# Patent

## Title
Method for treating pain in trigeminal neuralgia

## Abstract

The present invention is directed to the use of a class of peptide compounds for treating pain in trigeminal neuralgia.

## Background
CROSS REFERENCE TO RELATED APPLICATION
This application claims the benefit of U.S. Provisional Ser. No. 60/578,062, filed Jun. 9, 2004 and EPO 04013635.0, filed Jun. 9, 2004.


The present invention is directed to the use of a class of peptide compounds for treating pain in trigeminal neuralgia.
Certain peptides are known to exhibit central nervous system (CNS) activity and are useful in the treatment of epilepsy and other CNS disorders. These peptides which are described in the U.S. Pat. No. 5,378,729 have the Formula (Ia):




wherein

R is hydrogen, lower alkyl, lower alkenyl, lower alkynyl, aryl, aryl lower alkyl, heterocyclic, heterocyclic lower alkyl, lower alkyl heterocyclic, lower cycloalkyl, lower cycloalkyl lower alkyl, and R is unsubstituted or is substituted with at least one electron withdrawing group or electron donating group;
R1 is hydrogen or lower alkyl, lower alkenyl, lower alkynyl, aryl lower alkyl, aryl, heterocyclic lower alkyl, heterocyclic, lower cycloalkyl, lower cycloalkyl lower alkyl, each unsubstituted or substituted with an electron donating group or an electron withdrawing group; and
R2 and R3 are independently hydrogen, lower alkyl, lower alkenyl, lower alkynyl, aryl lower alkyl, aryl, heterocyclic, heterocyclic lower alkyl, lower alkyl heterocyclic, lower cycloalkyl, lower cycloalkyl lower alkyl, or Z-Y wherein R2 and R3 may be unsubstituted or substituted with at least one electron withdrawing group or electron donating group;
Z is O, S, S(O)a, NR4, PR4 or a chemical bond;
Y is hydrogen, lower alkyl, aryl, aryl lower alkyl, lower alkenyl, lower alkynyl, halo, heterocyclic, heterocyclic lower alkyl, and Y may be unsubstituted or substituted with an electron donating group or an electron withdrawing group, provided that when Y is halo, Z is a chemical bond, or
ZY taken together is NR4NR5R7, NR4OR5, ONR4R7, OPR4R5, PR4OR5, SNR4R7, NR4SR7, SPR4R5 or PR4SR7, NR4PR5R6 or PR4NR5R7,




R4, R5 and R6 are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, lower alkenyl, or lower alkynyl, wherein R4, R5 and R6 may be unsubstituted or substituted with an electron withdrawing group or an electron donating group; and
R7 is R6 or COOR8 or COR8;
R8 is hydrogen or lower alkyl, or aryl lower alkyl, and the aryl or alkyl group may be unsubstituted or substituted with an electron withdrawing group or an electron donating group; and
n is 1-4; and
a is 1-3.
U.S. Pat. No. 5,773,475 also discloses additional compounds useful for treating CNS disorders. These compounds are N-benzyl-2-amino-3-methoxy-propionamide having the Formula (IIa):




wherein

Ar is aryl which is unsubstituted or substituted with halo; R3 is lower alkoxy; and R1 is methyl.
The patents U.S. Pat. No. 5,378,729 and U.S. Pat. No. 5,773,475 are hereby incorporated by reference. However, neither of these patents describes the use of these compounds as specific analgesics for the treatment of pain in trigeminal neuralgia.
WO 02/074297 relates to the use of a compound according to Formula (IIa) wherein Ar is phenyl which may be substituted by at least one halo, R3 is lower alkoxy containing 1-3 carbon atoms and R1 is methyl for the preparation of pharmaceutical compositions useful for the treatment of allodynia related to peripheral neuropathic pain.
WO 02/074784 relates to the use of a compound having Formula (Ia) or/and Formula (IIa) showing antinociceptive properties for treating different types and symptoms of acute and chronic pain, especially non neuropathic inflammatory pain, e.g. rheumatoid arthritic pain or/and secondary inflammatory osteo-arthritic pain.
Pain is a subjective experience and the perception of pain is performed in particular parts of the Central Nervous System (CNS). Usually noxious (peripheral) stimuli are transmitted to the Central Nervous System (CNS) beforehand, but pain is not always associated with nociception. A broad variety of different types of clinical pain exists, that are derived from different underlying pathophysiological mechanisms and that will need different treatment approaches.
The perception of pain may be characterized by three major types of clinical pain:

    
    
        acute pain
        chronic pain
        neuropathic pain
    
    


