WO2005089761A1 - Combination for treating inflammatory diseases - Google Patents

Combination for treating inflammatory diseases Download PDF

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Publication number
WO2005089761A1
WO2005089761A1 PCT/IB2005/000606 IB2005000606W WO2005089761A1 WO 2005089761 A1 WO2005089761 A1 WO 2005089761A1 IB 2005000606 W IB2005000606 W IB 2005000606W WO 2005089761 A1 WO2005089761 A1 WO 2005089761A1
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Prior art keywords
histamine
pharmaceutical composition
leukotriene
receptor ligand
composition according
Prior art date
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PCT/IB2005/000606
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French (fr)
Inventor
Michael Yeadon
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Pfizer Limited
Pfizer, Inc.
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Priority claimed from GB0405994A external-priority patent/GB0405994D0/en
Application filed by Pfizer Limited, Pfizer, Inc. filed Critical Pfizer Limited
Publication of WO2005089761A1 publication Critical patent/WO2005089761A1/en

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435Heterocyclic 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
    • A61K31/47Quinolines; Isoquinolines
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00Drugs for disorders of the respiratory system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00Drugs for disorders of the respiratory system
    • A61P11/02Nasal agents, e.g. decongestants
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P11/00Drugs for disorders of the respiratory system
    • A61P11/06Antiasthmatics
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P17/00Drugs for dermatological disorders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P37/00Drugs for immunological or allergic disorders
    • A61P37/08Antiallergic agents

Definitions

  • the present invention relates to a pharmaceutical composition containing a combination of a leukotriene antagonist and a histamine H 3 receptor ligand.
  • the composition can be used in the treatment of inflammatory and/or allergic conditions.
  • Leukotrienes are mediators which belong to the group of eicosanoids. They are derivatives of arachidonic acid, a fatty acid which is a constituent of membrane phospholipids. The leukotrienes are formed from arachidonic acid via 5-lipoxygenase (5-LOX). At the present time, only the pathogenetically relevant role of the so-called cysteinyl-leukotrienes, to which LTC , LTD and
  • LTE 4 belong, has been confirmed.
  • the leukotrienes are very potent substances, producing a variety of biological effects when present in the nanomolar or picomolar concentration range. They have been implicated in a variety of disease states, including allergic rhinitis and adult respiratory distress syndrome.
  • Leukotriene receptor antagonists such as montelukast, have been shown to antagonize the effects of cysteinyl-leukotrienes, particularly LTD 4 .
  • Histamine H 3 receptors are found inter alia on presynaptic terminals of peripheral nerves, where they modulate autonomic neurotransmission and modulate a variety of end organ responses under control of the autonomic nervous system.
  • the present invention provides a pharmaceutical composition containing a combination of a leukotriene antagonist and a histamine H 3 receptor ligand.
  • Suitable compounds are those that are potent and selective, have no significant toxic effect at the therapeutic dose, and preferably are bioavailable following administration.
  • Potency of the histamine H 3 receptor ligand can be determined according to the assays known to the skilled person, in particular the assay described hereafter in the experimental section Preferred histamine H 3 receptor ligands have a potency, expressed as one or other well-accepted measure of affinity for the human histamine H 3 receptor i.e.: pA2 of 8 or greater, or pK b of 8 or greater, or Kj of 10nM or less. Suitable assays and references are described in the experimental section hereafter.
  • H 3 receptor ligand is meant to include H 3 receptor antagonists, H 3 receptor agonists and H 3 receptor inverse agonists. Preferred are H 3 receptor antagonists.
  • H 3 ligands are described in the scientific literature such as: Ganellin et al., Arch. Pharm. (Weinheim) (1998) 331 (12) 395-404; Walczynski et al, Farmaco (1999) 54 (10) 684-694; Walczynski et al., Arch. Pharm. (Weinheim) (1999) 332 389-398; Linney et al., J. Med. Chem. (2000) 43 (12) 2362-2370; Lazewska et al., Pharmazie (2001) 56 (12) 927-932 ; Meier et al., Bioorg. Med. Chem. (2002) 10(8) : 2535-2542 ; Lazewska et al. Pharmazie (2002) 57(12) 791-795 ; Shah et al., Bioorg. Med. Chem. Lett. (2002) 12 3309-3312.
  • Preferred leukotriene receptor antagonists are: montelukast (Singulair®, CAS 151767-02-1 ):
  • histamine H 3 receptor ligand is combined with montelukast, in particular montelukast sodium.
