Use of salts of the janus kinase inhibitor (r)-3-(4-(7h-pyrrolo[2,3-d]pyrimidin-4-yl)-1h- pyrazol-1-yl)-3- cyclopentylpropanenitrile
Abstract
A salt selected from: maleic acid salt of (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile; (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile sulfuric acid salt; and phosphoric acid salt of (R) -3- (4- (7 H -pyrrolo [2,3-d] pyrimidin-4-yl) -1 H -pyrazol-1-yl) -3-cyclopentylpropanonitrile.
Term
1.7 yearsto projected expiry
Projected expiry 12 June 2028, counted from filing; an application has no term until it is granted.
- Priority
- Filed
- Published
- Today
- Projected expiry
19 claims: 8 independent, 11 dependent
- 1REIVINDICACIONES 1. Una sal seleccionada de:sal de ácido maleico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo;sal de ácido sulfúrico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo;y sal de ácido fosfórico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo.
- 2La sal de la reivindicación 1 que es la sal de ácido maleico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1il)-3-ciclopentilpropanonitrilo.
- 3La sal de la reivindicación 1 que es la sal de ácido sulfúrico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol1-il)-3-ciclopentilpropanonitrilo.
- 4La sal de la reivindicación 1 que es la sal de ácido fosfórico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol1-il)-3-ciclopentilpropanonitrilo.
- 5La sal de la reivindicación 1 que está sustancialmente aislada.
- 6Un procedimiento de preparación de una sal de una cualquiera de las reivindicaciones 1 a 5 que comprende combinar (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo con ácido maleico, ácido sulfúrico o ácido fosfórico.
- 7Una composición que comprende al menos una sal de una cualquiera de las reivindicaciones 1 a 5 y al menos un vehículo farmacéuticamente aceptable.
- 8La composición de la reivindicación 7 que es adecuada para administración oral o tópica.
- 9La composición de la reivindicación 7 que es adecuada para administración tópica.
- 10Un procedimiento de modulación de una actividad de JAK que comprende poner en contacto JAK ex vivo con una sal de una cualquiera de las reivindicaciones 1 a 5.
- 11El procedimiento de la reivindicación 10, en el que dicha modulación es inhibición.
- 12Una sal de una cualquiera de las reivindicaciones 1 a 5 para su uso en el tratamiento de una enfermedad en un paciente en el que dicha enfermedad está asociada a actividad de JAK.
- 13La sal para su uso de la reivindicación 12 en la que dicha enfermedad es rechazo de aloinjerto o enfermedad de injerto contra huésped;o en la que dicha enfermedad es una enfermedad autoinmunitaria;o en la que dicha enfermedad es un trastorno de la piel;o en la que dicha enfermedad es una enfermedad vírica;o en la que dicha enfermedad es cáncer;o en la que dicha enfermedad se caracteriza por una JAK2 mutante;o en la que dicha enfermedad es un trastorno mieloproliferativo;o en la que dicha enfermedad es una enfermedad inflamatoria;o en la que dicha enfermedad es isquemia-reperfusión o relacionada con un evento isquémico;o en la que dicha enfermedad es anorexia o caquexia resultante de o asociada a cáncer;o en la que dicha enfermedad es fatiga resultante de o asociada a cáncer.
- 14La sal para su uso de la reivindicación 13 en la que dicha enfermedad autoinmunitaria es un trastorno de la piel, esclerosis múltiple, artritis reumatoide, artritis juvenil, diabetes tipo I, lupus, enfermedad inflamatoria del intestino, enfermedad de Crohn, miastenia grave, nefropatías por inmunoglobulina, miocarditis o trastorno de tiroides autoinmunitario;o en la que dicha enfermedad autoinmunitaria es trastorno de la piel bulloso;o en la que dicho trastorno de la piel es dermatitis atópica, psoriasis, sensibilización de la piel, irritación de la piel, erupción cutánea, dermatitis de contacto o sensibilización por contacto alérgico;o en la que dicha enfermedad viral es virus de Epstein Barr (VEB), hepatitis B, hepatitis C, VIH, HTLV 1, virus de la varicela zóster (VVZ) o virus del papiloma humano (VPH);o en la que dicho cáncer es un tumor sólido;o en la que dicho cáncer es cáncer de próstata, cáncer renal, cáncer hepático, cáncer de mama, cáncer de pulmón, cáncer de tiroides, sarcoma de Kaposi, enfermedad de Castleman o cáncer pancreático;o en la que dicho cáncer es hematológico;o en la que dicho cáncer es un cáncer de piel;o en la que dicho cáncer es mieloma múltiple;o en la que al menos una mutación de dicha JAK2 mutante reside en el dominio pseudo-cinasa de dicha JAK2;o en la que dicho trastorno mieloproliferativo (TMP) es policitemia vera (PV), trombocitemia esencial (TE), metaplasia mieloide con mielofibrosis (MMM), leucemia mielógena crónica (LMC), leucemia mielomonocítica crónica (LMMC), síndrome hipereosinofílico (SHE) o enfermedad sistémica de mastocitos (ESM);o en la que dicha enfermedad inflamatoria es una enfermedad inflamatoria del ojo;o en la que dicha enfermedad inflamatoria es una enfermedad inflamatoria de las vías respiratorias;o en la que dicha enfermedad inflamatoria es una miopatía inflamatoria;o en la que dicha enfermedad inflamatoria es miocarditis.
- 15La sal para su uso de la reivindicación 14, en la que dicho trastorno de la piel bulloso es pénfigo vulgar (PV) o penfigoide bulloso (PB);o en la que dicho cáncer es cáncer de próstata;o en la que dicho cáncer hematológico es linfoma, leucemia o mieloma múltiple;o en la que dicho cáncer de piel es linfoma cutáneo de linfocitos T o linfoma cutáneo de linfocitos B;o en la que dicha enfermedad inflamatoria del ojo es iritis, uveítis, escleritis o conjuntivitis;o en la que dicha enfermedad inflamatoria de las vías respiratorias se refiere a las vías respiratorias superiores;o en la que dicha enfermedad inflamatoria de las vías respiratorias se refiere a las vías respiratorias inferiores.