Acute clinical pain may result from inflammation or soft tissue injury, for instance. This type of pain is adaptive and has the biologically relevant function of warning and enabling healing and repair of an already damaged body part to occur undisturbed. A protective function is achieved by making the injured/inflamed area and surrounding tissue hypersensitive to all stimuli so that contact with any external stimulus is avoided. The neuronal mechanisms underlying this type of clinical pain are fairly well understood and pharmacological control of acute clinical pain is available and effective by means of e.g. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) up to opioids depending on type and extension of the sensation.
Chronic clinical pain appears as sustained sensory abnormalities resulting from an ongoing peripheral pathology such as cancer or chronic inflammation (e.g. arthritis) or it can be independent of the initiating triggers. The latter being maladaptive, offering no survival advantage and very often no effective treatment is available.
There are several causes of human neuropathy with considerable variability in symptoms and neurological deficits. Painful neuropathies are defined as neurological disorders characterised by persistence of pain and hypersensitivity in a body region, of which the sensory innervation has been damaged, but damage to sensory nerves does not always produce neuropathic pain, usually loss of sensation rather than hypersensitivity or pain are observed.
Neuropathic pain can be classified as peripheral and central neuropathic pain. Peripheral neuropathic pain is caused by injury or infection of peripheral sensory nerves, whereas central neuropathic pain is caused by damage to the CNS or/and the spinal cord. Both peripheral and central neuropathic pain can occur without obvious initial nerve damage.
Common analgesics like opioids and non-steroidal anti-inflammatory drugs (NSAIDs) improve only insufficiently chronic abnormal pain syndromes as peripheral and central neuropathic pain due to insufficient efficacy or limiting side effects. In the search for alternative treatment regimes to produce satisfactory and sustained pain relief, corticosteroids, conduction blockade, glycerol, antidepressants, local anesthetics, gangliosides and electrostimulation have been tried, but mainly anti-convulsants have been found useful against various types of peripheral neuropathic pain conditions. A subset of patients with neuropathic pain responds to opioids. Carbamazepine is effective in reducing pain in patients with trigeminal neuralgia.
If general overactivity and unleaded low threshold activation of sensory neurons is considered as one of the main syndroms of neuropathy and neuropathic pain sensation with a marked mechanoallodynia as the most disabling clinical sympton, selective inhibition of this pathophysiological event instead of general inhibition of high threshold noxious stimuli (by e.g. local anesthetics) of the normal sensory nociception provides clear advantages.
The mechanisms of trigeminal neuralgia are poorly understood. Current treatments use a variety of pharmacological, surgical, physical and psychological approaches. However, the evidence for many of the treatments is still limited. Mononeuropathies in general can be caused by any trauma or lesion or may even exist without a known cause, as is very often the case with atypical facial pain.
The use of compounds of Formula (Ib) or/and Formula (IIb) for treatment of pain in trigeminal neuralgia has not been reported. Thus, the present invention concerns the use of said compounds of Formulae (Ib) or/and (IIb) for the preparation of a pharmaceutical composition for the prevention, alleviation or/and treatment of trigeminal neuropathic pain and other forms of mononeuropathies or atypical facial pain.
Surprisingly, application of compounds (Ib) or/and (IIb), particularly (R)-2-acetamide-N-benzyl-3-methoxypropionamide (SPM 927) exhibited a significant efficacy in reducing mechanical hypersensitivity in rats with infraorbital nerve injury. Thus, the compounds are useful as analgesic or/and anti-allodynic compounds for treating trigeminal neuropathic pain. Treatment with SPM 927 particularly leads to a significant increase in the response threshold indicating analgesic or/and anti-allodynic activity in trigeminal neuralgia.
A compound according to the invention has the general Formula (Ib)




wherein

R is hydrogen, lower alkyl, lower alkenyl, lower alkynyl, aryl, aryl lower alkyl, heterocyclic, heterocyclic lower alkyl, lower alkyl heterocyclic, lower cycloalkyl or lower cycloalkyl lower alkyl, and R is unsubstituted or is substituted with at least one electron withdrawing group, and/or at least one electron donating group;
R1 is hydrogen or lower alkyl, lower alkenyl, lower alkynyl, aryl lower alkyl, aryl, heterocyclic lower alkyl, lower alkyl heterocyclic, heterocyclic, lower cycloalkyl, lower cycloalkyl lower alkyl, each unsubstituted or substituted with at least one electron donating group and/or at least one electron withdrawing group;
and
R2 and R3 are independently hydrogen, lower alkyl, lower alkenyl, lower alkynyl, aryl lower alkyl, aryl, halo, heterocyclic, heterocyclic lower alkyl, lower alkyl heterocyclic, lower cycloalkyl, lower cycloalkyl lower alkyl, or Z-Y wherein R2 and R3 may be unsubstituted or substituted with at least one electron withdrawing group and/or at least one electron donating group;
Z is O, S, S(O)a, NR4, NR′6, PR4 or a chemical bond;
Y is hydrogen, lower alkyl, aryl, aryl lower alkyl, lower alkenyl, lower alkynyl, halo, heterocyclic, heterocyclic lower alkyl, lower alkyl heterocyclic and Y may be unsubstituted or substituted with at least one electron donating group and/or at least one electron withdrawing group, provided that when Y is halo, Z is a chemical bond, or
ZY taken together is NR4NR5R7, NR4OR5, ONR4R7, OPR4R5, PR4OR5, SNR4R7, NR4SR7, SP4R5, PR4SR7, NR4PR5R6, PR4NR5R7 or N+R5R6R7,




R′6 is hydrogen, lower alkyl, lower alkenyl, or lower alkenyl which may be unsubstituted or substituted with at least one electron withdrawing group or/and at least one electron donating group;
R4, R5 and R6 are independently hydrogen, lower alkyl, aryl, aryl lower alkyl, lower alkenyl, or lower alkynyl, wherein R4, R5 and R6 may independently be unsubstituted or substituted with at least one electron withdrawing group or/and at least one electron donating group;
R7 is R6 or COOR8 or COR8, which R7 may be unsubstituted or substituted with at least one electron withdrawing group or/and at least one electron donating group;
R8 is hydrogen or lower alkyl, or aryl lower alkyl, and the aryl or alkyl group may be unsubstituted or substituted with at least one electron withdrawing group or/and at least one electron donating group; and
n is 1-4; and
a is 1-3.
Preferably the compound according has the general Formula (IIb)




