor neuron disorders or diseases, and inflammatory demyelinating disorders in adults and children. The compositions of the present invention may also be useful in the treatment of other disorders not listed herein, and any listing provided in this invention is for exemplary purposes only and is non-limiting.
In some embodiments, the compositions which comprise (R)-pramipexole may be effective as inhibitors of oxidative stress, inhibitors of lipid peroxidation, in the detoxification of oxygen radicals, and the normalization of mitochondrial function. Oxidative stress may be caused by an increase in oxygen and other free radicals, and has been associated with the fatal neurodegenerative disorder amyotrophic lateral sclerosis (ALS). ALS is a progressive neurodegenerative disorder involving the motor neurons of the cortex, brain stem, and spinal cord. About 10% of all ALS patients are familial eases, of which 20% have mutations in the superoxide dismutase 1 (SOD-1) gene. The SOD-1 enzyme may play a pivotal role in the pathogenesis and progression of familial amyotrophic lateral sclerosis (FALS). Recent studies also link the premature neuronal death associated with ALS to mutated mitochondrial genes which lead to abnormalities in functioning of the energy production pathways in mitochondria.
Compositions which comprise (R)-pramipexole may also be effective in the treatment of age related macular degeneration. As such, an embodiment of the invention may be a composition comprising (R)-pramipexole suitable for systemic administration, ocular administration or topical administration to the eye.
Thus, the neuroprotective effect of the compositions of the present invention may derive at least in part from the ability of the (R)-enantiomer of pramipexole to prevent neural cell death by at least one of three mechanisms. First, the (R)-enantiomer of pramipexole may be capable of reducing the formation of reactive oxygen species in cells with impaired mitochondrial energy production. Second, the (R)-enantiomer of pramipexole may partially restore the reduced mitochondrial membrane potential that has been correlated with Alzheimer's disease, Parkinson's disease and amyotrophic lateral sclerosis diseases. Third, the (R)-enantiomer of pramipexole may block the cell death pathways which are produced by pharmacological models of Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis diseases and mitochondrial impairment.
The compositions of these several embodiments which comprise (R)-pramipexole as an active agent may be effective as inhibitors of oxidative stress, inhibitors of lipid peroxidation, in the detoxification of oxygen radicals, and the normalization of mitochondrial function. Further, they may be effective as treatment for impaired motor function, and in degenerative diseases that may affect cardiac and striated muscle and retinal tissues. As such, they may be effective in the treatment of neurodegenerative diseases such as ALS, Parkinson's disease and Alzheimer's disease, and macular degeneration.
Another embodiment of the invention is a composition consisting essentially of a therapeutically effective amount of (R)-pramipexole and a non-effective dose amount of (S)-pramipexole. Another embodiment of the invention is a composition consisting essentially of a therapeutically effective amount of (R)-pramipexole and a NOAEL, dose amount of (S)-pramipexole. Another embodiment of the invention is a composition consisting of a therapeutically effective amount of (R)-pramipexole and a non-effective dose amount of (S)-pramipexole. Such compositions may preferably be therapeutic or pharmaceutical compositions. Another embodiment of the invention is a composition consisting of a therapeutically effective amount of (R)-pramipexole and a NOAEL dose amount of (S)-pramipexole. Such compositions may preferably be therapeutic or pharmaceutical compositions.
In another aspect, the present invention provides a tablet comprising at least about 100 mg of (R)-pramipexole and no more than about 1.5 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole. In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole. In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole. In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole. In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole. In some embodiments, the tablet comprises no more than 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises no more than 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises no more than 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises no more than 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises no more than 0.125 mg of (S)-pramipexole. In some embodiments, the tablet further comprises a pharmaceutically acceptable carrier.
In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 150 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 200 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 250 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 500 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the tablet comprises about 1000 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
The tablet may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the tablet has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the tablet has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the tablet has a chiral purity for (R)-pramipexole of 99.99% or greater.
The embodiments for the amount of (R)-pramipexole in the tablet, the amount of (S)-pramipexole in the tablet, and chiral purity, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In another aspect, the present invention provides a capsule comprising at least about 100 mg of (R)-pramipexole and no more than about 1.5 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole. In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole. In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole. In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole. In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole. In some embodiments, the capsule comprises no more than 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises no more than 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises no more than 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises no more than 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises no more than 0.125 mg of (S)-pramipexole. In some embodiments, the capsule further comprises a pharmaceutically acceptable carrier.
In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 150 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 200 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 250 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 500 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole and no more than about 1.0 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole and no more than about 0.333 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole and no more than about 0.3 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole and no more than about 0.2 mg of (S)-pramipexole. In some embodiments, the capsule comprises about 1000 mg of (R)-pramipexole and no more than about 0.125 mg of (S)-pramipexole.
The capsule may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the capsule has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the capsule has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the capsule has a chiral purity for (R)-pramipexole of 99.99% or greater.
The embodiments for the amount of (R)-pramipexole in the capsule, the amount of (S)-pramipexole in the capsule, and chiral purity, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In a further aspect, the present invention provides a pharmaceutical composition comprising at least about 25 mg of (R)-pramipexole and less than about 1.5 dopaminergic activity equivalents (“DAE”). Table 1 shows the DAE for a 25 mg dose of (R)-pramipexole as a function of a particular chiral purity of the (R)-pramipexole in the dose and the comparative binding affinity ratio.
In some embodiments, the pharmaceutical composition comprises less than about 0.5 dopaminergic activity equivalents (DAE). In some embodiments, the pharmaceutical composition comprises less than about 0.05 dopaminergic activity equivalents. These DAE values are derived from the no observable adverse effect levels of (R)-pramipexole as discussed herein. In some embodiments, the composition has a DAE which is less than the DAE as calculated from the MTD amount or non-effective dose amounts of (S)-pramipexole. With reference to non-effective dose amounts of (S)-pramipexole, in some embodiments, the DAE does not exceed about 1.0, does not exceed about 0.75, does not exceed about 0.5, does not exceed about 0.25, or does not exceed about 0.125. With reference to MTD amount, the composition may have a DAE of below 1.5, below 0.3, or below 0.2.
In some embodiments, the pharmaceutical composition comprises at least about 50 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 75 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 125 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 150 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 200 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 250 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 300 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 400 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 500 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 600 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 750 mg of (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises at least about 1000 mg of (R)-pramipexole.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments, the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule.
The embodiments for the amount of (R)-pramipexole in the composition, the DAE, chiral purity, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In some embodiments, the amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/g/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. In some embodiments, the amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the amount of (R)-pramipexole is from about 500 mg to about 1000 mg. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
The embodiments for the amount of (R)-pramipexole in the composition, the DAE, chiral purity, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In another aspect, the present invention provides a starting daily dose of (R)-pramipexole of at least about 25 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 50 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 75 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 125 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 150 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 200 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 300 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 400 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 500 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 600 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 750 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises at least about 1000 mg of (R)-pramipexole. In some embodiments, the starting daily dose comprises from about 600 mg to about 900 mg of (R)-pramipexole.
In some embodiments, the starting daily dose amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1'000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the starting daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the starting daily dose amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the starting daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the starting daily dose amount may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. The starting daily dose amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 50 mg to about 5000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 100 mg to about 3000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 300 mg to about 1500 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 500 mg to about 1000 mg.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form. In some embodiments the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule.
The embodiments for the stating daily dose of (R)-pramipexole in the composition, chiral purity, and dosage form, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
In another aspect, the present invention provides a pharmaceutical formulation comprising microcrystalline cellulose in an amount from about 20% to about 50% by weight of said formulation; mannitol in about from about 10% to about 30% by weight of said formulation; crospovidone in an amount from about 2% to about 6% of said formulation; magnesium stearate in an amount from about 0.01% to about 2% of said composition; and (R)-pramipexole. In some embodiments, the pharmaceutical composition comprises a diluent in an amount from about 20% to about 50% by weight of said formulation; optionally, a second diluent in an amount from about 10% to about 30% by weight of said formulation; optionally, a disintegrant in an amount from about 2% to about 6% of said formulation; optionally, a lubricant in an amount from about 0.01% to about 2% of said composition; and (R)-pramipexole. In some embodiments, the pharmaceutical composition microcrystalline cellulose, mannitol, croscarmellose sodium, magnesium stearate, or combination thereof. In some embodiments, the pharmaceutically acceptable carrier comprises microcrystalline cellulose, mannitol or combination thereof; and further optionally comprises croscarmellose sodium or magnesium stearate, or combination thereof.
The formulation may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the formulation has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the formulation has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the formulation has a chiral purity for (R)-pramipexole of 99.99% or greater.
The amount of (R)-pramipexole in the formulation may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole in the formulation may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the formulation of (R)-pramipexole is from about 600 mg to about 900 mg.
In some embodiments, the present invention provides a pharmaceutical composition comprising a pharmaceutical composition comprising microcrystalline cellulose in an amount from about 20% to about 50% by weight of said composition; mannitol in an amount from about 10% to about 30% by weight of said composition; crospovidone in an amount from about 2% to about 6% of said composition; magnesium stearate in an amount from about 0.01% to about 2% of said composition; and (R)-pramipexole. In some embodiments, the composition is suitable for oral administration. In some embodiments, the composition is a solid oral dosage form.
The composition may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95%, or more preferably at least 99.99%. In some embodiments, the chiral purity for (R)-pramipexole is 100%. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.9% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.95% or greater. In some embodiments, the composition has a chiral purity for (R)-pramipexole of 99.99% or greater.
The amount of (R)-pramipexole in the compositions may preferably be about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, from about 500 mg to about 1,000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole in the compositions may be about from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg, to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the amount of (R)-pramipexole is from about 600 mg to about 900 mg. In some embodiments, the present invention further provides pharmaceutical compositions comprising (R)-pramipexole having about 25 neuroprotective activity equivalents and less than about 1.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has less than about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has less than about 0.05 dopaminergic activity equivalents.
In some embodiments, the pharmaceutical composition has at least about 50, at least about 75, at least about 125, at least about 150, at least about 200, at least about 300, at least about 400, at least about 500, at least about 750, at least about 750, or at least about 100 neuroprotective activity equivalents. In some embodiments, the pharmaceutical composition has from about 50 to about 5,000, from about 100 to about 3,000, from about 300 to about 1,500, from about 500 to about 1,000, from about 25 to about 5,000, from about 100 to about 5,000, from about 200 to about 5,000, from about 250 to about 5,000, from about 300 to about 5,000, from about 400 to about 5,000, from 450 to about 5,000, from about 200, to about 3,000, from about 250 to about 3,000, from about 300 to about 3,000, from about 400 to about 3,000, from 450 to about 3,000, from about 100 to about 1,000, from about 200 to about 1,000, from about 250 to about 1,000, from about 300 to about 1,000, from about 400 to about 1,000, from about 600 to about 1,000, from 450 to about 1,000, or from about 600 to about 900 neuroprotective activity equivalents.
In some embodiments, the pharmaceutical composition has from about 50 to about 5,000 neuroprotective activity equivalents; and less than from about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 100 to about 3,000 neuroprotective activity equivalents; and less than from about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 200 to about 3,000 neuroprotective activity equivalents, and less than from about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 300 to about 1,500 neuroprotective activity equivalents; and less than from about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 500 to about 1,000 neuroprotective activity equivalents; and less than from about 0.5 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 50 to about 5,000 neuroprotective activity equivalents; and less than from about 0.05 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 100 to about 3,000 neuroprotective activity equivalents; and less than from about 0.05 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 200 to about 3,000 neuroprotective activity equivalents; and less than from about 0.05 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 300 to about 1,500 neuroprotective activity equivalents; and less than from about 0.05 dopaminergic activity equivalents. In some embodiments, the pharmaceutical composition has about 500 to about 1,000 neuroprotective activity equivalents; and less than from about 0.05 dopaminergic activity equivalents.
In some embodiments, the pharmaceutical composition is a solid oral dosage form, in some embodiments, the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule.
The embodiments for the neuroprotective activity equivalents, dopaminergic activity equivalents, and dosage forms in the composition, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
Methods of Treatment, Uses, and Compositions and Compounds for Use
In another aspect, the present invention provides a method for treating a neurodegenerative disease by administering a therapeutically effective amount of (R)-pramipexole. In accordance with this embodiment, the (R)-pramipexole may be formulated as a pharmaceutical or therapeutic composition by combining with one or more pharmaceutically acceptable carriers. Embodiments include pharmaceutical or therapeutic compositions that may be administered orally, preferably as a solid oral dose, and more preferably as a solid oral dose that may be a capsule or tablet. In a preferred embodiment, the pharmaceutical or therapeutic composition is formulated in tablet or capsule form for use in oral administration routes. The compositions and amounts of non-active ingredients in such a formulation may depend on the amount of the active ingredient, and on the size and shape of the tablet or capsule. Such parameters may be readily appreciated and understood by one of skill in the art. The therapeutically effective amount of (R)-pramipexole may be effective as an inhibitor of oxidative stress, an inhibitor of lipid peroxidation or in detoxification of oxygen radicals.
In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the therapeutically effective amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the dosage may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, preferably from about 300 mg to about 1,500 mg, or more preferably from about 500 mg to about 1,000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole may be from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the therapeutically effective amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
The pramipexole may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95% and more preferably at least 99.99%. In a preferred embodiment, the chiral purity for the R(+) enantiomer of pramipexole may be 100%.
In a further aspect, the present invention further provides a method of treating an acute neurodegenerative disease in a patient in need thereof comprising administering to the patient a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole. In some embodiments, the present invention provides use of a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole for the preparation of medicament for use in a method of treatment of an acute neurodegenerative disorder in a patient. In another aspect, the present invention provides a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole for use of in method of treatment of an acute neurodegenerative disorder in a patient.
In some embodiments, the acute neurodegenerative disease is selected from stroke, neurotrauma, acute metabolic dysfunction, sequelae from cerebral seizure, status epilepticus, and acute encephalitis.
In some embodiments, the patient is a naïve patient.
In some embodiments, the daily dose amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,000 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the daily dose amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the daily dose amount may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. In some embodiments, the daily dose amount of (R)-pramipexole is from about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, or from about 500 mg to about 1,000 mg. In some embodiments, the daily dose amount of (R)-pramipexole is from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the daily dose amount of (R)-pramipexole is from about 600 mg to about 900 mg. In some embodiments, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 50 mg to about 5,000 mg of (R)-pramipexole. In some embodiments, the daily dose amount is from about 100 mg to about 3,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 200 mg to about 3,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 300 mg to about 1,500 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
In some embodiments, the chiral purity for (R)-pramipexole is 99.5%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.6%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.7%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.8%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.9%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.95%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.99% or greater.
In some embodiments, the daily dose amount further comprises a no observable adverse effect level amount of (S)-pramipexole. In some embodiments, the no observable effective dose amount of (S)-pramipexole is an below 1.5 mg, below 0.5 mg, or below 0.05 mg per day.
In some embodiments, the daily dose amount further comprises a non-effective dose amount of (S)-pramipexole. In some embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 1.0 mg per day. In some embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 0.75 mg/day, 0.5 mg/day, 0.25 mg/day, or 0.125 mg/day. In some embodiments, the non-effective dose mount of (S)-pramipexole does not exceed a total dose of 0.125 mg/day.
In some embodiments of the methods of the invention, the daily dose amount is about 100 mg to about 3,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 200 to about 3,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 300 to about 1,500 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 100 mg to 3,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 200 mg to about 3,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 300 to about 11500 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In another embodiment, the (R)-pramipexole in each of the method embodiments described herein is administered as a pharmaceutical composition. In some embodiments, the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule. In some embodiments, the pharmaceutical composition comprises a pharmaceutically acceptable carrier.
The embodiments for disease states, patient type (naïve vs. not naïve), daily dose amounts, no observable adverse effect level dose amounts, non-effective dose amounts, and chiral purities for the methods of the invention, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
Any of the embodiments described herein for the methods can also be used for the uses of (R)-pramipexole in the preparation of medicaments for use in methods of treating an acute neurodegenerative disease, or in the daily dose of (R)-pramipexole for use in a method of treating an acute neurodegenerative disorder.
In a further aspect, the present invention further provides a method of treating a chronic neurodegenerative disease in a patient in need thereof, comprising administering to the patient a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole. In some embodiments, the present invention provides use of a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole for the preparation of medicament for use in a method of treatment of a chronic neurodegenerative disorder in a patient. In some embodiments, the present invention provides a daily dose amount of about 25 mg to about 5,000 mg of (R)-pramipexole for use of in method of treatment of a chronic neurodegenerative disorder in a patient.
