WO2005011690A1 - Utilisation de composes de 3,7-diazabicyclo[3,3,1]nonane pour traiter et/ou prevenir des evenements arythmiques chez des patients humains males - Google Patents
Utilisation de composes de 3,7-diazabicyclo[3,3,1]nonane pour traiter et/ou prevenir des evenements arythmiques chez des patients humains males Download PDFInfo
- Publication number
- WO2005011690A1 WO2005011690A1 PCT/EP2004/051532 EP2004051532W WO2005011690A1 WO 2005011690 A1 WO2005011690 A1 WO 2005011690A1 EP 2004051532 W EP2004051532 W EP 2004051532W WO 2005011690 A1 WO2005011690 A1 WO 2005011690A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- diazabicyclo
- carbon atoms
- nonane
- group containing
- tedisamil
- Prior art date
Links
- 241000282414 Homo sapiens Species 0.000 title claims abstract description 69
- BKIMMITUMNQMOS-UHFFFAOYSA-N nonane Chemical class CCCCCCCCC BKIMMITUMNQMOS-UHFFFAOYSA-N 0.000 title claims abstract description 37
- 238000011282 treatment Methods 0.000 title claims abstract description 26
- 230000003288 anthiarrhythmic effect Effects 0.000 title claims abstract description 18
- 239000003416 antiarrhythmic agent Substances 0.000 title claims abstract description 16
- 238000011321 prophylaxis Methods 0.000 title claims abstract description 10
- 206010003658 Atrial Fibrillation Diseases 0.000 claims abstract description 41
- 238000006243 chemical reaction Methods 0.000 claims abstract description 37
- 230000033764 rhythmic process Effects 0.000 claims abstract description 30
- 150000003839 salts Chemical class 0.000 claims abstract description 27
- 239000002253 acid Substances 0.000 claims abstract description 24
- 239000012453 solvate Substances 0.000 claims abstract description 17
- PTPQJKANBKHDPM-UHFFFAOYSA-N 3,7-diazabicyclo[3.3.1]nonane Chemical class C1NCC2CNCC1C2 PTPQJKANBKHDPM-UHFFFAOYSA-N 0.000 claims abstract description 8
- 125000004432 carbon atom Chemical group C* 0.000 claims description 36
- 150000001875 compounds Chemical class 0.000 claims description 26
- 125000000217 alkyl group Chemical group 0.000 claims description 25
- VZCYOOQTPOCHFL-OWOJBTEDSA-N Fumaric acid Chemical class OC(=O)\C=C\C(O)=O VZCYOOQTPOCHFL-OWOJBTEDSA-N 0.000 claims description 18
- 229910052757 nitrogen Inorganic materials 0.000 claims description 13
- 125000001316 cycloalkyl alkyl group Chemical group 0.000 claims description 12
- -1 3,7-diazabicyclo[3,3,1]nonane compound Chemical class 0.000 claims description 11
- 125000002947 alkylene group Chemical group 0.000 claims description 8
- 239000000825 pharmaceutical preparation Substances 0.000 claims description 8
- 229910052736 halogen Inorganic materials 0.000 claims description 7
- 150000002367 halogens Chemical group 0.000 claims description 7
- 238000004519 manufacturing process Methods 0.000 claims description 7
- VZCYOOQTPOCHFL-UHFFFAOYSA-N trans-butenedioic acid Natural products OC(=O)C=CC(O)=O VZCYOOQTPOCHFL-UHFFFAOYSA-N 0.000 claims description 7
- 125000003545 alkoxy group Chemical group 0.000 claims description 6
- 239000001530 fumaric acid Substances 0.000 claims description 6
- 229910052739 hydrogen Inorganic materials 0.000 claims description 6
- 239000001257 hydrogen Substances 0.000 claims description 6
- 125000004435 hydrogen atom Chemical group [H]* 0.000 claims description 6
- 125000004433 nitrogen atom Chemical group N* 0.000 claims description 4
- 125000001997 phenyl group Chemical group [H]C1=C([H])C([H])=C(*)C([H])=C1[H] 0.000 claims description 3
- 125000003342 alkenyl group Chemical group 0.000 claims description 2
- 125000001797 benzyl group Chemical group [H]C1=C([H])C([H])=C(C([H])=C1[H])C([H])([H])* 0.000 claims description 2
- 125000004186 cyclopropylmethyl group Chemical group [H]C([H])(*)C1([H])C([H])([H])C1([H])[H] 0.000 claims description 2
- 125000006410 propenylene group Chemical group 0.000 claims description 2
- QCQCHGYLTSGIGX-GHXANHINSA-N 4-[[(3ar,5ar,5br,7ar,9s,11ar,11br,13as)-5a,5b,8,8,11a-pentamethyl-3a-[(5-methylpyridine-3-carbonyl)amino]-2-oxo-1-propan-2-yl-4,5,6,7,7a,9,10,11,11b,12,13,13a-dodecahydro-3h-cyclopenta[a]chrysen-9-yl]oxy]-2,2-dimethyl-4-oxobutanoic acid Chemical compound N([C@@]12CC[C@@]3(C)[C@]4(C)CC[C@H]5C(C)(C)[C@@H](OC(=O)CC(C)(C)C(O)=O)CC[C@]5(C)[C@H]4CC[C@@H]3C1=C(C(C2)=O)C(C)C)C(=O)C1=CN=CC(C)=C1 QCQCHGYLTSGIGX-GHXANHINSA-N 0.000 claims 1
- 229960002926 tedisamil Drugs 0.000 abstract description 70
- CTIRHWCPXYGDGF-HDICACEKSA-N tedisamil Chemical compound [H][C@]12CN(CC3CC3)C[C@]([H])(CN(CC3CC3)C1)C21CCCC1 CTIRHWCPXYGDGF-HDICACEKSA-N 0.000 abstract description 53
- 238000001802 infusion Methods 0.000 description 30
- 239000000902 placebo Substances 0.000 description 23
- 229940068196 placebo Drugs 0.000 description 23
- 230000000694 effects Effects 0.000 description 15
- AZPYPAVFNGFTGB-ORRJWUSCSA-N (1S,5R)-3,7-bis(cyclopropylmethyl)spiro[3-aza-7-azoniabicyclo[3.3.1]nonane-9,1'-cyclopentane] (E)-but-2-enedioate (E)-but-2-enedioic acid Chemical compound OC(=O)\C=C\C(=O)O.OC(=O)\C=C\C(=O)O.OC(=O)\C=C\C(=O)O.C(C1CC1)N2C[C@@H]3CN(CC4CC4)C[C@H](C2)C35CCCC5.C(C6CC6)N7C[C@@H]8CN(CC9CC9)C[C@H](C7)C8%10CCCC%10 AZPYPAVFNGFTGB-ORRJWUSCSA-N 0.000 description 14