wherein

Ar is aryl, especially phenyl, which is unsubstituted or substituted with at least one halo; R3 is —CH2-Q, wherein Q is lower alkoxy; and R1 is lower alkyl, especially methyl.
The present invention is also directed to a pharmaceutical composition comprising a compound according to Formula (Ib) or/and Formula (IIb) useful for the prevention, alleviation or/and treatment of trigeminal neuropathic pain.
The “lower alkyl” groups when used alone or in combination with other groups, are lower alkyl containing from 1 to 6 carbon atoms, especially 1 to 3 carbon atoms, and may be straight chain or branched. These groups include methyl, ethyl, propyl, isopropyl, butyl, isobutyl, tertiary butyl, amyl, hexyl, and the like.
The “lower alkoxy” groups are lower alkoxy containing from 1 to 6 carbon atoms, especially 1 to 3 carbon atoms, and may be straight chain or branched. These groups include methoxy, ethoxy, propoxy, butoxy, isobutoxy, tert-butoxy, pentoxy, hexoxy and the like.
The “aryl lower alkyl” groups include, for example, benzyl, phenylethyl, phenylpropyl, phenylisopropyl, phenylbutyl, diphenylmethyl, 1,1-diphenylethyl, 1,2-diphenylethyl, and the like.
The term “aryl”, when used alone or in combination, refers to an aromatic group which contains from 6 up to 18 ring carbon atoms and up to a total of 25 carbon atoms and includes the polynuclear aromatics. These aryl groups may be monocyclic, bicyclic, tricyclic or polycyclic and are fused rings. A polynuclear aromatic compound as used herein, is meant to encompass bicyclic and tricyclic fused aromatic ring systems containing from 10-18 ring carbon atoms and up to a total of 25 carbon atoms. The aryl group includes phenyl, and the polynuclear aromatics e.g., naphthyl, anthracenyl, phenanthrenyl, azulenyl and the like. The aryl group also includes groups like ferrocenyl. Aryl groups may be unsubstituted or mono or polysubstituted with electron withdrawing or/and electron donating groups as described below.
“Lower alkenyl” is an alkenyl group containing from 2 to 6 carbon atoms and at least one double bond. These groups may be straight chained or branched and may be in the Z or E form. Such groups include vinyl, propenyl, 1-butenyl, isobutenyl, 2-butenyl, 1-pentenyl, (Z)-2-pentenyl, (E)-2-pentenyl, (Z)-4-methyl-2-pentenyl, (E)-4-methyl-2-pentenyl, pentadienyl, e.g., 1, 3 or 2,4-pentadienyl, and the like.
The term “lower alkynyl” is an alkynyl group containing 2 to 6 carbon atoms and may be straight chained as well as branched. It includes such groups as ethynyl, propynyl, 1-butynyl, 2-butynyl, 1-pentynyl, 2-pentynyl, 3-methyl-1-pentynyl, 3-pentynyl, 1-hexynyl, 2-hexynyl, 3-hexynyl and the like.
The term “lower cycloalkyl” when used alone or in combination is a cycloalkyl group containing from 3 to 18 ring carbon atoms and up to a total of 25 carbon atoms. The cycloalkyl groups may be monocyclic, bicyclic, tricyclic, or polycyclic and the rings are fused. The cycloalkyl may be completely saturated or partially saturated. Examples include cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, cyclooctyl, cyclodecyl, cyclohexenyl, cyclopentenyl, cyclooctenyl, cycloheptenyl, decalinyl, hydroindanyl, indanyl, fenchyl, pinenyl, adamantyl, and the like. Cycloalkyl includes the cis or trans forms. Cycloalkyl groups may be unsubstituted or mono or polysubstituted with electron withdrawing or/and electron donating groups as described below. Furthermore, the substituents may either be in endo or exo positions in the bridged bicyclic systems.
The term “electron-withdrawing and electron donating” refer to the ability of a substituent to withdraw or donate electrons, respectively, relative to that of hydrogen if the hydrogen atom occupied the same position in the molecule. These terms are well understood by one skilled in the art and are discussed in Advanced Organic Chemistry, by J. March, John Wiley and Sons, New York, N.Y., pp. 16-18(1985) and the discussion therein is incorporated herein by reference. Electron withdrawing groups include halo, including bromo, fluoro, chloro, iodo and the like; nitro, carboxy, lower alkenyl, lower alkynyl, formyl, carboxyamido, aryl, quaternary ammonium, haloalkyl such as trifluoromethyl, aryl lower alkanoyl, carbalkoxy and the like. Electron donating groups include such groups as hydroxy, lower alkoxy, including methoxy, ethoxy and the like; lower alkyl, such as methyl, ethyl, and the like; amino, lower alkylamino, di(loweralkyl) amino, aryloxy such as phenoxy, mercapto, lower alkylthio, lower alkylmercapto, disulfide (lower alkyldithio) and the like. One of ordinary skill in the art will appreciate that some of the aforesaid substituents may be considered to be electron donating or electron withdrawing under different chemical conditions. Moreover, the present invention contemplates any combination of substituents selected from the above-identified groups.
The term “halo” includes fluoro, chloro, bromo, iodo and the like.
The term “acyl” includes lower alkanoyl containing from 1 to 6 carbon atoms and may be straight chains or branched. These groups include, for example, formyl, acetyl, propionyl, butyryl, isobutyryl, tertiary butyryl, pentanoyl and hexanoyl.
As employed herein, a heterocyclic group contains at least one sulfur, nitrogen or oxygen ring atom, but also may include several of said atoms in the ring. The heterocyclic groups contemplated by the present invention include heteroaromatics and saturated and partially saturated heterocyclic compounds. These heterocyclics may be monocyclic, bicyclic, tricyclic or polycyclic and are fused rings. They may preferably contain up to 18 ring atoms and up to a total of 17 ring carbon atoms and a total of up to 25 carbon atoms. The heterocyclics are also intended to include the so-called benzoheterocyclics. Representative heterocyclics include furyl, thienyl, pyrazolyl, pyrrolyl, methylpyrrolyl, imidazolyl, indolyl, thiazolyl, oxazolyl, isothiazolyl, isoxazolyl, piperidyl, pyrrolinyl, piperazinyl, quinolyl, triazolyl, tetrazolyl, isoquinolyl, benzofuryl, benzothienyl, morpholinyl, benzoxazolyl, tetrahydrofuryl, pyranyl, indazolyl, purinyl, indolinyl, pyrazolindinyl, imidazolinyl, imadazolindinyl, pyrrolidinyl, furazanyl, N-methylindolyl, methylfuryl, pyridazinyl, pyrimidinyl, pyrazinyl, pyridyl, epoxy, aziridino, oxetanyl, azetidinyl, the N-oxides of the nitrogen containing heterocycles, such as the N-oxides of pyridyl, pyrazinyl, and pyrimidinyl and the like. Heterocyclic groups may be unsubstituted or mono or polysubstituted with electron withdrawing or/and electron donating groups.
The preferred heterocyclics are thienyl, furyl, pyrrolyl, benzofuryl, benzothienyl, indolyl, methylpyrrolyl, morpholinyl, pyridiyl, pyrazinyl, imidazolyl, pyrimidinyl, or pyridazinyl. The preferred heterocyclic is a 5 or 6-membered heterocyclic compound. The especially preferred heterocyclic is furyl, pyridyl, pyrazinyl, imidazolyl, pyrimidinyl, or pyridazinyl. The most preferred heterocyclics are furyl and pyridyl.
The preferred compounds are those wherein n is 1, but di (n=2), tri (n=3) and tetrapeptides (n=4) are also contemplated to be within the scope of the invention.
The preferred values of R is aryl lower alkyl, especially benzyl, especially those wherein the phenyl ring thereof is unsubstituted or substituted with electron donating groups or/and electron withdrawing groups, such as halo (e.g., F).
The preferred R1 is H or lower alkyl. The most preferred R1 group is methyl.
The preferred electron donating substituents or/and electron withdrawing substituents are halo, nitro, alkanoyl, formyl, arylalkanoyl, aryloyl, carboxyl, carbalkoxy, carboxamido, cyano, sulfonyl, sulfoxide, heterocyclic, guanidine, quaternary ammonium, lower alkenyl, lower alkynyl, sulfonium salts, hydroxy, lower alkoxy, lower alkyl, amino, lower alkylamino, di(loweralkyl) amino, amino lower alkyl, mercapto, mercaptoalkyl, alkylthio, and alkyldithio. The term “sulfide” encompasses mercapto, mercapto alkyl and alkylthio, while the term disulfide encompasses alkyldithio. Especially preferred electron donating or/and electron withdrawing groups are halo or lower alkoxy, most preferred are fluoro or methoxy. These preferred substituents may be present on any one of the groups in Formula (Ib) or/and (IIb), e.g. R, R1, R2, R3, R4, R5, R6, R′6, R7, R8 and/or R50 as defined herein.
The ZY groups representative of R2 and R3 include hydroxy, alkoxy, such as methoxy, ethoxy, aryloxy, such as phenoxy; thioalkoxy, such as thiomethoxy, thioethoxy; thioaryloxy such as thiophenoxy; amino; alkylamino, such as methylamino, ethylamino; arylamino, such as anilino; lower dialkylamino, such as, dimethylamino; trialkyl ammonium salt, hydrazino; alkylhydrazino and arylhydrazino, such as N-methylhydrazino, N-phenylhydrazino, carbalkoxy hydrazino, aralkoxycarbonyl hydrazino, aryloxycarbonyl hydrazino, hydroxylamino, such as N-hydroxylamino (—NH—OH), lower alkoxy amino [(NHOR18) wherein R18 is lower alkyl], N-lower alkylhydroxylamino [(NR18)OH wherein R18 is lower alkyl], N-lower alkyl-O-lower alkylhydroxyamino, i.e., [N(R18)OR19 wherein R18 and R19 are independently lower alkyl], and o-hydroxylamino (—O—NH2); alkylamido such as acetamido; trifluoroacetamido; lower alkoxyamino, (e.g., NH(OCH3); and heterocyclicamino, such as pyrazoylamino.
The preferred heterocyclic groups representative of R2 and R3 are monocyclic 5- or 6-membered heterocyclic moieties of the formula:




