Patent Publication Number: US-2013253027-A1

Title: Dosages of arylsulfonamide derivatives

Description:
Arylsufonamides are known for example from WO 03/106428, where compounds of formula (I) 
     
       
         
         
             
             
         
       
     
     as well as their salts are disclosed, in which: 
     R 1  represents an aromatic ring that is non-substituted or substituted by one or more atoms or groups of atoms chosen from among the halogens, C 1 -C 3  alkyl groups, C 1 -C 3  alcoxy groups, nitro, cyano, trifluoromethyl or trifluoromethoxy groups, 
     R 2  represents a hydrogen atom, or a straight, branched or cyclic hydrocarbon chain having 1 to 4 carbon atoms optionally substituted by a phenyl group, by a CONH 2  group or by one or more fluorine atoms, 
     R 3  represents a hydrogen atom, a hydroxy group, or with R 4  forms a —CH═N— group or a straight or branched C 2 -C 4  alkylene group, 
     R 4  represents a hydrogen atom or with R 3  forms a —CH═N— group or a straight or branched C 2 -C 4  alkylene group, 
     R 5  represents a hydrogen atom or a C 1 -C 3  alkyl group, 
     R 6  represents a hydrogen atom or a halogen, 
     Y represents a C 2 -C 4  alkylene group, saturated or unsaturated, straight or branched, optionally interrupted between two carbon atoms by an oxygen atom. 
     By aromatic system is meant a phenyl system, a 1- or 2-naphthyl system or a 2- or 3-thienyl system. 
     The content of WO 03/106428 is hereby incorporated by reference. 
     These compounds are described to be useful in the treatment of various forms of pain such as inflammatory hyperalgesia, allodynia, neuropathic pain associated for example with diabetes, neuropathy (constriction of sciatic nerve, lumbago), any form of trauma, surgery (tooth extraction, tonsil removal), interstitial cystitis, inflammatory bowel disease and cancer. 
     They are also described to be useful in the treatment of any pathology associated with neutrophil migration, such as acute respiratory distress syndrome, psoriasis, chronic lung obstruction, inflammatory bowel diseases, and rheumatoid arthritis. 
     The compounds, on account of their mode of action, also find use in the treatment or prevention of any pathological condition in which the B1 receptors of bradykinin are involved and in particular are over-expressed. 
     In addition to the various forms of pain and inflammatory diseases already cited, the compounds of formula (I) may, according to the disclosure of WO03/106428, be used to treat certain respiratory problems such as asthma, bronchitis, pleurisy or rhinitis of allergic and viral origin, certain forms of diabetes, certain skin diseases such as dermatitis, eczema, psoriasis, eye diseases such as glaucoma and retinitis, Alzheimer&#39;s disease, septic shock, trauma, especially involving the skull, some cancers, in particular by slowing or inhibiting the proliferation of cancer cells and more particularly cancer of the prostate. 
     It is further indicated that the compounds of formula (I) are used in a dosage dependent upon the mode of administration and the type of pathology, generally between 0.05 and 10 mg/kg of the treated patient. 
     It has been found according to the present invention that not all bradykinin B1 receptor antagonists are useful in the prevention, treatment and/ or reduction of macular oedema. It has now been found that compounds of formula (I) cited above as well as their pharmaceutically acceptable salts are useful in the prevention, treatment and/ or reduction of macular oedema, in particular macular oedema caused by or associated with diabetic retinopathy, and in particular that the dosage required to prevent, treat or reduce said macular oedema is far below what was indicated in the prior art. Indeed, the effective dose of compounds of formula (I) useful for the prevention, treatment or reduction of macular oedema, in particular caused by or associated with diabetic retinopathy is comprised between 0.004 and 0.03 mg/kg of patient/day. 
     This will be further exemplified by  FIG. 1 , summarizing the effect of the arylsulfonamide compound n° 49 given as eye drop on retinal vascular permeability in streptozotocin-induced diabetic Brown-Norway (A) and Wistar rats (B) 
     Diabetic retinopathy is a major complication that affects between 18% and 45% of diabetic patients, a population which is continuously expending worldwide. The number of Americans 40 years or older with diabetic retinopathy and vision-threatening diabetic retinopathy will triple in 2050, from 5.5 million in 2005 to 16.0 million diabetic retinopathy and from 1.2 million in 2005 to 3.4 million for vision-threatening diabetic retinopathy. Increase among those 65 years or older will be more pronounced (2.5 million to 9.9 million for diabetic retinopathy and 0.5 million to 1.9 million for vision-threatening diabetic retinopathy. Moreover incidence of diabetic macular edema over a 10-year period ranges from 20 to 40% among patients diagnosed before and after the age of 30. In this respect, this is the leading cause of blindness in working-age population in the United States. Incidence of diabetic retinopathy varies according to the race, type of diabetes, age and arterial blood pressure status. The prevalence of proliferative retinopathy, macular oedema and vision-threatening retinopathy is in the range of 2-5%, 5-7% and 6-8%, respectively. At early stages, diabetic retinopathy is characterized by ischemic areas of acellular capillaries, and as diabetes progresses over the time, retinal vascular leakage, vascular sprouting, angiogenesis and hemorrhage occur ultimately leading to loss of vision. In diabetic patients, there is a relationship between vision loss and clinically significant macular oedema, defined as vascular plasma leakage leading to fluid accumulation and the deposition of hard exudates within the center of the macula. 
     As will be further understood from the specification, the compounds of formula (I) have been shown to be particularly efficient to treat macular oedema. 
     In the context of the present specification, the term “macular oedema” has to be understood independently of the underlying disease causing it, and as being associated with any form of retinopathy. It for example includes macular oedema associated with or caused by diabetic retinopathy, age related macular degeneration, retinitis pigmentosa, ocular surgery, retinal vein occlusion (either central vein occlusion or branch vein occlusion, or both). Other examples of macular oedema are associated with or caused by vision threatening retinopathy, proliferative retinopathy, clinically significant macular oedema, or chronic macular edema during diabetic retinopathy, as well as any other stage of what is usually understood as being a diabetic retinopathy. 
     The compounds of the present invention are compounds of formula (I) as defined above, as well as their pharmaceutically acceptable salts. 
     All compounds can be made according to the processes described in WO 03/106428. 
     The pharmaceutically acceptable salts of the compounds of interest mentioned above under formula (I) may be chosen from sulfate, hemi-sulfate, fumarate, maleate, tartrate, citrate, lactate, succinate, benzoate, camsylate, acetate, phosphate, chlorure, bromure, aspartate or pamoate, for example. 
     Compounds of formula (I) are considered as being particularly useful in the prevention, treatment and/ or reduction of macular oedema, in particular macular oedema associated with or caused by diabetic retinopathy. It is for example the case of compound N[[4-(4,5-dihydro-1Himidazol-2yl)phenyl]methyl]-2-[ 2 -[-(4-methoxy-2,6-dimethylphenyl)sulfonyl]methylamino]ethoxy]-N-methyl-acetamide or its salts, such as its phosphate, sulphate, or hemisulfate salts. This compound is exemplified as compound n° 49 of WO 03/106428 and its structural formula is: 
     
