Patent Description:
The invention is defined in the claims. Any subject-matter outside the scope of the claims is not part of the invention and provided for reference or comparison purposes only.

Any reference to a method of treatment of the human or animal body by therapy using a certain compound or composition is to be understood as relating to said compound or composition for use in said method of treatment.

Glaucoma is a refractory eye disease caused by suffering from damage of the internal tissue (retina, optic nerve, etc.) of the eyeball due to the intraocular pressure increases resulted from various pathogenesis. As a method for treating glaucoma, intraocular pressure lowering therapy is generally used, and typical examples thereof include drug therapy, laser therapy, surgical therapy, etc..

In the drug therapy, drugs such as sympathomimetics (non-selective stimulants such as dipivefrin, etc., and α<NUM> receptor agonists such as brimonidine, etc.), sympathetic nerve blockers (β receptor blockers such as timolol, befunolol, carteolol, nipradilol, betaxolol, levobunolol, metipranolol, etc., and α<NUM> receptor blockers such as bunazosin hydrochloride, etc.), parasympathomimetics (pilocarpine, etc.), carbonic anhydrase inhibitors (acetazolamide, etc.), prostaglandins (isopropyl unoprostone, latanoprost, travoprost, bimatoprost, etc.), and Rho-associated coiled-coil containing protein kinase inhibitors (ripasudil), etc., have been used.

Also, in order to obtain a more potent effect of lowering an intraocular pressure, some reports have been made that drugs having an intraocular pressure lowering effect are used in combination. For example, in <CIT> (Patent Document <NUM>), administration of a combination of a sympathetic nerve blocker and a prostaglandin has been reported. Also, in <CIT> (Patent Document <NUM>), a therapeutic method for glaucoma by administering several drugs having an intraocular pressure lowering action in combination to the eye has been disclosed. Further, in <CIT> (Patent Document <NUM>), administration of a combination of a Rho-associated coiled-coil containing protein kinase inhibitor and a prostaglandin has been reported, and in <CIT> (Patent Document <NUM>), combination administration of a Rho-associated coiled-coil containing protein kinase inhibitor and a β receptor blocker has been reported. In addition, a combination drug of dorzolamide and timolol, a combination drug of latanoprost and timolol, a combination drug of brimonidine and timolol and the like are commercially available (Non-Patent Document <NUM>). Non-Patent Document <NUM> describes a fixed-dose combination of AR-<NUM> (= netarsudil) and latanoprost in a double-masked, <NUM>-day, randomised, controlled study in patients with open-angle glaucoma or ocular hypertension.

By the way, sepetaprost is the compound represented by the formula (<NUM>):
<CHM>
and described in Patent Document <NUM> as one of the huge number of the compounds. Since these compounds have a potent and sustained intraocular pressure lowering action, there are described that they are expected to be a therapeutic agent for glaucoma.

It is a very interesting task to find out a combination of prophylactic or therapeutic agents for glaucoma or ocular hypertension, which is useful as a prophylactic or therapeutic agent for glaucoma or ocular hypertension.

The present inventors have intensively studied the effect of the combination of prophylactic or therapeutic agents for glaucoma or ocular hypertension, and as a result, they have found that by using sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s) in combination, an intraocular pressure lowering action is enhanced as compared with the case where each drug is used alone, whereby they have accomplished the present invention.

By administering sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s) to an eye in combination, an intraocular pressure lowering action is enhanced. Accordingly, the present invention is useful as a prophylactic or therapeutic agent for glaucoma or ocular hypertension. Further, according to the present invention, sufficient safety as a pharmaceutical product is ensured.

In the following, the present invention will be explained in detail.

The present invention is directed to a prophylactic or therapeutic agent for glaucoma or ocular hypertension, which is characterized in that sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s) are administered in combination, wherein the Rho-associated coiled-coil containing protein kinase inhibitor(s) is at least one kind selected from the group consisting of netarsudil, a salt thereof, a hydrate thereof and a solvate thereof. Hereinafter, this combination is also simply referred to as the "therapeutic agent".