or those corresponding partially or fully saturated form thereof wherein n is 0 or 1; and

R50 is H or an electron withdrawing group or electron donating group;
A, E, L, J and G are independently CH, or a heteroatom selected from the group consisting of N, O, S;
but when n is 0, G is CH, or a heteroatom selected from the group consisting of NH, O and S with the proviso that at most two of A, E, L, J and G are heteroatoms.
When n is 0, the above heteroaromatic moiety is a five membered ring, while if n is 1, the heterocyclic moiety is a six membered monocyclic heterocyclic moiety. The preferred heterocyclic moieties are those aforementioned heterocyclics which are monocyclic.
If the ring depicted hereinabove contains a nitrogen ring atom, then the N-oxide forms are also contemplated to be within the scope of the invention.
When R2 or R3 is a heterocyclic of the above formula, it may be bonded to the main chain by a ring carbon atom. When n is 0, R2 or R3 may additionally be bonded to the main chain by a nitrogen ring atom.
Other preferred moieties of R2 and R3 are hydrogen, aryl, e.g., phenyl, aryl alkyl, e.g., benzyl and alkyl.
It is to be understood that the preferred groups of R2 and R3 may be unsubstituted or mono or poly substituted with electron donating or/and electron withdrawing groups. It is preferred that R2 and R3 are independently hydrogen, lower alkyl, which is either unsubstituted or substituted with electron withdrawing groups or/and electron donating groups, such as lower alkoxy (e.g., methoxy, ethoxy, and the like), N-hydroxylamino, N-lower alkylhydroxyamino, N-loweralkyl-O-loweralkyl and alkylhydroxyamino.
It is preferred that one of R2 and R3 is hydrogen.
It is preferred that n is one.
It is more prefered that n=1 and one of R2 and R3 is hydrogen. It is especially preferred that in this embodiment, R2 is hydrogen and R3 is lower alkyl or ZY;
Z is O, NR4 or PR4; Y is hydrogen or lower alkyl; ZY is




In another especially preferred embodiment, n=1, R2 is hydrogen and R3 is lower alkyl which may be substituted or unsubstituted with an electron donating or electron withdrawing group, NR4OR5, or ONR4R7.
In yet another especially preferred embodiment, n=1, R2 is hydrogen and R3 is lower alkyl which is unsubstituted or substituted with hydroxy or loweralkoxy, NR4OR5 or ONR4R7, wherein R4, R5 and R7 are independently hydrogen or lower alkyl, R is aryl lower alkyl, which aryl group may be unsubstituted or substituted with an electron withdrawing group and R1 is lower alkyl. In this embodiment it is most preferred that aryl is phenyl, which is unsubstituted or substituted with halo.
It is preferred that R2 is hydrogen and R3 is hydrogen, an alkyl group which is unsubstituted or substituted by at least an electron donating or electron withdrawing group or ZY. In this preferred embodiment, it is more preferred that R3 is hydrogen, an alkyl group such as methyl, which is unsubstituted or substituted by an electron donating group, or NR4OR5 or ONR4R7, wherein R4, R5 and R7 are independently hydrogen or lower alkyl. It is preferred that the electron donating group is lower alkoxy, and especially methoxy or ethoxy.
It is preferred that R2 and R3 are independently hydrogen, lower alkyl, or ZY;
Z is O, NR4 or PR4;
Y is hydrogen or lower alkyl or