- 241000282412 Homo Species 0.000 description 13
- 238000001990 intravenous administration Methods 0.000 description 13
- 206010003662 Atrial flutter Diseases 0.000 description 12
- 239000003814 drug Substances 0.000 description 8
- HQKMJHAJHXVSDF-UHFFFAOYSA-L magnesium stearate Chemical compound [Mg+2].CCCCCCCCCCCCCCCCCC([O-])=O.CCCCCCCCCCCCCCCCCC([O-])=O HQKMJHAJHXVSDF-UHFFFAOYSA-L 0.000 description 8
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 8
- 239000013543 active substance Substances 0.000 description 7
- 238000004458 analytical method Methods 0.000 description 7
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- 239000012458 free base Substances 0.000 description 7
- 230000000977 initiatory effect Effects 0.000 description 7
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- 239000003826 tablet Substances 0.000 description 7
- 239000008187 granular material Substances 0.000 description 6
- 239000000203 mixture Substances 0.000 description 6
- NXXZICGFHYJPGE-UHFFFAOYSA-N 3,7-bis(cyclopropylmethyl)spiro[3,7-diazabicyclo[3.3.1]nonane-9,1'-cyclopentane];dihydrochloride Chemical compound Cl.Cl.C1C(C23CCCC3)CN(CC3CC3)CC2CN1CC1CC1 NXXZICGFHYJPGE-UHFFFAOYSA-N 0.000 description 5
- GUBGYTABKSRVRQ-QKKXKWKRSA-N Lactose Natural products OC[C@H]1O[C@@H](O[C@H]2[C@H](O)[C@@H](O)C(O)O[C@@H]2CO)[C@H](O)[C@@H](O)[C@H]1O GUBGYTABKSRVRQ-QKKXKWKRSA-N 0.000 description 5
- 238000013194 cardioversion Methods 0.000 description 5
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- 239000008101 lactose Substances 0.000 description 5
- 238000012360 testing method Methods 0.000 description 5
- 229920002261 Corn starch Polymers 0.000 description 4
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 4
- 239000002775 capsule Substances 0.000 description 4
- 239000000969 carrier Substances 0.000 description 4
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- 238000011156 evaluation Methods 0.000 description 4
- 235000019359 magnesium stearate Nutrition 0.000 description 4
- 238000000034 method Methods 0.000 description 4
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- 239000001267 polyvinylpyrrolidone Substances 0.000 description 4
- QTBSBXVTEAMEQO-UHFFFAOYSA-N Acetic acid Chemical compound CC(O)=O QTBSBXVTEAMEQO-UHFFFAOYSA-N 0.000 description 3
- 241000282472 Canis lupus familiaris Species 0.000 description 3
- VEXZGXHMUGYJMC-UHFFFAOYSA-N Hydrochloric acid Chemical compound Cl VEXZGXHMUGYJMC-UHFFFAOYSA-N 0.000 description 3
- 241000700159 Rattus Species 0.000 description 3
- 208000018452 Torsade de pointes Diseases 0.000 description 3
- 208000002363 Torsades de Pointes Diseases 0.000 description 3
- KRKNYBCHXYNGOX-UHFFFAOYSA-N citric acid Chemical compound OC(=O)CC(O)(C(O)=O)CC(O)=O KRKNYBCHXYNGOX-UHFFFAOYSA-N 0.000 description 3
- 230000002526 effect on cardiovascular system Effects 0.000 description 3
- 239000013610 patient sample Substances 0.000 description 3
- 239000000047 product Substances 0.000 description 3
- 239000007787 solid Substances 0.000 description 3
- 239000000243 solution Substances 0.000 description 3
- 239000013589 supplement Substances 0.000 description 3
- 239000000454 talc Substances 0.000 description 3
- 235000012222 talc Nutrition 0.000 description 3
- 229910052623 talc Inorganic materials 0.000 description 3
- 238000002560 therapeutic procedure Methods 0.000 description 3
- 239000008215 water for injection Substances 0.000 description 3
- AOIVZQPSIHOHMP-HDICACEKSA-N (1r,5s)-7-(2-methylpropyl)-3-propan-2-ylspiro[3,7-diazabicyclo[3.3.1]nonane-9,1'-cyclohexane] Chemical compound C12([C@H]3CN(C[C@@H]2CN(C3)CC(C)C)C(C)C)CCCCC1 AOIVZQPSIHOHMP-HDICACEKSA-N 0.000 description 2
- 241001465754 Metazoa Species 0.000 description 2
- AFVFQIVMOAPDHO-UHFFFAOYSA-N Methanesulfonic acid Chemical compound CS(O)(=O)=O AFVFQIVMOAPDHO-UHFFFAOYSA-N 0.000 description 2
- 241000283973 Oryctolagus cuniculus Species 0.000 description 2
- 229920003080 Povidone K 25 Polymers 0.000 description 2
- QAOWNCQODCNURD-UHFFFAOYSA-N Sulfuric acid Chemical compound OS(O)(=O)=O QAOWNCQODCNURD-UHFFFAOYSA-N 0.000 description 2
- 239000004480 active ingredient Substances 0.000 description 2
- 230000002411 adverse Effects 0.000 description 2
- 230000001174 ascending effect Effects 0.000 description 2
- 230000001746 atrial effect Effects 0.000 description 2
- 229950002035 bertosamil Drugs 0.000 description 2
- 238000004364 calculation method Methods 0.000 description 2
- 238000013461 design Methods 0.000 description 2
- 238000003745 diagnosis Methods 0.000 description 2
- 238000011833 dog model Methods 0.000 description 2
- 231100000673 dose–response relationship Toxicity 0.000 description 2
- 230000002349 favourable effect Effects 0.000 description 2
- JVTAAEKCZFNVCJ-UHFFFAOYSA-N lactic acid Chemical compound CC(O)C(O)=O JVTAAEKCZFNVCJ-UHFFFAOYSA-N 0.000 description 2
