Treatment of ocular hypertension with a synergistic combination for ocular administration

Abstract: A use of an oculo-hypotensively synergistic combination of (a) a 13,14-dihydro-15-keto-20-lowerlakylprostaglandin or a pharamceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof, and (b) a polyoxyethylenesorbitan unsaturated higher aliphatic acid monoester for the manufacture of a medicament useful in treatment of ocular hypertension.

Description: The present invention relates to a treatment of ocular hypertension with a synergistic combination comprising (a) a 13,14-dihydro-15-keto-20-loweralkylprostaglandin compound and (b) a polyoxyethylenesorbitan unsaturated higher aliphatic acid ester. The compounds used as the component (a) in the present invention are prostaglandin analogues which can be obtained synthetically. Prostaglandins (hereinafter, prostaglandins are referred to as PGs) are members of a class of organic carboxylic acid that are contained in human and most other mammalian tissues or organs and that exhibit a wide range of physiological activities. Naturally occurring PGs possess as a common structural feature the prostanoic acid skeleton: Some synthetic analogues have somewhat modified skeletons. The primary PGs are classified based on the structural feature of the five-membered cycle moiety into PGAs, PGBs, PGCs, PGDs, PGEs, PGFs, PGGs, PGHs, PGIs and PGJs, and also on the presence or absence of unsaturation and oxidation in the chain moiety as: Subscript 1 13,14-unsaturated-15-OH Subscript 2 5,6- and 13,14-diunsaturated-15-OH Subscript 3 5,6- 13,14- and 17,18-triunsaturated-15-OH Further, PGFs are sub-classified according to the configuration of hydroxy group at position 9 into α(hydroxy group being in the alpha configuration) and β(hydroxy group being in the beta configuration). The fact that the above compounds under item (a) have ocular hypotensive activity has been known by Japanese Patent Publication No. A-108/1990. The above publication describes, on page 9, column 2, line 3 from bottom, that polysorbates can be used as the diluent for preparing nonaqueous solution or suspension containing the above mentioned compounds. The above description, however, only shows a possibility of using the polysorbates and does not show the fact that the activity of the component (a) is enhanced or side-effect of the same is suppressed. In addition, while compounds called polysorbates include polyoxyethylenesorbitan saturated aliphatic acid esters such as polysorbate 20 (polyoxyethylenesorbitan monolaurate), polysorbate 60 (polyoxyethylenesorbitan monostearate), polysorbate 65 (polyoxyethylenesorbitan tristearate) and polyoxyethylenesorbitan unsaturated aliphatic acid esters such as polysorbate 80 (polyoxyethylenesorbitan monooleate), the above mentioned description does not define that the aliphatic acid moiety in the polysorbates referred to therein is saturated or unsaturated. Therefore, it neither discloses specifically unsaturated esters and nor teaches that the unsaturated esters are superior to the saturated esters. Japanese Patent Publication No. A-313728/1988 describes that a formulation commercialized by Pharmacia contains PGF₂α isopropyl ester and polysorbate 80. However, PGF₂α is a primary PG having a double bond between positions 13 and 14 and a hydroxy group (in α-configuration) at position 15 in the main skeleton of 20 carbon atoms, while 13,14-dihydro-15-keto-20-loweralkyl-PGs, the component (a) are compounds having a saturated bond between positions 13 and 14 and an oxo group at position 15 in place of a hydroxy group, which has been believed to play an important role in the activities of the primary PGs, in the main skeleton of 21 or more carbon atoms by elongation of the omega chain. Therefore, the description shows neither co-use of the component (a) with polysorbate 80 nor enhanced activity or suppressed side-effect by the co-use. As regards polysorbate 80, it has been known that polysorbate 80 inhibits the absorption of an active compound when both are intramusclarly administered (Chem. Pharm. Bull., 24 , 2383-2390). It can be expected from this description that polysorbate 80 inhibits absorption of the component (a) when they are co-administered. Polysorbate 80 also known as an inducing agent of release of histamine (Agents and Actions, 16 , 470-477). It can be expected from this description that polysorbate 80 increases irritation when it is administered with an active agent such as the component (a) in the present invention. In conclusion, while it may be expected that co-administration of the component (a) with polysorbate 