- 16Una sal de una cualquiera de las reivindicaciones 1 a 5 para su uso en el tratamiento de cáncer;un trastorno de la piel;inflamación;artritis reumatoide;cáncer de próstata;psoriasis;mieloma múltiple;metaplasia mieloide con mielofibrosis (MMM);policitemia vera (PV);trombocitemia esencial (TE);micosis fungoide;un cáncer hematológico;leucemia mielógena crónica (LMC);leucemia linfoblástica aguda (LLA);o leucemia mielomonocítica crónica (LMMC).
- 17Una sal de una cualquiera de las reivindicaciones 1 a 5 para su uso en el tratamiento de metaplasia mieloide con mielofibrosis (MMM);policitemia vera (PV);o trombocitemia esencial (TE).
- 18Sal de ácido fosfórico de (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo para su uso en el tratamiento de un trastorno mieloproliferativo.
- 19El compuesto para su uso según la reivindicación 18, en el que dicho trastorno mieloproliferativo es metaplasia mieloide con mielofibrosis (MMM);policitemia vera (PV);o trombocitemia esencial (TE).
Independent claims19
98 paragraphs in 5 sections, as filed
Salts of the kinase inhibitor Janus (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3cyclopentylpropanonitrile
FIELD OF THE INVENTION
The present invention provides (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3cyclopentylpropanonitrile salt forms which are useful in the Modulation of the activity of Janus kinases and are useful in the treatment of diseases related to the activity of Janus kinases that include, for example, immunorelated diseases, skin disorders, myeloid proliferative disorders, cancer and other diseases.
BACKGROUND OF THE INVENTION
Protein kinases (PK) are a group of enzymes that regulate various important biological processes that include cell growth, survival and differentiation, organ formation and morphogenesis, neovascularization, tissue repair and regeneration, among others. Protein kinases exert their physiological functions by catalyzing the phosphorylation of proteins (or substrates) and thus modulating the cellular activities of the substrates in various biological contexts. In addition to functions in normal tissues / organs, many protein kinases also perform more specialized functions in a recipient of human diseases that include cancer. A subset of protein kinases (also called oncogenic protein kinases), when deregulated, can produce tumor formation and growth, and additionally contribute to tumor maintenance and progression (Blume-Jensen P et al., Nature 2001, 411 (6835): 355 -365). Until now, oncogenic protein kinases represent one of the largest and most attractive groups of protein targets for cancer intervention and drug development.
The Janus kinase family (JAK) plays a role in the cytokine-dependent regulation of proliferation and function of cells that participate in immune response. There are currently four members of the known mammalian JAK family: JAK1 (also known as Janus 1 kinase), JAK2 (also known as Janus 2 kinase), JAK3 (also known as Janus kinase leukocyte; JAKL; L-JAK and kinase Janus 3) and TYK2 (also known as protein tyrosine kinase 2). JAK proteins range in size from 120 to 140 kDa and comprise seven conserved JAK homology domains (JH); one of these is a functional catalytic kinase domain, and the other is a pseudo-kinase domain that possibly serves as a regulatory function and / or serves as a binding site for STAT (Scott, Godshall et al. 2002, above).
The blockade of signal transduction at the level of JAK kinases keeps the promise of developing treatments for human cancers. The inhibition of JAK kinases is also expected to have therapeutic benefits in patients suffering from immune skin disorders such as psoriasis, and skin sensitization. Accordingly, Janus kinase inhibitors or related kinases are widely sought and several publications report effective classes of compounds. For example, certain JAK inhibitors, which include (R) 3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile represented a Then, they are reported in US Pat. Serial No. 11 / 637,545 filed on December 12, 2006.
Thus, new or improved forms of existing Janus kinase inhibitors are continually needed to develop new, improved and more effective pharmaceutical formulations for the treatment of cancer and other diseases. The salt forms and procedures described in this document are directed towards these needs and other purposes.
SUMMARY OF THE INVENTION
The present invention provides, among other things, salts selected from: (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazole-1 maleic acid salt -yl) -3-cyclopentylpropanonitrile; (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile sulfuric acid salt; and phosphoric acid salt of (R) -3- (4- (7 H -pyrrolo [2,3-d] pyrimidin-4-yl) -1 H -pyrazol-1-yl) -3-cyclopentylpropanonitrile.
The present invention further provides methods of preparing a salt of the invention comprising combining (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazole-1- il) -3-cyclopentylpropanonitrile with maleic acid, sulfuric acid or phosphoric acid.
The present invention further provides compositions comprising a salt form of the invention and at least one pharmaceutically acceptable carrier.
The present invention further provides methods of modulating a JAK activity comprising contacting JAK with a salt of the invention.
The present invention further provides compounds for use in methods of treating a disease in a patient, in which the disease is associated with JAK activity, which comprises administering to the patient a therapeutically effective amount of a salt of the invention.
The present invention further provides compounds for use in methods of treating cancer, skin disorders or inflammation in a patient, comprising administering to the patient a therapeutically effective amount of a salt of the invention.
The present invention further provides the salts of the invention for use in methods of treating the human or animal body by therapy.
The present invention further provides the salts of the invention for use in the treatment of cancer, skin disorders or inflammation.
The present invention further provides use of the salts of the invention for the preparation of a medicament for use in the treatment of any of the diseases or disorders cited herein.
DETAILED DESCRIPTION
The present invention provides, among other things, salts of the JAK (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin4-yl) -1H-pyrazol-1-yl) -3- inhibitor cyclopentylpropanonitrile selected from the maleic acid salt, sulfuric acid salt and phosphoric acid salt. These salts modulate the activity of one or more JAK and are useful, for example, in the treatment of diseases associated with expression or activity of JAK.