- 239000007788 liquid Substances 0.000 description 2
- 238000012544 monitoring process Methods 0.000 description 2
- 239000008194 pharmaceutical composition Substances 0.000 description 2
- 239000000843 powder Substances 0.000 description 2
- LOUPRKONTZGTKE-LHHVKLHASA-N quinidine Chemical compound C([C@H]([C@H](C1)C=C)C2)C[N@@]1[C@H]2[C@@H](O)C1=CC=NC2=CC=C(OC)C=C21 LOUPRKONTZGTKE-LHHVKLHASA-N 0.000 description 2
- 230000000306 recurrent effect Effects 0.000 description 2
- 238000011160 research Methods 0.000 description 2
- YGSDEFSMJLZEOE-UHFFFAOYSA-N salicylic acid Chemical compound OC(=O)C1=CC=CC=C1O YGSDEFSMJLZEOE-UHFFFAOYSA-N 0.000 description 2
- 238000012216 screening Methods 0.000 description 2
- RMAQACBXLXPBSY-UHFFFAOYSA-N silicic acid Chemical compound O[Si](O)(O)O RMAQACBXLXPBSY-UHFFFAOYSA-N 0.000 description 2
- 235000012239 silicon dioxide Nutrition 0.000 description 2
- 239000011780 sodium chloride Substances 0.000 description 2
- 238000007619 statistical method Methods 0.000 description 2
- JOXIMZWYDAKGHI-UHFFFAOYSA-N toluene-4-sulfonic acid Chemical compound CC1=CC=C(S(O)(=O)=O)C=C1 JOXIMZWYDAKGHI-UHFFFAOYSA-N 0.000 description 2
- 230000002861 ventricular Effects 0.000 description 2
- 229910002016 Aerosil® 200 Inorganic materials 0.000 description 1
- OKTJSMMVPCPJKN-UHFFFAOYSA-N Carbon Chemical compound [C] OKTJSMMVPCPJKN-UHFFFAOYSA-N 0.000 description 1
- FEWJPZIEWOKRBE-JCYAYHJZSA-N Dextrotartaric acid Chemical compound OC(=O)[C@H](O)[C@@H](O)C(O)=O FEWJPZIEWOKRBE-JCYAYHJZSA-N 0.000 description 1
- 241000282326 Felis catus Species 0.000 description 1
- DGAQECJNVWCQMB-PUAWFVPOSA-M Ilexoside XXIX Chemical compound C[C@@H]1CC[C@@]2(CC[C@@]3(C(=CC[C@H]4[C@]3(CC[C@@H]5[C@@]4(CC[C@@H](C5(C)C)OS(=O)(=O)[O-])C)C)[C@@H]2[C@]1(C)O)C)C(=O)O[C@H]6[C@@H]([C@H]([C@@H]([C@H](O6)CO)O)O)O.[Na+] DGAQECJNVWCQMB-PUAWFVPOSA-M 0.000 description 1
- 208000004880 Polyuria Diseases 0.000 description 1
- ZLMJMSJWJFRBEC-UHFFFAOYSA-N Potassium Chemical compound [K] ZLMJMSJWJFRBEC-UHFFFAOYSA-N 0.000 description 1
- OFOBLEOULBTSOW-UHFFFAOYSA-N Propanedioic acid Natural products OC(=O)CC(O)=O OFOBLEOULBTSOW-UHFFFAOYSA-N 0.000 description 1
- VYPSYNLAJGMNEJ-UHFFFAOYSA-N Silicium dioxide Chemical compound O=[Si]=O VYPSYNLAJGMNEJ-UHFFFAOYSA-N 0.000 description 1
- 229920002472 Starch Polymers 0.000 description 1
- FEWJPZIEWOKRBE-UHFFFAOYSA-N Tartaric acid Natural products [H+].[H+].[O-]C(=O)C(O)C(O)C([O-])=O FEWJPZIEWOKRBE-UHFFFAOYSA-N 0.000 description 1
- 235000011054 acetic acid Nutrition 0.000 description 1
- 150000007513 acids Chemical class 0.000 description 1
- 239000003708 ampul Substances 0.000 description 1
- 230000002253 anti-ischaemic effect Effects 0.000 description 1
- 230000002763 arrhythmic effect Effects 0.000 description 1
- 150000008107 benzenesulfonic acids Chemical class 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
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- 230000001684 chronic effect Effects 0.000 description 1
- LOUPRKONTZGTKE-UHFFFAOYSA-N cinchonine Natural products C1C(C(C2)C=C)CCN2C1C(O)C1=CC=NC2=CC=C(OC)C=C21 LOUPRKONTZGTKE-UHFFFAOYSA-N 0.000 description 1
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- 150000001991 dicarboxylic acids Chemical class 0.000 description 1
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- 230000001882 diuretic effect Effects 0.000 description 1
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- 235000011087 fumaric acid Nutrition 0.000 description 1
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- 150000003840 hydrochlorides Chemical class 0.000 description 1
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- 239000000314 lubricant Substances 0.000 description 1
- VZCYOOQTPOCHFL-UPHRSURJSA-N maleic acid Chemical compound OC(=O)\C=C/C(O)=O VZCYOOQTPOCHFL-UPHRSURJSA-N 0.000 description 1
- 239000011976 maleic acid Substances 0.000 description 1
- 239000012528 membrane Substances 0.000 description 1
- 229940098779 methanesulfonic acid Drugs 0.000 description 1
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- 150000007524 organic acids Chemical class 0.000 description 1
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- 230000036284 oxygen consumption Effects 0.000 description 1
- FJKROLUGYXJWQN-UHFFFAOYSA-N papa-hydroxy-benzoic acid Natural products OC(=O)C1=CC=C(O)C=C1 FJKROLUGYXJWQN-UHFFFAOYSA-N 0.000 description 1
- 230000036470 plasma concentration Effects 0.000 description 1
- 229920001223 polyethylene glycol Polymers 0.000 description 1
- 239000011591 potassium Substances 0.000 description 1
- 229910052700 potassium Inorganic materials 0.000 description 1
- 239000003755 preservative agent Substances 0.000 description 1
- 229960001404 quinidine Drugs 0.000 description 1
- 230000036279 refractory period Effects 0.000 description 1
- 238000012552 review Methods 0.000 description 1
- 229960004889 salicylic acid Drugs 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