It is also preferred that R is aryl lower alkyl. The most preferred aryl for R is phenyl. The most preferred R group is benzyl. In a preferred embodiment, the aryl group may be unsubstituted or substituted with an electron donating or electron withdrawing group. If the aryl ring in R is substituted, it is most preferred that it is substituted with an electron withdrawing group, especially on the aryl ring. The most preferred electron withdrawing group for R is halo, especially fluoro.
The preferred R1 is lower alkyl, especially methyl.
It is more preferred that R is aryl lower alkyl and R1 is lower alkyl.
Further preferred compounds are compounds of Formula (Ib) wherein n is 1; R2 is hydrogen; R3 is hydrogen, a lower alkyl group, especially methyl which is substituted by an electron donating or electron withdrawing group or ZY; R is aryl, aryl lower alkyl, such as benzyl, wherein the aryl group is unsubstituted or substituted with an electron donating or electron withdrawing group and R1 is lower alkyl. In this embodiment, it is more preferred that R3 is hydrogen, a lower alkyl group, especially methyl, which may be substituted by electron donating group, such as lower alkoxy, (e.g., methoxy, ethoxy and the like), NR4OR5 or ONR4R7 wherein these groups are defined hereinabove.
The most preferred compounds utilized are those of the Formula (IIb):




wherein

Ar is aryl, especially phenyl, which is unsubstituted or substituted with at least one electron donating group or electron withdrawing group, especially halo,
R1 is lower alkyl, especially containing 1-3 carbon atoms; and
R3 is as defined herein, but especially hydrogen, loweralkyl, which is unsubstituted or substituted by at least an electron donating group or electron withdrawing group or ZY. It is even more preferred that R3 is, in this embodiment, hydrogen, an alkyl group which is unsubstituted or substituted by an electron donating group, NR4OR5 or ONR4R7. It is most preferred that R3 is CH2-Q, wherein Q is lower alkoxy, especially containing 1-3 carbon atoms; NR4OR5 or ONR4R7 wherein R4 is hydrogen or alkyl containing 1-3 carbon atoms, R5 is hydrogen or alkyl containing 1-3 carbon atoms, and R7 is hydrogen or alkyl containing 1-3 carbon atoms.
The most preferred R1 is CH3. The most preferred R3 is CH2-Q, wherein Q is methoxy.
The most preferred aryl is phenyl. The most preferred halo is fluoro.
The most preferred compounds include:

    (R)-2-acetamido-N-benzyl-3-methoxy-propionamide;
    O-methyl-N-acetyl-D-serine-m-fluorobenzyl-amide;
    O-methyl-N-acetyl-D-serine-p-fluorobenzyl-amide;
    N-acetyl-D-phenylglycine benzylamide;
    D-1,2-(N,O-dimethylhydroxylamino)-2-acetamide acetic acid benzylamide;
    D-1,2-(O-methylhydroxylamino)-2-acetamido acetic acid benzylamide.


It is to be understood that the various combinations and permutations of the Markush groups of R1, R2, R3, R and n described herein are contemplated to be within the scope of the present invention. Moreover, the present invention also encompasses compounds and compositions which contain one or more elements of each of the Markush groupings in R1, R2, R3, n and R and the various combinations thereof. Thus, for example, the present invention contemplates that R1 may be one or more of the substituents listed hereinabove in combination with any and all of the substituents of R2, R3, and R with respect to each value of n.
The compounds utilized in the present invention may contain one or more asymmetric carbons and may exist in racemic and optically active forms. The configuration around each asymmetric carbon can be either the D or L form. It is well known in the art that the configuration around a chiral carbon atoms can also be described as R or S in the Cahn-Prelog-lngold nomenclature system. All of the various configurations around each asymmetric carbon, including the various enantiomers and diastereomers as well as racemic mixtures and mixtures of enantiomers, diastereomers or both are contemplated by the present invention.
In the principal chain, there exists asymmetry at the carbon atom to which the groups R2 and R3 are attached. When n is 1, the compounds of the present invention is of the formula




wherein R, R1, R2, R3, R4, R5, R6, R′6, R7, R8, R50 Z and Y are as defined previously.