The salts of the invention have numerous advantageous properties with respect to the free base form and other salt forms. In particular, these salts were highly crystalline which would facilitate the preparation of pharmaceutical formulations and improve the general transport, handling and storage of the active ingredient. The salts of the invention also have aqueous solubility, dissolution rate, chemical stability (with prolonged storage stability), compatibility with superior excipients and reproducibility compared to the free base form.
In some embodiments, the salts of the invention are substantially isolated. By "substantially isolated" it is indicated that the salt is at least partially or substantially separated from the environment in which it was formed or detected. The partial separation may include, for example, a composition enriched in the salt of the invention. The substantial separation may include compositions containing at least about 50%, at least about 60%, at least about 70%, at least about 80%, at least about 90%, at least about 95%, at least about 97%, or at least about 99% by weight of the salt.
The salts of the invention also include all the isotopes of atoms that are produced in the salts. Isotopes include those atoms that have the same atomic number but different mass numbers. For example, hydrogen isotopes include tritium and deuterium.
The salts of the invention can be prepared using known techniques. Conventionally, a salt form is prepared by combining in solution the free base compound and an acid containing the anion of the desired salt form, and then isolating the solid salt product from the reaction solution (for example, by crystallization, precipitation, evaporation, etc.). Other salt formation techniques can be used.
Usage Procedures
The salts of the invention can modulate the activity of one or more Janus kinases (JAK). The term "modular" is intended to refer to an ability to increase or decrease the activity of one or more members of the JAK family of kinases. Accordingly, the compounds of the invention can be used in methods of modulating a JAK by contacting the JAK with any one or more of the compounds or compositions described herein. In some embodiments, the salts of the present invention may act as inhibitors of one or more JAK. In some embodiments, the compounds of the present invention may act by stimulating the activity of one or more JAK. In other embodiments, the compounds of the invention can be used to modulate the activity of a JAK in an individual in need of receptor modulation by administering a modulating amount of a salt of the invention.
JAK with which the present salts bind and / or modulate include any member of the JAK family. In some embodiments, the JAK is JAK1, JAK2, JAK3 or TYK2. In some embodiments, the JAK is JAK1 or JAK2. In some embodiments, the JAK is JAK2. In some embodiments, the JAK is JAK3.
The salts of the invention can be selective. By "selective" it is indicated that the compound binds to or inhibits a JAK with greater affinity or potency, respectively, compared to at least one other JAK. In some embodiments, the salts of the invention are selective inhibitors of JAK1 or JAK2 with respect to JAK3 and / or TYK2. In some embodiments, the compounds of the invention are selective inhibitors of JAK2 (for example, with respect to JAK1, JAK3 and TYK2). Without wishing to adhere to any theory, because JAK3 inhibitors can lead to immunosuppressive effects, a compound that is selective for JAK2 with respect to JAK3 and that is useful in the treatment of cancer (such as multiple myeloma, for example) can offer the additional advantage of having fewer immunosuppressive side effects. The selectivity can be at least about 5 times, 10 times, at least about 20 times, at least about 50 times, at least about 100 times, at least about 200 times, at least about 500 times or at least about 1000 times. Selectivity can be measured by routine procedures in the field. In some embodiments, the selectivity can be tested in the Km of each enzyme. In some embodiments, the salt selectivity of the invention by JAK2 with respect to JAK3 can be determined by the concentration of cellular ATP.
Another aspect of the present invention relates to compounds for use in methods of treating a disease or disorder associated with JAK in an individual (eg, patient) by administering to the individual in need of such treatment a quantity or dose of a salt of the present invention or a pharmaceutical composition thereof. A disease associated with JAK can include any disease, disorder or condition that is directly or indirectly linked to expression or activity of JAK, which includes excess expression and / or abnormal activity levels. A disease associated with JAK can also include any disease, disorder or condition that can be prevented, improved or cured by modulating JAK activity.
Examples of diseases associated with JAK include diseases that involve the immune system, including, for example, organ transplant rejection (for example, allograft rejection and graft versus host disease).
Other examples of JAK-associated diseases include autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, juvenile arthritis, type I diabetes, lupus, psoriasis, inflammatory bowel disease, ulcerative colitis, Crohn's disease, myasthenia gravis, immunoglobulin nephropathies, thyroid disorders autoimmune, and the like. In some embodiments, autoimmune disease is an autoimmune bullous skin disorder such as pemphigus vulgaris (PV) or bullous pemphigoid (PB).
Other examples of diseases associated with JAK include allergic conditions such as asthma, food allergies, atopic dermatitis and rhinitis. Other examples of JAK-associated diseases include viral diseases such as Epstein Barr virus (EBV), hepatitis B, hepatitis C, HIV, HTLV 1, varicella zoster virus (VZV) and human papillomavirus (HPV).
Other examples of diseases or conditions associated with JAK include skin disorders such as psoriasis (eg, psoriasis vulgaris), atopic dermatitis, rash, skin irritation, skin sensitization (for example, contact dermatitis or allergic dermatitis contact). For example, certain substances that include some pharmaceutical products when applied topically can cause skin sensitization. In some embodiments, co-administration or sequential administration of at least one JAK inhibitor of the invention together with the causative agent of unwanted sensitization may be useful in the treatment of such unwanted sensitization or dermatitis. In some embodiments, the skin disorder is treated by topical administration of at least one JAK inhibitor of the invention.
In other embodiments, JAK-associated disease is cancer that includes those characterized by solid tumors (e.g., prostate cancer, kidney cancer, liver cancer, pancreatic cancer, gastric cancer, breast cancer, lung cancer, head cancers and neck, thyroid cancer, glioblastoma, Kaposi's sarcoma, Castleman's disease, melanoma etc.), hematological cancers (eg, lymphoma, leukemia such as acute lymphoblastic leukemia, acute myelogenous leukemia (AML) or multiple myeloma) and skin cancer such as cutaneous T-cell lymphoma (LCLT) and cutaneous B-cell lymphoma. Examples of cutaneous T-lymphocyte lymphomas include Sezary syndrome and fungoid mycosis.
Diseases associated with JAK may additionally include those characterized by expression of a mutant JAK2 such as those that have at least one mutation in the pseudo-kinase domain (for example, JAK2V617F).
