Patent Abstract:
- 7 - chloro - n - benzothiophene - 2 - carboxamide has been found to have procognitive effects in humans at unexpectedly low doses . thus , - 7 - chloro - n - benzothiophene - 2 - carboxamide and pharmaceutically acceptable salts thereof can be used at unexpectedly low doses to improve cognition .

Detailed Description:
described below are human clinical trials demonstrating that ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide elicits positive effects on cognition at an unexpectedly low daily dose of 1 mg or less . the positive effects are observed in both patients suffering from schizophrenia and in normal subjects . also described below are studies showing that the free concentration of ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide in humans administered at daily 1 mg dose ( of ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride ) is at least an order of magnitude lower than that expected to be required to exert a positive effect on cognitive function , or can improve sensory electrophysiological responses which correlate with improved cognitive and functional performance in schizophrenia patients . also described below are studies demonstrating that that ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide has an unexpectedly long half - life in humans compared to that expected based on pre - clinical studies in animals . because ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide can improve cognition at an unexpectedly low free plasma concentration , it is less likely to elicit harmful side - effects on its own and is less likely to exhibit harmful interactions with other drugs . due to the unexpectedly low free plasma concentration required and the long half - life , ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide is expected to have special drug properties . these properties include a high margin of safety and a favorable dosing regimen ( e . g ., once daily dosing ), both of which are highly advantageous for treating patients with cognitive defects as well as patients that are required to take additional medications . the studies described below demonstrate that ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride can improve sensory electrophysiological responses which correlate with improved cognitive and functional performance in schizophrenia patients . these effects were observed at a daily dose as low as 0 . 3 mg . impairment of the ability of the central nervous system to inhibit irrelevant sensory information has long been used as a model for understanding the deficits of attention seen in schizophrenic patients . two approaches to the measurement of this ability have commonly been employed [ see ( heinrichs , 2004 ; potter et al ., 2006 ; turetsky et al ., 2007 ; umbricht and krljes , 2005 ) for reviews and meta - analyses ]: ( 1 ) the sensory gating paradigm in which the presentation of one stimulus normally suppresses the response elicited by a stimulus which rapidly follows it while schizophrenic patients typically exhibit less suppression ( gating ) of the second response ; and ( 2 ) the oddball or orienting paradigm in which a rare or unexpected event elicits a diminished response in schizophrenic patients because attentional resources are inappropriately focused on less salient aspects of the environment . two responses are commonly used to assess brain activity : ( 1 ) the auditory p50 response elicited by the second member of a pair of clicks ; and ( 2 ) the mismatch negativity ( mmn ) or n2 response evoked by a rarely occurring pure tone of no instructed relevance to the patient . abnormalities in both p50 gating and the mmn have been reported in schizophrenic patients . described below are studies assessing both of these responses in patients treated with ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride salt (“ the test compound ”). also presented below are studies assessing the influence of the test compound on the n100 and p300 components of the evoked response . these components emerge after the p50 component and are as much related to attention to , and memory for , task relevant stimuli as to the neural processes by which task irrelevant stimuli are filtered ( turetsky et al ., 2007 ; and sandman and patterson , 2000 ). the neurobiology of p50 sensory gating is well documented in studies of human and animal subjects . its regulation relies heavily on the integrity of the hippocampus and pathways that provide input to the hippocampus ( adler et al ., 1998 ). for example , lesions of the cholinergic pathway originating in the medial septal nucleus disrupt the gating response , as do antagonists of low affinity nicotinic receptors . cholinergic agonists , including nicotine itself ( adler et al ., 1993 ; duncan et al ., 2001 ), have been shown to enhance p50 gating ( freedman et al ., 2001 ; olincy et al ., 2006 ). the neurobiology