80 decreases effect and increases side-effect, there is no grounds for believing that, contrary to the above expectation, the co-administration results in increase of effect and decrease of side-effect. After an extensive study on the possibility that the effect of the component (a) in the present invention is improved by combining it with a variety of compounds, the present inventor has surprisingly discovered that the effect of the component (a) is significantly improved and side-effect is decreased by co-administration with a polyoxyethylenesorbitan unsaturated higher aliphatic acid monoester. Said discovery leads to the present invention. In a first aspect, the present invention provides a use of an oculo-hypotensively synergistic combination of (a) a 13,14-dihydro-15-keto-20-loweralkylprostaglandin or a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof, and (b) a polyoxyethylenesorbitan unsaturated higher aliphatic acid monoester for the manufacture of a medicament useful in treatment of ocular hypertension. The "13,14-dihydro-15-keto-20-loweralkylprostaglandins", used as the component (a) in the present invention and referred to as the component (a), include any prostaglandin derivatives which have a single bond in place of the double bond between positions 13 and 14, an oxo group in place of the hydroxy group at position 15 and a lower alkyl group at position 20 of the prostanoic acid nucleus. Nomenclature of the component (a) herein uses the numbering system of prostanoic acid represented in formula (A) shown above. While formula (A) shows a basic skeleton having twenty carbon atoms, the 13,14-dihydro-15-keto-20-loweralkyl-PG compounds used in the present invention increased in number of carbon atoms. The carbon atoms in Formula (A) are numbered 2 to 7 on the α-chain starting from the α-carbon atom adjacent to the carboxylic carbon atom which is numbered 1 and towards the five-membered ring, 8 to 12 on the said ring starting from the carbon atom on which the α-chain is attached, and 13 to 20 on the ω-chain starting from the carbon atom adjacent to the ring. When the number of carbon atoms is decreased in the α-chain, the number is deleted in order starting from position 2 and when the number of carbon atoms is increased in the α-chain, compounds are named as substituted derivatives having respective substituents at position 1 in place of carboxy group (C-1). Similarly, when the number of carbon atoms is increased in the ω-chain, compounds are named as substituted derivatives having respective substituents at position 20. Stereochemistry of the compounds is the same as that of above formula (A) unless otherwise specified. Thus, 13,14-dihydro-15-keto-PGs having 10 carbon atoms in the ω-chain is nominated as 13,14-dihydro-15-keto-20-ethyl-PGs. The above formula expresses a specific configuration which is the most typical one, and in this specification compounds having such a configuration are expressed without any specific reference to it. In general, PGDs, PGEs and PGFs have a hydroxy group on the carbon atom at position 9 and/or 11 but in the present specification the term "13,14-dihydro-15-keto-20-loweralkyl-PGs" includes PGs having a group other than a hydroxyl group at position 9 and/or 11. Such PGs are referred to as 9-dehydroxy-9-substituted-PGs or 11-dehydroxy-11- substituted-PGs. As stated above, nomenclature of the component (a) is based upon the prostanoic acid. These compounds, however, can also be named according to the IUPAC naming system. For example, 13,14-dihydro-15-keto-20-ethyl-PGE₂ is (Z)-7-{(1R,2R,3R)-3-hydroxy-2-[3-oxo-1-decyl]-5-oxocyclopentyl}-hept-5-enoic acid. 13,14-dihydro-15-keto-20-ethyl-PGF 2α isopropyl ester is isopropyl (Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-{3-oxo-1-decyl)-cyclopentyl]-hept-5-enoate. 13,14-dihydro-15-keto-20-methyl-PGF 2α methyl ester is methyl (Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-{3-oxo-1-nonyl}-cyclopentyl]-hept-5-enonate. Preferred Compounds The component (a) used in the present invention may be any derivatives of PG insofar as they are saturated between positions 13 and 14, have an oxo group at position 15 in place of the hydroxy group and have a lower alkyl group at position 20, and may have no double bond (PG subscript 1 compounds), a double bond between positions 5 and 6 (PG subscript 2 compounds), or two double bonds between positions 5 and 6 as well as positions 17 and 18 (PG subscript 3 compounds). Typical examples of the compounds used in the present invention are 13,14-dihydro-15-keto-20-loweralkyl-PGA₁, 13,14-dihydro-15-keto-20-loweralkyl-PGA₂, 