In some embodiments, the chronic neurodegenerative disease is selected from primary neurodegenerative disease, Huntington's Chorea, metabolically induced neurological damage, senile dementia of Alzheimer's type, age associated cognitive dysfunction, vascular dementia, multi-infarct dementia, Lewy body dementia, neurodegenerative dementia, neurodegenerative movement disorder, ataxia, Friedreich's ataxia, multiple sclerosis, spinal muscular atrophy, primary lateral sclerosis, seizure disorders, motor neuron disorder or disease, inflammatory demyelinating disorder, Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, hepatic encephalopathy, and chronic encephalitis.
In some embodiments, the patient is a naïve patient.
In some embodiments, the daily dose amount of (R)-pramipexole may be from about 0.01 mg/kg/day to about 10,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 0.1 mg/kg/day to about 1,000 mg/kg/day, from about 1 mg/kg/day to about 1,000 mg/kg/day, from about 1,000 mg/kg/day to about 10,0001 mg/kg/day, or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the daily dose amount of (R)-pramipexole may be from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiment, the daily dose amount of (R)-pramipexole may be from about 3 mg/kg/day to about 50 mg/kg/day. In some embodiments, the daily dose amount may be 10 mg/day to 1,500 mg/day, more preferably 100 mg/day to 600 mg/day. In some embodiments, the daily dose amount of (R)-pramipexole is from about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, from about 300 mg to about 1,500 mg, or from about 500 mg to about 1,000 mg. In some embodiments the daily dose amount of (R)-pramipexole is from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 1,000 mg. In some embodiments, the daily dose amount of (R)-pramipexole is from about 600 mg to about 900 mg. In some embodiments, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 50 mg to about 5,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 100 mg to about 3,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 200 mg to about 3,000 mg of (R)-pramipexole. In some embodiments, daily dose amount is from about 300 mg to about 1,500 mg of (R)-pramipexole. In some embodiments, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
In some embodiments, the chiral purity for (R)-pramipexole is 99.5%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.6%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.7%, or greater. In some embodiments, the chiral purity for (R)-pramipexole is 99.8%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.9%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.95%, or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.99% or greater.
In some embodiments, the daily dose amount further comprises a no observable adverse effect level amount of (S)-pramipexole. In some embodiments, the no observable effective dose amount of (S)-pramipexole is an below 1.5 mg, below 0.5 mg, or below 0.05 mg per day.
In some embodiments, the daily dose amount further comprises a non-effective dose amount of (S)-pramipexole. In some embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 1.0 mg per day. In some embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 0.75 mg/day, 0.5 mg/day, 0.25 mg/day, or 0.125 mg/day. In some embodiments, the non-effective dose mount of (S)-pramipexole does not exceed a total dose of 0.125 mg/day.
In some embodiments of the methods of the invention, the daily dose amount is about 100 mg to about 3,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 200 to about 3,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 300 to about 1,500 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments of the methods of the invention, the daily dose amount is from about 100 mg to 3,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 200 mg to about 3,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 300 to about 1,500 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In some embodiments of the methods of the invention, the daily dose amount is from about 500 mg to about 1,000 mg of (R)-pramipexole and the daily dose amount further comprises less than about 0.05 mg of (S)-pramipexole.
In another embodiment, the (R)-pramipexole in each of the method embodiments described herein is administered as a pharmaceutical composition. In some embodiments, the pharmaceutical composition is a tablet. In some embodiments, the pharmaceutical composition is a capsule. In some embodiments, the pharmaceutical composition comprises a pharmaceutically acceptable carrier.
The embodiments for disease states, patient type (naïve vs. not naïve), daily dose amounts, no observable adverse effect level dose amounts, non-effective dose amounts, and chiral purities for the methods of the invention, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
Any of the embodiments described herein for the methods can also be used for the uses of (R)-pramipexole in the preparation of medicaments for use in methods of treating a chronic neurodegenerative disease, or in the daily dose of (R)-pramipexole for use in a method of treating a chronic neurodegenerative disorder.
Kits
In another aspect, the present invention provides a kit comprising one or more pharmaceutical compositions comprising (R)-pramipexole and instructions for administering or prescribing the one or more pharmaceutical compositions, comprising a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of at least about 50 mg to about 5,000 mg of (R)-pramipexole to a patient. In addition, in some embodiments, the present invention provides kits comprising one or more pharmaceutical compositions according to any of the previous embodiments of the compositions described herein, or any combination thereof, and instructions for administering or prescribing the one or more pharmaceutical compositions, comprising a direction to administer or prescribe the one or more pharmaceutical compositions according to the embodiments of the methods described herein, or any combination thereof.
The pramipexole for use in the kits of the invention may have a chiral purity for (R)-pramipexole of at least 99.5%, preferably at least 99.6%, preferably at least 99.7%, preferably at least 99.8%, preferably at least 99.9%, preferably at least 99.95% and more preferably at least 99.99%. In a preferred embodiment, the chiral purity for the R(+) enantiomer of pramipexole may be 100%. In some embodiments, the chiral purity for the (R)-pramipexole is 99.9% or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.95% or greater. In some embodiments, the chiral purity for the (R)-pramipexole is 99.99% or greater.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of (R)-pramipexole of from about 0.1 mg/kg/day to about 1,000 mg/kg/day or from about 1 mg/kg/day to about 100 mg/kg/day. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of (R)-pramipexole of from about 3 mg/kg/day to about 70 mg/kg/day. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of (R)-pramipexole of from about 7 mg/kg/day to about 40 mg/kg/day. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of (R)-pramipexole of from about 50 mg to about 5,000 mg, from about 100 mg to about 3,000 mg, preferably from about 300 mg to about 1,500 mg, or more preferably from about 500 mg to about 1,000 mg. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of (R)-pramipexole of from about 25 mg to about 5,000 mg, from about 50 mg to about 5,000 mg, from about 100 mg to about 5,000 mg, from about 200 mg to about 5,000 mg, from about 250 mg to about 5,000 mg, from about 300 mg to about 5,000 mg, from about 400 mg to about 5,000 mg, from 450 mg to about 5,000 mg, from about 200 mg to about 3,000 mg, from about 250 mg to about 3,000 mg, from about 300 mg to about 3,000 mg, from about 400 mg to about 3,000 mg, from 450 mg to about 3,000 mg, from about 100 mg to about 1,000 mg, from about 200 mg to about 1,000 mg, from about 250 mg to about 1,000 mg, from about 300 mg to about 1,000 mg, from about 400 mg to about 1,000 mg, from about 600 mg to about 1,000 mg, or from 450 mg to about 11000 mg. In some embodiments, the starting daily dose amount of (R)-pramipexole is from about 600 mg to about 900 mg. This dose may be administered as a single daily dose, or may be divided into several doses administered throughout the day, for example, 1 to 5 doses per day, preferably two to three doses per day.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 100 mg to about 3,000 mg of (R)-pramipexole to a patient. In some embodiments, instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 200 mg to about 3,000 mg of (R)-pramipexole to a patient. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of from about 300 to about 1,500 mg of (R)-pramipexole to a patient. In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 500 to about 1,000 mg of (R)-pramipexole to a patient.
In some embodiments, the direction further results in administration of a non-effective dose amount of (S)-pramipexole. In embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 1.0 mg/day. In more preferred embodiments, the non-effective dose amount of (S)-pramipexole is an amount that does not exceed a total dose of 0.75 mg/day, 0.5 mg/day, 0.25 mg/day, and preferably 0.125 mg/day. In some embodiments, the non-effective dose amount is less than about 0.125 mg of (S)-pramipexole.
In some embodiments, the direction further results in administration of a no adverse effect level (NOAEL) dose amount of (S)-pramipexole. In some embodiments, the no observable effective dose amount of dose of (S)-pramipexole may be preferably below 1.5 mg, preferably below 0.5 mg, or more preferably below 0.05 mg. In some embodiments, the no observable adverse effect level dose amount is less than about 0.05 mg per day. In another preferred embodiment, the NOAEL dose amount of (S)-pramipexole is an amount that does not exceed 0.0007 mg/kg per unit dose. In some embodiments, the direction further results in administration of less than about 1.5 dopaminergic activity equivalents. In some embodiments, the direction further results in administration of less than about 0.5 dopaminergic activity equivalents. In some embodiments, the direction further results in administration of less than about 0.05 dopaminergic activity equivalents.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 100 mg to 3,000 mg of (R)-pramipexole to a patient; and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 200 mg to about 3,000 mg of (R)-pramipexole to a patient; and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 300 mg to about 1,500 mg of (R)-pramipexole to a patient; and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 500 mg to about 1,000 mg of (R)-pramipexole to a patient; and the chiral purity for the (R)-pramipexole is 99.95% or greater.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 100 mg to 3,000 mg of (R)-pramipexole and less than about 0.05 mg of (S)-pramipexole to a patient.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starling daily dose of from about 200 mg to 3,000 mg of (R)-pramipexole and less than about 0.05 mg of (S)-pramipexole to a patient.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 300 mg to 1,500 mg of (R)-pramipexole and less than about 0.05 mg of (S)-pramipexole to a patient.
In some embodiments, the instructions comprise a direction to administer or prescribe the one or more pharmaceutical compositions in an amount sufficient to result in administration of a starting daily dose of from about 500 mg to 1,000 of (R)-pramipexole and less than about 0.05 mg of (S)-pramipexole to a patient.
The embodiments for daily dose amounts, no observable adverse effect level dose amounts, non-effective dose amounts, and chiral purities for the kits of the invention, which are described herein separately for the sake of brevity, can be joined in any suitable combination.
The pharmaceutical or therapeutic compositions of the invention may be prepared, packaged, sold in bulk, as a single unit dose, or as multiple unit doses. The compositions may be formulated to be administered orally, ophthalmically, intravenously, intramuscularly, intra-arterially, intramedularry, intrathecally, intraventricularly, transdermally, subcutaneously, intraperitoneally, intravesicularly, intranasally, enterally, topically, sublingually, or rectally. The compositions of the invention may be administered orally, preferably as a solid oral dose, and more preferably as a solid oral dose that may be a capsule or tablet. In some embodiments, the compositions of the present invention may be formulated as tablets for oral administration.
The compounds of the present invention can be administered in the conventional manner by any route where they are active. Administration can be systemic, topical, or oral. For example, administration can be, but is not limited to, parenteral, subcutaneous, intravenous, intramuscular, intraperitoneal, transdermal, oral, buccal, or ocular routes, or intravaginally, intravesicularly, by inhalation, by depot injections, or by implants. Thus, modes of administration for the compounds of the present invention (either alone or in combination with other pharmaceuticals) can be, but are not limited to, sublingual, injectable (including short-acting, depot, implant and pellet forms injected subcutaneously or intramuscularly), or by use of vaginal creams, suppositories, pessaries, vaginal rings, rectal suppositories, intrauterine devices, and transdermal forms such as patches and creams.
The doses of the (R)-pramipexole which may be administered to a patient in need thereof may range between about 0.1 mg/kg per day and about 1,000 mg/kg per day. This dose may be administered as a single daily dose, or may be divided into several doses which are administered throughout the day, such as 1 to 5 doses, or two to three doses per day. The route of administration may include oral, sublingual, transdermal, rectal, or any accessible parenteral route. One of ordinary skill in the art will understand and appreciate the dosages and timing of the dosages to be administered to a patient in need thereof. The doses and duration of treatment may vary, and may be based on assessment by one of ordinary skill in the art based on monitoring and measuring improvements in neuronal and non-neuronal tissues. This assessment may be made based on outward physical signs of improvement, such as increased muscle control, or on internal physiological signs or markers. The doses may also depend on the condition or disease being treated, the degree of the condition or disease being treated and further on the age and weight of the patient.
Specific modes of administration will depend on the indication. The selection of the specific route of administration and the dose regimen may be adjusted or titrated by the clinician according to methods known to the clinician in order to obtain the optimal clinical response. The amount of compound to be administered may be that amount which is therapeutically effective. The dosage to be administered may depend on the characteristics of the subject being treated, e.g., the particular animal or human subject treated, age, weight, health, types of concurrent treatment, if any, and frequency of treatments, and can be easily determined by one of skill in the art (e.g., by the clinician).
A preferable route of administration of the compositions of the present invention may be oral, with a more preferable route being in the form of tablets, capsules, lozenges and the like. In preferred embodiments, the compositions of the present invention may be formulated as tablets for oral administration. A tablet may be made by compression or molding, optionally with one or more accessory ingredients. Compressed tablets may be prepared by compressing in a suitable machine the active ingredient in a free-flowing form such as a powder or granules, optionally mixed with a binder, lubricant, inert diluent, lubricating, surface active or dispersing agent. Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent.
The tablets may be uncoated or they may be coated by known techniques, optionally to delay disintegration and absorption in the gastrointestinal tract and thereby providing a sustained action over a longer period. The coating may be adapted to release the active compound in a predetermined pattern (e.g., in order to achieve a controlled release formulation) or it may be adapted not to release the active compound until after passage of the stomach (enteric coating). The coating may be a sugar coating, a film coating (e.g., based on hydroxypropyl methylcellulose, methylcellulose, methyl hydroxyethylcellulose, hydroxypropylcellulose, carboxymethylcellulose, acrylate copolymers, polyethylene glycols and/or polyvinylpyrrolidone), or an enteric coating (e.g., based on methacrylic acid copolymer, cellulose acetate phthalate, hydroxypropyl methylcellulose phthalate, hydroxypropyl methylcellulose acetate succinate, polyvinyl acetate phthalate, shellac, and/or ethylcellulose). Furthermore, a time delay material such as, e.g., glyceryl monostearate or glyceryl distearate may be employed. The solid tablet compositions may include a coating adapted to protect the composition from unwanted chemical changes, (e.g., chemical degradation prior to the release of the active drug substance).
Pharmaceutical formulations containing the compounds of the present invention and a suitable carrier may also be any number of solid dosage forms which include, but are not limited to, tablets, capsules, cachets, pellets, pills, powders and granules; topical dosage forms which include, hut are not limited to, solutions, powders, fluid emulsions, fluid suspensions, semi-solids, ointments, pastes, creams, gels and jellies, and foams; and parenteral dosage forms which include, but are not limited to, solutions, suspensions, emulsions, and dry powder; comprising an effective amount of a polymer or copolymer of the present invention. It is also known in the art that the active ingredients can be contained in such formulations with pharmaceutically acceptable diluents, fillers, disintegrants, binders, lubricants, surfactants, hydrophobic vehicles, water soluble vehicles, emulsifiers, buffers, humectants, moisturizers, solubilizers, preservatives and the like. The means and methods for administration are known in the art and an artisan can refer to various pharmacologic references for guidance. For example, Modern Pharmaceutics, Banker & Rhodes, Marcel Dekker, Inc. (1979); and Goodman & Gilman's The Pharmaceutical Basis of Therapeutics, 6th Edition, MacMillan Publishing Co., New York (1980) can be consulted.
The compounds of the present invention can be formulated for parenteral administration by injection, e.g., by bolus injection or continuous infusion. The compounds can be administered by continuous infusion over a period of about 15 minutes to about 24 hours. Formulations for injection can be presented in unit dosage form, e.g., in ampoules or in multi-dose containers, with an added preservative. The compositions can take such forms as suspensions, solutions or emulsions in oily or aqueous vehicles, and can contain formulatory agents such as suspending, stabilizing and/or dispersing agents.
For oral administration, the compounds can be formulated readily by combining these compounds with pharmaceutically acceptable carriers well known in the art. Such carriers enable the compounds of the invention to be formulated as tablets, pills, dragees, capsules, liquids, gels, syrups, slurries, suspensions and the like, for oral ingestion by a patient to be treated. Pharmaceutical preparations for oral use can be obtained by adding a solid excipient, optionally grinding the resulting mixture, and processing the mixture of granules, after adding suitable auxiliaries, if desired, to obtain tablets or dragee cores. Suitable excipients include, but are not limited to, fillers such as sugars, including, but not limited to, lactose, sucrose, mannitol, and sorbitol; cellulose preparations such as, but not limited to, maize starch, wheat starch, rice starch, potato starch, gelatin, gum tragacanth, methyl cellulose, hydroxypropylmethyl-cellulose, sodium carboxymethylcellulose, and polyvinylpyrrolidone (PVP). If desired, disintegrating agents can be added, such as, but not limited to, the cross-linked polyvinyl pyrrolidone, agar, or alginic acid or a salt thereof such as sodium alginate.
Dragee cores can be provided with suitable coatings. For this purpose, concentrated sugar solutions can be used, which can optionally contain gum arabic, talc, polyvinyl pyrrolidone, carbopol gel, polyethylene glycol, and/or titanium dioxide, lacquer solutions, and suitable organic solvents or solvent mixtures. Dyestuffs or pigments can be added to the tablets or dragee coatings for identification or to characterize different combinations of active compound doses.
Pharmaceutical preparations which can be used orally include, but are not limited to, push-fit capsules made of gelatin, as well as soft, sealed capsules made of gelatin and a plasticizer, such as glycerol or sorbitol. The push-fit capsules can contain the active ingredients in admixture with filler such as, e.g., lactose, binders such as, e.g., starches, and/or lubricants such as, e.g., talc or magnesium stearate and, optionally, stabilizers. In soft capsules, the active compounds can be dissolved or suspended in suitable liquids, such as fatty oils, liquid paraffin, or liquid polyethylene glycols. In addition, stabilizers can be added. All formulations for oral administration should be in dosages suitable for such administration.
For buccal or sublingual administration, the compositions can take the form of tablets, flash melts or lozenges formulated in any conventional manner.
For administration by inhalation, the compounds for use according to the present invention are conveniently delivered in the form of an aerosol spray presentation from pressurized packs or a nebulizer, with the use of a suitable propellant, e.g., dichlorodifluoromethane, trichlorofluoromethane, dichlorotetrafluoroethane, carbon dioxide or other suitable gas. In the case of a pressurized aerosol the dosage unit can be determined by providing a valve to deliver a metered amount. Capsules and cartridges of, e.g., gelatin for use in an inhaler or insulator can be formulated containing a powder mix of the compound and a suitable powder base such as lactose or starch.
The compounds of the present invention can also be formulated in rectal compositions such as suppositories or retention enemas, e.g., containing conventional suppository bases such as cocoa butter or other glycerides.
In addition to the formulations described previously, the compounds of the present invention can also be formulated as a depot preparation. Such long acting formulations can be administered by implantation (for example subcutaneously or intramuscularly) or by intramuscular injection.
Depot injections can be administered at about 1 to about 6 months or longer intervals. Thus, for example, the compounds can be formulated with suitable polymeric or hydrophobic materials (for example, as an emulsion in an acceptable oil) or ion exchange resins, or as sparingly soluble derivatives, for example, as a sparingly soluble salt.
In transdermal administration, the compounds of the present invention, for example, can be applied to a plaster, or can be applied by transdermal, therapeutic systems that are consequently supplied to the organism.
Pharmaceutical and therapeutic compositions of the compounds also can comprise suitable solid or gel phase carriers or excipients. Examples of such carriers or excipients include but are not limited to calcium carbonate, calcium phosphate, various sugars, starches, cellulose derivatives, gelatin, and polymers such as, e.g., polyethylene glycols.
The compounds of the present invention can also be administered in combination with other active ingredients, such as, for example, adjuvants, protease inhibitors, or other compatible drugs or compounds where such combination is seen to be desirable or advantageous in achieving the desired effects of the methods described herein.
Preparation of (R)- and (S)-Pramipexole
Processes for the preparation of pramipexole are described in U.S. Pat. No. 4,843,086 and U.S. Pat. No. 4,886,812 to Griss et al., each of which is incorporated by reference in its entirety. The (R)-pramipexole of the present invention may be synthesized and/or purified by methods disclosed in the copending U.S. Provisional Application No. 60/894,829 entitled “Methods of Synthesizing and Purifying R(+) and (S)-pramipexole”, filed on Mar. 14, 2007, and U.S. Provisional Application No. 60/894,814 entitled “Methods of Enantiomerically Purifying Chiral Compounds”, filed on Mar. 14, 2007, which are incorporated herein by reference in their entireties. Specifically, preparations of pramipexole which are chirally pure for the R(+) enantiomer may be produced using a bi-molecular nucleophilic substitution (SN2) reaction. A diamine, 2,6 diamino-4,5,6,7-tetrahydro-benzothiazole, is reacted with a propyl sulfonate or a propyl halide in polar solvents to generate an insoluble pramipexole salt in a one pot synthesis scheme. The pramipexole salt reaction product displays a high chemical purity and an increased optical purity over the reactants, which may be due to limited solubility of the pramipexole salt in the polar solvents of the reaction mixture. Purification of the final pramipexole synthesis product from the reaction mixture thus involves simple trituration and washing of the precipitated pramipexole salt in a volatile solvent such as an alcohol or heptane, followed by vacuum drying.