of the mmn is more complex . imaging studies suggest that the primary and secondary auditory cortices in the temporal lobe are important for its generation ( naatanen and alho , 1995 ). the dorsolateral prefrontal cortex also contributes ( schall et al ., 2003 ). the neurotransmitter systems underlying the mmn are understudied and largely unknown . yet , as is the case for p50 , nicotinic cholinergic systems appear important ( baldeweg et al ., 2006 ; dunbar et al ., 2007 ). the sensitivity of p300 and n100 to cholinergic compounds has been known for many years ( dierks et al ., 1994 ; kaga et al ., 1992 ). various cholinergic antagonists — such as scopolamine — profoundly reduce the amplitudes of these components . in contrast , the components are markedly improved in amplitude by cholinesterase inhibitors ( katada et al ., 2003 ; werber et al ., 2001 ) and other compounds that enhance cholinergic activity ( easton and bauer , 1997 ). the test described above was used to study the effect of the test compound on cognition in patients suffering from schizophrenia . prior to testing , the patients were dosed with : 1 mg of the test compound daily , 0 . 3 mg of the test compound daily or were administered a placebo for 20 days . subjects were tested as described below . p50 waves were elicited by clicks , 1 msec in duration , grouped in pairs in the classic s1 - s2 sequence and presented through earpieces inserted into the auditory canals . click intensity was adjusted individually to 50 db above the hearing threshold . the offset - to - onset time from s1 to s2 was fixed at 500 msec . the offset - to - onset time between click pairs was varied from 7 - 11 sec . a total of 30 pairs of clicks were presented during each of 5 or more trial blocks with a one minute rest period interposed between each block . eeg responses to the clicks were amplified to a gain of 10 k and filtered ( bandpass = 3 - 30 hz , 12 db roll - off ). they were collected from 63 tin electrodes positioned by an electrode cap ( compumedics neuroscan , inc .). additional electrodes of the same type were applied to the mid - forehead ( ground ) and in a vertical orientation above and below the left eye . interelectrode impedances were maintained below 10 kohms . all recordings were made with the subject sitting upright and relaxed but awake . the eeg and eye movement signals were sampled by an analog - to - converter programmed to retain eeg activity from 50 msec preceding to 325 msec following click onset . the sampling rate was 1000 hz . the digitized signals were stored in a database for subsequent analysis . the 150 sweeps of s1 and s2 responses were screened and sweeps with voltage deviations greater than 100 microvolts in the eye movement channels were rejected . the remaining accepted sweeps were formed into time point averages . while blinded to group assignment , the investigator visually examined the evoked potential waveforms at the fcz electrode site . when possible , the investigator identified a negative trough immediately prior to the p50 , the p50 itself , and the following n100 component . admittedly , a distinct p50 component could not be visually identified in all patients at all time points . in those cases , the data was coded as missing . p50 response amplitude was calculated as the voltage difference between the p50 peak and the preceding negative trough . the p50 gating ratio was then calculated after ( olincy et al ., 2006 ) as the amplitude of the p50 response to the second ( test ) stimulus divided by the amplitude of the p50 response to the first ( conditioning ) stimulus . a small gating ratio is considered normal or optimal . the p50 amplitude difference ( fuerst et al ., 2007 ) was also measured . it was the amplitude of the conditioning stimulus p50 response minus the amplitude of the test stimulus p50 response . a large p50 amplitude difference indicates normal gating . n100 amplitude was calculated as the peak voltage of n100 minus the average voltage during the brief , 50 msec prestimulus period . as was the case for p50 , n100 responses to the conditioning and test stimuli were calculated as ratios as well as differences . the mmn and p300 components were elicited during the so - called oddball sequence . the stimulus sequence was a series of lower ( 500 hz ) and higher ( 1000 hz ) pitched pure tones presented at a rate of 1 tone per 0 . 6 sec . the tones were 50 msec in duration , 50 db above hearing level , and randomly interspersed . the higher pitched tone was the oddball event . across the series of 600 tones , it occurred at a probability of 0 . 2 . the other tone occurred at the complementary probability of 0 . 8 . patients were instructed to ignore the tones and instead attend to a magazine held in the lap . during the task , eeg and eog activity were digitized at a rate of 500 hz per channel for 50 msec preceding and 500 msec following stimulus onset . trials contaminated by eyeblinks or eye movements were removed . an off - line program digitally filtered ( bandpass = 0 . 