  • the ideal ratio of these therapeutic principles is that which delivers free concentrations of each compound which are active at their respective receptors i.e. typically in the range of 1-5 x their respective pA2 values (Smith D, Jones B and Walker D (1996) "Design of drugs involving the concepts and theories of drug metabolism and pharmacokinetics", Medicinal Research Reviews, 16(3), 243-266) or other functionally equivalent measures of potency
  • the combination according to the invention can be used for the treatment of a patient (a mammal, in particular a human being) suffering from a H 3 mediated disease and/or leukotriene mediated disease.
  • the combination is used for treating a patient suffering from an allergic and/or inflammatory condition.
  • allergic and/or inflammatory conditions are seasonal and perennial allergic rhinits, non-allergic rhinitis, asthma, sinusitis, colds, dermatitis and uriticaria.
  • histamine H 3 receptor ligand and the leukotriene receptor antagonist according to the invention can be administered sequentially, separately or simultaneously.
  • the compounds can be formulated as a single dose, as separate doses or as a kit.
  • kits containing a leukotriene antagonist and a histamine H 3 receptor ligand for sequential, separate or simultaneous use in the treatment of inflammatory diseases.
  • the kit of the invention comprises two or more separate pharmaceutical compositions, and means for separately retaining said compositions, such as a container, divided bottle, or divided foil packet.
  • a container, divided bottle, or divided foil packet An example of such a kit is the familiar blister pack used for the packaging of tablets, capsules and the like.
  • the kit of the invention is particularly suitable for administering different dosage forms, for example, oral and parenteral, for administering the separate compositions at different dosage intervals, or for titrating the separate compositions against one another.
  • the kit typically comprises directions for administration and may be provided with a so-called memory aid.
  • Pharmaceutically acceptable salts of the leukotriene antagonists and the H 3 ligands to be used in the combination of the invention include the acid addition and base salts thereof.
  • Suitable acid addition salts are formed from acids which form non-toxic salts. Examples include the acetate, aspartate, benzoate, besylate, bicarbonate/carbonate, bisulphate/sulphate, borate, camsylate, citrate, edisylate, esylate, formate, fumarate, gluceptate, gluconate, glucuronate, hexafluorophosphate, hibenzate, hydrochloride/chloride, hydro- bromide/bromide, hydroiodide/iodide, isethionate, lactate, malate, maleate, malonate, mesylate, methylsulphate, naphthylate, 2-napsylate, nicotinate, nitrate, orotate, oxalate, palmitate, pamoate, phosphate/hydrogen phosphate/dihydrogen phosphate, saccharate, stearate, succinate, tartrate, tosylate and triflu
  • Suitable base salts are formed from bases which form non-toxic salts. Examples include the aluminium, arginine, benzathine, calcium, choline, diethylamine, diolamine, glycine, lysine, magnesium, meglumine, olamine, potassium, sodium, tromethamine and zinc salts.
  • Compounds used in the combination of the invention intended for pharmaceutical use may be administered as crystalline or amorphous products. They may be obtained, for example, as solid plugs, powders, or films by methods such as precipitation, crystallization, freeze drying, spray drying, or evaporative drying. Microwave or radio frequency drying may be used for this purpose.
  • excipient may be administered as a formulation in association with one or more pharmaceutically acceptable excipients.
  • excipient is used herein to describe any ingredient other than the compound(s) of the invention. The choice of excipient will to a large extent depend on factors such as the particular mode of administration, the effect of the excipient on solubility and stability, and the nature of the dosage form.
  • compositions suitable for the delivery of compounds of the present invention and methods for their preparation will be readily apparent to those skilled in the art. Such compositions and methods for their preparation may be found, for example, in 'Remington's Pharmaceutical Sciences', 19th Edition (Mack Publishing Company, 1995).
  • the compounds in the combination of the invention may be administered orally.
  • Oral administration may involve swallowing, so that the compound enters the gastrointestinal tract, or buccal or sublingual administration may be employed by which the compound enters the blood stream directly from the mouth.
  • Formulations suitable for oral administration include solid formulations such as tablets, capsules containing particulates, liquids, or powders, lozenges (including liquid-filled), chews, multi- and nano-particulates, gels, solid solution, liposome, films (including muco-adhesive), ovules, sprays and liquid formulations.
  • Liquid formulations include suspensions, solutions, syrups and elixirs. Such formulations may be employed as fillers in soft or hard capsules and typically comprise a carrier, for example, water, ethanol, polyethylene glycol, propylene glycol, methylcellulose, or a suitable oil, and one or more emulsifying agents and/or suspending agents. Liquid formulations may also be prepared by the reconstitution of a solid, for example, from a sachet.