In some embodiments, the (R)-pramipexole is prepared by dissolving a diamine of formula 2,6 diamino-4,5,6,7-tetrahydro-benzothiazole in an organic solvent, reacting the diamine with a propyl sulfonate or a propyl halide under conditions sufficient to generate and precipitate the pramipexole salt, and recovering the pramipexole salt. In a preferred embodiment, the propyl sulfonate may be propyl tosylate. In a further embodiment, the propyl halide may be propyl bromide. The pramipexole salt reaction product of this process displays a high chemical purity and an increased optical purity over the reactants. Without wishing to be bound by theory, the increased optical purity may be due to limited solubility of the pramipexole salt reaction product in the polar solvents of the reaction mixture. Purification of the final pramipexole reaction product from the reaction mixture thus involves simple trituration and washing of the precipitated pramipexole salt in a volatile solvent such as an alcohol or heptane, followed by vacuum drying.
In embodiments of the process, the diamine may be an R(+) diamine, or a mixture of the R(+) and an S diamine. The chemical purity of the final pramipexole salt may be at least about 97% or greater, preferably 98% or greater, more preferably 99% or greater. The R(+) enantiomers of the pramipexole salt generated using this process are generated from starting diamines which may be at least 55% optically pure, preferably 70% optically pure, and more preferably greater than 90% optically pure. The final pramipexole product may be enriched to 99.6% optical purity or greater, 99.7% optical purity or greater, preferably 99.8% optically purity or greater, and more preferably 99.9% optical purity or greater, 99.95% optical purity or greater, 99.99% optical purity or greater. In some embodiments, the optical purity may be 100%.
In embodiments of the process, the organic solvent may be a polar aprotic solvent such as tetrahydrofuran, dimethylformamide, dimethyl sulfoxide, dimethylacetamide, or hexamethylphosphoric triamide. The organic solvent may also be a low molecular weight alcohol such as ethanol, 1-propanol, or n-butanol. Further, the organic solvent may be any combination of the polar aprotic solvents and low molecular weight alcohols. The organic solvent may have a water content of from about 0 to about 10 volume percent. Preferably, the solvents used in the practice of this invention are standard ACS grade solvents. Further, the propyl sulfonate or a propyl halide may be added at about 1.0 to about 2.0 molar equivalents of the diamine.
In further embodiments of the process, the conditions sufficient to generate and precipitate the pramipexole salt may comprise heating the dissolved diamine at an elevated temperature, adding the propyl sulfonate or propyl halide which may be dissolved in di-isopropylethylamine and an organic solvent to form a mixture, and stirring the mixture for about 4 hours. Alternatively, the di-isopropylethylamine may be added to the reaction with the diamine, and the propyl sulfonate or propyl halide may be dissolved in an organic solvent to form a mixture, which may be added to the reaction with stirring over about 4 hours.
In this embodiment, the elevated temperature of the reaction may be below the boiling temperature of the reaction, specifically, below the boiling temperature of the organic solvent(s) of the reaction mixture. The elevated temperature may be lower than about 125° C., preferably lower than about 100° C., and more preferably about 95° C. or lower. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature.
In an alternative embodiment, the conditions sufficient to generate and precipitate the pramipexole salt may comprise using dimethylformamide as the organic solvent, heating the dissolved diamine at an elevated temperature, adding the propyl sulfonate or propyl halide which is dissolved in dimethylformamide to form a mixture, and stirring the mixture for about 4 hours. The elevated temperature of the reaction may be below the boiling temperature of the reaction, specifically, below the boiling temperature of the organic solvent(s) of the reaction mixture. The elevated temperature may be lower than about 125° C., preferably lower than about 100° C., and more preferably about 75° C. or lower. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature.
In a preferred alternative embodiment, the conditions sufficient to generate and precipitate the pramipexole salt comprise using dimethylformamide as the organic solvent and heating the dissolved diamine at an elevated temperature. A mixture of propyl sulfonate or propyl halide, at preferably 1.25 molar equivalents, dissolved in dimethylformamide, preferably 10 volumes, and di-isopropylethylamine, preferably 1.25 molar equivalents, is added slowly to the heated diamine with stirring over a period of about 4 hours. Alternatively, the di-isopropylethylamine may be added to the reaction with the diamine, and the propyl sulfonate or propyl halide may be dissolved in dimethylformamide to form a mixture, which may be added to the reaction with stirring for about 4 hours. The elevated temperature of the reaction may be below the boiling temperature of the reaction, specifically, below the boiling temperature of the organic solvent(s) of the reaction mixture. The elevated temperature may be lower than about 125° C., preferably lower than about 10° C., and more preferably about 65° C. or lower. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature.
Embodiments of the process further comprise cooling the reaction to a temperature of about room temperature, about 25° C., and stirring the reaction for about 2 hours. The process may further involve filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol, and drying the precipitate under vacuum. The pramipexole salt reaction product of this process may display an increased optical purity over the reactants.
Alternatively, the pramipexole sulfonate or halide salt can be reacted with concentrated HCl in an organic solvent, such as an alcohol, at a temperature of from about 0 to about 5° C. An organic solvent, such as methyl tert-butyl ether (MTBE), may be added, and the reaction may be stirred for an additional hour. The (R)-pramipexole dihydrochloride product may be recovered from the reaction mixture by filtering, washing with an alcohol and vacuum drying.
In an embodiment of the process, referred to as condition A in Table 7 and in the examples, the reaction condition which may be sufficient to generate the pramipexole product may include heating the dissolved diamine of formula II to an elevated temperature with continuous stirring. The elevated temperature is preferably less than the melting point of the chosen organic solvent, lower than about 125° C., preferably lower than about 100° C., and more preferably about 95° C. A solution of propyl sulfonate or propyl halide, which is dissolved in di-isopropylethylamine and an organic solvent to form a mixture, is added slowly over a period of several hours. This reaction mixture may then be stirred at temperature for an additional period of time such as, for example, about 4 hours. The times necessary for the reaction may vary with the identities of the reactants and solvent system, and with the chosen temperature, and would be understood by one of skill in the art.
In an alternate embodiment, the di-isopropylethylamine may be added to the reaction with the diamine, and the propyl sulfonate or propyl halide may be dissolved in an organic solvent to form a mixture, which may be added to the reaction with stirring over a period of several hours. This reaction mixture may then be stirred at temperature for an additional period of time such as, for example, at least 4 hours. The time necessary for the reaction to run to completion may vary with the identities of the reactants and solvent system, and with the chosen temperature, and would be understood by one of skill in the art.
In an alternative embodiment of the process, referred to as condition B in Table 7, the reaction conditions which are sufficient to generate the pramipexole product may include using dimethylformamide as the organic solvent, and heating the dissolved diamine of formula II to an elevated temperature with continuous stirring. The elevated temperature is preferably less than the melting point of the chosen organic solvent, lower than about 125° C., preferably lower than about 100° C., and more preferably about 75° C. A solution of propyl sulfonate or propyl halide, which is dissolved in dimethylformamide, may be added slowly over a period of several hours. This reaction mixture may then be stirred at temperature for an additional period of time such as, for example, about 4 hours. The time necessary for the reaction to run to completion may vary with the identities of the reactants and solvent system, and with the chosen temperature, and would be understood by one of skill in the art.
In a preferred alternative embodiment of the process, referred to as condition C in Table 7, the reaction includes using dimethylformamide as the organic solvent for dissolution of the diamine. The diamine of formula II may then be heated to an elevated temperature with continuous stirring. The elevated temperature is preferably less than the melting point of the chosen organic solvent, lower than about 125° C., preferably lower than about 100° C., and more preferably about 65° C. A solution of propyl sulfonate or propyl halide, preferably about 1.25 molar equivalents, may be dissolved in dimethylformamide, preferably about 10 volumes, and di-isopropylethylamine, preferably about 1.25 molar equivalents, to form a mixture. This mixture may be added slowly over a period of several hours to the heated diamine. This reaction mixture may then be stirred at temperature for an additional period of time such as, for example, about 4 hours. Alternatively, the di-isopropylethylamine may be added to the reaction with the diamine, and the propyl sulfonate or propyl halide may be dissolved in dimethylformamide to form a mixture, which may be added to the reaction with stirring over a period of several hours. This reaction mixture may then be stirred at temperature for an additional period of time such as, for example, about 4 hours. The time necessary for the reaction to run to completion may vary with the identities of the reactants and solvent system, and with the chosen temperature, and would be understood by one of skill in the art.
Purification of the final pramipexole product may include cooling the reactions disclosed above to a temperature of about 25° C., and stirring the reactions for a period of time such as, for example, about 2 hours. The purification may further include filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol, and drying the precipitate under vacuum. The final products of the reaction may be analyzed by high pressure liquid chromatography (HPLC) for chemical and chiral purity.
Further, 1H NMR and 13C NMR may be used to confirm the structure of the product pramipexole. Results of example syntheses using each of the several conditions which are embodiments of the present disclosure are listed in Table 7. Several example syntheses of pramipexole using conditions A and C of the present disclosure are detailed in Examples 5-7.
The sulfonate or halide salts of pramipexole may be converted to an HCl salt using a concentrated solution of HCl in ethanol. A p-TSA pramipexole salt may be re-dissolved in an alcohol, such as ethanol, and the mixture may be cooled to between about 0 and about 5° C. with continuous stirring. A concentrated HCl may then be added, followed by a solvent such as methyl tert-butyl ether (MTBE), and the mixture may be stirred for an hour at between about 0 and about 5° C. The reaction mixture may then be filtered, washed with an MTBE/alcohol solution, and dried under vacuum. The final product is pramipexole dihydrochloride. A detailed example of this synthesis may be found in Example 8.
An alternate method for conversion of the sulfonate or halide salts of pramipexole to an HCl salt involves the use of a concentrated solution of HCl and isopropyl acetate (IPAC). A sulfonate or halide salt of pramipexole may be taken up in IPAC and cooled to 15° C. HCl (gas) may be bubbled into the slurry for about 1 hour, after which the mixture may be filtered, washed with IPAC and dried under vacuum at room temperature to afford a pramipexole dihydrochloride salt. A detailed example of this synthesis may be found in Example 9.
The sulfonate or halide salts of pramipexole may alternatively be converted to the free base form of pramipexole. A p-TSA pramipexole salt may be dissolved in dichloromethane (DCM) and water. The resulting solution may then by brought to a pH of about 11-12 using NaOH. Two phases may be generated, and the aqueous phase may be extracted with DCM, dried over magnesium sulfate (MgSO4), filtered over Celite® and concentrated. The concentrated residue may be re-dissolved in MTBE and stirred as a slurry for several hours. The solids may then be filtered, washed with MTBE, and dried under vacuum at a temperature of about 35° C. The final product is pramipexole free base. A detailed example of this synthesis may be found in Example 10.
Alternatively, the sulfonate or halide salts of pramipexole may alternatively be converted to the free base form of pramipexole by a second process. In this second process, the p-TSA salt of pramipexole is dissolved in water and cooled to a temperature of about 10° C. This slurry is basified by addition of NaOH, diluted with brine, and extracted several times in DCM. The combined organic phases are then washed with brine, dried over MgSO4, filtered and concentrated to dryness. A detailed example of this synthesis may be found in Example 11.
The free base form of pramipexole may be converted to pramipexole dihydrochloride by bubbling HCl gas into a cooled solution of the pramipexole free base in IPAC. Alternatively, the free base form of pramipexole may be converted to pramipexole dihydrochloride by mixing with concentrated HCl at room temperature overnight. Detailed examples of the aforementioned synthesis schemes may be found in Examples 12 and 13, respectively.
Alternatively, the free base form of pramipexole may be converted to pramipexole fumarate by the addition of 2 molar equivalents of fumaric acid.