JAK-associated diseases may additionally include myeloproliferative disorders (TMP) such as polycythemia vera (PV), essential thrombocythemia (TE), myeloid metaplasia with myelofibrosis (MMM), chronic myelogenous leukemia (CML), chronic myelomonocytic leukemia (CML), syndrome hypereosinophilic (SHE), systemic mast cell disease (ESM), and the like.
Other diseases associated with JAK include inflammation and inflammatory diseases. Examples of inflammatory diseases include inflammatory diseases of the eye (for example, iritis, uveitis, scleritis, conjunctivitis, or related disease), inflammatory diseases of the respiratory tract (for example, the upper respiratory tract including the nose and sinuses such as rhinitis or sinusitis or lower respiratory tract including bronchitis, chronic obstructive pulmonary disease, and the like), inflammatory myopathy such as myocarditis, and other inflammatory diseases. Other inflammatory diseases treatable by the compounds of the invention include systemic inflammatory response syndrome (SRIS) and septic shock.
The JAK inhibitors described herein may additionally be used to treat ischemia reperfusion injuries or a disease or condition related to an inflammatory ischemic event such as stroke or cardiac arrest. The JAK inhibitors described herein can be further used to treat anorexia, cachexia or fatigue such as that resulting from or associated with cancer. The JAK inhibitors described herein can be used additionally to treat restenosis, sclerodermitis or fibrosis. The JAK inhibitors described herein may be further used to treat conditions associated with hypoxia or astrogliosis such as, for example, diabetic retinopathy, cancer or neurodegeneration. See, for example, Dudley, AC et al. Biochem J. 2005, 390 (Pt 2): 427-36 and Sriram, K. et al. J. Biol. Chem. 2004, 279 (19): 19936-47. Electronic publication of March 2, 2004.
The JAK inhibitors described herein can be further used to treat gout and high prostate size due to, for example, benign prostatic hypertrophy or benign prostatic hyperplasia.
As used herein, the term "contact" refers to putting together the indicated residues in an in vitro system or an in vivo system. For example, "contacting" a JAK with a salt of the invention includes the administration of a salt of the present invention with an individual or patient, such as a human being, having a JAK, in addition to, for example, introducing a salt of the invention in a sample containing a cellular or purified preparation containing JAK.
As used herein, the term "individual" or "patient," used interchangeably, refers to
any animal, which includes mammals, preferably mice, rats, other rodents, rabbits, dogs, cats, pigs, cattle, sheep, horses or primates, and most preferably humans.
As used herein, the term "therapeutically effective amount" refers to the amount of active salt or pharmaceutical agent that elicits the biological or medicinal response that is being sought in a tissue, system, animal, individual or human being by a researcher, veterinarian, medical doctor or other clinical professional.
As used herein, the term "treat" or "treatment" refers to one or more of (1) prevent the
disease; for example, to prevent a disease, condition or disorder in an individual who may have a predisposition to the disease, condition or disorder, but who does not yet experience or show the disease pathology or symptomatology; (2) inhibit the disease; for example, inhibiting a disease, condition or disorder in an individual who is experiencing or showing the pathology or symptomatology of the disease, condition or disorder; and (3) improve the disease; for example, improving a disease, condition or disorder in an individual who is experiencing or showing the pathology or symptomatology of the disease, condition or disorder (i.e., reversing the pathology and / or symptomatology) such as decreasing the severity of the disease.
Combination therapies
One or more additional pharmaceutical agents such as, for example, chemotherapeutic agents, anti-inflammatory agents, steroids, immunosuppressants, in addition to inhibitors of Bcr-Abl, Flt-3, RAF and FAK kinases such as, for example, those described in WO 2006 / 056399, or other agents, may be used in combination with the salts of the present invention for the treatment of diseases, disorders or conditions associated with JAK. The one or more additional pharmaceutical agents can be administered to a patient simultaneously or sequentially.
Examples of chemotherapeutic agents include proteasome inhibitors (for example, bortezomib), thalidomide, revlimid and DNA damaging agents such as melphalan, doxorubicin, cyclophosphamide, vincristine, etoposide, carmustine and the like.
Examples of steroids include corticosteroids such as dexamethasone or prednisone.
Examples of Bcr-Abl inhibitors include the compounds, and pharmaceutically acceptable salts thereof, of the genera and species disclosed in US Pat. No. 5,521,184, WO 04/005281, EP2005 / 009967, EP2005 / 010408 and US Pat. Serial No. 60 / 578,491.
Examples of suitable Flt-3 inhibitors include compounds, and their pharmaceutically acceptable salts, as disclosed in WO 03/037347, WO 03/099771 and WO 04/046120.
Examples of suitable RAF inhibitors include compounds, and their pharmaceutically acceptable salts, as disclosed in WO 00/09495 and WO 05/028444.
Examples of suitable FAK inhibitors include compounds, and their pharmaceutically acceptable salts, as disclosed in WO 04/080980, WO 04/056786, WO 03/024967, WO 01/064655, WO 00/053595 and WO 01/014402 .
In some embodiments, the salt forms of the invention can be used in combination with other kinase inhibitors such as imatinib, particularly for the treatment of patients resistant to imatinib or other kinases.
In some embodiments, one or more salt forms of the invention may be used in combination with a chemotherapeutic agent in the treatment of cancer, such as multiple myeloma, and may improve the treatment response with respect to the response to the chemotherapeutic agent alone, without exacerbation. of its toxic effects. Examples of additional pharmaceutical agents used in the treatment of multiple myeloma, for example, may include, without limitation, melphalan, melphalan plus prednisone [MP], doxorubicin, dexamethasone and Velcade (bortezomib). Other additional agents used in the treatment of multiple myeloma include inhibitors of Bcr-Abl, Flt3, RAF and FAK kinases. Additive or synergistic effects are desirable outcomes of combining a JAK inhibitor of the present invention with an additional agent. In addition, the resistance of multiple myeloma cells to agents such as dexamethasone may be reversible after treatment with a JAK inhibitor of the present invention. The agents can be combined with the present compounds in a single or continuous dosage form, or the agents can be administered simultaneously or sequentially as separate dosage forms.