In the therapeutic agent of the present invention, sepetaprost is the compound (<NPL>) represented by the following formula (<NUM>):
<CHM>
<CHM>
and is also referred to as <NUM>-propanyl <NUM>-{ (<NUM>, 5aR, 6R, 7R, 8aS)-<NUM>-[(1E, 3R)-<NUM>-(<NUM>, <NUM>-difluorophenoxy)-<NUM>-hydroxy-<NUM>-buten-<NUM>-yl]-<NUM>-hydroxyoctahydro-<NUM>-cyclopenta[b]oxepin-<NUM>-yl}butanoate.

Sepetaprost can be produced in accordance with the methods disclosed in <CIT> (Patent Document <NUM>), or a usual method in this technical field.

When there is proton tautomerism in sepetaprost, those tautomers (keto form and enol form) are also included in the scope of the present invention.

When there is crystal polymorphism and/or crystal polymorph group (crystal polymorph system) in sepetaprost, those crystal polymorphs and/or crystal polymorph group (crystal polymorph system) are also included in the scope of the present invention. Here, the crystal polymorph group (crystal polymorph system) means a crystal form at each stage when the crystal form changes to various crystal forms depending on the conditions and/or states (incidentally, in this state, a formulated state is also included) of production, crystallization and preservation of these crystals, and/or the whole thereof.

Sepetaprost may take a form of a hydrate or a solvate.

In the therapeutic agent of the present invention, a content of sepetaprost is not particularly limited, which may vary depending on the administration form, and in the case of eye drops, a lower limit of the content of sepetaprost is preferably <NUM> to <NUM>% (w/v), and more preferably <NUM> to <NUM>% (w/v). Here, "% (w/v)" means a mass (g) of an active ingredient(s) or an additive(s) contained in <NUM> of the drug. For example, <NUM>% (w/v) sepetaprost means that the content of sepetaprost contained in <NUM> of the drug is <NUM>.

Incidentally, when sepetaprost is in the form of a hydrate or a solvate, the content of sepetaprost may be calculated based on any of a free form, a hydrate or a solvate of sepetaprost.

The Rho-associated coiled-coil containing protein kinase inhibitor(s) in the therapeutic agent of the present invention is selected from the group consisting of netarsudil, a salt thereof, a hydrate thereof and a solvate thereof.

Further disclosed as examples of the Rho-associated coiled-coil containing protein kinase inhibitor(s) are (R)-trans-N-(pyridin-<NUM>-yl)-<NUM>-(<NUM>-aminoethyl)cyclohexanecarboxamide, (R)-(+)-N-(<NUM>-pyrrolo[<NUM>, <NUM>-b]pyridin-<NUM>-yl)-<NUM>-(<NUM>-aminoethyl)benzamide or the like disclosed in <CIT> and <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as <NUM>-(<NUM>-isoquinolinesulfonyl)homopiperazine, <NUM>-(<NUM>-isoquinolinesulfonyl)-<NUM>-methylpiperazine or the like disclosed in <CIT> and <NPL>); a Rho-associated coiled-coil containing protein kinase inhibitor such as (<NUM>-benzylpyrrolidin-<NUM>-yl)-(<NUM>-indazol-<NUM>-yl)amine or the like disclosed in <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as (<NUM>-benzylpiperidin-<NUM>-yl)-(<NUM>-indazol-<NUM>-yl)amine or the like disclosed in <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as N-[<NUM>-(<NUM>-fluorophenyl)-<NUM>,<NUM>-dimethoxy-<NUM>-quinazolinyl]-N-(<NUM>-indazol-<NUM>-yl)amine or the like disclosed in <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as N-<NUM>-(<NUM>-indazol-<NUM>-yl)-<NUM>,<NUM>-dimethoxy-N-<NUM>-pyridin-<NUM>-yl-quinazoline-<NUM>,<NUM>-diamine or the like disclosed in <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as <NUM>-methyl-<NUM>-(<NUM>-methyl-[<NUM>,<NUM>]diazepane-<NUM>-sulfonyl)isoquinoline or the like disclosed in <CIT>; a Rho-associated coiled-coil containing protein kinase inhibitor such as (S)-(-)-<NUM>-(<NUM>-fluoro-<NUM>-isoquinolinesulfonyl)-<NUM>-methyl-<NUM>,<NUM>-homopiperazine or the like disclosed in <CIT>; and a Rho-associated coiled-coil containing protein kinase inhibitor such as <NUM>-(<NUM>-amino-<NUM>-(isoquinolin-<NUM>-ylamino)-<NUM>-oxopropan-<NUM>-yl)benzyl <NUM>,<NUM>-dimethylbenzoate or the like disclosed in <CIT>.