TABLE 7







Experiments for SN2 preparation of pramipexole pTSA salt










Condition
Isomer
Batch Size
Results














A
R(+)
45
grams
Yield = 53.2 grams (52%)






Chemical Purity = 98.2% AUC






by HPLC






Chiral Purity = >99.5% AUC






by HPLC


A
S(−)
5
grams
Yield = 4.99 grams (44.2%)






Chemical Purity = 98.0% AUC






by HPLC






Chiral Purity = >99.6% AUC






by HPLC


A
Racemic
5
gram
Yield = 5.12 grams (45%)






Chemical Purity = 97.1% AUC






by HPLC






Chiral Purity = 1:1 R(+):S(−)






by HPLC


B
R(+)
5
gram
Yield = 4.6 grams (40%)






Chemical Purity = 94.9% AUC






by HPLC






Chiral Purity = 99.6% AUC






by HPLC


B
S(−)
10
gram
Yield = 9.81 grams (43.3%)






Chemical Purity = 94.9% AUC






by HPLC






Chiral Purity = 99.7% AUC






by HPLC


B
Racemic
5
gram
Yield = 2.9 grams (25.6%)






Chemical Purity = 98.3% AUC






by HPLC






Chiral Purity = 1:1 R(+):S(−)






by HPLC


C
R(+)
250
gram
Yield = 317.6 grams (56%)






Chemical Purity = 99.4% AUC






by HPLC






Chiral Purity = 99.8% AUC






by HPLC


C
S(−)
20
gram
Yield = 25.41 grams (56%)






Chemical Purity = 99.4% AUC






by HPLC






Chiral Purity = 99.7% AUC






by HPLC


C
Racemic
5
gram
Yield = 6.02 grams (53.1%)






Chemical Purity = 99.2% AUC






by HPLC






Chiral Purity = 1:1 R(+):S(−)






by HPLC


E*
R(+)
25
gram
Yield = 47%






Chiral Purity = 99.8% AUC






by HPLC


E*
S(−)
25
gram
Yield = 47%






Chiral Purity = 99.8% AUC






by HPLC





*Condition E is the same as Condition C, except that the recovery step does not incorporate dilution in MTBE. The MTBE increases the recovery (yield) from the synthesis reaction, but may reduce the overall chiral purity. Condition E is explained in more detail in Table 9.






The alternative process for preparing an enantiomerically pure pramipexole from a mixture of (R)-pramipexole and (S)-pramipexole involves using acid addition and trituration (precipitation) of an enantiomerically pure pramipexole based on insolubility of the enantiomers (R(+) and S(−)) in the resulting achiral salt solution. In embodiments of this process, enantiomerically pure pramipexole is triturated from an acid addition solution based on the insolubility of the enantiomers in the resulting achiral salt reagents. This embodiment, a process for preparing an enantiomerically pure pramipexole, comprises dissolving an enantiomerically enriched pramipexole in an organic solvent at an elevated temperature, adding a selected acid, cooling the reaction to room temperature, stirring the cooled reaction at room temperature for an extended time and recovering enantiomerically pure (R)-pramipexole. In a preferred embodiment, the selected acid may be added at from about 1 molar equivalent to about 2 molar equivalents of the enantiomerically enriched pramipexole.
In an embodiment of the process, the selected acid is p-toluenesulfonic acid (p-TSA) and the organic solvent is ethanol. In another embodiment of the process, the elevated temperature may be from about 65° C. to about 85° C. and the cooling occurs at a rate of about 25° C. per hour. The elevated temperature may also be a temperature lower than 125° C., preferably lower than 10° C., and more preferably about 75° C. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature, and may be easily appreciated by one of skill in the art. In yet another embodiment of the process, recovering enantiomerically pure pramipexole comprises cooling the reaction to a temperature of about 25° C. and stirring the reaction for at least about 2 hours. The recovery may further comprise filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol and drying the precipitate under vacuum.
In various embodiments of the process, the organic solvent may include, but is not limited to, acetonitrile, acetone, ethanol, ethyl acetate, methyl tert-butyl ether, methyl ethyl ketone, isopropyl acetate and isopropyl alcohol. In a preferred embodiment, the organic solvent is ethanol. The acid may include, but is not limited to, halogenic acids such as, for example, hydrobromic, hydrochloric, hydrofluoric and hydroiodic acid; inorganic acids such as, for example, nitric, perchloric, sulfuric and phosphoric acid; organic acids such as, for example, sulfonic acids (methanesulfonic, trifluoromethan sulfonic, ethanesulfonic, benzenesulfonic or p-toluenesulfonic), acetic, malic, fumaric, succinic, citric, benzoic, gluconic, lactic, mandelic, mucic, pamoic, pantothenic, oxalic and maleic acid; and aminoacids such as aspartic or glutamic acid. The acid may be a mono- or di-acid, such as a di-hydrohalogenic, di-sulfuric, di-phosphoric or di-organic acid. In all cases, the acid is used as an achiral reagent which is not selected on the basis of any expected or known preference for interaction with or precipitation of a specific optical isomer of the products of this disclosure. In a preferred embodiment, the selected acid is p-toluenesulfonic acid.
In embodiments of the process, the final chiral purity for an R(+) enantiomer of the pramipexole salt may be greater than 99% when the starting mixture contains pramipexole which is at least 55% optically pure for the R(+) enantiomer, preferably 80% optically pure for the R(+) enantiomer, preferably 85% optically pure for the R(+) enantiomer, more preferably 90% optically pure for the R(+) enantiomer and most preferably 95% optically pure for the R(+) enantiomer. The final chiral purity for an S(−) enantiomer of the pramipexole salt may be greater than 99% when the starting mixture contains pramipexole which is at least 55% optically pure for the S(−) enantiomer, preferably 80% optically pure for the S(−) enantiomer, preferably 85% optically pure for the S(−) enantiomer, more preferably 90% optically pure for the S(−) enantiomer and most preferably 95% optically pure for the S(−) enantiomer. The chiral purity of the final pramipexole salt may preferably be 99.6% or greater, 99.7% or greater, preferably 99.8% or greater, and more preferably 99.9% or greater. In some embodiments, the chiral purity of the final pramipexole salt may be 100%.
In embodiments, after the enantiomerically enriched pramipexole is dissolved in an organic solvent at an elevated temperature and the acid is added, the reaction may be cooled to room temperature at a rate of about 25° C./hour. The enantiomerically pure pramipexole may then be recovered from the reaction solution by stirring the reaction for at least about 2 hours, filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol and drying the precipitate under vacuum. The rates of cooling and the time required for the additional stirring may vary with the chosen organic solvent and acid, and may be easily appreciated by one skilled in the art. Additionally, the reaction volumes may dictate the degree of optical purification and the overall yield of the final pramipexole product. These volumes would be understood and appreciated by one of skill in the art. Examples of specific times, temperatures and volumes which enable the practice of this invention are given in the Examples.
In embodiments, the chiral purity of the pramipexole salt product for the R(+) enantiomer may be greater than 99% when the chiral purity of the starting pramipexole mixture for the R(+) enantiomer is greater than 55%, preferably greater than 70%, or more preferably greater than 90%. The chiral purity of the final pramipexole salt may be 99.6% or greater, 99.7% or greater, preferably 99.8% or greater, and more preferably 99.9% or greater, more preferably 99.95% or greater, even more preferably 99.99% or greater. In some embodiments, the chiral purity of the final pramipexole salt may be 100%.
Chirally pure pramipexole also may be prepared by the process of trituration of a single enantiomer of pramipexole from a mixture of R((+) and (S)-pramipexole by acid addition, based on insolubility of the enantiomers in the resulting achiral salt solution. The process comprises dissolving an enantiomerically enriched pramipexole in an organic solvent at an elevated temperature, adding from about 1.05 molar equivalents to about 2.05 molar equivalents of a selected acid, cooling the reaction to room temperature, stirring the cooled reaction at room temperature for an extended time and recovering enantiomerically pure pramipexole.
In embodiments, the elevated temperature of the reaction may be below the boiling temperature of the reaction, specifically, below the boiling temperature of the organic solvent(s) of the reaction mixture. The elevated temperature may be lower than about 125° C., more preferably lower than about 100° C., and more preferably about 75° C. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature, and would be appreciated by one of skill in the art.
In embodiments, the organic solvent may include, but is not limited to, acetonitrile, acetone, ethanol, ethyl acetate, methyl tert-butyl ether, methyl ethyl ketone, isopropyl acetate and isopropyl alcohol. In a preferred embodiment, the organic solvent is ethanol. In this embodiment, the acid may include, but is not limited to, halogenic acids such as, for example, hydrobromic, hydrochloric, hydrofluoric and hydroiodic acid; inorganic acids such as, for example, nitric, perchloric, sulfuric and phosphoric acid; organic acids such as, for example, sulfonic acids (methanesulfonic, trifluoromethan sulfonic, ethanesulfonic, benzenesulfonic or p-toluenesulfonic), acetic, malic, fumaric, succinic, citric, benzoic, gluconic, lactic, mandelic, mucic, pamoic, pantothenic, oxalic and maleic acid; and aminoacids such as aspartic or glutamic acid. The acid may be a mono- or di-acid, such as a di-hydrohalogenic, di-sulfuric, di-phosphoric or di-organic acid. In all cases, the acid is used as an achiral reagent which is not selected on the basis of any expected or known preference for interaction with or precipitation of a specific optical isomer of the products of this disclosure. In a preferred embodiment, the selected acid is p-toluenesulfonic acid.
In additional embodiments, after the enantiomerically enriched pramipexole is dissolved in an organic solvent at an elevated temperature and the acid is added, the reaction may be cooled to room temperature at a rate of about 25° C./hour. The chirally pure pramipexole may then be recovered from the reaction solution by stirring the reaction for at least about 2 hours, filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol and drying the precipitate under vacuum. The rates of cooling and the time required for the additional stirring may vary with the chosen organic solvent and acid, and would be appreciated by one skilled in the art. Additionally, the reaction volumes may dictate the degree of optical purification and the overall yield of the final pramipexole product. These volumes would be understood and appreciated by one of skill in the art. Examples of specific times, temperatures and volumes which enable the practice of this invention are given in the Examples.
In embodiments, the chiral purity for the R(+) enantiomer of the recovered pramipexole salt may be greater than 99% when the starting pramipexole material has a chiral purity for the R(+) enantiomer of greater than 55%, preferably greater than 70%, or more preferably greater than 90%. The chiral purity of the final pramipexole salt for the R(+) enantiomer may be 99.6% or greater, 99.7% or greater, preferably 99.8% or greater, and more preferably 99.9% or greater, more preferably 99.95% or greater, even more preferably 99.99% or greater. In a most preferred embodiment, the chiral purity of the final pramipexole salt for the R(+) enantiomer may be 100%.
The process may include dissolving an enantiomerically enriched pramipexole in an organic solvent at an elevated temperature, adding from about 1.05 equivalents to about 2.05 equivalents of a selected acid, cooling the reaction to room temperature, stirring the cooled reaction at room temperature for an extended period of time and recovering enantiomerically pure pramipexole of formula I.
In an embodiment of the process, the selected acid is p-toluenesulfonic acid (p-TSA) and the organic solvent is ethanol. In another embodiment of the process, the elevated temperature may be from about 65° C. to about 85° C. and the cooling occurs at a rate of about 25° C. per hour. The elevated temperature may also be a temperature lower than 125° C., preferably lower than 100° C., and more preferably about 75° C. The times necessary for the reaction may vary with the identities of the reactants, the solvent system and with the chosen temperature, and may be easily appreciated by one of skill in the art. In yet another embodiment of the process, recovering enantiomerically pure pramipexole comprises cooling the reaction to a temperature of about 25° C. and stirring the reaction for at least about 2 hours. The recovery may further comprise filtering the reaction to isolate a solid precipitate, washing the precipitate with an alcohol and drying the precipitate under vacuu.
In various embodiments of the process, the organic solvent may include, but is not limited to, acetonitrile, acetone, ethanol, ethyl acetate, methyl tert-butyl ether, methyl ethyl ketone, isopropyl acetate and isopropyl alcohol. In a preferred embodiment, the organic solvent is ethanol. The acid may include, but is not limited to, halogenic acids such as, for example, hydrobromic, hydrochloric, hydrofluoric and hydroiodic acid; inorganic acids such as, for example, nitric, perchloric, sulfuric and phosphoric acid; organic acids such as, for example, sulfonic acids (methanesulfonic, trifluoromethan sulfonic, ethanesulfonic, benzenesulfonic or p-toluenesulfonic), acetic, malic, fumaric, succinic, citric, benzoic, gluconic, lactic, mandelic, mucic, pamoic, pantothenic, oxalic and maleic acid; and aminoacids such as aspartic or glutamic acid. The acid may be a mono- or di-acid, such as a di-hydrohalogenic, di-sulfuric, di-phosphoric or di-organic acid. In all cases, the acid is used as an achiral reagent which is not selected on the basis of any expected or known preference for interaction with or precipitation of a specific optical isomer of the products of this disclosure. In a preferred embodiment, the selected acid is p-toluenesulfonic acid.
In embodiments of the process, the final chiral purity for an R(+) enantiomer of the pramipexole salt may be greater than 99% when the starting mixture contains pramipexole which is at least 55% optically pure for the R(+) enantiomer, preferably 80% optically pure for the R(+) enantiomer, preferably 85% optically pure for the R(+) enantiomer, more preferably 90% optically pure for the R(+) enantiomer and most preferably 95% optically pure for the R(+) enantiomer. The final chiral purity for an S(−) enantiomer of the pramipexole salt may be greater than 99% when the starting mixture contains pramipexole which is at least 55% optically pure for the S(−) enantiomer, preferably 80% optically pure for the S(−) enantiomer, preferably 85% optically pure for the S(−) enantiomer, more preferably 90% optically pure for the S(-) enantiomer and most preferably 95% optically pure for the S(−) enantiomer. The chiral purity of the final pramipexole salt may preferably be 99.6% or greater, 99.7% or greater, preferably 99.8% or greater, and more preferably 99.9% or greater. In a more preferred embodiment, the chiral purity of the final pramipexole salt may be 100%.
Results of example purifications using each of the several conditions which are embodiments of the present disclosure are listed in Table 8.