In some embodiments, a corticosteroid such as dexamethasone is administered to a patient in combination with at least one JAK inhibitor when dexamethasone is administered intermittently as opposed to continuously.
In some other embodiments, combinations of one or more JAK inhibitors of the invention with other therapeutic agents may be administered to a patient before, during, and / or after a bone marrow transplant or cytoblast transplant.
Pharmaceutical formulations and dosage forms
When used as pharmaceuticals, the salts of the invention can be administered in the form of pharmaceutical compositions. These compositions can be prepared in a manner well known in the pharmaceutical art, and can be administered by a variety of routes, which depend on whether local treatment is desired.
<dl><dt /><dd>or systemic and the area to be treated. Administration can be topical (including transdermal, epidermal, ophthalmic and mucous membranes that include intranasal, vaginal and rectal administration), pulmonary (for example, by inhalation or insufflation of powders or aerosols, including by nebulizer; intratracheal or intranasal), oral or parenteral. Parenteral administration includes intravenous, intraarterial, subcutaneous, intraperitoneal, intramuscular or infusion injection; or intracranial, for example, intrathecal or intraventricular administration. Parenteral administration may be in the form of a single bolus dose, or it may be, for example, by a continuous infusion pump. Pharmaceutical compositions and formulations for topical administration may include transdermal patches, ointments, lotions, creams, gels, drops, suppositories, sprays, liquids and powders. Conventional pharmaceutical vehicles, aqueous, powdered or oily bases, thickeners and the like may be necessary</dd></dl>
<dl><dt /><dd>or desirable. Coated preservatives, gloves and the like can also be useful.</dd></dl>
The present invention also includes pharmaceutical compositions containing, as active ingredient, one or more of the compounds of the previous invention in combination with one or more pharmaceutically acceptable carriers (excipients). In the preparation of the compositions of the invention, the active ingredient is normally mixed with an excipient, diluted with an excipient or enclosed in such a vehicle in the form of, for example, a capsule, envelope, paper and other container. If the excipient serves as a diluent, it can be a solid, semi-solid or liquid material, which acts as a vehicle, support or medium for the active ingredient. Thus, the compositions may be in the form of tablets, pills, powders, lozenges, sachets, seals, elixirs, suspensions, emulsions, solutions, syrups, aerosols (as a solid or in a liquid medium), ointments containing, by For example, up to 10% by weight of the active compound, soft and hard gelatin capsules, suppositories, sterile injectable solutions and sterile packaged powders.
In the preparation of a formulation, the active compound can be milled to provide the appropriate particle size before combining with the other components. If the active compound is substantially insoluble, it can be milled to a particle size of less than 200 mesh. If the active compound is substantially water soluble, the particle size can be adjusted by grinding to provide a substantially uniform distribution in the formulation, for example, approximately 40 mesh.
The compounds of the invention can be milled using known milling methods such as wet milling to obtain an appropriate particle size for tablet formation and for other types of formulation. The finely divided preparations (nanoparticle) of the compounds of the invention can be prepared by methods known in the art, for example, see International Patent Application No. WO 2002/000196.
Some examples of suitable excipients include lactose, dextrose, sucrose, sorbitol, mannitol, starches, gum arabic, calcium phosphate, alginates, tragacanth, gelatin, calcium silicate, microcrystalline cellulose, polyvinylpyrrolidone, cellulose, water, syrup and methylcellulose. The formulations may additionally include: lubricating agents such as talc, magnesium stearate and mineral oil; wetting agents; emulsifiers and suspending agents; preservatives such as methyl- and propylhydroxybenzoates; sweeteners; and flavorings. The compositions of the invention can be formulated so as to provide rapid, sustained or delayed release of the active ingredient after administration to the patient using methods known in the art.
The compositions may be formulated in a unit dosage form, each dosage containing from about 5 to about 1000 mg (1 g), more usually about 100 to about 500 mg, of the active ingredient. The term "unit dosage forms" refers to physically discrete units suitable as unit dosages for human subjects and other mammals, each unit containing a predetermined amount of active material calculated to produce the desired therapeutic effect, in association with a suitable pharmaceutical excipient.
The active compound can be effective in a wide dosage range and is generally administered in a pharmaceutically effective amount. It will be understood, however, that the amount of the compound actually administered will normally be determined by a physician, according to the relevant circumstances, which include the condition to be treated, the route of administration chosen, the current compound administered, age, weight and response of the individual patient, the severity of the patient's symptoms and the like.
To prepare solid compositions such as tablets, the main active ingredient is mixed with a pharmaceutical excipient to form a solid preformulation composition containing a homogeneous mixture of a compound of the present invention. When referring to these preformulation compositions as homogeneous, the active ingredient is normally dispersed uniformly throughout the composition so that the composition can be easily subdivided into equally effective unit dosage forms such as tablets, pills and capsules. This solid preformulation is then subdivided into unit dosage forms of the type described above containing, for example, about 0.1 to about 1000 mg of the active ingredient of the present invention.
The tablets or pills of the present invention may be coated or otherwise combined to provide a dosage form that provides the advantage of prolonged action. For example, the tablet
or pill may comprise an internal dosing and external dosing component, the latter being in the form of a wrapper over the former. The two components can be separated by an enteric layer that serves to resist disintegration in the stomach and allow the internal component to pass intact to the duodenum or to be delayed release. A variety of materials can be used for such enteric layers or coatings, including such materials various polymeric acids and mixtures of polymeric acids with materials such as Shellac, cetyl alcohol and cellulose acetate.
Liquid forms in which the compounds and compositions of the present invention may be incorporated for oral or injection administration include aqueous solutions, suitably flavored syrups, aqueous or oil suspensions, and emulsions flavored with edible oils such as seed oil. cotton, sesame oil, coconut oil or peanut oil, in addition to elixirs and similar pharmaceutical vehicles.