1 - 30 hz , 12 db roll - off ) responses to the rare and frequent events and constructed averaged event related responses for each electrode . at the fcz electrode , the mmn was measured by an automated algorithm that computed the summed amplitude , relative to the prestimulus baseline , over a 100 - 200 msec time window following the onsets of the rare ( oddball ) and frequent tones . mmn was then recalculated as the voltage difference between these responses . p300 amplitude was measured at the pz electrode site as the peak amplitude between 250 and 500 msec following stimulus onset . the plan for the analysis of the eeg measures was developed prior to breaking of the blind . it was based on the study design involving 3 groups ( n = 8 high dose , n = 8 moderate dose , n = 4 placebo ) and 4 time points ( 1 predrug + 3 postdrug ). the plan offered several alternative strategies based upon the completeness and quality of the recordings . unfortunately , in the case of the p50 / n100 gating study , it was necessary to discard several patients and post - treatment assignment time points from the analysis because , in those instances , a p50 waveform was not identifiable and therefore could not be measured . this problem has been acknowledged in the literature , but has not been discussed as openly and frequently as a skeptical scientist would like . for the analysis of p50 and n100 , we adopted strategy 1 b : “ if many postdrug data points are missing / corrupted , then the remaining postdrug data points will be averaged together to create a single postdrug data point .” the significant number of missing or unmeasurable p50 &# 39 ; s , unfortunately , removed another of our analysis options , wherein we hoped to focus on the subgroup of patients who showed the poorest sensory gating at baseline and might show the strongest improvement in gating after treatment . of the 12 patients who provided valid and measurable p50 responses , 2 were in the placebo group , and 5 were in each of the two active dose groups . fig1 a and 1b present the results of simple analyses of covariance wherein all time points during the treatment period with valid data were averaged together to yield a single value . this value was then adjusted by regressing it against the baseline value and estimating a new value as if all patients possessed the same baseline . then , a simple f test was performed . in support of the assumption of no significant differences between the treatment groups at the baseline ( i . e ., before treatment ), we conducted simple anovas evaluating the effect of treatment on all of the evoked potential components discussed presently . in no case did treatment significantly affect the baseline value . fig1 a shows a non - significant [ f = 1 . 16 , p = 0 . 36 ] reduction ( i . e ., normalization ) of the p50 gating ratio among patients receiving the 1 . 0 mg dose of the test compound . in contrast , fig1 b shows the p50 amplitude difference score — a metric with superior reliability . it likewise shows normalization at the high dose . however , in this case , the change approaches statistical significance [ f = 3 . 97 , p = 0 . 07 ]. fig2 a and 2b present an identical analysis of the n100 gating ratio and amplitude difference . here , the gating ratio demonstrates a more reliable effect of the medication [ f = 3 . 04 , p = 0 . 10 ] than does the amplitude difference [ f = 1 . 02 , p = 0 . 38 ]. in fig2 a , normalization is suggested by a lower score . in fig2 b , normalization is indicated by the opposite direction of change . mmn and p300 amplitude reflect activation of multiple precortical and cortical pathways sensitive to stimulus novelty , short term memory , and attention . mmn was calculated as the voltage difference over 100 - 200 msec post - stimulus onset between the responses to the rare and frequent stimuli . a more negative mmn suggests normal cognitive function . p300 is not entirely independent of mmn . p300 was calculated as the peak amplitude relative to the average voltage of the waveform during the 50 msec prestimulus period . a more positive p300 response is indicative of improved cognitive function . p300 is maximal in amplitude when the eliciting stimulus is both rare and task relevant ( i . e ., attended ). in the present study , the rare stimulus was not task relevant . in fact , the patient was instructed to perform no task and to ignore the stimuli . in the present study , therefore , p300 amplitude is very small in comparison to amplitudes recorded under active task conditions . the present p300 component is more similar to the small , frontally - generated p300a described by knight and colleagues than the large , parietally - generated p300b described in most studies of attentional dysfunction in schizophrenia . in the analysis of p50 and n100 the baseline value was the covariate and all values obtained during the treatment period were averaged together . data loss from unidentifiable mmn and p300 components was minimal . these analyses were conducted upon data obtained from n = 4 patients treated with placebo , n = 7 patients treated with 0 . 