In the therapeutic agent of the present invention, a content of the Rho-associated coiled-coil containing protein kinase inhibitor(s) is not particularly limited, which may vary depending on the administration form, and in the case of eye drops, a content of the Rho-associated coiled-coil containing protein kinase inhibitor(s) is preferably <NUM> to <NUM>% (w/v), and more preferably <NUM> to <NUM>% (w/v).

Incidentally, when the Rho-associated coiled-coil containing protein kinase inhibitor(s) is in the form of a salt, a hydrate or a solvate, the contents of these Rho-associated coiled-coil containing protein kinase inhibitor(s) may be calculated based on any of a free form, a salt, a hydrate or a solvate of the Rho-associated coiled-coil containing protein kinase inhibitor(s).

Reference compound ripasudil is the compound (<NPL>) represented by the following formula (<NUM>)
<CHM>
which is also referred to as (S)-(-)-<NUM>-(<NUM>-fluoro-<NUM>-isoquinolinesulfonyl)-<NUM>-methyl-<NUM>, <NUM>-homopiperazine. Since it has a Rho-associated coiled-coil containing protein kinase inhibitory action, and promotes drainage of aqueous humor from the main outflow passage via travecula-Schlemm's canal, it has been sold as a therapeutic agent for glaucoma and ocular hypertension (Glanatec (Registered Trademark) eye drops <NUM>%).

The salt of ripasudil is not particularly limited as long as it is a pharmacologically acceptable salt. Specific examples include an inorganic acid salt such as hydrochloride, hydrobromide, hydroiodide, nitrate, sulfate or phosphate; an organic acid salt such as acetate, trifluoroacetate, benzoate, oxalate, malonate, succinate, maleate, fumarate, tartrate, citrate, methanesulfonate, ethanesulfonate, trifluoromethanesulfonate, benzenesulfonate, p-toluenesulfonate, glutamate or aspartate; a metal salt such as sodium salt, potassium salt, calcium salt or magnesium salt; an inorganic salt such as ammonium salt; or an organic amine salt such as triethylamine salt or guanidine salt, preferably hydrochloride, and further preferably monohydrochloride.

In the therapeutic agent of the present invention, netarsudil is the compound (<NPL>) represented by the following formula (<NUM>):
<CHM>
which is also referred to as [<NUM>-[(<NUM>)-<NUM>-(aminomethyl)-<NUM>-(isoquinolin-<NUM>-ylamino)-<NUM>-oxoethyl]phenyl]methyl <NUM>,<NUM>-dimethylbenzoate. Since it has a Rho-associated coiled-coil containing protein kinase inhibitory action and a norepinephrine transporter (NEP) inhibitory action, and exhibits an intraocular pressure lowering action, it has been sold as a therapeutic agent for glaucoma and ocular hypertension in the United States (RHOPRESSA (Registered Trademark) <NUM>%).