Compositions for inhalation or insufflation include solutions and suspensions in pharmaceutically acceptable aqueous or organic solvents, or mixtures thereof, and powders. Liquid or solid compositions may contain suitable pharmaceutically acceptable excipients as described above. In some embodiments, the compositions are administered orally or nasally for local or systemic effect. The compositions can be nebulized using inert gases. Nebulized solutions can be breathed directly from the nebulizer device or the nebulizer device can be attached to a facial store, or intermittent positive pressure respirator. Compositions in solution, suspension or powder can be administered orally
or nasally of devices that administer the formulation in an appropriate manner.
The amount of salt or composition administered to a patient will vary depending on what is being administered, the purpose of administration, such as prophylaxis or therapy, the patient's condition, mode of administration, and the like. In therapeutic applications, the compositions can be administered to a patient already suffering from a disease in an amount sufficient to cure or at least partially stop the symptoms of the disease and its complications. Effective doses will depend on the condition of the disease being treated, in addition to the criteria of the attached clinical professional depending on factors such as the severity of the disease, the age, weight and general condition of the patient, and the like.
The compositions administered to a patient may be in the form of pharmaceutical compositions as described above. These compositions can be sterilized by conventional sterilization techniques, or they can be sterilized by filtration. The aqueous solutions can be packaged for use as such, or lyophilized, the lyophilized preparation being combined with a sterile aqueous vehicle before administration. The pH of the compound preparations will normally be between 3 and 11, more preferably 5 to 9, and most preferably 7 to 8. It will be understood that the use of certain of the above excipients, vehicles or stabilizers will cause salt formation Pharmaceuticals
The therapeutic dosage of the salts of the present invention may vary, for example, according to the particular use for which the treatment is made, the mode of administration of the compound, the health and condition of the patient and the criteria of the prescribing physician. The proportion or concentration of a salt of the invention in a pharmaceutical composition may vary depending on several factors that include dosage, chemical characteristics (eg, hydrophobia) and the route of administration. For example, the salts of the invention can be provided in an aqueous physiological buffer solution containing from about 0.1 to about 10% by weight / volume of the compound for parenteral administration. Some typical dose ranges are from about 1 µg / kg to about 1 g / kg body weight per day. In some embodiments, the dose range is from about 0.01 mg / kg to about 100 mg / kg body weight per day. The dosage is likely to depend on variables such as the type and degree of progression of the disease or disorder, the overall health status of the particular patient, the relative biological efficacy of the selected compound, the formulation of the excipient and its route of administration. Effective doses can be extrapolated from dose response curves derived from in vitro or animal model test systems.
The compositions of the invention may additionally include one or more additional pharmaceutical agents such as a chemotherapeutic, steroid, anti-inflammatory or immunosuppressive compound, examples of which are listed above herein.
Marked compounds and test procedures
Another aspect of the present invention relates to labeled salts of the invention (radiolabeled, fluorescently labeled, etc.) that would be useful not only in imaging techniques, but also in tests, both in vitro and in vivo, to locate and quantify JAK in tissue samples, which includes being human, and to identify JAK ligands by binding the inhibition of a labeled compound. Accordingly, the present invention includes JAK assays containing such labeled compounds.
The present invention further includes isotopically labeled salts of the invention. An "isotopically" or "radiolabeled" compound is a salt of the invention in which one or more atoms are replaced or substituted with an atom that has an atomic mass or mass number different from the atomic mass or mass number normally found in nature. (that is, it occurs naturally). Suitable radionuclides that can be incorporated into compounds of the present invention include, but are not limited to, 2H (also written as D by deuterium), 3H (also written as T by tritium), 11C, 13C, 14C, 13N, 15N, 15O , 17O, 18O, 18F, 35S, 36Cl, 82Br, 75Br, 76Br, 77Br, 123I, 124I, 125I and 131I. The radionuclide that is incorporated into the present radiolabeled compounds will depend on the specific application of that radiolabeled compound. For example, for in vitro metalloprotease labeling and competition assays, compounds that incorporate 3H, 14C, 82Br, 125I, 131I, 35S or will generally be the most useful. For radio imaging applications 11C 18F, 125I, 123I, 124I, 131I, 75Br, 76Br
or 77Br will generally be the most useful.
It is understood that a "radiolabeled compound" or "labeled" is a salt that has incorporated at least one radionuclide. In some embodiments, the radionuclide is selected from the group consisting of 3H, 14C, 125I, 35S and 82Br.
The present invention may additionally include synthetic methods for incorporating radioisotopes into compounds of the invention. Synthetic procedures for incorporating radioisotopes into organic compounds are well known in the art, and a person skilled in the art will readily recognize the procedures applicable to the compounds of the invention.
A labeled salt of the invention can be used in a screening assay to identify / evaluate compounds. For example, a newly synthesized or identified compound (i.e., test compound) that is labeled can be evaluated for its ability to bind to JAK by monitoring its concentration variation when it contacts the JAK, by marking monitoring. For example, a test compound (labeled) can be evaluated for its ability to reduce the binding of another compound that is known to bind to a JAK (i.e., conventional compound). Therefore, the ability of a test compound to compete with the conventional compound to bind to JAK correlates directly with its binding affinity. In contrast, in some other screening tests, the conventional compound is labeled and the test compounds are not labeled. Accordingly, the concentration of the labeled conventional compound is monitored in order to evaluate the competition between the conventional compound and the test compound, and thus the relative binding affinity of the test compound is determined.
Kits
The present invention also includes pharmaceutical kits useful, for example, in the treatment or prevention of diseases or disorders associated with JAK, such as cancer, inflammation or skin disorders, including one
or more containers containing a pharmaceutical composition comprising a therapeutically effective amount of a salt of the invention. Such kits may additionally include, if desired, one or more of various components of conventional pharmaceutical kits such as, for example, containers with one or more pharmaceutically acceptable carriers, additional containers, etc., as will be readily apparent to those skilled in the art. matter. Instructions, both as pamphlets and labels, that indicate quantities of the components to be administered, guidelines for administration and / or guidelines for mixing the components, can also be included in the kit.