  • the compounds in the combination of the invention may also be used in fast- dissolving, fast-disintegrating dosage forms such as those described in Expert Opinion in Therapeutic Patents, (6), 981-986 by Liang and Chen (2001 ).
  • the drug may make up from 1 wt% to 80 wt% of the dosage form, more typically from 5 wt% to 60 wt% of the dosage form.
  • tablets generally contain a disintegrant.
  • disintegrants examples include sodium starch glycolate, sodium carboxymethyl cellulose, calcium carboxymethyl cellulose, croscarmellose sodium, crospovidone, polyvinylpyrrolidone, methyl cellulose, microcrystalline cellulose, lower alkyl-substituted hydroxypropyl cellulose, starch, pregelatinised starch and sodium alginate.
  • the disintegrant will comprise from 1 wt% to 25 wt%, preferably from 5 wt% to 20 wt% of the dosage form.
  • Binders are generally used to impart cohesive qualities to a tablet formulation. Suitable binders include microcrystalline cellulose, gelatin, sugars, polyethylene glycol, natural and synthetic gums, polyvinylpyrrolidone, pregelatinised starch, hydroxypropyl cellulose and hydroxypropyl methylcellulose. Tablets may also contain diluents, such as lactose (monohydrate, spray-dried monohydrate, anhydrous and the like), mannitol, xylitol, dextrose, sucrose, sorbitol, microcrystalline cellulose, starch and dibasic calcium phosphate dihydrate.
  • lactose monohydrate, spray-dried monohydrate, anhydrous and the like
  • mannitol xylitol
  • dextrose sucrose
  • sorbitol microcrystalline cellulose
  • starch dibasic calcium phosphate dihydrate
  • Tablets may also optionally comprise surface active agents, such as sodium lauryl sulfate and polysorbate 80, and glidants such as silicon dioxide and talc.
  • surface active agents such as sodium lauryl sulfate and polysorbate 80
  • glidants such as silicon dioxide and talc.
  • surface active agents may comprise from 0.2 wt% to 5 wt% of the tablet, and glidants may comprise from 0.2 wt% to 1 wt% of the tablet.
  • Tablets also generally contain lubricants such as magnesium stearate, calcium stearate, zinc stearate, sodium stearyl fumarate, and mixtures of magnesium stearate with sodium lauryl sulphate.
  • Lubricants generally comprise from 0.25 wt% to 10 wt%, preferably from 0.5 wt% to 3 wt% of the tablet.
  • Other possible ingredients include anti-oxidants, colourants, flavouring agents, preservatives and taste-masking agents.
  • Exemplary tablets contain up to about 80% drug, from about 10 wt% to about 90 wt% binder, from about 0 wt% to about 85 wt% diluent, from about 2 wt% to about 10 wt% disintegrant, and from about 0.25 wt% to about 10 wt% lubricant.
  • Tablet blends may be compressed directly or by roller to form tablets. Tablet blends or portions of blends may alternatively be wet-, dry-, or melt- granulated, melt congealed, or extruded before tabletting.
  • the final formulation may comprise one or more layers and may be coated or uncoated; it may even be encapsulated.
  • Solid formulations for oral administration may be formulated to be immediate and/or modified release.
  • Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
  • Suitable modified release formulations for the purposes of the invention are described in US Patent No. 6,106,864. Details of other suitable release technologies such as high energy dispersions and osmotic and coated particles are to be found in Verma et al, Pharmaceutical Technology On-line, 25(2), 1-14 (2001 ). The use of chewing gum to achieve controlled release is described in WO 00/35298.
  • the compounds in the combination of the invention may also be administered directly into the blood stream, into muscle, or into an internal organ.
  • Suitable means for parenteral administration include intravenous, intraarterial, intrapehtoneal, intrathecal, intraventricular, intraurethral, intrasternal, intracranial, intramuscular and subcutaneous.
  • Suitable devices for parenteral administration include needle (including microneedle) injectors, needle-free injectors and infusion techniques.
  • Parenteral formulations are typically aqueous solutions which may contain excipients such as salts, carbohydrates and buffering agents (preferably to a pH of from 3 to 9), but, for some applications, they may be more suitably formulated as a sterile non-aqueous solution or as a dried form to be used in conjunction with a suitable vehicle such as sterile, pyrogen-free water.
  • excipients such as salts, carbohydrates and buffering agents (preferably to a pH of from 3 to 9)
  • a suitable vehicle such as sterile, pyrogen-free water.
  • parenteral formulations under sterile conditions may readily be accomplished using standard pharmaceutical techniques well known to those skilled in the art.