In the therapeutic agent of the present invention, the salt of netarsudil is not particularly limited as long as it is a pharmacologically acceptable salt. Specific examples include an inorganic acid salt such as hydrochloride, hydrobromide, hydroiodide, nitrate, sulfate or phosphate; an organic acid salt such as acetate, trifluoroacetate, benzoate, oxalate, malonate, succinate, maleate, fumarate, tartrate, citrate, mesylate (methanesulfonate), ethanesulfonate, trifluoromethanesulfonate, benzenesulfonate, p-toluenesulfonate, glutamate or aspartate; a metal salt such as sodium salt, potassium salt, calcium salt or magnesium salt; an inorganic salt such as ammonium salt; or an organic amine salt such as triethylamine salt or guanidine salt, preferably mesylate (methanesulfonate) or hydrochloride, and more preferably dimesylate (dimethanesulfonate) or dihydrochloride.

When there is proton tautomerism in netarsudil or a salt thereof, those tautomers (keto form and enol form) are also included in the scope of the present invention.

When there is crystal polymorphism and/or crystal polymorph group (crystal polymorph system) in netarsudil or a salt thereof, those crystal polymorphs and/or crystal polymorph group (crystal polymorph system) are also included in the scope of the present invention. Here, the crystal polymorph group (crystal polymorph system) means a crystal form at each stage when the crystal form changes to various crystal forms depending on the conditions and/or states (incidentally, in this state, a formulated state is also included) of production, crystallization and preservation of these crystals, and/or the whole thereof.

In the therapeutic agent of the present invention, netarsudil or a salt thereof may take a form of a hydrate or a solvate. As the salt and hydrate of netarsudil, netarsudil dimesylate (<NPL>) is most preferable. In the therapeutic agent of the present invention, netarsudil or a salt thereof, or a hydrate or a solvate thereof is also simply referred to as "netarsudil".

In the therapeutic agent of the present invention, a content of netarsudil or a salt thereof is not particularly limited, which may vary depending on the administration form, and in the case of eye drops, a lower limit of the content of netarsudil or a salt thereof is preferably <NUM>% (w/v), more preferably <NUM>% (w/v), further preferably <NUM>% (w/v), and particularly preferably <NUM>% (w/v). Also, an upper limit of the above-mentioned content is preferably <NUM>% (w/v), more preferably <NUM>% (w/v), further preferably <NUM>% (w/v), and particularly preferably <NUM>% (w/v). In more detail, the above-mentioned content may be a range in which any of the above-mentioned lower limit and upper limit are combined, and preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), further preferably <NUM> to <NUM>% (w/v), particularly preferably <NUM> to <NUM>% (w/v), and most preferably <NUM>% (w/v).

Incidentally, when is her netarsudil or a salt thereof is in the form of a salt, a hydrate or a solvate, the contents of these netarsudil or a salt thereof may be calculated based on any of a free form, a salt, a hydrate or a solvate of netarsudil or a salt thereof.

In the therapeutic agent of the present invention, in addition to sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s), one or more of the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension may be further used in combination. The other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension may be any drug as long as it has an intraocular pressure lowering action and is useful for the treatment for glaucoma, and there may be mentioned non-selective sympathomimetics, α<NUM> receptor agonists, α<NUM> receptor blockers, β receptor blockers, parasympathomimetics, carbonic anhydrase inhibitors, prostaglandins and the like.