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- 125000001424 substituent group Chemical group 0.000 description 1
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
- A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/33—Heterocyclic compounds
- A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
- A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
- A61K31/4995—Pyrazines or piperazines forming part of bridged ring systems
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P9/00—Drugs for disorders of the cardiovascular system
- A61P9/06—Antiarrhythmics
Definitions
- the present invention relates to a novel medicinal use of 3,7-diazabicyclo- [3,3,1]nonane compounds, preferably of 9,9-alkylene-3,7-diazabicyclo[3,3J]-nonane compounds, and most preferably to a novel medicinal use of tedisamil, and of pharmaceutically acceptable acid addition salts and/or solvates of said compounds.
- 9,9-Alkylene-3,7-diazabicyclononane compounds of formula I and their pharmacological activities are known from published European Patent No. EP 103,833 and the corresponding U.S. Pat. No. 4,550,112, and Finnish Patent No. FI 76,338.
- Compounds of formula I are a sub-group of the 9,9-N,N'-tetra-substituted 3,7-diaza- bicyclo[3.3J]nonane compounds described in the aforementioned patent specifications and can be prepared by the methods described therein.
- the aforementioned patent specifications disclose that the compounds have useful cardio-active properties, particularly oxygen-saving effects and effects on the heart rate and heart rhythm in general, and are distinguished by a high physiological tolerance.
- the compounds show a satisfactory anti-arrhythmic action even at low doses.
- the undesired negative effect on the contractile power of the heart is extremely low; i.e. the compounds have a particularly favourable ratio of a nti -arrhythmic or the refractory period of the heart prolonging activities, to negative inotropic secondary activities.
- Another object of the invention is to provide new anti-arrhythmic pharmaceutical compositions having an improved activity profile for the use in male human patients.
- the objects of the invention are achieved by surprisingly discovering that 3,7- diazabicyclo-[3,3,1]nonane compounds, preferably of 9,9-alkylene-3,7- diazabicyclo[3,3J]-nonane compounds, and most preferably tedisamil, and of pharmaceutically acceptable acid addition salts and/or solvates of said compounds are particularly suitable for the treatment and/or prophylaxis of anti-arrhythmic events in male human patients, preferably for conversion of recent onset of atrial fibrillation (Afib) or flutter to normal sinus rhythm (NSR) in male human patients.
- Afib atrial fibrillation
- NSR normal sinus rhythm
- an anti -arrhythmic pharmaceutical composition comprising an anti-arrhythmic amount effective in male human patients of at least one anti-arrhythmic active 3,7-diaza-bicyclo[3,3J]nonane compound as described in the present invention.
- the subject of the invention is therefore the use of the use of 3,7-diaza- bicyclo[3,3J]nonane compounds, its physiologically acceptable acid addition salts and/or solvates thereof for the production of a pharmaceutical preparation for the treatment and/or prophylaxis of anti-arrhythmic events in male human patients, preferably for conversion of recent onset of atrial fibrillation (Afib) or flutter to normal sinus rhythm (NSR) in male human patients.
- Afib atrial fibrillation
- NSR normal sinus rhythm
- the compounds suitable for this novel medicinal use in male human patients are 3,7-diazabicyclo[3,3J]nonane compounds corresponding to the Formula I:
- R1 represents an alkyl group containing from 1 to 6 carbon atoms, an alkylene group containing from 3 to 6 carbon atoms having a double bond which is not linked directly to the nitrogen atom, a cycloalkylalkyl group containing from 4 to 9 carbon atoms, or a benzyl group
- R2 represents a lower alkyl group
- R3 represents a lower alkyl group
- R2 and R3 together form an alkylene chain containing from 3 to 6 carbon atoms
- R4 represents an alkyl group containing from 1 to 6 carbon atoms, an alkenyl group containing from 3 to 6 carbon atoms having a double bond which is not linked directly to the nitrogen atom, a cycloalkylalkyl group containing from 4 to 9 carbon atoms, a group corresponding to the Formula a:
- R5 represents hydrogen, halogen, lower alkyl or lower alkoxy
- Z represents an alkylene chain containing from 1 to 3 carbon atoms or a propenylene chain having a double bond which is conjugated with the phenyl group, or a group corresponding to the Formula b:
- R6 represents hydrogen, halogen, lower alkyl or lower alkoxy
- R7 represents hydrogen, halogen, lower alkyl or lower alkoxy
- Particularly suited compounds for the novel medicinal use in male human patients according to the invention are compounds of Formula I, wherein R1 represents an alkyl group containing from 1 to 6 carbon atoms or a cycloalkylalkyl group containing from 4 to 7 carbon atoms.