TABLE 8







Experiments for preparation of the R(+) enantiomer of pramipexole










Acid
Solvent
Batch Size
Results





p-TSA
ethanol
298.7 mg
Yield = 489.5 mg (90.3%)





Start Chiral Purity = 91% AUC R(+) by HPLC





Final Chiral Purity = 100% AUC by HPLC


MSA
acetonitrile
300.0 mg
Yield = 431.8 mg (98.9%)





Start Chiral Purity = 91% AUC R(+) by HPLC





Final Chiral Purity = 99.23% AUC by HPLC


fumaric
acetonitrile
301.0 mg
Yield = 532 mg (84.2%)


(hot ethanol)


Start Chiral Purity = 91% AUC R(+) by HPLC





Final Chiral Purity = 99.26% AUC by HPLC


phosphoric
acetonitrile
299.4 mg
Yield = 592 mg (~100%)





Start Chiral Purity = 91% AUC R(+) by HPLC





Final Chiral Purity = 100% AUC by HPLC









The chemical and chiral purity of the preparations of (R)-pramipexole may be verified with at least HPLC, 13C-NMR, 1H-NMR, and FTIR. In preferred embodiments, the (R)-pramipexole may be synthesized by the method described above, which yields enantiomerically pure material. Alternatively, the (R)-pramipexole may be purified from mixtures of R(+) and (S)-pramipexole using a purification scheme which is disclosed in copending U.S. Provisional Application No. 60/894,829 entitled “Methods of Synthesizing and Purifying E(+) and (S)-pramipexole”, filed on Mar. 14, 2007, and U.S. Provisional Application No. 60/894,814 entitled “Methods of Enantiomerically Purifying Chiral Compounds”, filed on Mar. 14, 2007, which are incorporated herein by reference in their entireties.
By way of explanation, and not wishing to be bound by theory, the solubility of (R)-pramipexole and (S)-pramipexole may be the same in the trituration step of the synthesis and purification processes. As example, if a synthesis process is carried out with 90 grams of the R(+) diamine and 10 grams of the S(−)diamine, and the solubility of the final pramipexole product is 10 grams for either enantiomer, then 80 grams of the (R)-pramipexole product and 0 grams of the (S)-pramipexole product would precipitate (assuming a 100% chemical conversion from the diamine and no change in molecular weight in going to the pramipexole product). That is, 10 grams of each enantiomer of pramipexole may be expected to go into solution. This would lead to a pramipexole product with a 100% chiral purity for the R(+) enantiomer. The opposite ratio of starting materials for the synthesis process (90 grams of the S(−) diamine and 10 grams of the R(+) diamine) may generate a reaction product of 90 grams of the (S)-pramipexole and 10 grams of the (R)-pramipexole. From this reaction product mixture, 80 grams of the S(−) enantiomer and 0 grams of the R(+) enantiomer of pramipexole would be expected to precipitate, leading to a pramipexole product with a 100% chiral purity for the S(−) enantiomer. In this thought experiment, one can imagine that the volumes which are used for a reaction may have a large potential effect on the final yield and chiral purity. That is, too large a volume will reduce the yield as more of the pramipexole enantiomer products will go into solution (but increase the chiral purity) and too small a volume will increase the yield as less of the pramipexole products will go into solution (but reduce the chiral purity).
To better define the actual limits of the reaction volumes and optical purities attainable using methods of the disclosure, various ratios of chiral purity for the starting diamine material were tested. As shown in Table 9, the synthesis and purification process was tested using the following ratios of the starting R(+) and S(−) diamine: 80:20, 20:80, 85:15, 15:85, 90:10, 10:90, 95:5 and 5:95. Additionally, three specific reaction conditions were tested which varied either the reaction volume or a post reaction recovery step. These trials demonstrated that the enantiomers of pramipexole are equally insoluble (or soluble) in the organic solvents utilized in the various embodiments of the synthesis processes disclosed herein.







TABLE 9







Experiments for SN2 preparation of pure enantiomers of pramipexole










Ratio





of starting
Condition C




diamines
(yield/chiral
Condition D
Condition E


R(+):S(−)
purity)
(yield/chiral purity)
(yield/chiral purity)





80:20
—
29%/99%  
34%/98.2%


20:80
—
30%/99.4%
35%/95.7%


85:15
43%/86.8%
36%/99.8%
39%/99.9%


15:85
52%/88.9%
27%/99.6%
37%/99.9%


90:10
47%/95.9%
—
—


10:90
58%/93.6%
—
—


95:5 
50%/99.6%
—
—


 5:95
47%/99.6%
—
—





Condition C: The reaction is performed in 10 volumes of DMF and 1.25 equivalents of propyl tosylate at 65-67° C. The reaction is then cooled to room temperature and diluted with 8 volumes of MTBE.


Condition D: The reaction is performed in 18 volumes of DMF and 1.25 equivalents of propyl tosylate at 65-67° C. The reaction is then cooled to room temperature and diluted with 8 volumes of MTBE.


Condition E: The reaction is performed in 10 volumes of DMF and 1.25 equivalents of propyl tosylate at 65-67° C. The reaction is then cooled to room temperature with no dilution in MTBE.






The data in Table 9 demonstrate that both enantiomers of pramipexole have similar, if not the same, solubility. Further, the data show that the synthesis is equally efficient for either enantiomer of pramipexole. These data also demonstrate that the enantiomers behave independently of one another, in that the solubility of one enantiomer appears to be unaffected by the concentration in solution of the other. For example, the various synthesis reactions carried out using condition C all have chemical yields of about 50%, independent of the percentage of predominant diamine enantiomer of the starting material. When the volume of the organic solvent used in the synthesis reaction is increased, the chemical yield is reduced, but the chiral yield is increased. This is apparent by comparison of the reaction carried out in conditions C and D, where an 85:15 ratio of R(+):S(−) diamine produced a pramipexole product having an 86.8% chiral purity for the R(+) enantiomer when the reaction used 10 volumes of the organic solvent and a 99.8% chiral purity for the R(+) enantiomer when the reaction used 18 volumes of the organic solvent. Note also that the chemical yield was reduced in the reaction using a larger volume of organic solvent (43% yield in condition C and 36% yield in condition D).
In Table 9, condition E is the same as condition C, except that the recovery step does not incorporate dilution in MTBE. The MTBE is observed to increase pramipexole recovery (yield) from the synthesis reaction, but may reduce the overall chiral purity. This is born out by a comparison of the results for trials carried out in an 85:15 ratio of R(+):S(−) diamine, which produced a pramipexole product having a 86.8% chiral purity for the R(+) enantiomer when the reaction included the MTBE organic solvent and a 99.9% chiral purity for the R(+) enantiomer when the reaction did not include the MTBE organic solvent. The chemical yield was reduced by exclusion of the MTBE dilution in the recovery step, a 43% yield in condition C as opposed to a 39% yield in condition E.
The chirally pure (R)-pramipexole prepared by any of the above methods may be converted to a pharmaceutically acceptable salt of (R)-pramipexole. For example, (R)-pramipexole dihydrochloride is a preferred pharmaceutical salt due its high water solubility. (R)-pramipexole dihydrochloride may be prepared from other salts of (R)-pramipexole in a one step method comprising reacting the (R)-pramipexole, or (R)-pramipexole salt, with concentrated HCl in an organic solvent, such as an alcohol, at a reduced temperature. In some embodiments, the reduced temperature is a temperature of from about 0° C. to about 5° C. An organic solvent such as methyl tert-butyl ether, may be added, and the reaction may be stirred for an additional hour. The (R)-pramipexole dihydrochloride product may be recovered from the reaction mixture by filtering, washing with an alcohol and vacuum drying.
Each of the methods disclosed herein for the manufacture and purification of (R)-pramipexole or a pharmaceutically acceptable salt thereof may be scalable to provide industrial scale quantities and yields, supplying products with both high chemical and chiral purity. In some embodiments, the enantiomerically pure (R)-pramipexole may be manufactured in large batch quantities as may be required to meet the needs of a large scale pharmaceutical use.
Various aspects of the present invention will be illustrated with reference to the following non-limiting examples.
EXAMPLES
Example 1
Measurement of the Dopamine Receptor Affinities for the R(+) and S(−) Enantiomers of Pramipexole
The S(−) enantiomer of pramipexole has historically been characterized as a high affinity dopamine receptor ligand at the D2 (both the S and L isoforms), D3 and D4 receptors, although the highest affinity is seen for the D3 receptor subtype. The dopamine receptor ligand affinity of (S)-pramipexole and of (R)-pramipexole from journal publications has been tabulated (data are reproduced in Table 10). Although the conditions under which each study or experiment was carried out are slightly different, and different radio-ligands were used, the data show comparable affinities for the various dopamine receptors. Studies we conducted on the dopamine receptor affinities of the S(−) and the R(+) enantiomers of pramipexole are also shown in Table 10. These data demonstrate an unexpectedly large difference in the affinities of the two enantiomers of pramipexole for all dopamine receptors. Table 10 shows that; instead of the expected 10-20 fold difference in binding affinity for D2 receptor affinity, and 50-fold difference in binding affinity for D3 receptor affinity as derived from the literature, the values we found were typically 10-fold higher (290- and 649-fold, respectively) (Table 10).







TABLE 10







Comparative binding affinity data for pramipexole enantiomers











Receptor
Source
S(−)
R(+)
Ratio S:R














D2 binding, IC50 (nM)
Lit.*
4,700
43,000
9


D2 binding, IC50 (nM)
Lit.**
402
8,330
21


D2 binding, IC50 (nM)
Actual***
6.2
1,800
290


D3 binding, IC50 (nM)
Lit.**
4.2
211
50


D3 binding, IC50 (nM)
Actual***
0.94
610
649





*Schneider, C. S.; Mierau, J., “Dopamine Autoreceptor Agonists: Resolution and Pharmacological Activity of 2,6-Diaminotetrahydrobenzothiazole and an Aminothiazole Analogue of Apomorphine”, (1987). J. Med. Chem. 30: 494-498


**Wong, S. K.-F.; Shrikhande, A. V., S. K.-F. Wong, “Activation of Extracellular Signal-Regulated Kinase by Dopamine D2 and D3 Receptors”,. (2003) Society for Neuroscience Abstracts


***Data from current study






Ale (R)-pramipexole and (S)-pramipexole were supplied as dry powder to our contract research partner Cerep by the manufacturer AMRI. Solutions of (R)-pramipexole and (S)-pramipexole were prepared from stock solutions in DMSO. Eight concentrations of (R)-pramipexole or (S)-pramipexole (0.01 nM, 0.1 nM, 1 nM, 10 nM, 100 nM, 100 mM, 10 mM and 100 mM) were used to displace standard reference radiolabeled dopamine agonists. These concentrations were tested in cell lines expressing select human cloned dopamine receptors (D2S, D3). Previous work in the literature and our data demonstrated no significant interaction with D1 and D5 dopamine receptors. Group results for the interaction of (R)-pramipexole or (S)-pramipexole with each receptor are expressed as the IC50 in Table 10.
These data indicate that IC50 values of (R)-pramipexole at these receptors are approximately 290 to 649 times that of the IC50 values for (S)-pramipexole. Further, these data suggest that the ratio of the IC50 values for (R)-pramipexole to (S)-pramipexole at the D2 receptor are approximately 14 to 32 times larger than the ratios suggested by the literature, at least when the chiral purities were beyond the limits of detection (LOD 0.05%) (chiral purity greater than 99.95%). Similarly, the data suggest that the ratio of the IC50 (values for (R)-pramipexole to (S)-pramipexole at the D3 receptor are approximately 13 times larger than the ratios suggested by the literature, at least when the chiral purities were beyond the limits of detection (chiral purity greater than 99.95%). These data also suggest that if dopamine receptor affinity is the major contributing factor to limiting dose tolerance of the S(−) enantiomer, then pure preparations of the R(+) enantiomer should have a maximum tolerated dose (MTD) and/or a no observable adverse effect level dose (NOAEL) of at least 290 times greater than the S(−) enantiomer's MTD and/or NOAEL. Thus, even a small contamination of the (R)-pramipexole compositions of the present invention by the S(−) enantiomer, at levels as low as 0.5% or less, may effect the observed MTD and NOEL.
Example 2
In vivo studies to determine the MTD and NOAEL in dogs for 100% pure preparations of the R(+) and S(−) enantiomers of pramipexole, and a mixture (R 99.5%/S 0.5%). The form of (R)-pramipexole was (R)-pramipexole dihydrochloride monohydrate.
The following in vivo study in beagle dogs was undertaken to test the hypothesis that the large observed difference in receptor binding affinities for the R(+) and S(−) enantiomers of pramipexole will translate to a large observed difference in the observed maximum tolerated dose (MTP) and/or no observable adverse effect level (NOAEL) of the two enantiomers. Dogs were administered preparations of each enantiomer prepared as a highly purified compound (100% pure preparations (within the limits of analytical detectability)), or a preparation of the R(+) enantiomer contaminated by 0.5% of the S(−) enantiomer of pramipexole.
Three groups of four non-naïve male beagle dogs were used in the study. Each group was administered various doses of either the R(+) or S(−) enantiomer prepared as a highly purified compound, or a preparation of the R(+) enantiomer contaminated by 0.5% of the S(−) enantiomer of pramipexole. Doses were administered orally by gavage and clinical observations were taken continuously following dosing: hourly for the first four hours, and then twice daily cage-side observations for the duration of the inter-dose or post-dose interval. Observations were made of clinical signs, mortality, injury and availability of food and water. Animals were lasted for 24 hr prior to dosing. Dogs in each group were exposed to only one drug, or the combination; each dose was administered only once, with a subsequent dose administered after a recovery period of 4 days. The data are summarized in Table 11.
A NOAEL was established at a dose level of 25 mg/kg for the R(+) enantiomer when administered to non-naïve dogs, while a dose level of 75 mg/kg may be considered an MTD in non-naïve dogs. For the S(−) enantiomer, a NOAEL of 0.00125 mg/kg and an MTD of 0.0075 mg/kg was found in non-naïve dogs. For the composition containing a mixture of the two enantiomers (99.5% (R)-pramipexole and 0.5% (S)-pramipexole), the NOAEL was found to be 0.25 mg/kg, which corresponds to a dose of 00125 mg/kg of the S(−) enantiomer, while the MTD is 1.5 mg/kg, which corresponds to a dose of 0.0075 mg/kg of the S(−) enantiomer. These data indicate that the NOAEL for the R(+) enantiomer of pramipexole is approximately 20,000-fold greater than for the S(−) enantiomer in non-naïve dogs, while the MTD is about 10,000-fold greater.







TABLE 11







Clinical observations in male beagle dogs


for administration of pramipexole compositions


SUMMARY OF CLINICAL FINDINGS*









Dose Amount (mg/kg)

















7.5
25
75
0.0075
0.025
0.00125
1.5
5
0.25



R(+)
R(+)
R(+)
S(−)
S(−)
S(−)
mixture**
mixture
mixture



(Day 1)
(Day 4)
(Day 8)
(Day 1)
(Day 4)
Day 8)
(Day 1)
(Day 4)
(Day 8)