Specific examples of the non-selective sympathomimetics include dipivefrin, specific examples of the α<NUM> receptor agonists include brimonidine and apraclonidine, specific examples of the α<NUM> receptor blockers include bunazosin, specific examples of the β receptor blockers include timolol, befunolol, carteolol, nipradilol, betaxolol, levobunolol and metipranolol, specific examples of the parasympathomimetics include pilocarpine, specific examples of the carbonic anhydrase inhibitors include dorzolamide, brinzolamide and acetazolamide, and specific examples of the prostaglandins include isopropyl unoprostone, latanoprost, travoprost and bimatoprost. These include a form of a salt pharmaceutically acceptable as a medicine. Specific examples of the salt include an inorganic acid salt such as hydrochloride, hydrobromide, hydroiodide, nitrate, sulfate or phosphate; an organic acid salt such as acetate, trifluoroacetate, benzoate, oxalate, malonate, succinate, maleate, fumarate, tartrate, citrate, methanesulfonate, ethanesulfonate, trifluoromethanesulfonate, benzenesulfonate, p-toluenesulfonate, glutamate or aspartate; a metal salt such as sodium salt, potassium salt, calcium salt or magnesium salt; an inorganic salt such as ammonium salt; or an organic amine salt such as triethylamine salt or guanidine salt.

Further, the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension may take a form of a hydrate or a solvate.

In the therapeutic agent of the present invention, when it is used in combination with the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension, a content thereof is not particularly limited, which may vary depending on a kind and an administration form of the prophylactic or therapeutic agent to be contained, and a preferred content in the case of eye drops is as follows.

The content of the non-selective sympathomimetics may vary depending on a kind of the drug, and in the case of dipivefrin, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v).

The content of the α<NUM> receptor agonists may vary depending on a kind of the drug, and in the case of brimonidine, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v), <NUM>% (w/v), <NUM>% (w/v) or <NUM>% (w/v). Also, in the case of apraclonidine, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v).

The content of the α<NUM> receptor blockers may vary depending on a kind of the drug, and in the case of bunazosin, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v).

The content of the β receptor blockers may vary depending on a kind of the drug, and in the case of timolol, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v), <NUM>% (w/v) or <NUM>% (w/v). Also, in the case of befunolol, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v), <NUM>% (w/v) or <NUM>% (w/v). In the case of carteolol, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v). In the case of nipradilol, it is preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v). In the case of betaxolol, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v). In the case of levobunolol, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v). In the case of metipranolol, it is preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v).

The content of the parasympathomimetics may vary depending on a kind of the drug, and in the case of pilocarpine, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v), <NUM>% (w/v), <NUM>% (w/v), <NUM>% (w/v) or <NUM>% (w/v).

The content of the carbonic anhydrase inhibitors may vary depending on a kind of the drug, and in the case of dorzolamide, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v), <NUM>% (w/v) or <NUM>% (w/v). Also, in the case of brinzolamide, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v). Also, in the case of acetazolamide, it is preferably <NUM> to <NUM>% (w/v), and more preferably <NUM> to <NUM>% (w/v). Incidentally, when acetazolamide is orally administered, <NUM> to <NUM> may be used as a daily dose.

The content of the prostaglandins may vary depending on a kind of the drug, and in the case of latanoprost, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), further preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v). In the case of isopropyl unoprostone, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), further preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v). In the case of bimatoprost, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), further preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v) or <NUM>% (w/v). In the case of travoprost, it is preferably <NUM> to <NUM>% (w/v), more preferably <NUM> to <NUM>% (w/v), and particularly preferably <NUM>% (w/v).

Incidentally, when the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension is in the form of a salt, a hydrate or a solvate, the content of the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension may be calculated based on any of a free form, a salt, a hydrate or a solvate of the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension.

The therapeutic agent of the present invention is characterized in that sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s) as defined in the claims are administered in combination whereby glaucoma or ocular hypertension is to be prevented or treated. As the glaucoma in the therapeutic agent of the present invention, primary open-angle glaucoma, secondary open-angle glaucoma, normal tension glaucoma, hypersecretion glaucoma, primary angle-closure glaucoma, secondary angle-closure glaucoma, plateau iris glaucoma, combined-mechanism glaucoma, developmental glaucoma, steroid induced glaucoma, exfoliation glaucoma, amyloid glaucoma, neovascular glaucoma, malignant glaucoma, capsular glaucoma of the lens, plateau iris syndrome and the like are exemplified.