- R1 represents an alkyl group containing from 1 to 6 carbon atoms or a cycloalkylalkyl group containing from 4 to 7 carbon atoms.
- the substituent R4 represents an alkyl group containing from 1 to 6 carbon atoms, a cycloalkylalkyl group containing from 4 to 7 carbon atoms, or a group corresponding to Formula b.
- Preferred compounds for the novel medicinal use in male human patients according to the invention are compounds of Formula I, wherein R1 represents an alkyl group containing from 3 to 6 carbon atoms or a cycloalkylalkyl group containing from 4 to 7 carbon atoms, and R4 represents an alkyl group containing from 3 to 6 carbon atoms or a cycloalkylalkyl group containing from 4 to 7 carbon atoms.
- Said 3,7-diazabicyclo- [3,3,1]nonane compound may be a 9,9-alkylene-3,7-diazabicyclo[3.3J]nonane compound of Formula I wherein R2 and R3 together form an alkylene chain containing from 4 to 5 carbon atoms, and R1 and R4 independently of one another each denote a straight-chain or branched alkyl group of 3-4 carbon atoms or the cyclopropylmethyl group, and physiologically acceptable acid addition salts and/or solvates thereof.
- Preferred salts for this group of compounds are fumaric acid salts of 9,9-alkylene-3,7- diazabicyclo[3.3J]nonane compounds containing 1.5 moles of fumaric acid per mole of compound of formula I.
- Further preferred compounds for the novel medicinal use in male human patients according to the invention are compounds selected from the group consisting of N,N'- dicyclopropyl-methyl-9, 9-tetramethylen-3,7-diazabicyclo[3,3J]nonane (tedisamil), N- isobutyl-N'-isopropyl-9,9-pentamethylen-3,7-diazabicyclo[3,3J]nonane, and physiologically acceptable acid addition salts and/or solvates thereof.
- Preferred salts for this group of compounds are fumaric acid salts of N,N'-dicyclopropyimethyl-9, 9- tetramethylene-3,7-diazabicyclo[3,3J]nonane (tedisamil) or of N-isobutyl-N'-isopropyl- 9,9-pentamethylene-3,7-diazabicyclo[3,3J]nonane containing 1.5 moles of fumaric acid per mole of said 9,9-alkylene-3,7-diazabicyclo[3.3J]-nonane compound.
- hydrochloride salts are also very suitable for the novel medicinal use according to the present invention in male human patients.
- Particularly preferred 3,7-diazabicyclo[3,3J]nonane compounds are the 9,9- alkylene-3,7-diazabicyclo[3.3J]nonane compound tedisamil and the physiologically compatible acid addition salts and/or solvates thereof, these are most preferably used as compounds for the production of pharmaceutical preparations for the treatment and/or prophylaxis of of antiarrhythmic male human patients, preferably in conversion of recent onset of atrial fibrillation (Afib) or flutter to normal sinus rhythm (NSR) in male human patients.
- Afib atrial fibrillation
- NSR normal sinus rhythm
- a tedisamil acid addition salt it may preferably be used according to the invention in the form of tedisamil hydrochloride or in the form of tedisamil sesquifumarate for the treatment of male human patients.
- Further pharmacologic-ally compatible acid addition salts of tedisamil are known from European Patent No. EP 103,833.
- salts with inorganic acids e.g.
- sulfuric acid or hydrohalic acids especially hydrochloric acid
- organic acids for instance lower aliphatic monocarboxylic or dicarboxylic acids such as acetic acid, fumaric acid, tartaric acid, lactic acid, maleic acid, citric acid or salicylic acid
- sulfonic acids for instance lower alkyl sulfonic acids such as methane sulfonic acid, or benzene sulfonic acids optionally substituted in the benzene ring by halogen or lower alkyl, such as p-toluene sulfonic acid, are suitable as physiologically acceptable acid addition salts of the compounds of Formula I.
- the superior anti-arrhythmic effect of the compounds of Formula I in male human patients in particular in the conversion of recent onset of atrial fibrillation (Afib) or flutter to normal sinus rhythm (NSR) in male human patients, can be demonstrated by clinical test data with human patients which prove the surprising suitability of 3,7- diazabicyclo[3,3J]nonane compounds, e.g. of tedisamil and its acid addition salts, for the treatment and/or prophylaxis of anti-arrhythmic effects in male human patients, preferably for conversion of recent onset of atrial fibrillation (Afib) or flutter to normal sinus rhythm (NSR) in male human patients.
- This first clinical study in humans was a Multi-Center, Double-Blind, Randomized, Placebo-Controlled, Sequential Ascending Dose Groups Study to evaluate the Efficacy and Safety of Intravenous Tedisamil in the Rapid Conversion to Normal Sinus Rhythm in Patients with Atrial Fibrillation or Flutter.
- the active ingredient used was tedisamil dihydrochloride.
- the study was designed as a phase II study and executed in 35 to 40 centers in 3 to 4 countries. Study duration: Screening: up to 48 hours; treatment (in- patient): single 30-minute infusion; safety follow up: 24 hours (in-patient) with continuous telemetry and 28 day safety follow up.
- the primary efficacy objective of the study was to demonstrate the superiority of any dose of tedisamil to placebo in the termination of atrial fibrillation/flutter as measured by the percentage of human patients converted to normal sinus rhythm (NSR) (for at least 60 seconds) at any time within 2.5 hours after the start of infusion, in humans.
- NSR normal sinus rhythm
- Secondary efficacy objectives were to determine the percentage of human patients remaining in sinus rhythm at 2.5 hours after initiation of the intravenous infusion of tedisamil versus placebo; to determine the percentage of human patients remaining in sinus rhythm at 24 hours after initiation of the intravenous infusion of tedisamil versus placebo; to determine the time to conversion after the start of the infusion of tedisamil versus placebo; and to determine the dose- and plasma concentration-response relationships of tedisamil versus placebo.