Behavior/Activity











Activity decreased
0/4
0/4
2/4
3/4
4/4
0/4
4/4
4/4
0/4


Convulsions - clonic
0/4
0/4
1/4
0/4
0/4
0/4
0/4
0/4
0/4


Salivation
0/4
0/4
3/4
0/4
0/4
0/4
0/4
0/4
0/4


Tremors
0/4
0/4
4/4
1/4
3/4
0/4
1/4
2/4
0/4


Excretion











Emesis
0/4
0/4
2/4
3/4
4/4
0/4
1/4
3/4
1/4


Feces hard
1/4
0/4
0/4
1/4
0/4
0/4
0/4
0/4
0/4


Feces mucoid
0/4
0/4
0/4
0/4
0/4
0/4
1/4
1/4
0/4


Feces soft
0/4
0/4
1/4
0/4
0/4
0/4
2/4
1/4
1/4


Feces watery
0/4
0/4
0/4
0/4
0/4
0/4
1/4
1/4
0/4


External Appearance











Lacrimation
0/4
0/4
0/4
0/4
0/4
0/4
0/4
0/4
0/4


Eye/Ocular











Pupils dilated
0/4
0/4
2/4
0/4
0/4
0/4
0/4
0/4
0/4


Pelage/Skin











Skin warm to touch
1/4
0/4
1/4
0/4
0/4
0/4
0/4
0/4
0/4





*Number of animals affected/Total number of animals


**Mixture of 99.5% (R)-pramipexole and 0.5% (S)-pramipexole.






The data shown in Table 11 indicate that the receptor affinities identified (see Table 10) contribute in a straightforward fashion to the observed differences in the MTD and NOAEL doses for the R(+) and S(−) enantiomers of pramipexole. These data also indicate that the chiral purity for the R(+) enantiomer of pramipexole in embodiments of the compositions of the present invention (refer to Tables 5 and 6) may need to be in excess of 99.9%, depending on the final total dose, to avoid the adverse side effects of (S)-pramipexole.
Further, the data in Table 11 demonstrate that the NOAEL, and MTD for the combination composition (99.5% (R)-pramipexole and 0.5% (S)-pramipexole) may be determined directly by the dose of the S(−) enantiomer in the composition. Thus, a small (fractional percentage) contamination of a composition of (R)-pramipexole by the S(−) enantiomer may reduce the MTD and NOEL of the composition. For example, in these experiments, the MTD of pramipexole was reduced from 75 mg/kg for the R(+) enantiomer to a total dose of 1.5 mg/kg of the mixed composition (a factor of 50), and the NOAEL was reduced from 25 mg/kg to 0.25 mg/kg, respectively (a factor of 100). Since the shift in MTD and NOAEL may be predicted by the dose of the S(−) enantiomer of pramipexole in the mixture, the shift for any unknown mixture may be calculated based on the percentage contamination of the (R)-pramipexole by the S(−) enantiomer, relative to the MTD and NOAEL for (S)-pramipexole. This indicates that any contamination of an (R)-pramipexole dosing solution with (S)-pramipexole will have a measurable effect on these indicators of dose tolerability.
Example 3.1
Toxicology studies in rats and minipigs and Phase I studies in healthy adult volunteers. Two-week and three-month toxicology studies of (R)-pramipexole in rats and minipigs were completed. NOAEL dose levels of 150 mg/kg at two-weeks and 100 mg/kg at three-months for rats and 75 mg/kg at two-weeks and 50 mg/kg at three-months for minipigs were established. Phase I studies of healthy adult volunteers have demonstrated that (R)-pramipexole in ascending single doses up to 300 mg and multiple doses up to 200 mg per day for 41⁄2 days is safe and well-tolerated. The Mirapex® label specifies a starting dose of 0.125 mg and a maximum total daily dose of 4.5 mg. The Phase I data demonstrate, therefore, that (R)-pramipexole may be safely administered (1) at starting doses that are at least 2400-fold higher than the Mirapex® starting dose and (2) at steady state doses that are at least 44-fold higher than the highest recommended dose of Mirapex. The form of (R)-pramipexole was (R)-pramipexole dihydrochloride monohydrate.
The preliminary results of the clinical studies and the toxicology studies are discussed. Exposure at steady state in rats, minipigs, and humans is linear across all doses studied. After 3 months of dosing, the current No Observed Adverse Effect Level (NOAEL) in rats has been determined to be 100 mg/kg; and the current NOAEL in minipigs has been determined to be 50 mg/kg. The mean steady state AUC in rats at the NOAEL dose of 100 mg/kg was 61,299 and 61,484 h*ng/mL, for males and females, respectively, and for minipigs at the NOAEL dose of 50 mg/kg was 91,812 and 131,731 h*ng/mL for males and females, respectively. The mean steady state AUC in humans at a dose of 100 mg Q12H (200 mg total daily dose) was 2,574 h*ng/mL. The drug has been safe, well-tolerated, and free of clinically significant adverse events in healthy adult subjects at single doses up to 300 mg and at multiple doses up to 100 mg Q12H, and the projected human exposure associated with a daily dose of 250 mg Q12H is expected to be greater than 13-fold lower than exposures seen at the NOAEL in male minipigs and approximately 9-fold lower than exposures seen at the NOAEL in male and female rats after 13 weeks of dosing.
3.2—Clinical Studies. (R)-pramipexole has been studied at single daily doses of 50, 150 and 300 mg and twice daily doses of 50 and 100 mg for 41⁄2 days in healthy adult volunteers. The drug has been safe and well-tolerated in both studies and there were no serious adverse events, discontinuations due to adverse events, or dose-related or clinically significant adverse events in either study. The most frequent adverse events have been dizziness and headache, all of which have been mild to moderate in severity and resolved without intervention.
3.2.1—Summary of (Blinded) Safety and Pharmacokinetic Results of (R)-pramipexole (Ascending Single-Dose Study). Three sequential panels of 8 subjects each received single doses of (R)-pramipexole (6 subjects) or placebo (2 subjects) at ascending dose levels of 50, 150, and 300 mg. Safety observations included vital signs, physical examination, clinical laboratory tests, ECGs, and adverse event reporting. Blood and urine samples were collected pre-dose and for 72 hours post-dose to assess the pharmacokinetics. All 24 subjects completed the study as planned. There were no serious adverse events; 46% of all subjects reported at least one non-serious adverse event (AE). Most AEs were mild; the most frequent AE was mild dizziness in 21% of subjects. There were no clinically significant safety observations at any dose level.
Pharmacokinetic data indicated that (R)-pramipexole is rapidly absorbed with mean maximum concentrations of 125, 360, and 781 ng/mL reached at approximately 2 hours post-dose for the 50, 150, and 300 mg dose groups, respectively (see FIG. 1 and Table 12, below). Mean exposures (AUC0-∝) were 1254, 3815, and 8623 h*ng/mL for the 50, 150, and 300 mg dose groups, respectively. Both Cmax and AUC increased in proportion to dose across the dose levels tested. Urinary excretion of unchanged drug accounted for approximately 70% of drug elimination across dose levels. The mean T1/2 was 6-7 hours and was independent of dose. Comparison of the mean plasma concentrations (FIG. 2) and mean pharmacokinetic parameters (Table 12) after administration of a single 150 mg following a high fat/high calorie breakfast with those after administration of 150 mg under fasted conditions demonstrates essentially no effect of a meal on the absorption and elimination of (R)-pramipexole.
Results of this study demonstrate that single oral doses of 50, 150, and 300 mg (R)-pramipexole are safe and well-tolerated. The drug is orally bioavailable and the pharmacokinetics are linear. Absorption and elimination are not affected by a high fat/high calorie meal.







TABLE 12







Summary of pharmacokinetic parameters for (R)-pramipexole after oral administration of single 50 mg,


150 mg, and 300 mg doses to healthy volunteers under fasted conditions and 150 mg under fed conditions.










Fasted
Fed











Parameter1
50 mg
150 mg
300 mg
150 mg





Cmax (ng/mL)
 125 ± 22.0 (6)
 360 ± 60.4 (6)
781 ± 158 (6)
315 ± 062 (6)


Tmax (h)
2.04 (6)
2.04 (6)
1.96 (6)
2.58 (6)


AUC(0-t) (h * ng/mL)
989 ± 295 (6)
3,387 ± 746 (6)  
8,339 ± 3,202 (6)
3,099 ± 920 (6)  


AUC(inf) (h * ng/mL)
1,254 ± 347 (6)  
3,815 ± 972 (5)  
8,623 ± 3,262 (6)
3,397 ± 944 (6)  


λz (h−1)
0.1064 ± 0.0171 (6)
0.1001 ± 0.0087 (5)
0.1151 ± 0.0309 (6)
0.1152 ± 0.0256 (6)


t1⁄2 (h)
6.65 ± 1.07 (6)
6.96 ± 0.56 (5)
6.40 ± 1.73 (6)
6.28 ± 1.48 (6)


CL/F (mL/min)
706 ± 182 (6)
692 ± 183 (5)
659 ± 260 (6)
774 ± 165 (6)


Vz/F (L)
 395 ± 61.9 (6)
411 ± 081 (5)
 346 ± 98.5 (6)
 406 ± 62.8 (6)


Ue (mg)
35.3 ± 5.19 (6)
60.5 ± 7.04 (6)
 198 ± 28.0 (6)
. ± . (0)


Fe (% Dose)
70.7 ± 10.4 (6)
40.3 ± 4.69 (6)
65.8 ± 9.33 (6)
. ± . (0)


CLr (mL/min)
628 ± 149 (6)
 310 ± 74.3 (6)
441 ± 159 (6)
. ± . (0)





1Mean ± standard deviation (N) except for Tmax for which the median (N) is reported.






3.2.2—Summary of (Blinded) Safety and Pharmacokinetic Results of (R)-pramipexole (Ascending Multiple-Dose Study). This study is ongoing and has not yet been unblinded with respect to treatment assignments, and only clinical observations and pharmacokinetic data are available for the first 2 panels. To date, 2 sequential panels of 8 subjects each were enrolled to receive multiple doses of (R)-pramipexole (6 subjects) or placebo (2 subjects). The first panel was administered a singe dose of 50 mg, followed 48 hours later by 41⁄2 days of multiple dosing (twice daily) at 50 mg Q12 hours. The second panel was administered a singe dose of 100 mg, followed 48 hours later by 41⁄2 days of multiple dosing (twice daily) at 100 mg Q12 hours. Safety observations included vital signs, physical examination, clinical laboratory tests, ECGs, and adverse event reporting. Blood samples were collected pre-dose on Day 1 and serially for 48 hours post-dose to assess the single-dose pharmacokinetics. Blood samples were collected pre-dose on Days 5, 6, and 7 to confirm steady-state was achieved, and serially through 72 hours post-dose on Day 7 to assess the steady-state pharmacokinetics of (R)-pramipexole. Urine samples were collected for 12 hours after dosing on Day 7 to assess urinary excretion.
All 16 subjects enrolled to date have completed the study as planned. There were no deaths, reports of serious adverse events, or discontinuations because of adverse events during the study. Both dose levels were well tolerated. In cohort 1, all adverse events were mild in intensity, with the exception of moderate headaches reported by 2 subjects. In cohort 2, all adverse events were mild in intensity, with the exception of moderate “stiffness in back” and a moderate vasovagal response reported in 1 subject. An asymptomatic mild increase in heart rate upon standing (without change in blood pressure) was reported by the principal investigator for 1 of the 8 subjects dosed in cohort 1 (50 mg cohort) and for 2 of the 8 subjects dosed in cohort 2 (100 mg cohort). There were no clinically significant safety observations at any dose level.
Pharmacokinetic data are shown in Table 13 and FIG. 3. Cmax and AUC0-12) increased 37% and 40%, respectively from Day 1 to Day 7 for subjects receiving 50 mg Q12H, with essentially no change in Tmax. Mean exposure AUC(0-12) at Day 7 was 1449 h*ng/mL for the 50 mg Q12H dose group. Cmax and AUC(0-12) increased 24% and 38%, respectively from Day 1 to Day 7 for subjects receiving 100 mg Q12H, with essentially no change in Tmax. Mean exposure AUC(0-12) at Day 7 was 2465 h*ng/mL for the 100 mg Q12H dose group. Results of this study demonstrate that multiple oral doses of 50 and 100 mg (R)-pramipexole administered twice daily are safe and well-tolerated. The drug is orally bioavailable and the pharmacokinetics are linear at steady state, with no significant accumulation.







TABLE 13







Summary of pharmacokinetic parameters for (R)-pramipexole


during oral administration of 50 mg and 100 mg doses on Day 1,


Q12H on Days 3 through 6, and a single dose on Day 7 to


healthy volunteers under fasted conditions.









Dose









Parameter1
50 mg
100 mg





Day 1




Cmax (ng/mL)
 139 ± 15.3 (6)
 248 ± 30.4 (6)


Tmax (h)
1.83 (6)
1.92 (6)


AUC(0-12) (h * ng/mL)
1,035 ± 121 (6)  
1,776 ± 260 (6)  


AUC(0-t) (h * ng/mL)
1,463 ± 280 (6)  
2,545 ± 497 (6)  


AUC(inf) (h * ng/mL)
1,502 ± 280 (6)  
2,574 ± 505 (6)  


λz (h−1)
0.1132 ± 0.0230 (6)
0.1073 ± 0.0161 (6)


t1⁄2 (h)
6.34 ± 1.31 (6)
6.57 ± 0.88 (6)


CL/F (mL/min)
571 ± 107 (6)
665 ± 107 (6)


Vz/F (L)
 306 ± 45.8 (6)
 373 ± 51.0 (6)


Day 7




Cmax (ng/mL)
 191 ± 20.9 (6)
306 ± 055 (6)


Tmax (h)
1.75 (6)
2.00 (6)


AUC(0-12) (h * ng/mL)
1,449 ± 221 (6)  
2,465 ± 299 (6)  


λz (h−1)
0.1025 ± 0.0186 (6)
0.0894 ± 0.0117 (6)


t1⁄2 (h)
6.96 ± 1.30 (6)
7.88 ± 1.19 (6)


CL/F (mL/min)
 585 ± 81.6 (6)
 684 ± 76.1 (6)


Vz/F (L)
 346 ± 30.1 (6)
 466 ± 82.2 (6)


Ue (mg)
. ± . (0)
. ± . (0)


Fe (% Dose)
. ± . (0)
. ± . (0)


CLr (mL/min)
. ± . (0)
. ± . (0)





1Mean = standard deviation (N) except for Tmax for which the median (N) is reported.






3.3—Toxicology Studies. In a 2-week repeat-dose toxicology studies in rats, animals received 50, 150, and 500 mg/kg doses of (R)-pramipexole for 14 days. (R)-pramipexole caused mortality at the high dose of 500 mg/kg and statistically significant changes in body weight gain and food consumption for both sexes were observed in the animals surviving to terminal sacrifice. No target organ toxicity by histopathology examination was identified at any dose. The NOAEL for this 2-week study in rats was determined to be 150 mg/kg. Following this study, 3- and 6-month repeat dose toxicology studies were completed at doses of 30, 100, and 300 mg/kg. The results of the 3-month study contain some target organ toxicity by histopathology examination at the highest dose (300 mg/kg) with no test article related deaths and no significant clinical observations outside of several incidences of convulsions in high dose rats lasting approximately 2 minutes. The animals' health did not appear to be otherwise adversely affected by these convulsions. Test article-related microscopic changes were observed in the liver (minimal grade cholestasis correlating with increased total bilirubin), ileal small intestine (minimal grade mineralization), and thymus (minimal grade lymphoid depletion correlating with lower group thymus weights compared to controls). The NOAEL for the 3-month study in rats is considered to be 100 mg/kg. Systemic exposure (AUC0-last) at week 13 at the NOAEL dose of 100 mg/kg was 61,299 h*ng/mL in males and 61,484 h*ng/mL in females. The in-life phase of the 6-month toxicology study in rats was recently completed and histopatholgic examinations are pending. There were no mortalities at any dose level between the 13-week and 26-week sacrifices.
In a 2-week repeat-dose toxicology study in minipigs, animals received 7.5, 25 and 75 mg/kg doses of (R)-pramipexole for 14 days. No target organ toxicity by histopathology examination was identified at any dose. Clinical observations included salivation, decreased activity, emesis and inappetance, with higher incidences of emesis in females than males, and mostly in the 75 mg/kg group. The incidence of emesis at 75 mg/kg (at least one episode in 5 of 8 animals dosed at 75 ng/kg) suggested this dose is close to the limit of tolerability for (R)-pramipexole for chronic dosing in minipigs. Since no test article related toxicological changes were observed at the high dose, the NOAEL for the 2-week study was considered to be greater than or equal to 75 mg/kg. Based on this study, 3-, and 6-, and 9-month repeat dose studies of (R)-pramipexole in minipigs were initiated at dose levels of 7.5, 25 and 75 mg/kg. At month 2, dose levels were reduced to 7.5, 25 and 50 mg/kg due to mortalities at the 75 mg/kg level. The 3- and 6-month repeat dose studies have now been completed at the 7.5, 25 and 50 mg/kg dose levels and the 9-month repeat dose study is ongoing. No target organ toxicity by histopathology examination was identified at any dose level following animal sacrifice after 3 months of exposure. The NOAEL for the 3-month study in minipigs is considered to be 50 mg/kg. Systemic exposure (AUC0-24) at week 13 at the NOAEL dose of 50 mg/kg/day was 91,812 h*ng/mL in males and 131,731 h*ng/mL in females. The in-life phase of the 6-month toxicology study in minipigs was recently completed and histopatholgic examinations are pending. There were no mortalities attributed to test article or significant clinical observations at any dose level between the 13-week and 26-week sacrifices. The ongoing 9-month toxicology studies in minipigs have now passed month 7 and no deaths attributed to test article or significant clinical observations have occurred at any dose level.
3.4. Human Dosages. The development of (R)-pramipexole as a treatment of ALS is based on a maximally tolerated dose strategy, derived either from tolerability or safety data from studies in humans or from the results of animal toxicology studies. To date there have been no dose-limiting tolerability observations in humans. Therefore, in order to progress dosing in humans, it is necessary to closely examine the exposure at which toxicity has been observed in rats and minipigs. Pharmacokinetic data obtained to date suggest that pharmacokinetics in humans will continue to be dose-proportional at higher doses, and that the accumulation factor will be constant. Safety and toxicokinetic results from the 3 month toxicology studies in rats and minipigs show no adverse effects of chronic dosing up to 100 mg/kg in rats and 50 mg/kg in minipigs. Analysis of safety margins in (R)-pramipexole exposure between the NOAEL for minipigs and the projections of human exposure, therefore, support progression of total daily doses up to 500 mg in humans. The projected steady-state exposure of (R)-pramipexole at a total daily dose of 500 mg administered as 250 mg Q12H is approximately 7,000 h*ng/mL, which is greater than 13-fold lower than exposures seen at the NOAEL in male minipigs and approximately 9-fold lower than exposures seen at the NOAEL in male and female rats after 13 weeks of dosing.
FIGS. 4 and 5 are plots of exposure vs. dose for rats and minipigs, respectively, compared with humans. Each graph displays the relationship between exposure as expressed by AUC (h*ng/mL) and dose as expressed by body surface area (mg/m2) at every dose level administered to each species in both the 2-week and 13-week assessments. Individual data points with error bars are the mean±SD. The dashed horizontal line at the bottom of both charts illustrates the extrapolated steady state AUC (7,000 h*ng/mL) in humans at 250 mg Q12H. Table 17A and Table 178 are an integrated summary of all human pharmacokinetic estimates obtained in the two Phase I studies.