       
         
         
             
             
         
       
     
     It is referred to in the present specification as “compound n° 49”. 
    
    
     EXAMPLE 1 
     Effect Of Arylsulfonamide Compounds Of Formula (I) On Macular Oedema 
     The effect of the arylsulfonamide compounds of formula (I) on macular oedema, and in particular on macular oedema associated with or caused by diabetic retinopathy diabetic retinopathy have been investigated as explained below. 
     Administration of streptozotocin to rodents produces a massive destruction of pancreatic β-cells, and thus, triggers marked elevation of glycemia and development of a diabetic state which, in part, mimics early stages of type 1 diabetes. In this regard, streptozotocin-treated rats develop an inflammatory retinopathy featured by rupture of the blood-retinal barrier, increase of inflammatory mediators, cytokines and growth factors (VEGF, basic fibroblast growth factor), microglial cell activation and leukostasis. 
     Compound n° 49 (fumarate and phosphate salts) was given as eye drop for 7 days to streptozotocin-diabetic pigmented Brown-Norway and non-pigmented Wistar rats and its effect on retinal edema was then determined. 
     Male Brown-Norway or Wistar rats were made diabetic by subcutaneous injection of 65 mg/kg intraperitoneal streptozotocin. Rats with a glycemia&lt;350 mg/dl were discarded from the study. Seven days later, Brown-Norway rats were treated twice daily for 7 days with a single eye drop (10 μl) containing 0.1, 0.3, 1 and 3% phosphate salt of compound n° 49 or its vehicle (Saline Solution). Wistar rats were treated over the same period (from day 7 for 7 days) with a single eye drop (10 μl) containing 0.3 and 1% fumarate salt of compound n° 49 or its vehicle (Saline Solution). On day 15, retinal vascular leakage was determined by measurement of retinal content of Evans Blue dye. 
     As shown in  FIG. 1  retinal vascular permeability was significantly increased in diabetic Brown-Norway and Wistar rats compared to control normoglycemic rats. In diabetic Brown-Norway and Wistar rats, compound n° 49 did not affect glycemia. In diabetic Brown-Norway rats, the phosphate salt of compound n° 49 reduced in dose-dependent manner retinal oedema with a maximum of 55%. In two separate preliminary studies, 1% compound n° 49 eye drops reduced retinal edema with a maximum of 58% and 63% (data not shown). In diabetic Wistar rats, both 0.3 and 1% compound n° 49 fumarate salt abolished retinal vascular permeability ( FIG. 1 ). These data show that in two different rat strains made diabetic with streptozotocin, compound n° 49 markedly reduced rupture of the blood retinal barrier. 
       FIG. 1  shows the effect of compound n° 49 given as eye drop on retinal vascular permeability in streptozotocin-induced diabetic Brown-Norway (A) and Wistar rats (B). More specifically,  FIG. 1A  is the dose-response of compound n° 49 instilled twice a day for 7 days as eye drops (0.1 to 3%) on retinal vascular leakage in streptozotocin-diabetic Brown-Norway rats. Recombinant tissue kallikrein binding protein (rKBP) was used as a reference drug and was given intravitreally 48 hours before vascular leakage measurement. Values are means ±standard error mean of 12 eyes/group (6 rats). *** means that P&lt;0.001 in a Student&#39;s t-test. 
       FIG. 1B  shows the effect of compound n° 49 instilled twice a day for 7 days as eye drops (0.3 and 1%) on retinal vascular leakage in streptozotocin-diabetic Wistar rats. Values are means±standard error mean of 6 to 11 eyes/group. **means P&lt;0.01; *** means P&lt;0.001 in a one-way ANOVA followed by a Student&#39;s t-test. 