The invention will be described in greater detail by way of specific examples. The following examples are offered for illustrative purposes and are not intended to limit the invention in any way. Those skilled in the art will readily recognize a variety of non-critical parameters that can be changed or modified giving essentially the same results.
EXAMPLES
Example 1: Preparation of the maleic acid salt of (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) 3-cyclopentylpropanonitrile
To a test tube was added (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile (153.7 mg, 0.5 mmol) and maleic acid (61.7 mg) followed by isopropyl alcohol (IPA) (4 ml). The resulting mixture was heated until clear, cooled to room temperature and then stirred for another 2.5 hours. The precipitate was collected by filtration and the cake was washed with 0.8 ml of cold IPA. The cake was dried under vacuum at constant weight to provide the final salt product (173 mg).
The maleic acid salt was shown to be a 1: 1 salt by 1 H NMR and the crystallinity was confirmed by powder X-ray diffraction (XRPD). Differential scanning calorimetry (DSC) gave a sharp melting peak at approximately 175.96 ° C (appearance at 175.67 ° C). The product only showed a slight weight loss up to 150 ° C by thermogravimetric analysis (TGA).
Example 2: Preparation of the phosphoric acid salt of (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) 3-cyclopentylpropanonitrile
To a test tube was added (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile (153.5 mg) and phosphoric acid (56.6 mg) followed by isopropyl alcohol (IPA) (5.75 ml). The resulting mixture was heated until it was clear, cooled to room temperature and then stirred for another 2 hours. The precipitate was collected by filtration and the cake was washed with 0.6 ml of cold IPA. The cake was dried under vacuum at constant weight to provide the final salt product (171.7 mg).
The phosphoric acid salt was shown to be a 1: 1 salt by 1 H NMR and the crystallinity was confirmed by powder X-ray diffraction (XRPD). Differential scanning calorimetry (DSC) gave a sharp melting peak at approximately 198.66 ° C. The product showed little weight loss up to 200 ° C per TGA.
Example 3: Preparation of the sulfuric acid salt of (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) 3-cyclopentylpropanonitrile
To a test tube was added (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile (153.0 mg) and sulfuric acid (56.1 mg) followed by acetonitrile (7.0 ml). The resulting mixture was heated until it was clear, cooled to room temperature and then stirred for another 2 hours. The precipitate was collected by filtration and the cake was washed with 0.8 ml of cold acetonitrile. The cake was dried under vacuum at constant weight to provide the final salt product (180 mg).
The sulfuric acid salt was shown to be a 1: 1 salt by 1 H NMR and the crystallinity was confirmed by powder X-ray diffraction (XRPD). Differential scanning calorimetry (DSC) gave a sharp melting peak at approximately 186.78 ° C. The product showed little weight loss up to 175 ° C for TGA.
Example A
In vitro test of JAK kinases
The inhibitory activity of test compounds on JAK targets can be tested according to the following in vitro assay described in Park et al., Analytical Biochemistry 1999, 269, 94-104. The catalytic domains of human JAK1
(aa 837-1142), Jak2 (aa 828-1132) and Jak3 (aa 781-1124) with a N-end His mark are expressed using baculovirus in insect cells and purified. The catalytic activity of JAK1, JAK2 or JAK3 is tested by measuring the phosphorylation of a biotinylated peptide. The phosphorylated peptide was detected by time-resolved homogeneous fluorescence (HTRF). The IC50 of the compounds are measured for each kinase in the reactions containing the enzyme, ATP and 500 nM peptide in 50 mM Tris buffer (pH 7.8) with 100 mM NaCl, 5 mM DTT and 0.1 mg / ml ( 0.01%) of BSA. The concentration of ATP in the reactions is 90 µM for Jak1, 30 µM for Jak2 and 3 µM for Jak3. The reactions are carried out at room temperature for 1 h and then stopped with 20 µl of 45 mM EDTA, 300 nM SA-APC, 6 nM Eu-Py20 in assay buffer (Perkin Elmer, Boston, MA). The binding to the europium-labeled antibody takes place for 40 minutes and the HTRF signal is measured in a Fusion plate reader (Perkin Elmer, Boston, MA). It was found that both the phosphoric acid salt of the invention and the corresponding free base compound had IC50 values of less than 50 nM for each of JAK1, JAK2 and JAK3.
Various modifications of the invention, in addition to those described herein, will be apparent to those skilled in the art from the above description. Such modifications are also intended to be within the scope of the appended claims. Each reference cited in this application is incorporated herein by reference in its entirety.