In the therapeutic agent of the present invention, as for the dosage form, a formulation comprising sepetaprost, and a separate formulation comprising the Rho-associated coiled-coil containing protein kinase inhibitor(s) may be administered (concomitant administration), or a single formulation (combination drug) comprising sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s) may be administered. Also, when one or more of the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension is used in combination in addition to sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s), then, sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s), and the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension may be administered concomitantly, a combination drug comprising optional component(s) of these and the remaining component(s) may be administered concomitantly, or a combination drug comprising all the components may be administered.

The therapeutic agent of the present invention may be administered orally or parenterally, no particular technique is required for formulation thereof, and a formulation can be prepared by using a commonly used technique. As dosage forms, there may be mentioned eye drops, eye ointments, injections, tablets, capsules, granules, powders and the like, and eye drops or eye ointments are preferred.

When sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s), and the other prophylactic or therapeutic agent(s) for glaucoma or ocular hypertension are separately formulated, formulations can be each prepared according to the known method. As a formulation of the Rho-associated coiled-coil containing protein kinase inhibitor(s) or the other prophylactic or therapeutic agent for glaucoma or ocular hypertension, formulations already commercially available may be also used.

Also, when one formulation containing the respective components is to be prepared, it can be prepared according to a known method.

In the case of preparing eye drops, sepetaprost and the Rho-associated coiled-coil containing protein kinase inhibitor(s) are added to purified water, a buffer solution or the like, and stirred, and then, a pH of the mixture is adjusted with a pH adjusting agent to prepare a desired eye drop. In addition, if necessary, an additive(s) commonly used in eye drops may be used, and as the additives, there may be mentioned an isotonic agent, a buffering agent, a surfactant, a stabilizer, a preservative, a solubilizing agent, and the like.

A pH of the eye drops may be within the range which is allowable for ophthalmic formulations, it is preferably in the range of pH <NUM> to <NUM>, and more preferably in the range of pH <NUM> to <NUM>.

In the case of preparing eye ointments, it can be prepared by using a commonly used base, and as the base, there may be mentioned white petrolatum, liquid paraffin, and the like.

In the case of preparing oral formulations such as tablets, capsules, granules, powders, and the like, it can be prepared by adding a bulking agent, a lubricant, a binder, a disintegrating agent, a coating agent, a film agent, and the like, as necessary. As the bulking agent, there may be mentioned lactose, crystalline cellulose, starch, vegetable oil, and the like, as the lubricant, there may be mentioned magnesium stearate, talc, and the like, as the binder, there may be mentioned hydroxypropyl cellulose, polyvinylpyrrolidone, and the like, as the disintegrating agent, there may be mentioned carboxymethylcellulose calcium, low-substituted hydroxypropylmethyl cellulose, and the like, as the coating agent, there may be mentioned hydroxypropyl methylcellulose, macrogol, silicone resin, and the like, and as the film agent, there may be mentioned a gelatin film, and the like.

An administration method of the therapeutic agent of the present invention can be appropriately changed depending on the dosage form, the severity of symptoms of a patient to be administered to, the age, the body weight, the administration route, the judgment of a doctor, and the like, and in the case of a combination drug comprising sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s), it may be administered <NUM> to <NUM> times a day, preferably once or twice a day, and most preferably once a day. When a formulation comprising sepetaprost and a formulation comprising a Rho-associated coiled-coil containing protein kinase inhibitor(s) are administered concomitantly, each formulation may be administered at different times or simultaneously <NUM> to <NUM> times a day, preferably once or twice a day, and most preferably once a day. Incidentally, in the concomitant administration, when the formulations are administered at different times, the order of administering the formulations is not limited, and after one formulation is administered, the other formulation may be administered within <NUM> hours, preferably within <NUM> hours, more preferably within <NUM> hour, further preferably within <NUM> minutes, particularly preferably within <NUM> minutes, and most preferably promptly. In the above-mentioned administration method, in the case of eye drop administration, it is preferable to administer <NUM> to <NUM> drops per once, more preferably to administer <NUM> or <NUM> drops, and most preferably to administer <NUM> drop.