3 mg of the test compound , and n = 8 patients treated with 1 . 0 mg of the test compound . fig3 a and 3b show the results of the analysis of mmn and p300 amplitudes during the oddball task . both evoked potential components were sensitive to the test compound in the predicted direction : mmn [ f = 4 . 96 , p = 0 . 02 ]; p300 [ f = 6 . 88 , p = 0 . 008 ]. in a dose - related manner , the test compound increased mmn and p300 amplitudes . despite the small number of patients enrolled in this trial , the analysis revealed several significant or marginally significant results . both the 0 . 3 mg and 1 . 0 mg doses of the test compound evoked significantly ( p & lt ; 0 . 05 ) larger p300 and mmn components than were seen under the placebo condition . the effects of the test compound on an earlier component of the evoked response component ( i . e ., the p50 ) were limited to the highest , 1 . 0 mg , dose and were technically not significant ( p = 0 . 1 ). these results indicate that both the 0 . 3 mg dose and 1 . 0 mg dose of the test compound are anticipated to be effective in treating schizophrenia . the relative sensitivity or insensitivity of various evoked response components to the test compound may be related to their size and reliability of measurement . in addition , sensitivity differences may relate to differences across the components in their neural generators and innervation by cholinergic afferents . indeed , the two components ( mmn and p300 ) which were most sensitive to the test compound are generated or modulated by frontal cortical pathways that receive input from brainstem cholinergic fibers . the p50 is , in contrast , generated subcortically . the impact of the test compound on cognition in normal subjects was assessed as described below . in these studies , subjects were treated with the test compound dissolved in cranberry juice . the impact of the test compound on cognition in normal subjects was assessed in a sad ( single ascending dose ) study with the digit symbol substitution test ( dsst ). utilizing this test , the test compound was shown to have pro - cognitive effects at a daily dose as low as 1 mg . this is unexpected since acetylcholine esterase inhibitors , which indirectly activates the alpha7 receptor by increasing acetylcholine levels , are not understood to exhibit pro - cognitive effects in normal subject and , even in patients with cognitive impairment , are not understood to exhibit pro - cognitive effects after a single dose . the positive effects of the test compound in the dsst indicate a beneficial effect on working memory and executive function . in the mad ( multiple ascending dose ) studies cognition was assessed using tests from the cogstate battery ( cogstate . com ). utilizing this test , the test compound was shown to have pro - cognitive effects at daily a dose as low as 1 mg . the cogstate battery is a proprietary computerized cognitive battery of tests measure various cognitive domains including : attention , identification capability , working memory , visual memory , and executive function . in these studies , the test compound was found to have a positive impact on : visual motor skills , learning , executive function , and delayed memory . the profile of the response was unique insofar as the test compound had positive effects on non - verbal learning and memory and executive function without having a stimulatory effect on attention . the magnitude of the effects were , in many cases , significant with effect sizes being & gt ; 0 . 4 ( a threshold effect size which is commonly accepted as having clinical significance ). this therapeutic profile ( pro - cognitive effects on nonverbal learning and memory and executive function without a central stimulatory effect ) indicates that the drug may be very beneficial in treating patients that have , as a feature of their condition , symptoms of anxiety or agitation . ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride shows effects at unexpectedly low dose and free plasma concentration the studies described above demonstrate that ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride administered at a daily dose of 1 . 0 mg or 0 . 3 mg can improve cognition in patients suffering from schizophrenia and in normal subjects . the fact that a 0 . 3 mg or 1 . 