Contents5
131 members in 43 offices
Priority claims9
| Document | Office | Kind | Date |
|---|---|---|---|
| 943705P | United States of America | – | |
| 94370507 | United States of America | P | |
| 94370507 | United States of America | P | |
| 2008066662 | United States of America | W | |
| 2008066662 | United States of America | W | |
| 943705P | – | – | – |
| PCTUS2008066662 | – | – | – |
| US20070943705P | – | – | – |
| WO2008US66662 | – | – | – |
Members131
| Document | Office | Kind | |
|---|---|---|---|
| EP0252447A2 | European Patent Office (EPO) | A2 | |
| JPS6326942A | Japan | A | |
| US4774432A | United States of America | A | |
| EP0252447A3 | European Patent Office (EPO) | A3 | |
| CA1280461C | Canada | C | |
| EP0252447B1 | European Patent Office (EPO) | B1 | |
| DE3782196D1 | Germany | D1 | |
| DE3782196T2 | Germany | T2 | |
| US2008312259A1 | United States of America | A1 | |
| AU2008266183A1 | Australia | A1 | |
| CA2689663A1 | Canada | A1 | |
| WO2008157208A2 | World Intellectual Property Organization (WIPO) | A2 | |
| WO2008157208A3 | World Intellectual Property Organization (WIPO) | A3 | |
| ECSP099802A | Ecuador | A | |
| MX2009013402A | Mexico | A | |
| CR11151A | Costa Rica | A | |
| DOP2009000280A | Dominican Republic | A | |
| EP2173752A2 | European Patent Office (EPO) | A2 | |
| SMAP201000002A | San Marino | A | |
| KR20100049010A | Republic of Korea | A | |
| EA201070013A1 | Eurasian Patent Organization (EAPO) | A1 | |
| IL202524D0 | Israel | D0 | |
| MA31517B1 | Morocco | B1 | |
| SMP201000002B | San Marino | B | |
| JP2010529209A | Japan | A | |
| GT200900314A | Guatemala | A | |
| HK1143161A1 | Hong Kong, China | A1 | |
| CN101932582A | China | A | |
| CO6251256A2 | Colombia | A2 | |
| TN2009000514A1 | Tunisia | A1 | |
| CU20090213A7 | Cuba | A7 | |
| NI200900216A | Nicaragua | A | |
| GEP20125533B | Georgia | B | |
| NZ581803A | New Zealand | A | |
| ME00960B | Montenegro | B | |
| SG182198A1 | Singapore | A1 | |
| UA99467C2 | Ukraine | C2 | |
| CU20120155A7 | Cuba | A7 | |
| CU23933B1 | Cuba | B1 | |
| AU2008266183B2 | Australia | B2 | |
| CN101932582B | China | B | |
| CN103524509A | China | A | |
| EP2173752B1 | European Patent Office (EPO) | B1 | |
| DK2173752T3 | Denmark | T3 | |
| US2014094476A1 | United States of America | A1 | |
| US2014094477A1 | United States of America | A1 | |
| JP5475653B2 | Japan | B2 | |
| US8722693B2 | United States of America | B2 | |
| ZA200908826B | South Africa | B | |
| PT2173752E | Portugal | E | |
| EP2740731A1 | European Patent Office (EPO) | A1 | |
| ES2467665T3This record | Spain | T3 | |
| EA019784B1 | Eurasian Patent Organization (EAPO) | B1 | |
| IL232410D0 | Israel | D0 | |
| HRP20140541T1 | Croatia | T1 | |
| SI2173752T1 | Slovenia | T1 | |
| PL2173752T3 | Poland | T3 | |
| RS53245B | Serbia | B | |
| US8822481B1 | United States of America | B1 | |
| US8829013B1 | United States of America | B1 | |
| US2014303196A1 | United States of America | A1 | |
| BRPI0814254A2 | Brazil | A2 | |
| KR20150036210A | Republic of Korea | A | |
| HK1198652A1 | Hong Kong, China | A1 | |
| MY154969A | Malaysia | A | |
| KR101549876B1 | Republic of Korea | B1 | |
| SG10201509887UA | Singapore | A | |
| CN103524509B | China | B | |
| EP2740731B1 | European Patent Office (EPO) | B1 | |
| DK2740731T3 | Denmark | T3 | |
| CU24179B1 | Cuba | B1 | |
| US9376439B2 | United States of America | B2 | |
| ES2575797T3 | Spain | T3 | |
| HRP20160717T1 | Croatia | T1 | |
| SI2740731T1 | Slovenia | T1 | |
| CA2689663C | Canada | C | |
| EP3070090A1 | European Patent Office (EPO) | A1 | |
| MX342814B | Mexico | B | |
| PL2740731T3 | Poland | T3 | |
| RS54878B1 | Serbia | B1 | |
| US2016339031A1 | United States of America | A1 | |
| CY1115145T1 | Cyprus | T1 | |
| HUE029236T2 | Hungary | T2 | |
| IL202524A | Israel | A | |
| CY1117693T1 | Cyprus | T1 | |
| BRPI0814254A8 | Brazil | A8 | |
| US10016429B2 | United States of America | B2 | |
| EP3070090B1 | European Patent Office (EPO) | B1 | |
| US2019046534A1 | United States of America | A1 | |
| IL264276D0 | Israel | D0 | |
| DK3070090T3 | Denmark | T3 | |
| PT3070090T | Portugal | T | |
| HRP20190385T1 | Croatia | T1 | |
| TR201903488T4 | Türkiye | T4 | |
| RS58449B1 | Serbia | B1 | |
| SI3070090T1 | Slovenia | T1 | |
| ES2714092T3 | Spain | T3 | |
| NO2019025I1 | Norway | I1 | |
| EP3495369A1 | European Patent Office (EPO) | A1 | |
| LT3070090T | Lithuania | T |
Numbers
- Publication
- 2467665
- Publication, DOCDB
- 2467665
- Publication, EPODOC
- ES2467665T
- Application
- 8770794
- Application, DOCDB
- 08770794
- Application, EPODOC
- ES20080770794T
Titles2
- Spanish
- Sales del inhibidor de cinasas Janus (R)-3-(4-(7H-pirrolo[2,3-d]pirimidin-4-il)-1H-pirazol-1-il)-3-ciclopentilpropanonitrilo
- English
- Salts of the kinase inhibitor Janus (R) -3- (4- (7H-pyrrolo [2,3-d] pyrimidin-4-yl) -1H-pyrazol-1-yl) -3-cyclopentylpropanonitrile
Classification
- CPC, 38
- C07D487/04
- A61K31/519
- C07B2200/07
- A61P1/00
- A61P1/04
- A61P11/00
- A61P13/12
- A61P17/00
- A61P17/06
- A61P19/02
- A61P21/00
- A61P21/04
- A61P25/00
- A61P27/02
- A61P29/00
- A61P31/12
- A61P31/14
- A61P31/18
- A61P31/20
- A61P31/22
- A61P35/00
- A61P35/02
- A61P35/04
- A61P37/00
- A61P37/02
- A61P37/06
- A61P37/08
- A61P43/00
- A61P7/00
- A61P9/00
- A61P9/10
- A61P3/10
- A61K9/0053
- A61K9/20
- A61P17/08
- A61P17/12
- C07B2200/13
- C07D403/04
- IPC, 2
- C07D487 04
- A61K31 519