As used herein, the term configuration shall refer to the configuration around the carbon atom to which R2 and R3 are attached, even though other chiral centers may be present in the molecule. Therefore, when referring to a particular configuration, such as D or L, it is to be understood to mean the D or L stereoisomer at the carbon atom to which R2 and R3 are attached. However, it also includes all possible enantiomers and diastereomers at other chiral centers, if any, present in the compound.
The compounds of the present invention are directed to all the optical isomers, i.e., the compounds of the present invention are either the L-stereoisomer or the D-stereoisomer (at the carbon atom to which R2 and R3 are attached). These stereoisomers may be found in mixtures of the L and D stereoisomer, e.g., racemic mixtures. The D stereoisomer is preferred.
More preferred is a compound of Formula (III) in the R configuration, preferably substantially enantiopure, wherein the substituent R is benzyl which is unsubstituted or substituted with at least one halo group, wherein R3 is CH2-Q, wherein Q is lower alkoxy containing 1-3 carbon atoms and wherein R1 is methyl. Preferably R is unsubstituted benzyl or benzyl substituted with at least one halo group which is a fluoro group.
Depending upon the substituents, the present compounds may form addition salts as well. All of these forms are contemplated to be within the scope of this invention including mixtures of the stereoisomeric forms.
The manufacture of the utilized compounds is described in U.S. Pat. Nos. 5,378,729 and 5,773,475, the contents of both of which are incorporated by reference.
The compounds utilized in the present invention are useful as such as depicted in the Formulae (Ib) or/and (IIb) or can be employed in the form of salts in view of its basic nature by the presence of the free amino group. Thus, the compounds of Formulae (Ib) or/and (IIb) form salts with a wide variety of acids, inorganic and organic, including pharmaceutically acceptable acids. The salts with therapeutically acceptable acids are of course useful in the preparation of formulation where enhanced water solubility is most advantageous.
These pharmaceutically acceptable salts have also therapeutic efficacy. These salts include salts of inorganic acids such as hydrochloric, hydroiodic, hydrobromic, phosphoric, metaphosphoric, nitric acid and sulfuric acids as well as salts of organic acids, such as tartaric, acetic, citric, malic, benzoic, perchloric, glycolic, gluconic, succinic, aryl sulfonic, (e.g., p-toluene sulfonic acids, benzenesulfonic), phosphoric, malonic, and the like.
The present invention is further directed to a method for the prevention, alleviation or/and treatment of a disease or condition as described above in a mammal, including a human being, comprising administering at least one compound of Formulae (Ib) or/and (IIb).
It is preferred that the compound utilized in the present invention is used in therapeutically effective amounts.
The physician will determine the dosage of the present therapeutic agents which will be most suitable and it will vary with the form of administration and the particular compound chosen, and furthermore, it will vary with the patient under treatment, the age of the patient, the type of malady being treated. He will generally wish to initiate treatment with small dosages substantially less than the optimum dose of the compound and increase the dosage by small increments until the optimum effect under the circumstances is reached. When the composition is administered orally, larger quantities of the active agent will be required to produce the same effect as a smaller quantity given parenterally. The compounds are useful in the same manner as comparable therapeutic agents and the dosage level is of the same order of magnitude as is generally employed with these other therapeutic agents.
In a preferred embodiment, the compounds of the present invention are administered in amounts ranging from about 1 mg to about 100 mg per kilogram of body weight per day, more preferably in amounts ranging from about 1 mg to about 10 mg per kilogram of body weight per day. This dosage regimen may be adjusted by the physician to provide the optimum therapeutic response. Patients in need thereof may be treated with doses of the compound of the present invention of at least 50 mg/day, preferably of at least 200 mg/day, more preferably of at least 300 mg/day and most preferably of at least 400 mg/day. For example, a patient in need thereof may be treated with doses at a maximum of 6 g/day, more preferably a maximum of 1 g/day and most preferably a maximum of 600 mg/day. In some cases, however, lower or higher doses may be needed.
In another preferred embodiment, the daily doses are increased until a predetermined daily dose is reached which is maintained during the further treatment.
In yet another preferred embodiment, several divided doses may be administered daily. For example, three doses per day may be administered, preferably two doses per day. It is more preferred to administer a single dose per day.
In yet another preferred embodiment, an amount of the compounds of the present invention may be administered which results in a plasma concentration of 0.1 to 15 μg/ml (trough) and 5 to 18.5 μg/ml (peak), calculated as an average over a plurality of treated subjects.
The compounds of Formulae (Ib) or/and (IIb) may be administered in a convenient manner, such as by oral, intravenous (where water soluble), intramuscular, intrathecal or subcutaneous routes. Oral or/and i.v. administration is preferred.
The pharmaceutical composition of the present invention may be prepared for the treatment regimen as described above, in particular for the treatment with doses as described above, to effect plasma concentrations as described above, for administration periods or/and administration routes as specified in the embodiments of the present invention as described above.
In another preferred embodiment, the method of the present invention as described above for the treatment of a mammal including a human being in need thereof comprises administering a compound of the present invention in combination with administering a further active agent for the prevention, alleviation or/and treatment of trigeminal neuropathic pain. The compound of the present invention and the further active agent may be administered together, i.e. in a single dose form, or may be administered separately, i.e. in a separate dose form. Thus, the pharmaceutical composition of the present invention may comprise a compound of the present invention as defined above and may further comprise a further active agent for the prevention, alleviation or/and treatment of trigeminal neuropathic pain. The pharmaceutical composition may comprise a single dose form or may comprise a separate dose form comprising a first composition comprising a compound of the present invention as defined above and a second composition comprising the further active agent.
The compounds of the present invention may be used for the preparation of a pharmaceutical composition as described above.