13,14-dihydro-15-keto-20-loweralkyl-PGA₃, 13,14-dihydro-15-keto-20-loweralkyl-PGB₁, 13,14-dihydro-15-keto-20-loweralkyl-PGB₂, 13,14-dihydro-15-keto-20-loweralkyl-PGB₃, 13,14-dihydro-15-keto-20-loweralkyl-PGC₁, 13,14-dihydro-15-keto-20-loweralkyl-PGC₂, 13,14-dihydro-15-keto-20-loweralkyl-PGC₃, 13,14-dihydro-15-keto-20-loweralkyl-PGD₁, 13,14-dihydro-15-keto-20-loweralkyl-PGD₂, 13,14-dihydro-15-keto-20-loweralkyl-PGD₃, 13,14-dihydro-15-keto-20-loweralkyl-PGE₁, 13,14-dihydro-15-keto-20-loweralkyl-PGE₂, 13,14-dihydro-15-keto-20-loweralkyl-PGE₃, 13,14-dihydro-15-keto-20-loweralkyl-PGF₁, 13,14-dihydro-15-keto-20-loweralkyl-PGF₂, 13,14-dihydro-15-keto-20-loweralkyl-PGF₃, wherein PG is as defined above as well as their substitution products or derivatives. Examples of substitution products or derivatives include pharmaceutically or physiologically acceptable salts and esters at the carboxy group at the alpha chain, unsaturated derivatives having a double bond or a triple bond between positions 2 and 3 or positions 5 and 6, respectively, substituted derivatives having substituent(s) on carbon atom(s) at position 3, 5, 6, 16, 17, 19 and/or 20 and compounds having lower alkyl or a hydroxy (lower) alkyl group at position 9 and/or 11 in place of the hydroxy group, of the above PGs. Examples of substituents present in preferred compounds are as follows: Substituents on the carbon atom at position 3, 17 and/or 19 include lower alkyl, for example, C₁₋₄ alkyl, especially methyl and ethyl. Substituents on the carbon atom at position 16 include lower alkyl e.g. methyl or ethyl, hydroxy and halogen atom e.g. chlorine or fluorine, and aryloxy e g. trifluoromethylphenoxy. Substituents on the carbon atom at position 17 include halogen atom e.g. chlorine or fluorine. Substituents on the carbon atom at position 20 include lower alkoxy e.g. C₁₋₄ alkoxy and lower alkoxy (lower) alkyl e.g. C₁₋₄ alkoxy-C₁₋₄ alkyl. Substituents on the carbon atom at position 5 include halogen atom e.g. chlorine or fluorine. Substituents on the carbon atom at position 6 include oxo group forming carbonyl. Stereochemistry of PGs having hydroxy, lower alkyl or lower (hydroxy) alkyl substituent on the carbon atom at position 9 and/or 11 may be alpha, beta or mixtures thereof. 13,14-dihydro-15-keto-20-loweralkyl-PGs compounds are those having a lower alkyl e.g. C₁₋₆ alkyl such as methyl, ethyl, propyl, isopropyl, butyl, hexyl, preferably C₂₋₄ alkyl and most preferably ethyl at position 20. A group of preferred compounds used in the present invention has the formula wherein X and Y are hydrogen, hydroxy, halo, lower alkyl, hydroxy(lower)alkyl, or oxo, with the proviso that at least one of X and Y is a group other than hydrogen, and 5-membered ring may have at least one double bond, A is -COOH or its pharmaceutically acceptable salt or ester, R₁ is bivalent saturated or unsaturated, lower or medium aliphatic hydrocarbon residue which is unsubstituted or substituted with halo, oxo or aryl, R₂ is saturated or unsaturated, medium aliphatic hydrocarbon residue having 6 or more carbon atoms in the main or straight chain moiety which is unsubstituted or substituted with halo, hydroxy, oxo, lower alkoxy, lower alkanoyloxy, cyclo(lower)alkyl, aryl or aryloxy. In the above formula, the term "unsaturated" in the definitions for R₁ and R₂ is intended to include at least one and optionally more than one double bond and/or triple bond isolatedly, separately or serially present between carbon atoms of the main and/or side chains. According to usual nomenclature, an unsaturation between two serial positions is represented by denoting the lower number of said two positions, and an unsaturation between two distal positions is represented by denoting both of the positions. Preferred unsaturation is a double bond at position 2 and a double or triple bond at position 5. The term "lower or medium aliphatic hydrocarbon residue" or "medium aliphatic hydrocarbon residue" refers to a straight or branched chain hydrocarbyl group having 1 to 14 carbon atoms or 6 to 14 carbon atoms, respectively, (for a side chain, 1 to 3 carbon atoms being preferred) and preferably 2 to 8 carbon atoms for R₁ and 6 to 9 carbon atoms for R₂. The term "halo" denotes fluoro, chloro, bromo and iodo. The term "lower" throughout the specification is intended to include a group having 1 to 6 carbon atoms unless otherwise specified. The term "lower alkyl" as a group or a moiety in hydroxy(lower)alkyl, monocyclic aryl(lower) alkyl, monocyclic aroyl(lower)alkyl or halo(lower)alkyl includes saturated and straight or branched chain hydrocarbon radicals containing 1 to 