  • solubility of compounds used in the preparation of parenteral solutions may be increased by the use of appropriate formulation techniques, such as the incorporation of solubility-enhancing agents.
  • Formulations for parenteral administration may be formulated to be immediate and/or modified release.
  • Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
  • compounds of the invention may be formulated as a solid, semi-solid, or thixotropic liquid for administration as an implanted depot providing modified release of the active compound. Examples of such formulations include drug- coated stents and PGLA microspheres.
  • the compounds in the combination of the invention may also be administered topically to the skin or mucosa, that is, dermally or transdermally.
  • Typical formulations for this purpose include gels, hydrogels, lotions, solutions, creams, ointments, dusting powders, dressings, foams, films, skin patches, wafers, implants, sponges, fibres, bandages and microemulsions. Liposomes may also be used.
  • Typical carriers include alcohol, water, mineral oil, liquid petrolatum, white petrolatum, glycerin, polyethylene glycol and propylene glycol. Penetration enhancers may be incorporated - see, for example, J Pharm Sci, 88 (10), 955-958 by Finnin and Morgan (October 1999).
  • topical administration include delivery by electroporation, iontophoresis, phonophoresis, sonophoresis and microneedle or needle-free (e.g. PowderjectTM, BiojectTM, etc.) injection.
  • Formulations for topical administration may be formulated to be immediate and/or modified release.
  • Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
  • the compounds in the combination of the invention can also be administered intranasally or by inhalation.
  • the combinations of the invention may be administered rectally or vaginally, for example, in the form of a suppository, pessary, or enema.
  • Cocoa butter is a traditional suppository base, but various alternatives may be used as appropriate.
  • Formulations for rectal/vaginal administration may be formulated to be immediate and/or modified release.
  • Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
  • the combinations of the invention may also be administered directly to the eye or ear, typically in the form of drops of a micronised suspension or solution in isotonic, pH-adjusted, sterile saline.
  • Other formulations suitable for ocular and aural administration include ointments, biodegradable (e.g. absorbable gel sponges, collagen) and non-biodegradable (e.g. silicone) implants, wafers, lenses and particulate or vesicular systems, such as niosomes or liposomes.
  • a polymer such as crossed-linked pol acrylic acid, polyvinylalcohol, hyaluronic acid, a cellulosic polymer, for example, hydroxypropylmethylcellulose, hydroxyethylcellulose, or methyl cellulose, or a heteropolysaccharide polymer, for example, gelan gum, may be incorporated together with a preservative, such as benzalkonium chloride.
  • a preservative such as benzalkonium chloride.
  • Such formulations may also be delivered by iontophoresis.
  • Formulations for ocular/aural administration may be formulated to be immediate and/or modified release.
  • Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted, or programmed release.
  • the compounds in the combination of the invention may be combined with soluble macromolecular entities, such as cyclodextrin and suitable derivatives thereof or polyethylene glycol-containing polymers, in order to improve their solubility, dissolution rate, taste-masking, bioavailability and/or stability for use in any of the aforementioned modes of administration.
  • soluble macromolecular entities such as cyclodextrin and suitable derivatives thereof or polyethylene glycol-containing polymers
  • Drug-cyclodextrin complexes are found to be generally useful for most dosage forms and administration routes. Both inclusion and non- inclusion complexes may be used.
  • the cyclodextrin may be used as an auxiliary additive, i.e. as a carrier, diluent, or solubiliser. Most commonly used for these purposes are alpha-, beta- and gamma-cyclodextrins, examples of which may be found in International Patent Applications Nos. WO 91/11172, WO 94/02518 and WO 98/55148.
  • the total daily dose of the histamine H 3 receptor ligand is typically in the range 0.1 mg to 100mg and the total daily dose of the leukotriene receptor antagonist is typically in the range of 1 mg to 10mg depending, of course, on the mode of administration.
  • the total daily dose may be administered in single or divided doses.
  • Cell pellets from HEK-293 cells stably expressing the human histamine H 3 receptor were homogenised in ice-cold 50mM Tris-HCI buffer containing a protease inhibitor cocktail (Roche®, United Kingdom) using a ground glass homogeniser. Homogenates were centrifuged at 48000g for 30min at 4°C. The membrane pellet was resuspended in 50mM Tris-HCI in the same volume as the original cell pellet. Aliquots of membrane preparations were stored at - 80°C and were used for [ 3 H]-N ⁇ -methylhistamine binding experiments.
  • Tissues were washed by over flow with fresh Krebs-Henseleit buffer at 15-20 min intervals for a period of 1 hour prior to the start of an experiment.