The compounds of Formulae (Ib) or/and (IIb) may be orally administered, for example, with an inert diluent or with an assimilable edible carrier, or it may be enclosed in hard or soft shell gelatin capsules, or it may be compressed into tablets, or it may be incorporated directly into the fool of the diet. For oral therapeutic administration, the active compound of Formulae (Ib) or/and (IIb) may be incorporated with excipients and used in the form of ingestible tablets, buccal tablets, troches, capsules, elixirs, suspensions, syrups, wafers, and the like. Such compositions and preparations should contain at least 1% of active compound of Formulae (Ib) or/and (IIb). The percentage of the compositions and preparations may, of course, be varied and may conveniently be between about 5 to about 80% of the weight of the unit. The amount of active compound of Formulae (Ib) or/and (IIb) in such therapeutically useful compositions is such that a suitable dosage will be obtained. Preferred compositions or preparations according to the present invention contains between about 10 mg and 6 g active compound of Formulae (Ib) or/and (IIb).
The tablets, troches, pills, capsules and the like may also contain the following: A binder such as gum tragacanth, acacia, corn starch or gelatin; excipients such as dicalcium phosphate; a disintegrating agent such as corn starch, potato starch, alginic acid and the like; a lubricant such as magnesium stearate; and a sweetening agent such as sucrose, lactose or saccharin may be added or a flavoring agent such as peppermint, oil of wintergreen, or cherry flavoring. When the dosage unit form is a capsule, it may contain, in addition to materials of the above type, a liquid carrier.
Various other materials may be present as coatings or otherwise modify the physical form of the dosage unit. For instance, tablets, pills, or capsules may be coated with shellac, sugar or both. A syrup or elixir may contain the active compound, sucrose as a sweetening agent, methyl and propylparabens as preservatives, a dye and flavoring such as cherry or orange flavor. Of course, any material used in preparing any dosage unit form should be pharmaceutically pure and substantially non-toxic in the amounts employed. In addition, the active compound may be incorporated into sustained-release preparations and formulations. For example, sustained release dosage forms are contemplated wherein the active ingredient is bound to an ion exchange resin which, optionally, can be coated with a diffusion barrier coating to modify the release properties of the resin.
The active compound may also be administered parenterally or intraperitoneally. Dispersions can also be prepared in glycerol, liquid, polyethylene glycols, and mixtures thereof and in oils. Under ordinary conditions of storage and use, these preparations contain a preservative to prevent the growth of microorganisms.
The pharmaceutical forms suitable for injectable use include sterile aqueous solutions (where water soluble) or dispersions and sterile powders for the extemporaneous preparation of sterile injectable solutions or dispersions. In all cases the form must be sterile and must be fluid to the extent that easy syringability exists. It must be stable under the conditions of manufacture and storage and must be preserved against the contaminating action of microorganisms such as bacteria and fungi. The carrier can be a solvent or dispersion medium containing, for example, water, ethanol, polyol (for example, glycerol, propylene glycol, and liquid polyethylene glycol, and the like), suitable mixtures thereof, and vegetable oils. The proper fluidity can be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions and by the use of surfactants. The prevention of the action of microorganisms can be brought about by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, thimerosal, and the like. In many cases, it will be preferable to include isotonic agents, for example, sugars or sodium chloride. Prolonged absorption of the injectable compositions can be brought about by the use in the compositions of agents delaying absorption, for example, aluminium monostearate and gelatin.
Sterile injectable solutions are prepared by incorporating the active compound in the required amount in the appropriate solvent with various of the other ingredients enumerated above, as required, followed by filtered sterilization. Generally, dispersions are prepared by incorporating the various sterilized active ingredient into a sterile vehicle which contains the basic dispersion medium and the required other ingredients from those enumerated above. In the case of sterile powders for the preparation of sterile injectable solutions, the preferred methods of preparation are vacuum drying the freeze-drying technique plus any additional desired ingredient from previously sterile-filtered solution thereof.
As used herein, “pharmaceutically acceptable carrier” includes any and all solvents, dispersion media, coatings, antibacterial and antifungal agent, isotonic and absorption delaying agents for pharmaceutical active substances as well known in the art. Except insofar as any conventional media or agent is incompatible with the active ingredient, its use in the therapeutic compositions is contemplated. Supplementary active ingredients can also be incorporated into the compositions.
It is especially advantageous to formulate parenteral compositions in dosage unit form or ease of administration and uniformity of dosage. Dosage unit form as used herein refers to physically discrete units suited as unitary dosages for the mammalian subjects to be treated; each unit containing a predetermined quantity of active material calculated to produce the desired therapeutic effect in association with the required pharmaceutical carrier. The specifics for the novel dosage unit forms of the invention are dictated by and directly dependent on (a) the unique characteristics of the active material an the particular therapeutic effect to be achieved, and (b) the limitations inherent in the art of compounding such as active material for the treatment of disease in living subjects having a diseased condition in which bodily health is impaired as herein disclosed in detail.
The principal active ingredient is compounded for convenient and effective administration in effective amounts with a suitable pharmaceutically acceptable carrier in dosage unit form as hereinbefore described. A unit dosage form can, for example, contain the principal active compound in amounts ranging from about 10 mg to about 6 g. Expressed in proportions, the active compound is generally present in from about 1 to about 750 mg/ml of carrier. In the case of compositions containing supplementary active ingredients, the dosages are determined by reference to the usual dose and manner of administration of the said ingredients.
As used herein the term “patient” or “subject” refers to a warm blooded animal, and preferably mammals, such as, for example, cats, dogs, horses, cows, pigs, mice, rats and primates, including humans. The preferred patient is a human.
The term “treat” refers to either relieving the pain associated with a disease or condition or alleviating the patient's disease or condition.
The compounds of the present invention are administered to a patient suffering from the aforementioned type of pain in an analgesic effective amount. These amounts are equivalent to the therapeutically effective amounts described hereinabove.
The following example shows the properties of SPM 927 in reducing trigeminal pain in a rats with ischemic infraorbital nerve injury.
The used substance was SPM 927 which is the synonym for Harkoseride. The standard chemical nomenclature is (R)-2-acetamide-N-benzyl-3-methoxypropionamide.