6, carbon atoms, e.g. methyl, ethyl, propyl, isopropyl, butyl, isobutyl, t-butyl, pentyl and hexyl. The term "lower alkoxy" refers to the group lower-alkyl-O- wherein lower alkyl is as defined above. The term "hydroxy(lower)alkyl" refers to lower alkyl as defined above which is substituted with at least one hydroxy group, e.g. hydroxymethyl, 1-hydroxyethyl, 2-hydroxyethyl and 1-methyl-1-hydroxyethyl. The term "lower alkanoyloxy" refers to a group of the formula: RCO-O- wherein RCO- is an acyl group formed by oxidation of a lower alkyl group as defined above, e.g. acetyl. The term "cyclo(lower)alkyl" refers to a cyclic group formed by cyclization of a lower alkyl group as defined above. The term "aryl" includes unsubstituted or substituted aromatic carbocyclic or heterocyclic (preferably monocyclic) groups, e.g. phenyl, tolyl, xylyl and thienyl. Examples of substituents are halo and halo(lower)alkyl wherein halo and lower alkyl being as defined above. The term "aryloxy" refers to a group of the formula: ArO- wherein Ar is aryl as defined above. Suitable "pharmaceutically acceptable salts" includes conventional non-toxic salts, and may be a salt with an inorganic base, for example an alkali metal salt (e.g. sodium salt or potassium salt.) and an alkaline earth metal salt (e.g. calcium salt or magnesium salt.), ammonium salt, a salt with an organic base, for example, an amine salt (e.g. methylamine salt, dimethylamine salt, cyclohexylamine salt, benzylamine salt, piperidine salt, ethylenediamine salt, ethanolamine salt, diethanolamine salt, triethanolamine salt, tris(hydroxymethylamino)ethane salt, monomethyl-monoethanolamine salt or procaine salt, caffeine salt.), a basic amino acid salt (e.g. arginine salt or lysine salt.), tetraalkyl ammonium salt and the like. These salts can be prepared by the conventional process, for example from the corresponding acid and base or by salt interchange. Examples of the "pharmaceutically acceptable esters" are aliphatic esters, for example, lower alkyl ester e.g. methyl ester, ethyl ester, propyl ester, isopropyl ester, butyl ester, isobutyl ester, t-butyl ester, pentyl ester or 1-cyclopropylethyl ester, lower alkenyl ester e.g. vinyl ester or allyl ester, lower alkynyl ester e.g. ethynyl ester or propynl ester, hydroxy(lower) alkyl ester e.g. hydroxyethyl ester, lower alkoxy(lower)-alkyl ester e.g. methoxymethyl ester or 1-methoxyethyl ester, and aromatic esters, for example, optionally substituted aryl ester e.g. phenyl ester, tosyl ester, t-butylphenyl ester, salicyl ester, 3,4-di-methoxyphenyl ester or benzamidophenyl ester, aryl(lower)alkyl ester e.g. benzyl ester, trityl ester or benzhydryl ester. The term "pharmaceutically" is intended to be "ophthalmically" when used in connection with an ophthalmic composition. Preferred examples of A include -COOH, -COOCH₃, -COOCH₂CH₃ and -COOCH(CH₃)₂. The configuration of the ring and the α- and/or omega chain in the above formula (I) may be the same as or different from that in the primary PGs. However, the present invention also includes a mixture of a compound having a primary configuration and that of an unprimary configuration. Examples of the typical compounds of the present invention are 13,14-dihydro-15-keto-20-loweralkyl-PGAs to Fs and their derivatives e.g. , Δ²-derivatives, 3R,S-methyl-derivatives, 6-oxo-derivatives, 5R,S-fluoro-derivatives, 5,5-difluoro-derivatives, 16R,S-methyl-derivatives, 16,16-dimethyl-derivatives, 16R,S-fluoro-derivatives, 16,16-difluoro-derivatives, 17S-methyl-derivatives, 17R,S-fluoro-derivatives, 17,17-difluoro-derivatives and 19-methyl-derivatives. The component (a) may be in the keto-hemiacetal equilibrium by forming a hemiacetal between hydroxy group at position 11 and ketone at position 15. The proportion of both tautomeric isomers, when present, varies depending on the structure of the rest of the molecule or kind of any substituent present and, sometimes, one isomer may predominantly be present in comparison with the other. However, in this invention, it is to be appreciated that the compounds used in the invention include both isomers. Further, while the compounds used in the invention may be represented by a structure or name based on keto-form regardless of the presence or absence of the isomers, it is to be noted that such structure or name does not intend elimination of the hemiacetal type of compounds. In the present invention, any of the individual tautomeric isomers, a mixture thereof, or optical isomers, a mixture thereof, a racemic mixture, and other isomers such as steric isomers can be used in the same purpose. Some of the