The detailed description of the above-mentioned therapeutic agent of the present invention is also applied to the prophylactic or therapeutic agent for glaucoma or ocular hypertension comprising sepetaprost of the present invention, which is characterized by being used concomitantly with a Rho-associated coiled-coil containing protein kinase inhibitor(s) as defined in the claims. The detailed description of the above-mentioned therapeutic agent of the present invention is also applied to an intraocular pressure-lowering agent of the present invention, which is characterized in that sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s) as defined in the claims are combined. The detailed description of the above-mentioned therapeutic agent of the present invention is also applied to an intraocular pressure-lowering agent of the present invention comprising sepetaprost, which is characterized by being used concomitantly with a Rho-associated coiled-coil containing protein kinase inhibitor(s) as defined in the claims.

Also, detailed description of the above-mentioned therapeutic agent of the present invention is also applied to the embodiment of the present invention mentioned below.

One embodiment of the present invention is a composition for use in the prophylaxis or treatment for glaucoma or ocular hypertension comprising sepetaprost, which is characterized by being administered in combination with a Rho-associated coiled-coil containing protein kinase inhibitor(s).

One embodiment of the present invention is sepetaprost for use in the prophylaxis or treatment for glaucoma or ocular hypertension, which is characterized by being used concomitantly with a Rho-associated coiled-coil containing protein kinase inhibitor(s).

One embodiment of the present invention is a combination of sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s) for use in the prophylaxis or treatment for glaucoma or ocular hypertension.

In the following, results of pharmacological tests are shown. These are for better understanding of the present invention.

In order to examine usefulness of the combination of sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s), the effect of lowering an intraocular pressure when sepetaprost and ripasudil which is a Rho-associated coiled-coil containing protein kinase inhibitor were administered concomitantly to experimental animals (normal pressure monkeys) was investigated.

Sepetaprost was dissolved in purified water containing a solubilizing agent, and then, a sepetaprost solution with a desired concentration was prepared by using a commonly used method.

Commercially available ripasudil eye drop (Kowa Company, Ltd. , GLANATEC (Registered Trademark) eye drops <NUM>%) was used as it was.

An effect of lowering an intraocular pressure when sepetaprost and ripasudil were administered concomitantly was investigated. As a comparative subject, an effect of lowering an intraocular pressure when sepetaprost or ripasudil was administered alone was also investigated. As a control, the base of the sepetaprost solution and physiological saline solution were administered.

The test was carried out in the same manner as the above-mentioned concomitant administration test except for changing the ripasudil solution to the physiological saline solution.

The test was carried out in the same manner as the above-mentioned concomitant administration test except for changing the sepetaprost solution to the base of the sepetaprost solution.

The test was carried out in the same manner as the above-mentioned concomitant administration test except for changing the sepetaprost solution to the base of the sepetaprost solution and changing the ripasudil solution to the physiological saline solution.

The changes in the lowering of the intraocular pressure with the lapse of time for each administered group are shown in <FIG> and Table <NUM>. The changes in the intraocular pressure values are shown by an average value ± SEM of the difference from the value (<NUM> hour) before administration of eight monkeys in each group with regard to each measurement time point of each individual. Comparison of the control group with the sepetaprost group, the ripasudil group, or the sepetaprost/ripasudil concomitant use group, and comparison of the sepetaprost/ripasudil concomitant use group with the sepetaprost group or the ripasudil group was carried out by, after carrying out the Bartlett test, in the case where dispersion is uniform, using the Dunnett test, or in the case of ununiform, using the Steel test. The significance level with respect to the control group was shown as ##: p<<NUM> in the Dunnett test, and *: p<<NUM> and **: p<<NUM> in the Steel test. The significance level with respect to the sepetaprost/ripasudil concomitant group was shown as†: p<<NUM> and ††: p<<NUM> in the Dunnett test, and $$: p<<NUM>. 01in the Steel test.