  • Tissues were electrically field stimulated using platinum parallel wire electrodes positioned vertically at either side of the segment. Tissues were stimulated with single pulses of 5V and 1 ms pulse width every 10s beginning at the end of the equilibration period and continuing for the duration of the experiment. Responses to field stimulation were recorded as the average amplitude (maximum-minimum) of three twitch responses over a period of 30s.
  • Cumulative dose response curves to R- ⁇ methyl histamine were generated over the concentration range 1x10 "10 M to 1x 10 "5 M in half-log increments, using a contact time of 2 min.
  • the preparation described above was sufficiently robust to allow 4 reproducible R ⁇ MH curves to be generated in each tissue when a 1 hour gap was left between agonist dose response curves.
  • pK B values point estimates of pA2, Arunlakshana & Schild, (1959), Brit. J. Pharmacol., vol 14, p48-57
  • H 3 activity was determined according to the methods of Valentine et al, 1999,
  • bronchoalveolar lavage Twenty-four hours later the rats were overdosed with sodium pentobarbitone and bronchoalveolar lavage (BAL) was performed. The trachea was exposed by a mid-ventral incision caudal to the larynx followed by blunt dissection. A cut- down Portex leur-fitting cannula (2.0 mm outside diameter) was inserted into the trachea and tied-in securely. Using a 2.5 ml syringe, 2.5 ml of room temperature PBS (pH 7.4) containing 2.6 mM EDTA was slowly instilled into the lungs via the cannula and the BAL fluid (BALf) was immediately aspirated and stored on ice.
  • BALf BAL fluid
  • Nasal congestion was determined in anesthetized cats according to the method of McLeod et al 1999 (Am. J. Rhonil., 13, 391-99). Briefly, pentobarbitone anesthetized cats were mechanically ventilated with ambient air. One nostril was sealed externally and a cuffed endotracheal tube inserted in a retrograde manner via the oesophagus into the nasopharynx. Using a constant air flow through the tube, the pressure (and thus resistance) was determined and modulated by nasal exposure to the mast cell degranulating agent 48/80, and pre or post treatment with H3 or LT antagonists, or a combination of these agents.
  • Nasal congestion as measured by acoustic rhinomanonmetry, was determined in anesthetized guinea-pigs, according to the method of Joynson et al 2003 (proceedings of the World Inflammation Congress, Vancouver). Briefly, male Dunkin-Hartley guinea-pigs were anaesthetized with urethane (50mg/kg i.p.) and placed in a supine position. The trachea was cannulated through which the animals breathed spontaneously.
  • An acoustic rhinomter (GJ Electronik, Denmark) was used to measure cross-sectional area of the nasal cavity as a function of distance, and was modulated by various stimuli including nasal allergen (ovalbumin) in previously actively sensitized animals. Test compounds were administered alone or in combination as pre- or post- treatments.

Abstract

The present invention relates to a pharmaceutical compostion containing a combination of a leukotriene receptor antagonist and a histamine H3 receptor antagonist, wherein the leukotriene receptor antagonist is particularly selected from montelukast, pranlukast and zafirlukast. The composition can be used for treating an allergic and/or inflammatory condition, such as seasonal and perennial allergic rhinits, non-allergic rhinitis, asthma, sinusitis, colds, dermatitis and uriticaria.

Description

Combination for treating inflammatory diseases
The present invention relates to a pharmaceutical composition containing a combination of a leukotriene antagonist and a histamine H3 receptor ligand. The composition can be used in the treatment of inflammatory and/or allergic conditions.
Leukotrienes are mediators which belong to the group of eicosanoids. They are derivatives of arachidonic acid, a fatty acid which is a constituent of membrane phospholipids. The leukotrienes are formed from arachidonic acid via 5-lipoxygenase (5-LOX). At the present time, only the pathogenetically relevant role of the so-called cysteinyl-leukotrienes, to which LTC , LTD and
LTE4 belong, has been confirmed. The leukotrienes are very potent substances, producing a variety of biological effects when present in the nanomolar or picomolar concentration range. They have been implicated in a variety of disease states, including allergic rhinitis and adult respiratory distress syndrome. Leukotriene receptor antagonists, such as montelukast, have been shown to antagonize the effects of cysteinyl-leukotrienes, particularly LTD4.
Histamine H3 receptors are found inter alia on presynaptic terminals of peripheral nerves, where they modulate autonomic neurotransmission and modulate a variety of end organ responses under control of the autonomic nervous system.
The present invention provides a pharmaceutical composition containing a combination of a leukotriene antagonist and a histamine H3 receptor ligand.