compounds used in the present invention may be prepared by the method disclosed in Japanese Patent Publications (unexamined) No. A-108/1990. Alternatively, these compounds may be prepared by a process analogous to that described in the above publications in combination with the known synthetic method for the five-membered ring moiety. In the process for preparing 13,14-dihydro-15-keto-compound: A commercially available (-)-Corey lactone, which is used as a starting material, is subjected to Collins oxidation to give an aldehyde. The aldehyde is allowed to react with dimethyl (2-oxoalkyl)phosphonate anion to give an α,β-unsaturated ketone, and the resultant is reduced to ketone. The carbonyl group of the ketone is allowed to react with a diol to give a ketal, thereby protected, then a corresponding alcohol is obtained by elimination of the phenylbenzoyl group, and the resulting hydroxy group is protected with dihydropyran to give a tetrapyranyl ether. Thus, precursors of PGs wherein the ω-chain is 13,14-dihydro-15-keto-alkyl can be obtained. Using the above tetrapyranyl ether as a starting material, 6-keto-PG₁s of the formula: may be obtained as follows: The tetrapyranyl ether is reduced using diisobutyl aluminium hydride to give a lactol, which is allowed to react with a ylide obtained from (4-carboxybutyl)triphenylphosphonium bromide, and the resultant is subjected to esterification followed by cyclization, combining the 5,6-double bond and the C-9 hydroxyl group with NBS or iodine, providing a halide. The resultant is subjected to dehydrohalogenation with DBU to give a 6-keto compound, which is subjected to Jones oxidation followed by deprotection to give the objective compound. Further, PG₂s of the formula: may be obtained as follows: The above tetrapyranyl ether is reduced to the lactol, which is allowed to react with a ylide obtained from (4-carboxybutyl)triphenylphosphonium bromide to give a carboxylic acid. The resultant is subjected to esterification followed by Jones oxidation and deprotection to give the objective compound. In order to obtain PG₁s of the formula: using the above tetrapyranyl ether as a starting material, in the same manner as PG₂ of the formula: the 5,6-double bond of the resulting compound is subjected to catalytic reduction followed by deprotection. To prepare 5,6-dehydro-PG₂s containing a hydrocarbon chain of the formula: a monoalkyl copper complex or a dialkyl copper complex of the formula: is subjected to 1,4-addition with 4R-t-butyldimethylsilyloxy-2-cyclopenten-1-one, and the resulting copper enolate is seized with 6-carboalkoxy-1-iodo-2-hexyne or a derivative thereof. PGs containing a methyl group instead of a hydroxy group at the C-11 position may be obtained as follows: PGA obtained by Jones oxidation of the hydroxy group at the C-9 position of the 11-tosylate is allowed to react with a dimethyl copper complex to give 11-dehydroxy-11-methyl-PGE. Alternatively, an alcohol obtained after elimination of p-phenylbenzoyl group is converted to a tosylate. An unsaturated lactone obtained by DBU treatment of the tosylate is converted to a lactol. After introduction of an α -chain using Wittig reaction, the resulting alcohol (C-9 position) is oxidized to give PGA. PGA is allowed to react with dimethyl copper complex to give 11-dehydroxy-11-methyl-PGE. The resultant is reduced using sodium borohydride and the like to give 11-dehydroxy-11-methyl-PGF. PGs containing a hydroxymethyl group instead of a hydroxyl group at the C-11 position is obtained as follow: 11-dehydroxy-11-hydroxymethyl-PGE is obtained by a benzophenone-sensitized photoaddition of methanol to PGA. The resultant is, for example, reduced using sodium borohydride to give 11-dehydroxy-11-hydroxymethyl-PGF. 16-Fluoro-PGs may be obtained using dimethyl (3-fluoro-2-oxoalkyl)phosphonate anion in the preparation of an α ,β-unsaturated ketone. Similarly, 19-methyl-PGs may be obtained using a dimethyl (6-methyl-2-oxoalkyl)phosphonate anion. The preparations in the present invention are not construed to be limited to them, and suitable means for protection, oxidation, reduction and the like may be employed. The polyoxyethylenesorbitan unsaturated higher aliphatic acid monoesters used as the component (b) in the present invention are higher aliphatic acid monoesters of sorbitan pre-reacted with ordinarily 15 to 25 moles and preferably 20 moles of ethyleneoxide, and may contain a small amount of di- or tri-esters. The unsaturated higher aliphatic acid includes those having 10 to 24 and preferably 14 to 20 carbon atoms. Preferred examples are myristoleic acid, palmitoleic acid, oleic