0 mg dose of ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride can elicit an effect in various measures of cognition is surprising because at these dosages the concentration of free drug is well below the k i of the compound to bind to the alpha7 receptor . in order for a small molecule to exert action at its target , often a cell receptor , it must bind to its target . thus , in general , a small molecule drug is expected to exhibit activity when the free drug concentration at the target ( i . e ., the concentration of drug that is free and available to bind to the target ) approaches or exceeds the k i of the drug for target . studies have shown that in numerous cases the free drug concentration in a particular tissue is about equal to the free drug concentration in plasma ( mauer et al ., 2005 and trainor , 2007 ). for the brain , the free plasma concentration is generally considered to represent the maximum possible free drug concentration . the free drug concentration in plasma ([ free drug ] plasma ) is determined by measuring the total drug concentration in the plasma ([ total drug ] plasma ) and the free fraction of the drug , i . e ., the fraction of the drug that is not bound to plasma protein ( fu plasma ): [ free drug ] plasma =[ total drug ] plasma × fu plasma . the total plasma drug concentration and the fraction that binds to plasma protein can both be measured using techniques known to those of skill in the art . studies on ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide determined that the ec ref for human alpha7 receptor is approximately 0 . 158 μm and the k i ( rat membrane ) is approximately 10 nm . additional studies found the following values for the free fraction of drug : rat fu plasma = 0 . 112 , dog fu plasma = 0 . 107 , human fu plasma = 0 . 129 . multiple ascending dose ( mad ) human clinical trials were conducted . the maximum plasma concentration was determined and used to calculate the maximum free drug concentration which was used to determine the maximum free drug concentration as a fraction of the ec ref of the drug for human alpha7 receptor and the maximum free drug concentration as a fraction of the k i of the drug for rat brain alpha7 receptors . the ec ref , the concentration of drug which elicits equal response in oocytes transfected with cloned human alpha7 receptor at 50 μm acetylcholine ( the endogenous receptor ligand ), was determined to be 0 . 158 μm . the k i for rat brain alpha7 receptors was determined to be 10 nm . in human single and multiple ascending dose clinical trials in both healthy and schizophrenia patients , a 0 . 3 mg daily dose and a 1 . 0 mg daily dose were shown to improve cognitive function or correlates of cognitive function . as can been seen from table 1 which presents an analysis of the free drug concentration , the 0 . 3 mg dose of ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide hydrochloride produces a maximum free plasma concentration of 0 . 073 - 0 . 283 nm which is 0 . 005 to 0 . 0018 of the alpha7 ec ref and 0 . 0073 to 0 . 0283 of the alpha7 k i . these values are 35 - 2000 times lower than would have anticipated if efficacy was to be achieved when the free plasma concentration reached the k i , or the ec ref concentrations . when a similar calculation is performed for the 1 . 0 mg doses ( free plasma of 0 . 237 - 1 . 06 nm ) these fractional values of the k i and ec ref concentrations are 0 . 0015 to 0 . 0067 ( ec ref ) and 0 . 0237 to 0 . 106 ( k i ). these values are 9 . 4 - 667 times lower than expected . table 2 presents half - life ( t 1 / 2 ) data for ( r )- 7 - chloro - n -( quinuclidin - 3 - yl ) benzo [ b ] thiophene - 2 - carboxamide obtained from pre - clinical species as well as the half - life in humans determined in clinical trials . the half - life determined in rat and dog suggested a human half - life much shorter than the observed 60 hr half - life ( initial allometric scaling suggested a half - life of about 8 hours ). the unexpectedly long half - life in humans has several advantages . it allows for once a day dosing . the drug will also have a very small dynamic plasma range over the course of a day ( about 15 - 20 %). thus , if a patient misses a daily dose , the plasma level and the consequent brain level will not be altered by a great degree . this means that the beneficial effects of the drug will be less dependent upon careful adherence to a specific dosing scheme . third , long half - life and slow elimination also mean that the final dose will be lower than expected . this readily observed by looking at the c max values on day 1 versus day 21 . the c max values on day 21 are about 3 . 6 - 4 . 2 times higher than the day 1 values . this ratio will translate into a dose that is 3 . 6 - 4 . 2 times lower than would normally be expected due to this favorable accumulation . adler , l . e ., hoffer , l . d ., wiser , a ., freedman , r ., 1993 . normalization of auditory physiology by cigarette smoking in schizophrenic patients . am j psychiatry 150 , 1856 - 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