     The route by which the phosphate salt of compound n° 49 reaches the retina following topical instillation was investigated to determine whether it is mainly by systemic circulation or by the trans- and/or peri-ocular pathway. Diabetic Brown-Norway rats were treated with 3% compound n° 49 phosphate in a single eye for 7 days or subcutaneously with matching daily dosage (0.6 mg/rat). In eyes treated with compound n° 49, retinal vascular permeability was significantly reduced by 37% (P&lt;0.001) whilst the contralateral eye remained unaffected. In addition, a daily subcutaneous administration of 0.6 mg compound n° 49 phosphate rat had no effect on retinal vascular permeability. These data indicate that compound n° 49 phosphate upon topical administration likely reached retinal vasculature through trans-corneal and scleral/choroidal circulation with no or minimal contribution of systemic redistribution. 
     In order to explore molecular pathways involved into reduction of retinal vascular permeability by compound n° 49 phosphate in diabetic rats, expression of mRNA of cytokines, vasoactive mediators and growth factors was quantified in retina of control and diabetic Wistar rats treated or not with 1% compound n° 49 phosphate eye drops for 7 days. Expression of mRNA of B 1 R, B 2 R, i-NOS, e-NOS, COX-2, ICAM-1, VEGF-R2, VEGF-a, IL-1β and HIF-1α was increased in diabetic rat retina compared to control by 7.5-fold (P&lt;0.05), 5.5, 15- (P&lt;0.01), 6.5- , 8- (P&lt;0.05), 8- , 5- (P&lt;0.05), 12-, 6.5- (P&lt;0.01) and 7-fold (P&lt;0.05), respectively. Expression of TNF-α mRNA remained unchanged. After 7 days treatment with 1% Compound n° 49 eye drops, mRNA expression of B 1 R, B 2 R, i-NOS, e-NOS, COX-2, ICAM-1, VEGF-A, IL-1α and HIF-1α was down-regulated to control level whilst expression of VEGF-A was reduced by 50%. In accordance with the literature (Gardner and Antonetti, 2008), these data show that the retina of diabetic rats displays inflammatory features. Interestingly, compound n° 49 phosphate blunted the retinal inflammatory response associated with the development of diabetes without affecting glycemia. 
     The effect of compound n° 49 phosphate on leukocyte adhesion to the retinal vasculature of streptozotocin-diabetic Wistar rats was also investigated using the same protocol of administration of compound n° 49 phosphate (1% eye drop twice-a-day for 7 days). The number of leukocytes in retinal vessels of diabetic rats was significantly increased compared to control non-diabetic animals (P&lt;0.05). Following treatment with compound n° 49 phosphate, leukostasis in diabetic rats was significantly blunted (P&lt;0.05). These findings are consistent with a reduction of ICAM-1 expression by compound n°49 phosphate, since ICAM-1 has been shown to play a key role in leukocyte adhesion. 
     Further, an ocular distribution study in albino and pigmented rabbits has been performed. The distribution of radioactivity in ocular tissues and plasma was investigated following a single ocular administration of 30 μl of a 2% (base equivalent)  14 C-compound n° 49 formulation to albino (right eye only) and compared with pigmented rabbits (both eyes). 
     Different pharmacokinetics profiles were obtained in tissues. Specifically:
         Longer t½ for pigmented rabbit in vitreous, retina and choroids (at least 2-fold higher than in albino)   Higher area under the curve (AUC) 0-48 for pigmented rabbit in aqueous, retina, choroids, whole blood and plasma (at least 2-fold higher than in albino)   Lower C max  for pigmented rabbit (at least 2-fold lower than in albino)       