It is believed that this combination gives a synergistic clinical effect in relief of the symptoms of allergic rhinitis and avoids or reduces certain side effects associated with treatments in current use such as Hi antagonists/pseudoephedrine combinations. Histamine and leukotrienes are major mediators in allergy manifest in diseases such as allergic rhinitis. Surprisingly and unexpectedly, histamine H3 receptor ligands and LT antagonists produce synergistic relief of the signs and symptoms of allergic rhinitis, as assessed by methods such as nasal congestion, nasal and ocular itching and lachrymation.
The suitability of the histamine H3 receptor ligand and the leukotriene antagonist can be readily determined by evaluation of their potency and selectivity followed by evaluation of their toxicity, pharmacokinetics (absorption, metabolism, distribution and elimination), etc in accordance with standard pharmaceutical practice. Suitable compounds are those that are potent and selective, have no significant toxic effect at the therapeutic dose, and preferably are bioavailable following administration.
Potency of the histamine H3 receptor ligand can be determined according to the assays known to the skilled person, in particular the assay described hereafter in the experimental section Preferred histamine H3 receptor ligands have a potency, expressed as one or other well-accepted measure of affinity for the human histamine H3 receptor i.e.: pA2 of 8 or greater, or pKb of 8 or greater, or Kj of 10nM or less. Suitable assays and references are described in the experimental section hereafter.
In the present application "H3 receptor ligand" is meant to include H3 receptor antagonists, H3 receptor agonists and H3 receptor inverse agonists. Preferred are H3 receptor antagonists.
A background on histamine H3 receptor ligands together with examples of suitable compounds can be found in Expert Opin. Then Patents (2003) 13(6) .-851-865.
Other examples of H3 ligands are described in the scientific literature such as: Ganellin et al., Arch. Pharm. (Weinheim) (1998) 331 (12) 395-404; Walczynski et al, Farmaco (1999) 54 (10) 684-694; Walczynski et al., Arch. Pharm. (Weinheim) (1999) 332 389-398; Linney et al., J. Med. Chem. (2000) 43 (12) 2362-2370; Lazewska et al., Pharmazie (2001) 56 (12) 927-932 ; Meier et al., Bioorg. Med. Chem. (2002) 10(8) : 2535-2542 ; Lazewska et al. Pharmazie (2002) 57(12) 791-795 ; Shah et al., Bioorg. Med. Chem. Lett. (2002) 12 3309-3312.
The following patent applications also describe suitable histamine H3 receptor ligands: WO00/64884, WO03/004480, US2002/0058659, US2003/0130253, US2003/0135056, US6417218, US6437147, WO03/064411 , WO03/066604, WO02/24657, WO02/24658, WO02/24659, WO02/244141 , WO99/42458, US6407132, WO00/06254, WO01/74773, WO01/74810, WO01/74813, WO01/7814, WO01/7815, US6436939, US6489337, WO02/12214, WO02/24695, WO03/044059, WO02/079168, WO02/12190, WO02/12224, WO02/40461 , WO02/4074758, WO02/06223, WO01/66534, US2002/0111340, US2002/0169188, US2002/0183309, WO03/059341 , US2002/0082272, US2002/0082278, US2002/0103235, WO02/32893, WO02/072570, WO02/24657, WO02/24658, WO02/24659, WO02/44141 , WO02/076925, WO04/018432, US6448282. Particularly suitable examples of H3 ligands are found in WO02/12190, WO02/12224, WO02/076925 and WO04/018432.
Specific compounds that could be used as a histamine H3 receptor ligand in the present invention are
Figure imgf000004_0001
Figure imgf000005_0001
A-320436
Figure imgf000005_0002
A-331440
Figure imgf000005_0003
ABT-239
Figure imgf000005_0004
A-431404 CH,
Figure imgf000006_0001
A-304121
Figure imgf000006_0002
Cipralisant
Figure imgf000006_0003
Ciproxifan
Figure imgf000006_0004
FUB-181
Figure imgf000007_0001
FUB-407
Figure imgf000007_0002
GR-175737
Figure imgf000007_0003
GT-2016
Figure imgf000007_0004
GT-2394
Figure imgf000007_0005
Impentamine
Figure imgf000008_0001
JNJ-5207852
Figure imgf000008_0002
SCH-49648
Figure imgf000008_0003
SCH-50971
Figure imgf000008_0004
SCH-79687
Figure imgf000008_0005
Verongamine
Figure imgf000009_0001
NCC-0028-1049
Preferred leukotriene receptor antagonists are: montelukast (Singulair®, CAS 151767-02-1 ):
1-((R-(3-(2-(7-chloro-2-quinolinyl)ethenyl)phenyl)-3-(2-(2-hydroxy-2- propyl)phenyl)thio)methyl)cyclopropoaneacetate, and pharmaceutically acceptable salts thereof, in particular the sodium salt, which is described in US 5,565,473; pranlukast (CAS 103177-37-3); N-[4-oxo-2-( 1 H-tetrazol-5 -yl)-4H- 1 - benzopyran-8-yl] -p-(4-phenylbutoxy) benzamide and pharmaceutically acceptable salts thereof, which is described in EP 173,516; zafirlukast (CAS 107753-78-6) Cyclopentyl-3 -[2-methoxy4-[(o-tol ylsulfonyl)carbamoyl] - benzyl]- 1 -methylindole-5-carbamate and pharmaceutically acceptable salts thereof, which is described in EP 199,543.