FIGURE LEGEND
FIG. 1 shows the effect (median±median absolute deviation, M.A.D.) of administration of vehicle (n=23 males, open circles) or SPM 927 at 7.5 mg/kg (open circles, 7 females), SPM 927 at 15 (open squares, 7 females, 8 males), 20 (filled circles, 7 females, 7 males) and 30 mg/kg (filled squares, 15 males) on vocalization threshold to stimulation with von Frey hairs in male (A) and female (B) rats after infraorbital (IoN) nerve injury. *=p<0.05 and **=p<0.01 compared to baseline at time 0 with Wilcoxon signed-ranks test.



EXAMPLE
The present study, shows the analgesic effects SPM 927 in a rat model of injury to the infraorbital nerve (IoN) which is regarded as a model of trigeminal neuropathic pain.
Materials and Methods
Male and female Sprague-Dawley rats (Mölleg{dot over (a)}rd, Denmark) weighing 200-250 g at the start of the experiments were used. All experimental procedures were approved by the local research ethics committee.
Photochemically-Induced Ischemic Infraorbital Nerve (IoN) Injury
Rats were anesthetized with chloral hydrate. The left IoN was exposed via a longitudinal incision at the maxillary region and all branches of the nerve were carefully lifted on a glass hook. A piece of aluminium foil was placed under the nerve and the nerve was irradiated for 6 min with the tunable argon ion laser. The rat was positioned so that the laser beam was perpendicular and transversal to the exposed nerve. Immediately before irradiation erythrosin B was injected i.v. and the injection was repeated after 5 min. After irradiation the wound was closed in layers.
Assessment of Mechanical Sensitivity after IoN Injury
Mechanical sensitivity was tested with a series of von Frey filaments. The rat was gently held by the experimenter and the von Frey filaments were applied in ascending order to the IoN territory on the hairy skin of the vibrissal pad. The stimulation with each filament consisted of four consecutive applications at 1/s on the injured and then on the contralateral side. The response threshold was taken as the force at which the rat either exhibited a withdrawal reaction or escape/attack in 75% of trials (Vos et al. 1994). The rats were habituated to the testing procedure for several days before nerve injury and baseline response was determined in two sessions. Testing was carried out 3, 7, 10 and 14 d after the injury to assess the development of mechanical hypersensitivity. The effect of SPM 927 (7.5, 15, 20 and 30 mg/kg) was tested 14-16 days after injury when mechanical hypersensitivity was well established. Measurements were taken 30 min, 1 h, 2 h, and 3 h following drug injection.
Drugs and Statistics
SPM 927 was dissolved in physiological saline and injected intraperitoneally. The data are expressed as median±M.A.D. and analysed with Wilcoxon signed-ranks test.
Results
Effects of SPM 927 on Mechanical Hypersensitivity after IoN Injury
Partial injury to the IoN leads to the development of mechanical hypersensitivity in the innervation area of the nerve. Normal response threshold to mechanical stimulation was between 18-40 g whereas after injury, the response threshold decreased significantly for both male and female rats (median 5.8 g and 4.0 g respectively). The mechanical hypersensitivity developed rapidly after IoN nerve injury, reaching peak level within 3 days and was stable thereafter for at least 3-4 weeks with the irradiation parameter used in the present study. In male rats SPM 927 at 15 or 20 mg/kg did not alleviate mechanical hypersensitivity whereas at 30 mg/kg it significantly alleviated mechanical hypersensitivity for 3 h (FIG. 1A). In female rats, SPM 927 significantly and markedly alleviated mechanical hypersensitivity at doses of 15 or 20 mg/kg whereas it has no effect at 7.5 mg/kg (FIG. 1B). SPM 927 did not cause motor deficits.
CONCLUSION
Systemic SPM 927 produced a dose-dependent analgesic or/and anti-allodynic effect in a rat model of trigeminal neuropathic pain following single dose administration. Thus, SPM 927 and related compounds are useful for the treatment of pain during trigeminal neuralgia in mammals including humans. As this nerve injury can be regarded as a model for a mononeuropathy, SPM 927 and related compounds are also useful for the treatment of pain resulting from neuropathies of other nerves (mononeuropathies). Furthermore, it can be regarded as an extended model for atypical facial pain. Consequently, SPM 927 and related compounds are useful for the treatment of atypical facial pain.
REFERENCES


    Vos, B. P., Strassmann, A. M. and Maciewicz R. J. Behavioral evidence of trigeminal neuropathic pain following chronic constriction injury to the rat's infraorbital nerve. J. Neurosci. 1994; 14:2708-2323.

## Claims

1. A method for alleviating and/or treating neuropathic trigeminal pain in a subject in need of such alleviation and/or treatment, the method comprising administering to a subject a compound of Formula (IIb)




wherein
Ar is phenyl which is unsubstituted or substituted with at least one halo group;
R3 is CH2-Q, wherein Q is lower alkoxy containing 1-3 carbon atoms; and
R1 is lower alkyl containing 1-3 carbon atoms, or a pharmaceutically acceptable salt thereof, in a dosage amount of about 50 mg/day to about 1 g/day.

2. The method of claim 1, wherein the subject has neuropathic trigeminal pain and atypical facial pain.

3. The method of claim 1 wherein, in the compound of Formula (IIb), Ar is unsubstituted phenyl.

4. The method of claim 1 wherein, in the compound of Formula (IIb), halo is fluoro.

5. The method of claim 1 wherein, in the compound of Formula (IIb), R3 is CH2-Q, wherein Q is alkoxy containing 1-3 carbon atoms, and Ar is unsubstituted phenyl.

6. The method of claim 1, wherein the compound of Formula (IIb) is (R)-2-acetamido-N-benzyl-3-methoxypropionamide or a pharmaceutically acceptable salt thereof.

7. The method of claim 6 wherein the compound is substantially enantiopure.

8. The method of claim 1, wherein the compound is administered at increasing daily doses until a predetermined daily dose is reached which is maintained during further treatment.

9. The method of claim 1, wherein the compound is administered in no more than three doses per day.

10. The method of claim 6, wherein the compound is administered in an amount resulting in a plasma concentration of the compound of 0.1 to 15 μg/ml (trough) and 5 to 18.5 μg/ml (peak).

11. The method of claim 1, wherein the compound is administered orally or intravenously.

12. The method of claim 1, further comprising administering to the subject a further active agent for alleviation and/or treatment of neuropathic trigeminal pain.

13. The method of claim 12, wherein the compound of Formula (IIb) and the further active agent are administered in a single dose.

14. The method of claim 1, wherein the subject is a mammal.

15. The method of claim 14 wherein the subject is a human.

16. The method of claim 1, wherein the compound of Formula (IIb) or a pharmaceutically acceptable salt thereof is administered in a dosage amount of about 200 mg/day to about 1 g/day.

17. The method of claim 16, wherein the compound of Formula (IIb) or a pharmaceutically acceptable salt thereof is administered in a dosage amount of about 200 mg/day to about 600 mg/day.

18. The method of claim 1, wherein the compound of Formula (IIb) is (R)-2-acetamido-N-benzyl-3-methoxypropionamide in an oral dosage amount of about 50 mg/day to about 600 mg/day.

19. The method of claim 18, wherein the dosage amount is about 200 mg/day to about 600 mg/day.

20. A method for alleviating and/or treating neuropathic trigeminal pain in a subject in need of such alleviation and/or treatment, the method comprising administering to the subject (R)-2-acetamido-N-benzyl-3-methoxypropionamide.