     These values are related to the compound pigment fixation in retina and choroids. 
     Similar pharmacokinetic profiles were found in plasma with:
         a Cmax of 88 ng/mL   a Tmax between 15 and 30 minutes   a t½ of approximately 20 hours.       

     When administering compound n°49 to the right eye of albino rabbits, a low concentration was detected in the left eye for aqueous humour and retina, indicating a slight movement of drug. 
     Compounds of formula (I) for the prevention, treatment and/ or reduction of macular oedema, in particular associated with or caused by diabetic retinopathy, such as amongst others compound n°49, are usually topically administered to humans via a sterile eye drop solution. The doses range from one drop (the volume of one drop being approximately 30 μL) of a 1% solution once daily, up to two drops of a 2% solution, twice daily. Based on the assumption of a 70 kg patient, the doses vary between 0.004 mg/kg of patient/day (1 drop daily of a 1% solution in one eye only) and 0.03 mg/kg of patient/day (2 drops twice a day of a 2% solution in both eyes). 
     Compound of formula (I) for the prevention, treatment and/ or reduction of macular oedema, such as for example compound n° 49, can be given once a day, for example in the morning, or 12 hours apart for the twice daily administration (morning and evening). 
     Examples of doses of compound of formula (I) or one of its pharmaceutically acceptable salts, for the prevention, treatment and/ or reduction of macular oedema, in particular associated with or caused by diabetic retinopathy, are:
         1% solutions once or twice a day in one eye or both eyes, or   2% solutions once or twice a day in one eye or both eyes, amongst others.       