acid, gadoleic acid and linoleic acid. Polyoxyethylene (20) sorbitan monooleate is also known as polysorbate 80 and commercialized under names of Sorlate®, Tween® 80, Monitan®, Olothorb®, etc. Since the component (a) has an activity of lowering ocular pressure without accompanying transient ocular hypertension as shown by the primary PGs, the combination of (a) and (b) can be used for the manufacture of a medicament for the treatment of various disease and conditions in which lowering of ocular pressure is desirous, for example glaucoma, ocular hypertension and other disease which accompanies increase in ocular pressure. As used herein, the term "treatment" or "treating" refers to any means of control of a disease in a mammal, including preventing the disease, curing the disease, relieving the disease and arresting or relieving the development of the disease. The combination has an advantage, by containing the component (b) in addition to the component (a), that it has a synergistically increased ocular hypotensive action, thus enabling reduce in dosage, and/or lowering the side-effect. The ratio (a):(b) in the combination varies, without limitation, ordinarily within the range 1:1 to 1:500, preferably 1:3 to 1:200 and most preferably 1:5 to 1:100. While the dosage of the component (a) varies depending on condition of the component(a) varies depending on condition of the patient, severity of the disease, purpose of the treatment, judgement of the physician and total dosage of the combination, it is ordinarily within the range 0.005 to 2% and preferably 0.01 to 1% by weight. The dosage of the component (b) varies, for example, depending on the concentration of the component (a) and ordinarily within the range 0.005 to 20% and preferably 0.01 to 10% by weight. Components (a) and (b) may be administered simultaneously or sequentially. The combination according to the present invention can be administered in the form of a pharmaceutical composition containing the components (a) and (b) and optionally other ingredients conveniently used in the ophthalmic composition, such as carrier, diluent or excipient. The ophthalmic composition used according to the invention includes liquids such as ophthalmic solution, emulsion, dispersion etc. and semisolids such as ophthalmic gel, ointment etc. Diluents for the aqueous solution or suspension include, for example, distilled water and physiological saline. Diluents for the nonaqueous solution and suspension include, for example, vegetable oils e.g. olive oil, liquid paraffin, mineral oil, and propylene glycol and p-octyldodecanol. The composition may also contain isotonization agents such as sodium chloride, boric acid, sodium citrate, etc. to make isotonic with the lacrimal fluid and buffering agents such as borate buffer, phosphate buffer, etc. to maintain pH about 5.0 to 8.0. Further, stabilizers such as sodium sulfite, propylene glycol, etc., chelating agents such as sodium edetate, etc., thickeners such as glycerol, carboxymethylcellulose, carboxyvinyl polymer, etc. and preservatives such as methyl paraben, propyl paraben, etc. may also be added. these can be sterilized e.g. by passing through a bacterial filter or by heating. The ophthalmic ointment may contain vaseline, Plastibase® or Macrogol as a base and surfactant for increasing hydrophilicity. It may also contain geling agents such as carboxymethylcellulose, methylcellulose, methylcellulose or carboxyvinyl polymer. In addition, the composition may contain antibiotics such as chloramphenicol or penicillin in order to prevent or treat bacterial infection. A more complete understanding of the present invention can be obtained by reference to the following Preparation Examples, Formulation Examples and Test Examples which are provided herein. Preparations Preparations of 13,14-dihydro-15-keto-20-ethyl-PGA₂ isopropyl ester, 13,14-dihydro-15-keto-20-ethyl-PGE₂ isopropyl ester and 13,14-dihydro-15-keto-20-ethyl-PGF₂α isopropyl ester (cf. Preparation chart I): 1) Preparation of 1S-2-oxa-3-oxo-6R-(3-oxo-1-trans-decenyl)-7R-(4-phenylbenzoyloxy)-cis-bicyclo[3.3.0]-octane (3): Commercially available (-)-Corey lactone (1) (7 g) was subjected to Collins oxidation in dichloromethane to give aldehyde (2). The resultant was allowed to react with dimethyl (2-oxononyl)phosphonate (4.97 g) anion to give 1S-2-oxa-3-oxo-6R-(3,3-ethylendioxy-1-trans-decenyl)-7R-(4-phenylbenzoyloxy)-cis-bicyclo[3.3.0]-octane (3). 2) Preparation of 1S-2-oxa-3-oxo-6R-(3-oxodecyl)-7R-(4-phenylbenzoyloxy)-cis-bicyclo[3.3.0]-octane (4): Unsaturated ketone (3) (7.80 g) was reduced in ethyl acetate (170 ml) using 5% Pd/C under hydrogen atmosphere. The product obtained after the usual work-up (4) was used in the following reaction. 