Most preferably the histamine H3 receptor ligand is combined with montelukast, in particular montelukast sodium.
The ideal ratio of these therapeutic principles is that which delivers free concentrations of each compound which are active at their respective receptors i.e. typically in the range of 1-5 x their respective pA2 values (Smith D, Jones B and Walker D (1996) "Design of drugs involving the concepts and theories of drug metabolism and pharmacokinetics", Medicinal Research Reviews, 16(3), 243-266) or other functionally equivalent measures of potency
Figure imgf000009_0002
The combination according to the invention can be used for the treatment of a patient (a mammal, in particular a human being) suffering from a H3 mediated disease and/or leukotriene mediated disease. In particular the combination is used for treating a patient suffering from an allergic and/or inflammatory condition. Examples of such allergic and/or inflammatory conditions are seasonal and perennial allergic rhinits, non-allergic rhinitis, asthma, sinusitis, colds, dermatitis and uriticaria.
It is to be appreciated that all references herein to treatment include curative, palliative and prophylactic treatment.
The histamine H3 receptor ligand and the leukotriene receptor antagonist according to the invention can be administered sequentially, separately or simultaneously. To this effect, the compounds can be formulated as a single dose, as separate doses or as a kit.
Thus, according to a further aspect of the invention, there is provided a kit containing a leukotriene antagonist and a histamine H3 receptor ligand for sequential, separate or simultaneous use in the treatment of inflammatory diseases.
The kit of the invention comprises two or more separate pharmaceutical compositions, and means for separately retaining said compositions, such as a container, divided bottle, or divided foil packet. An example of such a kit is the familiar blister pack used for the packaging of tablets, capsules and the like.
The kit of the invention is particularly suitable for administering different dosage forms, for example, oral and parenteral, for administering the separate compositions at different dosage intervals, or for titrating the separate compositions against one another. To assist compliance, the kit typically comprises directions for administration and may be provided with a so-called memory aid. Pharmaceutically acceptable salts of the leukotriene antagonists and the H3 ligands to be used in the combination of the invention include the acid addition and base salts thereof.
Suitable acid addition salts are formed from acids which form non-toxic salts. Examples include the acetate, aspartate, benzoate, besylate, bicarbonate/carbonate, bisulphate/sulphate, borate, camsylate, citrate, edisylate, esylate, formate, fumarate, gluceptate, gluconate, glucuronate, hexafluorophosphate, hibenzate, hydrochloride/chloride, hydro- bromide/bromide, hydroiodide/iodide, isethionate, lactate, malate, maleate, malonate, mesylate, methylsulphate, naphthylate, 2-napsylate, nicotinate, nitrate, orotate, oxalate, palmitate, pamoate, phosphate/hydrogen phosphate/dihydrogen phosphate, saccharate, stearate, succinate, tartrate, tosylate and trifluoroacetate salts.
Suitable base salts are formed from bases which form non-toxic salts. Examples include the aluminium, arginine, benzathine, calcium, choline, diethylamine, diolamine, glycine, lysine, magnesium, meglumine, olamine, potassium, sodium, tromethamine and zinc salts.
For a review on suitable salts, see "Handbook of Pharmaceutical Salts: Properties, Selection, and Use" by Stahl and Wermuth (Wiley-VCH, Weinheim, Germany, 2002).
Compounds used in the combination of the invention intended for pharmaceutical use may be administered as crystalline or amorphous products. They may be obtained, for example, as solid plugs, powders, or films by methods such as precipitation, crystallization, freeze drying, spray drying, or evaporative drying. Microwave or radio frequency drying may be used for this purpose.
They may be administered as a formulation in association with one or more pharmaceutically acceptable excipients. The term "excipient" is used herein to describe any ingredient other than the compound(s) of the invention. The choice of excipient will to a large extent depend on factors such as the particular mode of administration, the effect of the excipient on solubility and stability, and the nature of the dosage form.