     Besides, it has been shown that compound n°49 administered under phosphate salt form has an equivalent activity to the fumarate salt. 
     EXAMPLE 2 
     Comparison Of The Effect Of An Arylsulfonamide Compound Of Formula (I) Versus Another Bradykinin B1 Receptor Antagonist 
     Experimental Protocol 
     In order to induce diabetes, adult Brown-Norway rats (8-12 weeks of age) were given a single intraperitoneal injection of freshly made streptozotocin (STZ) (50 mg/kg of body weight in 10 mmol/L of citrate buffer, pH 4.5). Serum glucose level was examined 2 days after the STZ injection and weekly thereafter. Only the animals with blood glucose levels higher than 350 mg/dL were used as diabetic rats. 
     Non-diabetic rats (6-8 rats) were used as positive control group without the treatment with STZ or compound n°49 or B (Control group in  FIG. 2 ). 
     Eight (8) days after the onset of diabetes (i.e. on Day 8), the diabetic rats were separated into groups, with 6-8 rats per group (12-16 eye): 
     The treatments were as follows: 
     From Day 8 to Day 14, animals were treated daily with 10 μl ocular instillation in both eyes of 1% of Compound n°49 (solubilised in physiologic serum (0.9% NaCl) as fumarate salt—“Cpd 49” group), 1% of Compound B (solubilised in physiologic serum (0.9% NaCl) as dichlorhydrate salt—“Cpd B” group), or corresponding saline vehicle (“Diab” group, i.e. physiologic serum (0.9% NaCl)). In two experiments, a group of diabetic rats were treated by intravitreal route with recombinant kallikrein-binding protein (“rKBP” group) which was used as a positive reference drug. In such conditions, rKBP has been shown to consistently reduce retinal vascular leakage by approximately 50% (Dr. J X Ma, Charlesson LLC, Oklahoma City, Okla., USA). 
     Compound B has the following formula: 
     
       
         
         
             
             
         
       
     
     At Day 14, vascular permeability was quantified by measuring Evans Blue-albumin leakage from blood vessels into the retina following a documented protocol (Gao Get al., Diabetologia, 46, 689-698, 2003). Briefly, Evans blue was injected through the femoral vein and circulated for 2 h. Then the rats were infused via the left ventricle with pre-warmed PBS. Immediately after perfusion, retina were carefully dissected under an operating microscope and homogenized. Evans blue dye concentration in the retina homogenate was measured using a spectrometer and normalized by total protein concentration. 
     Statistical Analysis: 
       FIG. 2  represents the results of retinal vascular leakage in STZ diabetic rats (3 studies). 
     First, vascular leakage mean in rKBP-treated and vehicle-treated rats was compared using a parametric or non parametric test (depending on variance homogeneity). If the difference between the two means was statistically significant, the means of drug- and vehicle-treated groups were compared using a one-way ANOVA (or a non parametric analysis if the variances are not homogeneous) followed by post-hoc testing. In  FIG. 2 : P values are inferior to 0.001 (“***”) according to Dunnet test; “NS” means non-significant. 
     Bradykinin B1 Receptor Antagonists: 
     Both Compound n°49 and Compound B were shown to be Bradykinin B1 Receptor Antagonists. In particular Compound B had an inhibition constant (Ki) of 1.6 nM for the human B1 receptor and had a pA2 of 7.8. Ki was calculated based on the concentration-response curves resulting from competitive binding experiments with [3H]des-Arg10-kallidin, a ligand specific for B1 receptor on HEK293 human cell membranes. pA2 was calculated based on the Schild curve resulting from curves of the concentration-response to des-Arg10-kallidin (B1 receptor agonist) on rat ileum. 
     Conclusion: 
     According to the above results, it has been shown that two Bradykinin B1 Receptor antagonists have not necessary the same activity on macular oedema, especially upon topical administration as demonstrated above. Accordingly, some Bradykinin B1 Receptor 
     Antagonists such as Compound B may have a non-significant activity on macular oedema, whereas compounds of formula (I) can be used for the prevention, treatment and/ or reduction of macular oedema, in particular associated with or caused by diabetic retinopathy.