TABLE 17A







Summary of the human pharmacokinetic estimates obtained in the two Phase


I studies with healthy volunteers
















Dose
Dosing

Cmax
Tmax
AUC (0-t)
AUC (inf)
AUC (0-12)


Study
(mg)
Regimen
Food
(ng/mL)
(h)
(h * ng/mL)
(h * ng/mL)
(h * ng/mL)


















CL001
50
SD
Fasted
125 ±
2.04 (6)
989 ±
1,245 ± 347 (6)
—






22.0 (6)

295 (6)





150
SD
Fasted
360 ±
2.04 (6)
3,387 ±
3,815 ± 972 (5)
—






60.4 (6)

746 (6)





300
SD
Fasted
781 ±
1.96 (6)
8,339 ±
8,623 ± 3,262 (6)
—






158 (6)

3,202 (6)





150
SD
Fasted
315 ±
2.58 (6)
3,099 ±
3,397 ± 944 (6)
—






062 (6)

920 (6)




CL002
50
Q12H
Fasted
139 ±
1.83 (6)
1,463 ±
1,502 ± 280 (6)
1,035 ± 121 (6)




(Day 1)

15.3 (6)

280 (6)






(Day 7)
Fasted
191 ±
1.75 (6)
—
—
1,449 ± 221 (6)






20.9 (6)







100
Q12H
Fasted
248 ±
1.92 (6)
2,545 ±
2,574 ± 505 (6)
1,776 ± 260 (6)




(Day 1)

30.4 (6)

497 (6)






(Day 7)
Fasted
306 ±
2.00 (6)
—
—
2,465 ± 299 (6)






055 (6)







250
Q12H
Fasted
—
—
—
—
—




(Day 1)










(Day 7)
Fasted
—
—
—
—
—





Mean ± standard deviation (N) except for Tmax for which the median (N) is reported.


SD = single dose













TABLE 17B







Summary of the human pharmacokinetic estimates obtained in the two Phase


I studies with healthy volunteers (continued)















Dose
Dosing
t1⁄2
CL/F
Vz/F
Ue
CLx
















Study
(mg)
Regimen
Food
(h)
(mL/h)
(L)
(mg)
(% Dose)
(mL/min)



















CL001
50
SD
Fasted
6.65 ±
706 ±
395 ±
35.3 ± 5.19 (6)
70.7 = 10.4
628 = 149 (6)






1.07 (6)
182 (6)
61.9 (6)

(6)




150
SD
Fasted
6.96 ±
692 ±
411 ±
60.5 ± 7.04 (6)
40.3 =
310 = 74.3 (6)






0.56 (5)
183 (5)
081 (5)

4.69(6)




300
SD
Fasted
6.40 ±
659 ±
346 ±
 198 ± 28.0 (6)
65.8 =
441 = 159 (6)






1.73 (6)
260 (6)
98.5 (6)

9.33(6)




150
SD
Fasted
6.28 ±
774 ±
406 ±
. ± (0)
. ± (0)
. ± (0)






1.48 (6)
165 (6)
62.8 (6)





CL002
50
Q12H
Fasted
6.34 ±
571 ±
306 ±
—
—
—




(Day 1)

1.31 (6)
107 (6)
45.8 (6)







(Day 7)
Fasted
6.96 ±
585 ±
346 ±
. ± (0)
. ± (0)
. ± (0)






1.30 (6)
81.6 (6)
30.1 (6)






100
Q12H
Fasted
6.57 ±
665 ±
373 ±
—
—
—




(Day 1)

0.88 (6)
107 (6)
51.0 (6)







(Day 7)
Fasted
7.88 ±
684 ±
466 ±
. ± (0)
. ± (0)
. ± (0)






1.19 (6)
76.1 (6)
82.2 (6)






250
Q12H
Fasted
—
—
—







(Day 1)











(Day 7)
Fasted
—
—
—





Mean ± standard deviation (N) except for Tmax for which the median (N) is reported.


SD = single dose






Exposure at steady state in rats, minipigs, and humans is linear across all doses studied. After 3 months of dosing, the NOAEL in rats has been determined to be 100 mg/kg; and the NOAEL in minipigs has been determined to be 50 mg/kg. The mean AUC in rats at the NOAEL was 61,299 and 61,484 h*ng/mL for males and females, respectively, and for minipigs was 91,812 and 131,731 h*ng/mL for males and females, respectively. The mean AUC in humans at steady state at a dose of 100 mg Q12H (200 mg total daily dose) was 2,574 h*ng/mL.
Example 4
Preparation of Capsules with (R)-pramipexole. (R)-(+)-pramipexole dihydrochloride monohydrate is filled in hard gelatin capsules with no excipients. The capsules used for the drug product are #00 blue opaque gelatin capsules from Hawkins Chemical Group. Dose strengths of 50 and 500 mg are produced. Matching placebo capsules are filled with microcrystalline cellulose. Capsules are prepared by weighing individual empty capsules and recording the weight (We). Specified amount of active drug substance are individually weighed and hand-filled into a capsule bottom using a Torpac® filling funnel. A purity adjustment factor of 1.0638 is used to adjust for the water weight (monohydrate) in the salt form, i.e., a 50 mg dose should have a target fill of 50×1.0638-53.16 mg. Capsule tops are joined with the filled capsule bottom. The filled capsules are then weighed, and the weight is recorded (Wf). The calculated weight of the drug substance in the capsule (Wt−Wc) is recorded. If this calculated weight is within +/−5% of the nominal weight, then the capsule is cleaned, polished, and placed into and appropriately labeled container. If the calculated weight is outside of the specified range, the capsule is discarded. The free-base weight per capsule (free-base weight per mg of capsule contents multiplied by till weight) is 90% to 100% of the calculated label claim. Total impurities are ≦2%. The appearance is a blue capsule containing white to off-white powder.
Example 4B
Preparation of Tablets with (R)-pramipexole. Capsules with 125 mg dose strength are prepared with the composition shown in Table 17. Capsules are generally prepared under conditions of 60 to 74° F. and a relative humidity of 30 to 60%. Microcrystalline cellulose, mannitol, crospovidone, magnesium stearate, and (R)-pramipexole (milled) are weighed out in the amounts shown in the column “Quantity/batch” in Table 14. The microcrystalline cellulose, mannitol, crospovidone, and (R)-pramipexole are then hand screened through a #20 mesh stainless steel screen and transferred to a Maxiblend V-blender with a 4 quart shell. The materials are then mixed using the Maxiblend V-blender for 10 minutes. The magnesium stearate is then screened using a 30 mesh stainless steel hand screen and transferred to the blender. The powders are then mixed for five minutes. The final blend is then emptied into a labeled, double PE-lined drum and the gross, tare, and net weights are recorded.
Tablets are prepared using a Minipress II B with 5 stations of 3⁄8′′ round, standard, concave tooling and gravity feed frame. The final blend is placed in the hopper and the tablet press set up is run according to the specifications in Table 15.







TABLE 14







Tablet and Batch Compositions












Quantity/
Quantity/


Ingredient
Percent
unit (mg)
batch (g)













(R)-Pramipexole (milled)
40.00
125.00
400.000


Microcrystalline cellulose (Avicel
35.25
110.16
352.512


PH102) (Diluent)





Mannitol (Pearlitol SD100) (Diluent)
20.00
62.50
200.000


Crospovidone (Polyplasdone XL)
4.00
12.50
40.000


(Disintegrant)





Magnesium stearate (vegetable source,
0.75
2.34
7.488


grade 905-G) (Lubricant)





Total
100.00
312.50
1000.000
















TABLE 15







Tablet Press Settings








Parameter
Target (range)





Average tablet weight
3.125 g (3.031 g to 3.219 g) (+/− 3%)


(10 tablets)



Target weight (individual
312.5 mg (296.9 mg to 328.1 mg) (+/− 5%)


tablet)



Target hardness
12 Kp (6 Kp to 18 Kp)


Press speed
20 rpm (10 to 30 rpm)