3) Preparation of 1S-2-oxa-3-oxo-6R-(3,3-ethylenedioxy-decyl)-7R-(4-phenylbenzoyloxy)-cis-bicyclo[3.3.0]-octane (5): Saturated ketone (4) was converted to ketal (5) in dry benzene (150 ml) using ethylene glycol and p-toluenesulfonic acid (catalytic amount). 4) Preparation of 1S-2-oxa-3-oxo-6R-(3,3-ethylenedioxy-decyl)-7R-hydroxy-cis-bicyclo[3.3.0]-octane (6): To a solution of ketal (5) in absolute methanol (150 ml) was added potassium carbonate (2.73 g). The mixture was stirred overnight at room temperature. After neutralization with acetic acid, the resultant was concentrated under reduced pressure. The resulting crude product was extracted with ethyl acetate. The organic layer was washed with a dilute aqueous solution of sodium bicarbonate and a saline, and dried. The crude product obtained after evapolation was chromatographed to give alcohol (6). Yield; 3.31 g 5) Preparation of lactol (7): Alcohol (6) (0.80 g) was reduced in dry toluene (8 ml) using DIBAL-H at -78 °C to give lactol (7). 6) Preparation of 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-PGF₂α (8): A DMSO solution of lactol (7) was added to ylide prepared from (4-carboxybutyl)triphenylphosphonium bromide (3.65 g). The reaction mixture was stirred overnight to give carboxylic acid (8). 7) Preparation of 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-PGF₂α isopropyl ester (9): Carboxylic acid (8) was converted to 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-PGF₂α isopropyl ester (9) using DBU and isopropyl iodide in acetonitrile. Yield; 0.71 g 8) Preparation of 13,14-dihydro-15-keto-20-ethyl-PGF₂α isopropyl ester (10): 13,14-Dihydro-15,15-ethylenedioxy-20-ethyl-PGF₂α isopropyl ester (9) (0.71 g) was kept in acetic acid/THF/water (3/1/1) at 40 °C for 3 hours. The crude product obtained after concentration under reduced pressure was chromatographed to give 13,14-dihydro-15-keto-20-ethyl-PGF₂α isopropyl ester (10). Yield; 0.554 g 9) Preparation of 13,14-dihydro-15-keto-20-ethyl-PGA₂ isopropyl ester (12): A solution of 13,14-dihydro-15-keto-20-ethyl-PGF₂α isopropyl ester (10) (0.125 g) and p-toluenesulfonyl chloride (0.112 g) in pyridine (5 ml) was maintained at 0 °C for 2 days. According to the usual work-up, tosylate (11) was obtained. Tosylate (11) was subjected to Jones oxidation in acetone (8 ml) at -25 °C. The crude product obtained after the usual work-up was chromatographed to give 13,14-dihydro-15-keto-20-ethyl-PGA₂α isopropyl ester (2). Yield; 0.060 g 10) Preparation of 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-11-t-butyldimethylsiloxy-PGF₂α isopropyl ester (13): 13,14-Dihydro-15,15-ethylenedioxy-20-ethyl-PGF₂α isopropyl ester (9) (3.051 g) was dissolved in dry N,N-dimethylformamide (25 ml), t-butyldimethylsilyl chloride (1.088 g) and imidazole (0.49 g) was added thereto. The resultant was stirred at room temperature overnight. The reaction mixture was concentrated under reduced pressure, and the resulting crude product was chromatographed to give 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-11-t-butyldimethylsiloxy-PGF₂α isopropyl ester (13). Yield; 2.641 g 11) Preparation of 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-11-t-butyldimethylsiloxy-PGE₂ isopropyl ester (14): 13,14-Dihydro-15,15-ethylenedioxy-20-ethyl-11-t-butyldimethylsiloxy-PGF₂α isopropyl ester (13) (1.257 g) was subjected to Jones oxidation at -40 °C. After the usual work-up, the resulting crude product was chromatographed to give 13,14-dihydro-15,15-ethylenedioxy-20-ethyl-11-t-butyldimethylsiloxy-PGE₂ isopropyl ester (14). Yield; 1.082 g 12) Preparation of 13,14-dihydro-15-keto-20-ethyl-PGE₂ isopropyl ester (15): To a solution of 13,14-dihydro-15,15-ethylene-dioxy-20-ethyl-11-t-butyldimethylsiloxy-PGE₂ isopropyl ester (14) in acetonitrile was added hydrofluoric acid (46% aqueous solution). The mixture was stirred at room temperature for 40 minutes. The crude products obtained after usual work-up was chromatographed to give 13,14-dihydro-15-keto-20-ethyl-PGE₂ isopropyl ester (15). Yield; 0.063 g (97 %) Test Example 1 Japanese white rabbits (weight: 2.5-3.5 kg, 4-9 animals/group) were fixed and eyes were anesthetized by dropping 0.4% oxybuprocaine hydrochloride to eyes. The ocular pressure measured at 0.5-1 hour after the fixation was taken as the 0 hour value and values of pressure thereafter were measured in the course of time administering by eye-dropping each 50µl of the following formulations. An electronic pneumatonometer (Alcon) was used