As clearly seen from <FIG> and Table <NUM>, the concomitantly administered group of sepetaprost and ripasudil showed more excellent intraocular pressure lowering action and sustained effect of the action than the single drug administered group, that is, the sepetaprost administered group and the ripasudil administered group. In particular, at <NUM>, <NUM> and <NUM> hours after administration, the amounts of change in the intraocular pressure values for the concomitantly administered group of sepetaprost and ripasudil was larger than the sum of the amounts of change in the intraocular pressure values for the sepetaprost administered group and for the ripasudil administered group, and the synergistic effect of the intraocular pressure lowering action was confirmed.

From the above, it was found that by combining sepetaprost with a Rho-associated coiled-coil containing protein kinase inhibitor(s), more potent intraocular pressure lowering action and a sustained effect of the action can be obtained.

In order to examine usefulness of the combination of sepetaprost and a Rho-associated coiled-coil containing protein kinase inhibitor(s), the effect of lowering an intraocular pressure when sepetaprost and netarsudil which is a Rho-associated coiled-coil containing protein kinase inhibitor were administered concomitantly to experimental animals (normal pressure monkeys) was investigated.

Dimesylate of netarsudil was dissolved in a physiological saline solution containing a solubilizing agent, and then, a netarsudil solution having a desired concentration was prepared by using a commonly used method.

An effect of lowering an intraocular pressure when sepetaprost and netarsudil were administered concomitantly was investigated. As a comparative subject, an effect of lowering an intraocular pressure when sepetaprost or netarsudil was administered alone was also investigated. As a control, the base of the sepetaprost solution and the base of the netarsudil solution were administered.

The test was carried out in the same manner as the above-mentioned concomitant administration test except for changing the netarsudil solution to the base of the netarsudil solution.

The test was carried out in the same manner as the above-mentioned concomitant administration test except for changing the sepetaprost solution to the base of the sepetaprost solution and changing the netarsudil solution to the base of the netarsudil solution.

The changes in the lowering of the intraocular pressure with the lapse of time for each administered group are shown in <FIG> and Table <NUM>. The change in the intraocular pressure values are shown by an average value ± SEM of the difference from the value (<NUM> hour) before administration of eight monkeys in each group with regard to each measurement time point of each individual. Comparison of the control group with the sepetaprost group, the netarsudil group, or the sepetaprost/netarsudil concomitant use group, and comparison of the sepetaprost/netarsudil concomitant use group with the sepetaprost group or the netarsudil group was carried out by, after carrying out the Bartlett test, in the case where dispersion is uniform, using the Dunnett test, or in the case of ununiform, using the Steel test. The significance level with respect to the control group was shown as *: p<<NUM> and **: p<<NUM> in the Steel test, and *: #: p<<NUM> and ###: p<<NUM> in the Dunnett test. The significance level with respect to the sepetaprost/netarsudil concomitant use group was shown as†: p<<NUM> in the Dunnett test.

As clearly seen from <FIG> and Table <NUM>, the concomitantly administered group of sepetaprost and netarsudil showed more excellent intraocular pressure lowering action and sustained effect of the action than the single drug administered group, that is, the sepetaprost administered group and the netarsudil administered group.

Claim 1:
A combination of sepetaprost, a hydrate thereof or a solvate thereof, and a Rho-associated coiled-coil containing protein kinase inhibitor(s), for use in a method of prophylaxis or treatment of glaucoma or ocular hypertension, wherein the Rho-associated coiled-coil containing protein kinase inhibitor(s) is at least one kind selected from the group consisting of netarsudil, a salt thereof, a hydrate thereof and a solvate thereof.