Example 5
Preparation of (R)-pramipexole p-TSA salt: Condition A: All reagents were purchased from CNH technologies, Fisher, Aldrich, G. J. Chemicals, Puritan, TCI and Spectrum and were used as provided. Proton nuclear magnetic resonance spectra were obtained on a Bruker AC 300 spectrometer at 300 MHz. HPLC analysis for chiral purity was performed on a Chiralpak® IA column (5 μM, 250×4.6 mm) at 30° C. using a mobile phase of heptane/ethanol/diethylamine (80:20:2 v/v/v). HPLC analysis for chemical purity was performed on a Sunfire® column (3.5 μM, 150×4.6 mm) at 30° C. using two mobile phases: A—0.5% TFA in water; and B—0.5% TFA in methanol. A gradient of 5% B to 80% B was used to separate the diamine and pramipexole peaks. A detection wavelength of 265 nm was used for both HPLC analyses.
Each of the processes detailed in examples 5-14 may also be scaled for industrial manufacturing processes, as shown in examples 15-17. Certain examples have been detailed at both the laboratory scale and the industrial manufacturing scale to demonstrate that the chemical and chiral yields are independent of the scale of the synthesis.
A 2.0 liter, three-necked flask was equipped with an overhead stirrer, a temperature probe, a heating mantle, a claisen joint, a reflux condenser, and a 500 ml addition funnel. The flask was charged with 45 grams of R(+)-2,6 diamino-4,5,6,7-tetrahydro-benzothiazole, followed by 750 ml of n-propanol. Under continuous stirring, the mixture was heated to a temperature of 95° C. over 15 minutes generating a clear solution. The addition funnel was charged with a solution of 74 grams propyl tosylate and 60 ml diisopropylethyleamine in 250 ml n-propanol. This solution was added dropwise to the 2.0 liter flask with continuous stirring over a period of 4 hours. The reaction was continued with stirring for an additional 8 hours at 95° C., after which the solution was brought to room temperature, and stirring was continued for an additional 4 hours.
The precipitated material was collected by filtration and washed three times using 100 ml reagent grade alcohol each time. The alcohol washed precipitated cake was then washed with 100 ml heptane and dried under high vacuum for 2 hours. The final weight of the dried product was 53.2 grams, representing a 52.2% yield. HPLC was used to determine the chemical purity of the R(+)-2,6-diamino-4,5,6,7-tetrahydro-benzothiazole ((R)-pramipexole) as 98.2% and the chiral purity as greater than 99.5%. 1H NMR and 13C NMR were used to confirm the structure.
Example 6
Preparation of racemic pramipexole p-TSA salt: Condition A: A 250 ml, three necked flask was equipped with a magnetic stirrer, a temperature probe, a heating mantle, a claisen joint, a reflux condenser, and a 100 ml addition funnel. The flask was charged with 5 grams of racemic 2,6 diamino-4,5,6,7-tetrahydro-benzothiazole, followed by 80 ml of n-propanol. Under continuous stirring, the mixture was heated to a temperature of 95° C. over 15 minutes generating a clear solution. The addition funnel was charged with a solution of 10.12 grams propyl tosylate and 8.2 ml diusopropylethyleamine in 28 ml n-propanol. This solution was added dropwise to the 250 ml flask with continuous stirring over a period of 2 hours. The reaction was continued with stirring for an additional 6 hours at 95° C., after which the solution was brought to room temperature, and stirring was continued for an additional 6 hours.
The precipitated material was collected by filtration and washed two times using 25 ml reagent grade alcohol each time. The alcohol washed precipitated cake was then washed with 25 ml heptane and dried under high vacuum for 1 hours. The final weight of the dried product was 5.12 grams, representing a 45% yield. HPLC was used to determine the chemical purity of the racemic 2,6-diamino-4,5,6,7-tetrahydro-benzothiazole (racemic pramipexole) as 97.12%, and the chiral purity showed a 1:1 mixture of the R(+) and (S)-pramipexole. 1H NMR was used to confirm the structure.
Example 7
Preparation of (R)-pramipexole p-TSA salt: Condition C: A 12 L, three necked flask was equipped with an overhead stirrer, a temperature probe, a heating mantle, a claisen joint, a condenser, and a 500 ml addition funnel. The flask was charged with 250 grams of R(+)-2,6 diamino-4,5,6,7-tetrahydro benzothiazole (R(+) diamine), followed by 2 L of dimethyl formamide (DMF). Under continuous stirring, the mixture was heated to a temperature of 65° C. The addition funnel was charged with a solution of 386.6 grams propyl tosylate (1.25 molar equivalents) and 322 ml diisopropylethyleamine (1.25 molar equivalents) in 500 ml DMF. This solution was added to the 12 L flask dropwise over a period of 2.0 hours. The reaction was monitored by analysis on HPLC.
The reaction was continued at 65° C. for an additional 5 hours, after which the solution was gradually cooled to room temperature and stirred overnight. The solution was diluted with 2 L MTBE and stirred for an additional 0.5 hours. The precipitated material was collected by filtration and washed with 500 ml MTBE, followed by 3 washes of 500 ml each reagent alcohol. The washed precipitated cake was dried under high vacuum.
The final weight of the dried product was 317.6 grams, representing a 56% yield. HPLC was used to determine the chemical purity of the R(+)-2,6-diamino-4,5,6,7-tetrahydro-benzothiazole ((S)-pramipexole) as 98.4% and the chiral purity as greater than 99.8%. 1H NMR and 13C NMR was used to confirm the structure: 1H NMR (300 MHz, DMSO-d6) δ 8.5 (br.s, 2H), 7.5 (d, 2H), 71.2 (d, 1H), 6.8 (s, 2H), 3.4 (m, 1H), 2.95 (m, 3H), 2.6 (m, 2H, merged with DMSO peak), 2.3 (s, 3H), 2.15 (m, 1H), 1.8 (m, 1H), 1.55 (m, 2H), 0.9 (t, 3H); 13C NMR (300 MHz, DMSO-d6) δ 167.0, 145.5, 144.6, 138.4, 128.6, 125.8, 110.7, 53.9, 46.5, 25.8, 25.6, 24.5, 21.2, 19.6, 11.3.
Example 8
Conversion of (R)-pramipexole p-TSA salt to (R)-pramipexole dihydrochloride: (R)-pramipexole p-TSA salt (50 grams; 0.13 mol) was taken into 150 ml absolute ethanol and cooled to between 0 and 5° C. with continuous stirring. Concentrated HCl (33 ml) was slowly added to the reaction while maintaining the temperature at between 0 and 5° C., and the mixture was stirred for an additional 15 minutes. MTBE (200 ml) was added to the mixture, and stirring was continued for an additional 1.5 hours at temperature. The reaction mixture was then filtered, washed twice with an MTBE/ethanol solution (2:1, 2×50 ml wash volumes), and dried under vacuum at 30° C. overnight. The final product was 34 grams of (R)-pramipexole dihydrochloride, indicative a of 92% yield, and a 97.3% chemical purity as determined by HPLC.
Example 9
Conversion of (R)-pramipexole p-TSA salt to (R)-pramipexole dihydrochloride: (R)-pramipexole p-TSA salt (10 grams; 0.026 mol) was dissolved in 200 ml IPAC and cooled to 15° C. with continuous stirring. HCl gas was bubbled into the slurry for 1 hour. The mixture was then filtered, washed with IPAC, and dried overnight under vacuum at room temperature. The final product was 6.8 grains of (R)-pramipexole dihydrochloride, indicative a of 92% yield, and a 97% chemical purity as determined by HPLC.
Example 10
Conversion of (R)-pramipexole p-TSA salt to (R)-pramipexole free base: (R)-pramipexole p-TSA salt (25 grams; 0.065 mol) was dissolved in 200 ml DCM and mixed into a slurry. 10 ml of water was added and the mixture was basified with 12 ml of 6N NaOH to a pH of 11-12. The two phases were split, and the aqueous was extracted with 200 ml of DCM. The combined organic phases were dried over MgSO4, filtered over Celite® and concentrated. The residue was dissolved in 100 ml MTBE and slurried for several hours. The solids were then filtered, washed with MTBE and dried under vacuum at 35° C. The final product was 9.1 grams of (R)-pramipexole dihydrochloride, indicative a of 66% yield, and a 98% chemical purity as determined by HPLC.
Example 11
Conversion of (R)-pramipexole p-TSA salt to (R)-pramipexole free base Freebase formation was performed on a 200 gram scale. A 5 L, three necked, round-bottomed flask, equipped with an over head stirrer, thermometer, and addition funnel was charged with 200 g (0.522 mol) of (R)-pramipexole P-SA salt and 1 L of water. The mixture was stirred and cooled to 10° C. The slurry was basified to a pH of about 11-12 by the slow addition of 200 ml of 6 N NaOH over period of 15 min. The reaction mixture was diluted with 500 ml of brine (sodium chloride dissolved in water) and extracted with 3×1 L, of dichloromethane. The combined organic phases were washed with 1.0 L of brine, dried over MgSO4, filtered and concentrated to dryness. The residue was triturated with 1 L of 1:1 IPAC:Heptane, the resulting slurry was stirred for 1 hour, filtered and the filter cake was washed with 2×250 ml of 1:1 mixture of IPAC:Heptane. The filter cake was collected and dried at 40° C. under high vacuum for 24 hours to give 94.1 grams (R)-pramipexole (85.5%) as a white solid. The chemical purity was 100% AUC as tested by HPLC, and the chiral purity was 100% AUC as tested by HPLC. 1H NMR and 13C NMR was used to confirm the structure: 1H NMR (300 MHz, DMSO-δ6) δ 6.6 (s, 2H), 2.8 (m, 2H), 2.5 (m, 2H, merged with DMSO peak), 2.2 (m, 1H), 1.9 (m, 1H), 1.5-1.3 (m, 4H), 0.85 (t, 3H); 13C NMR (300 MHz, DMSO-d6) δ 166.2, 144.8, 113.6, 54.2, 49.1, 30.0, 29.6, 25.2, 23.5, 12.3.
Example 12
Conversion of (R)-pramipexole free base to (R)-pramipexole dihydrochloride: The freebase of (R)-pramipexole (4.8 grams; 0.022 mol) was dissolved in 200 ml of IPAC and cooled to 15° C. HCl gas was bubbled into the slurry for 1 hour. The mixture was then filtered, washed with IPAC and dried under vacuum at room temperature overnight. The final product was 6.4 grams of (R)-pramipexole dihydrochloride, indicative a of 100% yield, and a 97% chemical purity as determined by HPLC.
Example 13
Conversion of (R)-pramipexole free base to (R)-pramipexole dihydrochloride: The freebase of (R)-pramipexole (50 grams; 0.13 mol) was dissolved in 500 ml of IPAC. Under continuous stirring, the mixture was slowly charged with 78 ml of concentrated HCl at a temperature of 25° C. The mixture was stirred overnight at ambient conditions ( ̃25° C.), filtered and dried under vacuum at 40° C. The final product was 68 grams of (R)-pramipexole dihydrochloride, indicative a of 95% yield.
Example 14
Optical purification of (R)-pramipexole using achiral acid addition: Pramipexole enantioenriched for the R(+) enantiomer ( ̃300 mg) was dissolved in 10 ml of the chosen solvent at 75° C. (see examples in Table 8; ethanol or acetonitrile). Complete dissolution was observed in all samples. Acid addition was made at 1.05 molar equivalents for the p-TSA (solvent is ethanol; 2.97 ml of 0.5 M acid) and MSA (solvent is acetonitrile; 1.49 ml of 1.0 M acid), and 2.05 molar equivalents for the fumaric (solvent is acetonitrile; 5.84 ml of 0.5 M acid) and phosphoric (solvent is acetonitrile; 2.90 ml of 1.0 M acid). The reaction mixtures were cooled to room temperature at a rate of 25° C./hour and stirred at room temperature for an additional 19 hours. The solids obtained by this trituration step were isolated by filtration and dried under high vacuum at room temperature. These products were analyzed by HPLC, 1H NMR, thermal gravimetric analysis, differential scanning calorimetry, X-ray powder diffraction (XPRD), Fourier transform infrared spectroscopy and moister-sorption analysis. The XI-D patterns showed that the p-TSA, MSA and fumarate salt forms of the (R)-pramipexole were crystalline, while the phosphate salt form of the (R)-pramipexole was amorphous.
Example 15
Industrial scale resolution of racemic diamine: A 72 L, unjacketed reactor was charged with racemic 2,6 diamino-4,5,6,7-tetrahydro-benzothiazole (rac-diamine) (4.5 kg; 26.6 mol) and 58.5 L water, and heated as a suspension to a temperature of about 60° C. to 65° C. Resolution of the enantiomers was achieved by addition of one equivalent of (D)-(−)-Tartaric acid (3991 grams; 26.6 mol) in 4.5 f, of water, after which the resulting solution was heated to a temperature of about 70° C. to 75° C. and maintained at this temperature for about 1 hour. The mixture was allowed to cool to a temperature of about 20° C. to 25° C. and stirred for an additional 15 hours, after which the mixture was filtered and the solids were washed 3× with water (6.3 L each wash).
The wet solids, which contain the R(+) enantiomer of the diamine, were charged to the reactor followed by 54 L of water, and the mixture was heated to a temperature of about 70° C. to 75° C. for 2 hours. The mixture was allowed to cool to a temperature of about 20° C. to 25° C. and stirred for 17 hours. The mixture was then filtered and the solids were washed 2× with water (4.5 L each wash). The wet solids were transferred to a jacketed reactor and the reactor was charged with 8.1 L of water. The mixture was cooled to a temperature of about 0° C. to 5° C. and cautiously charged with concentrated 1.625 L of HCl, followed by 1.155 L of 50% NaOH to achieve a pH of about 9-10. During the addition the temperature was maintained at about 0° C. to 5° C., and stirred for an additional hour at temperature. The resulting mixture was then filtered and the solids were washed 2× with cold (0° C. to 5° C.) water (1.125 L each wash). The solids were transferred to a jacketed reactor and were reslurried once more with 4.5 L of water at 0° C. to 5° C. The solids were filtered and dried under warm air (40° C. to 45° C.) to give 1940 grams of the product (R(+) diamine) as a white solid, with an 86% yield for the R(+) enantiomer.
The mother liquors of the initial resolution step, which contain the S(−) enantiomer of the diamine, were concentrated to afford diamine with a 95.5% yield for the S(−) enantiomer.







TABLE 16







Experiments for industrial scale resolution of the R(+)


enantiomer of diamine










Input
Yield (%) of
Chemical Purity
Chiral Purity


(grams)
R(+) enantiomer
(AUC % by HPLC)
(AUC % by HPLC)





1000
76
>99
98.3


4500
86
>99
98.5


4100
54
>99
98.5









Example 16
Industrial scale preparation of propyl tosylate: A 100 L glass, jacketed reactor was charged with 1-propanol (2.098 kg; 34.9 mol), triethylamine (4.585 kg; 45.3 mol; 1.3 equivalents) and DCM (20.1 L). The mixture was cooled to a temperature of about 5° C. to 15° C. and cautiously charged with a solution of p-toluenesulfonyl chloride (6 kg; 31.47 mol; 0.9 equivalents) in DCM (10.5 L) over 30 minutes. Once the addition was complete the mixture was warmed to a temperature of about 18° C. to 22° C. and stirred for 12 hours. The reaction mixture was assayed by 1H NMR (in CDCl3) and deemed complete. HCl (6 N; 2.98 L) was cautiously charged while maintaining the temperature below 25° C. The aqueous phase was removed, and the organic phase was washed 2× with water (21 L, each wash), dried with MgSO4, and filtered over Celite®. The filtered solids were then washed with DCM (4 L) and concentrated to a residue. The residue was dissolved in heptane and concentrated again to afford a final propyl tosylate product (6.385 kg, 95% yield).
The present invention provides evidence that the dopamine receptor affinity of (R)-pramipexole is actually much lower than previously appreciated. In a study using beagle dogs presented herein, it has been shown that the functional separation between the (S)-pramipexole and (R)-pramipexole enantiomers (10,000-20,000 fold) is much greater than previously expected. These data also show that contamination of the composition of pure (R)-pramipexole with small, known amounts of (S)-pramipexole results in a predictable shift in the MTD of the composition. These data demonstrate that (R)-pramipexole can be dosed at levels that can more fully and unexpectedly exploit the lower-potency neuroprotective potential of the compound without the theoretical MTD limitation previously assumed, and without the need for dose titration. The application presents methods for using pure compositions of (R)-pramipexole in acute and chronic neurodegenerative disorders previously inaccessible to this drug and immediately at full-strength without dose-titration and at higher theoretical MTDs. Additionally, the data showing that a pure composition of (R)-pramipexole can be mixed with a known amount of (S)-pramipexole to produce dopamine receptor agonist effects determined solely by the contribution of the (S)-enantiomer allows for the use of compositions comprising the mixture of known amounts of pure (R)- and (S)-enantiomers for use in neurodegenerative disorders amenable to both dopamine receptor agonist treatment and neuroprotection, such as PD.
Example 17
Industrial scale preparation of (R)-pramipexole p-TSA salt: Condition C: A 72 liter unjacketed reactor was charged with 1.84 kg (10.87 mol) of R(+)-2,6 diamino-4,5,6,7-tetrahydro-benzothiazole (R(+) diamine), followed by 14.7 L of dimethyl formamide (DMF). Under continuous stirring, the mixture was heated to a temperature of between 65° C. and 68° C. A solution of 2926 grams propyl tosylate and 1761 grams diisopropylethyleamine in 3.455 L DMF was added slowly over a period of 2 hours. The reaction was continued at 67° C. for an additional 4 hours, after which the solution was gradually cooled to room temperature (18° C. to 22° C.) and stirred for an additional 15 hours. The solution was diluted with 14.72 L of MTBE over a time period of 30 minutes, and stirred for an additional 1 hour. The precipitated material was collected by filtration and washed with 7.32 L MTBE, followed by 3 washes of 3.68 L each of ethanol, and a wash with 9.2 L heptane. The washed precipitated cake was dried under high vacuum at 30° C. to 35° C. The final weight of the dried product was 2090 grams, representing a 50% yield.
Although the present invention has been described in considerable detail with reference to certain preferred embodiments thereof, other versions are possible. Therefore the spirit and scope of the appended claims should not be limited to the description and the preferred versions contained within this specification.

## Claims

1. A method of treating amyotrophic lateral sclerosis in a patient in need thereof comprising administering to said patient a single unit dose of about 150 milligrams to about 5,000 milligrams of (R)-pramipexole in a pharmaceutical composition.

2. The method of claim 1, wherein said patient is a naïve patient.

3. The method of claim 1, wherein said single unit dose is from about 200 milligrams to about 3,000 milligrams of (R)-pramipexole.

4. The method of claim 1, wherein said single unit dose is from about 300 milligrams to about 1,500 milligrams of (R)-pramipexole.

5. The method of claim 1, wherein said single unit dose is from about 500 milligrams to about 1,000 milligrams of (R)-pramipexole.

6. The method of claim 1, wherein the chiral purity for the (R)-pramipexole is 99.9%, or greater.

7. The method of claim 1, wherein the chiral purity for the (R)-pramipexole is 99.95%, or greater.

8. The method of claim 1, wherein the chiral purity for the (R)-pramipexole is 99.99% or greater.

9. The method of claim 1, wherein said single unit dose is from about 200 mg to about 1,000 mg of (R)-pramipexole.

10. The method of claim 1, wherein said single unit dose is from about 250 mg to about 1,000 mg of (R)-pramipexole.

11. The method of claim 1, wherein said single unit dose is from about 300 mg to about 1,000 mg of (R)-pramipexole.

12. The method of claim 1, wherein said single unit dose is from about 400 mg to about 1,000 mg of (R)-pramipexole.

13. The method of claim 1, wherein said single unit dose is from about 600 mg to about 1,000 mg of (R)-pramipexole.

14. The method of claim 1, wherein said single unit dose is from about 450 mg to about 1,000 mg of (R)-pramipexole.

15. The method of claim 1, wherein said single unit dose is from about 600 mg to about 900 mg of (R)-pramipexole.

16. The method of claim 1, wherein said single unit dose is about 150 milligrams.

17. The method of claim 1, wherein said single unit dose is about 300 milligrams.

18. The method of claim 1, wherein said pharmaceutical composition is administered in a route of administration selected from oral, ophthalmic, intravenous, intramuscular, intra-arterial, intramedular, intrathecal, intraventricular, transdermal, subcutaneous, intraperitoneal, intravesicular, intranasal, enteral, topical, sublingual and rectal.

19. The method of claim 1, wherein said pharmaceutical composition is administered orally.

20. The method of claim 1, wherein said pharmaceutical composition is selected from a tablet and a capsule.

21. The method of claim 1, wherein said pharmaceutical composition comprises less than about 1.5 dopaminergic activity equivalents.

22. The method of claim 1, wherein said pharmaceutical composition comprises less than about 0.5 dopaminergic activity equivalents.

23. The method of claim 1, wherein said pharmaceutical composition comprises less than about 0.05 dopaminergic activity equivalents.

24. A method of treating amyotrophic lateral sclerosis in a naïve patient comprising administering to said naive patient a starting dose of about 300 milligrams of (R)-pramipexole or a pharmaceutical salt thereof in a single unit dose, wherein the chiral purity for the (R)-pramipexole is 99.95%.

25. A method of treating a amyotrophic lateral sclerosis in a naïve patient comprising administering to said naïve patient a starting dose of about 600 milligrams of (R)-pramipexole or a pharmaceutical salt thereof in a single unit dose, wherein the chiral purity for the (R)-pramipexole is 99.95%.

26. A method of treating amyotrophic lateral sclerosis in a patient comprising administering to said patient a pharmaceutical composition comprising about 150 milligrams of (R)-pramipexole or a pharmaceutical salt thereof in a single unit dose twice a day, wherein the chiral purity for the (R)-pramipexole is 99.95%.

27. A method of treating amyotrophic lateral sclerosis in a patient comprising administering to said patient a pharmaceutical composition comprising about 300 milligrams of (R)-pramipexole or a pharmaceutical salt thereof in a single unit dose twice a day, wherein the chiral purity for the (R)-pramipexole is 99.95%.

28. A method of treating amyotrophic lateral sclerosis of claim 24, wherein said (R)-pramipexole or pharmaceutically acceptable salt thereof is (R)-pramipexole dihydrochloride monohydrate.

29. A method of treating amyotrophic lateral sclerosis of claim 25, wherein said (R)-pramipexole or pharmaceutically acceptable salt thereof is (R)-pramipexole dihydrochloride monohydrate.

30. A method of treating amyotrophic lateral sclerosis of claim 26, wherein said (R)-pramipexole or pharmaceutically acceptable salt thereof is (R)-pramipexole dihydrochloride monohydrate.

31. A method of treating amyotrophic lateral sclerosis of claim 27, wherein said (R)-pramipexole is (R)-pramipexole dihydrochloride monohydrate.