- Safety objective determining the safety and tolerability of tedisamil versus placebo.
- a multi-center, double-blind, randomized, placebo-controlled, sequential ascending dose groups study to evaluate the efficacy and safety of intravenous tedisamil versus placebo.
- the study drug was infused over 30 minutes, receiving half the dose within 10 minutes and half the dose within the remaining 20 minutes
- the first patient group received 0.4 mg/kg bodyweight (bw), infused as 0.2 mg/kg bw within 10 minutes, continued with 0.2 mg/kg bw infused within 20 minutes.
- the next higher dose 0.6 mg/kg bw (0.3 mg/kg bw infused within 10 min, continued with 0.3 mg/kg bw infused within 20 minutes) was only administered after the initial dose has been assessed (blinded) and found to be safe.
- a third stage may be added with a higher dose. Tedisamil blood concentrations were assessed during the infusion (at 10 and 30 minutes), at conversion to normal sinus rhythm, at recurrence and 24 hours after start of infusion.
- Planned number of human subjects 330 randomized (110 patients per dose group)
- Atrial fibrillation or flutter with a duration of > 3 hours and ⁇ 48 hours, occurring as a first or recurrent episode.
- Placebo (vehicle) administered as a 30-minute intravenous infusion.
- the total infusion time is 30 minutes, with half the dose infused within 10 minutes, and half the dose infused within the remaining 20 minutes.
- Primary efficacy the percentage of human patients converted to normal sinus rhythm (for at least 60 seconds) at any time within 2.5 hours after the initiation of the infusion of study drug.
- the percentage of conversion to normal sinus rhythm (at any time within 2.5 hours after the initiation of the infusion) in the placebo group is equal to 20% and the clinically relevant difference is 20%.
- the percentage of conversion to normal sinus rhythm in the placebo group is equal to 10% and the clinically relevant difference is 40%.
- Interim analyses for efficacy was performed halfway the first and second stages by an external statistician. The purpose is to terminate a stage when the tedisamil dose used in that stage is inefficacious.
- each interim analysis was a predictive power calculation for the comparison of tedisamil and placebo with respect to the primary efficacy variable.
- Blinded safety reviews were performed at the same time as the efficacy analyses and, in addition, at the end of the each stage (if applicable).
- the analysis of a second study in humans confirmed the finding of the first study, e.g. that there is a gender difference related to efficacy, e.g. that male human patients show a higher conversion rate compared to women when treated with tedisamil.
- the active ingredient used was tedisamil sesqifumarate.
- the study was designed as a phase II study and executed in 30 to 40 centers in 5 countries. Study duration: Screening: up to 48 hours; treatment (in-patient): single 30-minute infusion; safety follow up: 24 hours (in-patient) with continuous telemetry and 28 day safety follow up.
- the primary efficacy objective of the study in humans was to demonstrate the superiority of any dose of tedisamil sesquifumarate to placebo in the rapid conversion to normal sinus rhythm (for at least 60 seconds), as measured by the percentage of subjects converted at any time within 2.5 hours after the start of infusion.
- Secondary efficacy objectives were to determine the percentage of subjects converting to normal sinus rhythm at any time within 2.5 hours after start of the intravenous infusion and in normal sinus rhythm at 2.5 hours after initiation of the infusion of tedisamil sesquifumarate versus placebo; to determine the percentage of subjects converting to normal sinus rhythm at any time within 2.5 hours after start of the intravenous infusion and in normal sinus rhythm at 24 hours after initiation of the infusion of tedisamil sesquifumarate versus placebo; to determine the percentage of human subjects converting to normal sinus rhythm at any time within 2.5 hours after start of the intravenous infusion and in normal sinus rhythm at hospital discharge; to determine the time to conversion to normal sinus rhythm after the start of the infusion of tedisamil sesquifumarate versus placebo; to determine the dose- and concentration -response relationships of tedisamil sesquifumarate versus placebo; and to determine the energy required for DC cardioversion of tedisamil sesquifumarate versus placebo.
- Safety objective
- the study drug was infused over 30 minutes, receiving half the dose within 10 minutes and half the dose within the remaining 20 minutes.
- Subjects were randomly assigned to receive either: - 0.32 mg tedisamil free base per kg bodyweight (bw) (0J6 mg/kg bw within 10 minutes, followed by 0J6 mg/kg bw within 20 minutes); or - 0.48 mg tedisamil free base per kg bw (0.24 mg/kg bw within 10 min, followed by 0.24 mg/kg bw within 20 minutes); or - 0.64 mg tedisamil free base per kg bw (0.32 mg/kg bw within 10 min, followed by 0.32 mg/kg bw within 20 minutes); or - a 30 minute placebo infusion.
- Atrial fibrillation or flutter with a duration of > 3 hours and ⁇ 45 days, occurring as a first or recurrent episode.
- Test Product, Dose and Mode of Administration - Tedisamil free base 0.32 mg/kg body weight (equivalent to 0.51 mg/kg tedisamil sesquifumarate and to 0.4 mg/kg tedisamil dihydrochloride - Tedisamil free base 0.48 mg/kg body weight (equivalent to 0.77 mg/kg tedisamil sesquifumarate and to 0.6 mg/kg tedisamil dihydrochloride - Tedisamil free base 0.64 mg/kg body weight (equivalent to 1.02 mg/kg tedisamil sesquifumarate and to 0.8 mg/kg tedisamil dihydrochloride
- Placebo (vehicle) administered as a 30-minute intravenous infusion similar to tedisamil infusion.
- the total infusion time is 30 minutes, with half the dose infused within 10 minutes, and half the dose infused within the remaining 20 minutes.
- Secondary efficacy percentage of human subjects in normal sinus rhythm at any time within 2.5 hours and at 24 hours after start of infusion, as well as at hospital discharge, time to conversion, dose- and concentration-response relationships and DC cardioversion energy.