for measurement. Maximum decrease in ocular pressure (mean value) of each of the formulations was compared in the Table 1. Formulation Example 1 (Comparative) Methyl (Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]-hept-5-noate [13,14-dihydro-15-keto-20-ethyl-PGF₂α methyl ester, hereinafter referred to as Compound A] 0.05 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 2 (Comparative) Compound A 0.05 g Methyl cellulose 0.1 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 3 (Comparative) Compound A 0.05 g Glycerol 2.6 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 4 (Comparative) Compound A 0.05 g 2-phenylethanol 0.4 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 5 (inventive) Compound A 0.05 g Polysorbate 80 0.4 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Maximum decrease in ocular pressure (mmHg) Formulation 1 (n=9) -6.3 Formulation 2 (n=4) -4.3 Formulation 3 (n=4) -6.6 Formulation 4 (n=4) -4.5 Formulation 5 (n=5) -8.5 Test Example 2 Japanese white rabbits (weight: 2.5-3.5 kg, 6 animals/group) were fixed and eyes were anesthetized by dropping 0.4% oxybuprocaine hydrochloride to eyes. The ocular pressure measured at 0.5-1 hour after the fixation was taken as the 0 hour value and values of pressure thereafter were measured in the course of time administering by eye-dropping each 50µl of the following formulations. An electronic pneumatonometer (Alcon) was used for measurement. Maximum decrease in ocular pressure (mean value) of each of the formulations was compared in the Table 2. In addition, simultaneously with the measurement of ocular pressure, presence or absence of side-effects such as bloodshot were observed and, if any, evaluated on the basis of the scoring system shown in the Table infra. The maximum side-effect scores (mean) for each of the Formulation Examples are shown below. Formulation Example 6 (Comparative) Isopropyl (Z)-7-[(1R,2R,3R,5S)-3,5-dihydroxy-2-(3-oxodecyl)cyclopentyl]-hept-5-enoic acid [13,14-dihydro-15-keto-20-ethyl-PGF₂α isopropyl ester hereinafter referred to as Compound B] 0.05 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 7 (Inventive) Compound B 0.05 g Polysorbate 80 0.4 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 8 (Inventive) Compound B 0.05 g Polysorbate 80 1.0 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 9 (Inventive) Compound B 0.05 g Polysorbate 80 2.0 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml Formulation Example 10 (Inventive) Compound B 0.05 g Polysorbate 80 5.0 g Sodium chloride 0.8 g Sterilized water q.s. to 100 ml The above results show that the co-administration of the component (b) increased synergistically the activity and decreased the side-effects of the component (a).

Claims: A use of an oculo-hypotensively synergistic combination of (a) a 13,14-dihydro-15-keto-20-C₁ to C₆ lahylprostaglandin or a pharmceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof, and (b) a polyoxyethylenesorbitan unsaturated C₁₀ to C₂₄ aliphatic acid monoester for the manufacture of a medicament useful in treatment of ocular hypertension. The use according to Claim 1, in which the component (a) is a 13,14-dihydro-15-keto-20-C₁ to C₆ alkylprostaglandin A, B, C, D, E or F, or a pharmaceutically acceptable salt thereof, or a pharmaceutically acceptable ester thereof. The use according to Claim 1, in which the component (a) is a 13,14-dihydro-15-keto-20-ethylprostaglandin A, B, C, D, E or F, or a pharmaceutically acceptable salt thereof, or a C₁ to C₆ alkyl ester thereof. The use according to Claim 1, in which the component (a) is a 13,14-dihydro-15-keto-20-C₁ to C₆ alkylprostaglandin F₂α or a pharmaceutically acceptable salt thereof, or a C₁ to C₆ alkyl ester thereof. The use according to Claim 1, in which the component (a) is a 13,14-dihydro-15-keto-20-ethylprostaglandin F₂α, or a pharmaceutically acceptable salt thereof, or a C₁ to C₆ alkyl ester thereof. The use according to Claim 1, in which the component (b) is polyoxyethylenesorbitan monooleate. The use according to Claim 1, in which the medicament is in a form suitable for administration of components (a) and (b) in the ratio (a):(b) of 1:1 to 1:500. The use according to Claim 1, in which the medicament is in a form suitable for administration of components (a) and (b) simultaneously. The use according to Claim 1, in which the medicament is in a form suitable for administration of components (a) and (b) sequentially.

Inventors: UENO RYUJI, UENO, RYUJI
Applicants: R TECH UENO LTD, R-TECH UENO, LTD.
Application year: 1991
Main classification: A61K31
IPC codes: A61K31, A61K9, A61K47, A61P9, A61P27