- Percentages of conversion will be compared among treatment groups using the (Pearson) chi-square statistics. Times to conversion will be compared among treatment groups using the log-rank test. Dose-response and concentration-response relationships and the energy required for DC conversion will be examined using descriptive statistics. Subjects with atrial fibrillation and atrial flutter will be separately analyzed. In addition, both populations will be pooled for analysis. All analyses involving the atrial flutter subject population will be considered as exploratory. Table I: Conversion of recent onset of atrial fibrillation (Afib) to NSR Conversion to NSR at any time within 2.5 hrs after start of infusion. ITT human patient sample; human patients with DC cardioversion are excluded.
- Table II Conversion of recent onset of atrial fibrillation (Afib) to NSR Conversion to NSR at any time within 2.5 hrs after start of infusion. Human patients with atrial fibrillation ITT human patient sample; human patients with DC cardioversion are excluded.
- Table III Conversion of recent onset of atrial fibrillation (Afib) to NSR Conversion to NSR at any time within 2.5 hrs after start of infusion. ITT human patient sample; human patients with DC cardioversion are excluded.
- 3,7-diazabicyclo-[3,3J]nonane compounds preferably of 9,9-alkylene-3,7-diazabicyclo[3,3J]-nonane compounds, and most preferably of tedisamil, and of pharmaceutically acceptable acid addition salts and/or solvates, may be contained according to the invention, together with conventional pharmaceutical auxiliaries and/or carriers, in solid or liquid pharmaceutical preparations dedicated to the administration in humans.
- solid preparations are preparations which can be administered orally, such as tablets, coated tablets, capsules, powders or granules, or alternatively suppositories.
- compositions may contain conventional pharmaceutical inorganic and/or organic carriers, such as talcum, lactose or starch, in addition to conventional pharmaceutical auxiliaries, for example lubricants or tablet disintegrating agents.
- Liquid preparations such as suspensions or emulsions of 3,7-diazabicyclo- [3,3J]nonane compounds, preferably of 9,9-alkylene-3,7-diazabicyclo[3,3,1]-nonane compounds, and most preferably of tedisamil, and of pharmaceutically acceptable acid addition salts and/or solvates thereof, may contain the usual diluents such as water, oils and/or suspension agents such as polyethylene glycols and the like.
- Other auxiliaries may additionally be added, such as preservatives, taste correctives and the like.
- the 3,7-diazabicyclo-[3,3J]nonane compounds preferably of 9,9-alkylene-3,7- diazabicyclo[3,3J]-nonane compounds, and most preferably tedisamil, and pharmaceutically acceptable acid addition salts and/or solvates thereof, can be mixed and formulated with the pharmaceutical auxiliaries and/or carriers in known manner.
- 3,7-diazabicyclo- [3,3,1]nonane compounds preferably of 9,9-alkylene-3,7-diazabicyclo[3,3,1]-nonane compounds, and most preferably tedisamil, and pharmaceutically acceptable acid addition salts and/or solvates thereof, can for example be mixed with the auxiliaries and/or carriers in conventional manner and can be wet or dry granulated.
- the granules or powder can be poured directly into capsules or be pressed into tablet cores in conventional manner. These can be coated in known manner if desired.
- Examples 1 to 3 describe pharmaceutical preparations according to the invention which contain an active substance of Formula I, and also the production of such pharmaceutical preparations.
- the following examples explain the production of pharmaceutical preparations containing tedisamil dihydrochloride.
- Pharmaceutical preparations containing tedisamil sesquifumarate may be obtained in an analogous manner.
- Example 1 Tablets Composition:
- the active substance was mixed with corn starch and finely powdered lactose in a mixer.
- the resulting mixture was thoroughly moistened with a 20% solution of polyvinylpyrrolidone ("Kollidon 25", from BASF) in deionized water. If necessary, additional deionized water was added.
- the moist granules were passed through a 2 mm sieve, dried on trays at 40 DEG C. and then passed through a 1 mm sieve (Frewitt machine). After the granules had been mixed with magnesium stearate and talcum, tablets weighing 115 mg were pressed therefrom, so that each tablet contained 20 mg of the active substance.
- Example 2 Capsules Composition
- the active substance was mixed with corn starch and finely powdered lactose in a mixer.
- the resulting mixture was thoroughly moistened with a 20% solution of polyvinylpyrrolidone ("Kollidon 25", from BASF) in deionized water. If necessary, deionized water was added.
- the moist granules were passed through a 1.6 mm sieve (Frewitt machine), dried on trays at 40 DEG C, and then passed through a 1 mm sieve (Frewitt).
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Abstract
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
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CA002533492A CA2533492A1 (fr) | 2003-07-21 | 2004-07-19 | Utilisation de composes de 3,7-diazabicyclo[3,3,1]nonane pour traiter et/ou prevenir des evenements arythmiques chez des patients humains males |
JP2006520832A JP2006528155A (ja) | 2003-07-21 | 2004-07-19 | 3,7−ジアザビシクロ[3.3.1]ノナン化合物の、ヒト男性患者の抗不整脈事象治療及び/又は予防のための使用 |
BRPI0412247-0A BRPI0412247A (pt) | 2003-07-21 | 2004-07-19 | uso de compostos 3,7-diazabiciclo[3.3.1]nonano para o tratamento e/ou profilaxia de episódios arrìtmicos em doentes humanos do sexo masculino |
MXPA06000796A MXPA06000796A (es) | 2003-07-21 | 2004-07-19 | Uso de los compuestos 3,7-diazabiciclo [3,3,1]nonano para el tratamiento y/o profilaxis de eventos antiarritmicos en pacientes humanos varones. |
EP04742001A EP1648456A1 (fr) | 2003-07-21 | 2004-07-19 | Utilisation de composes 3,7-diazabicyclo¬3,3,1|nonane pour le traitement et/ou la prophylaxie d'incidents arythmiques chez des patients males |
AU2004260624A AU2004260624A1 (en) | 2003-07-21 | 2004-07-19 | Use of 3,7-diazabicyclo`3, 3,1 !nonane compounds for the treatment and/or prophylaxis of anti-arrhythmic events in male human patients |
Applications Claiming Priority (2)
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EP03102243.7 | 2003-07-21 | ||
EP03102243 | 2003-07-21 |
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WO2005011690A1 true WO2005011690A1 (fr) | 2005-02-10 |
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PCT/EP2004/051532 WO2005011690A1 (fr) | 2003-07-21 | 2004-07-19 | Utilisation de composes de 3,7-diazabicyclo[3,3,1]nonane pour traiter et/ou prevenir des evenements arythmiques chez des patients humains males |
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EP (1) | EP1648456A1 (fr) |
JP (1) | JP2006528155A (fr) |
CN (1) | CN1822833A (fr) |
AU (1) | AU2004260624A1 (fr) |
BR (1) | BRPI0412247A (fr) |
CA (1) | CA2533492A1 (fr) |
MX (1) | MXPA06000796A (fr) |
WO (1) | WO2005011690A1 (fr) |
Cited By (4)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2014134419A1 (fr) * | 2013-03-01 | 2014-09-04 | Gilead Sciences, Inc. | Utilisation de bloqueurs ikach pour le traitement de maladies cardiaques |
US9403782B2 (en) | 2011-05-10 | 2016-08-02 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9598435B2 (en) | 2011-07-01 | 2017-03-21 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9695192B2 (en) | 2011-07-01 | 2017-07-04 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
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US4550112A (en) * | 1982-09-18 | 1985-10-29 | Kali-Chemie Pharma Gmbh | 3,7-Diazabicyclo(3,3,1)nonane compounds and their use in treating heart disease |
US4912113A (en) * | 1987-09-09 | 1990-03-27 | Kali-Chemie Pharma Gmbh | 3,7-diazabicyclo(3,3,1)nonane compounds and pharmaceutical compositions containing such compounds |
US5324732A (en) * | 1991-12-03 | 1994-06-28 | Kali-Chemie Pharma Gmbh | Crystalline fumaric acid salts of 9,9-alkylene-3,7-diazabicyclononane compounds and pharmaceutical compositions containing them |
WO2004045591A2 (fr) * | 2002-11-18 | 2004-06-03 | Solvay Pharmaceuticals Gmbh | Preparations pahrmaceutiques liquides contenant des composes 3,7-diazabicyclo[3,3,1] nonane et methode de traitement de manifestations anti-arythmiques |
-
2004
- 2004-07-19 BR BRPI0412247-0A patent/BRPI0412247A/pt not_active Application Discontinuation
- 2004-07-19 MX MXPA06000796A patent/MXPA06000796A/es not_active Application Discontinuation
- 2004-07-19 AU AU2004260624A patent/AU2004260624A1/en not_active Abandoned
- 2004-07-19 JP JP2006520832A patent/JP2006528155A/ja not_active Withdrawn
- 2004-07-19 CA CA002533492A patent/CA2533492A1/fr not_active Abandoned
- 2004-07-19 CN CNA200480019884XA patent/CN1822833A/zh active Pending
- 2004-07-19 WO PCT/EP2004/051532 patent/WO2005011690A1/fr not_active Application Discontinuation
- 2004-07-19 EP EP04742001A patent/EP1648456A1/fr not_active Withdrawn
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US4550112A (en) * | 1982-09-18 | 1985-10-29 | Kali-Chemie Pharma Gmbh | 3,7-Diazabicyclo(3,3,1)nonane compounds and their use in treating heart disease |
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US5324732A (en) * | 1991-12-03 | 1994-06-28 | Kali-Chemie Pharma Gmbh | Crystalline fumaric acid salts of 9,9-alkylene-3,7-diazabicyclononane compounds and pharmaceutical compositions containing them |
WO2004045591A2 (fr) * | 2002-11-18 | 2004-06-03 | Solvay Pharmaceuticals Gmbh | Preparations pahrmaceutiques liquides contenant des composes 3,7-diazabicyclo[3,3,1] nonane et methode de traitement de manifestations anti-arythmiques |
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FISCHBACH PETER S ET AL: "Tedisamil in a chronic canine model of atrial flutter", JOURNAL OF CARDIOVASCULAR PHARMACOLOGY, vol. 34, no. 2, August 1999 (1999-08-01), pages 212 - 218, XP009023056, ISSN: 0160-2446 * |
FLORES N A: "Tedisamil (Solvay).", CURRENT OPINION IN INVESTIGATIONAL DRUGS (LONDON, ENGLAND: 2000) ENGLAND JAN 2001, vol. 2, no. 1, January 2001 (2001-01-01), pages 97 - 103, XP009023055, ISSN: 1472-4472 * |
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Cited By (6)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US9403782B2 (en) | 2011-05-10 | 2016-08-02 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9682998B2 (en) | 2011-05-10 | 2017-06-20 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9598435B2 (en) | 2011-07-01 | 2017-03-21 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9676760B2 (en) | 2011-07-01 | 2017-06-13 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
US9695192B2 (en) | 2011-07-01 | 2017-07-04 | Gilead Sciences, Inc. | Fused heterocyclic compounds as ion channel modulators |
WO2014134419A1 (fr) * | 2013-03-01 | 2014-09-04 | Gilead Sciences, Inc. | Utilisation de bloqueurs ikach pour le traitement de maladies cardiaques |
Also Published As
Publication number | Publication date |
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BRPI0412247A (pt) | 2006-09-19 |
EP1648456A1 (fr) | 2006-04-26 |
CN1822833A (zh) | 2006-08-23 |
CA2533492A1 (fr) | 2005-02-10 |
JP2006528155A (ja) | 2006-12-14 |
MXPA06000796A (es) | 2006-04-07 |
AU2004260624A1 (en) | 2005-02-10 |
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