Pharmaceutical compositions suitable for the delivery of compounds of the present invention and methods for their preparation will be readily apparent to those skilled in the art. Such compositions and methods for their preparation may be found, for example, in 'Remington's Pharmaceutical Sciences', 19th Edition (Mack Publishing Company, 1995).
The compounds in the combination of the invention may be administered orally. Oral administration may involve swallowing, so that the compound enters the gastrointestinal tract, or buccal or sublingual administration may be employed by which the compound enters the blood stream directly from the mouth.
Formulations suitable for oral administration include solid formulations such as tablets, capsules containing particulates, liquids, or powders, lozenges (including liquid-filled), chews, multi- and nano-particulates, gels, solid solution, liposome, films (including muco-adhesive), ovules, sprays and liquid formulations.
Liquid formulations include suspensions, solutions, syrups and elixirs. Such formulations may be employed as fillers in soft or hard capsules and typically comprise a carrier, for example, water, ethanol, polyethylene glycol, propylene glycol, methylcellulose, or a suitable oil, and one or more emulsifying agents and/or suspending agents. Liquid formulations may also be prepared by the reconstitution of a solid, for example, from a sachet.
The compounds in the combination of the invention may also be used in fast- dissolving, fast-disintegrating dosage forms such as those described in Expert Opinion in Therapeutic Patents, (6), 981-986 by Liang and Chen (2001 ). For tablet dosage forms, depending on dose, the drug may make up from 1 wt% to 80 wt% of the dosage form, more typically from 5 wt% to 60 wt% of the dosage form. In addition to the drug, tablets generally contain a disintegrant. Examples of disintegrants include sodium starch glycolate, sodium carboxymethyl cellulose, calcium carboxymethyl cellulose, croscarmellose sodium, crospovidone, polyvinylpyrrolidone, methyl cellulose, microcrystalline cellulose, lower alkyl-substituted hydroxypropyl cellulose, starch, pregelatinised starch and sodium alginate. Generally, the disintegrant will comprise from 1 wt% to 25 wt%, preferably from 5 wt% to 20 wt% of the dosage form.
Binders are generally used to impart cohesive qualities to a tablet formulation. Suitable binders include microcrystalline cellulose, gelatin, sugars, polyethylene glycol, natural and synthetic gums, polyvinylpyrrolidone, pregelatinised starch, hydroxypropyl cellulose and hydroxypropyl methylcellulose. Tablets may also contain diluents, such as lactose (monohydrate, spray-dried monohydrate, anhydrous and the like), mannitol, xylitol, dextrose, sucrose, sorbitol, microcrystalline cellulose, starch and dibasic calcium phosphate dihydrate.
Tablets may also optionally comprise surface active agents, such as sodium lauryl sulfate and polysorbate 80, and glidants such as silicon dioxide and talc. When present, surface active agents may comprise from 0.2 wt% to 5 wt% of the tablet, and glidants may comprise from 0.2 wt% to 1 wt% of the tablet.
Tablets also generally contain lubricants such as magnesium stearate, calcium stearate, zinc stearate, sodium stearyl fumarate, and mixtures of magnesium stearate with sodium lauryl sulphate. Lubricants generally comprise from 0.25 wt% to 10 wt%, preferably from 0.5 wt% to 3 wt% of the tablet. Other possible ingredients include anti-oxidants, colourants, flavouring agents, preservatives and taste-masking agents.
Exemplary tablets contain up to about 80% drug, from about 10 wt% to about 90 wt% binder, from about 0 wt% to about 85 wt% diluent, from about 2 wt% to about 10 wt% disintegrant, and from about 0.25 wt% to about 10 wt% lubricant.
Tablet blends may be compressed directly or by roller to form tablets. Tablet blends or portions of blends may alternatively be wet-, dry-, or melt- granulated, melt congealed, or extruded before tabletting. The final formulation may comprise one or more layers and may be coated or uncoated; it may even be encapsulated.
The formulation of tablets is discussed in "Pharmaceutical Dosage Forms: Tablets, Vol. 1", by H. Lieberman and L. Lachman, Marcel Dekker, N.Y., N.Y., 1980 (ISBN 0-8247-6918-X).
Solid formulations for oral administration may be formulated to be immediate and/or modified release. Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
Suitable modified release formulations for the purposes of the invention are described in US Patent No. 6,106,864. Details of other suitable release technologies such as high energy dispersions and osmotic and coated particles are to be found in Verma et al, Pharmaceutical Technology On-line, 25(2), 1-14 (2001 ). The use of chewing gum to achieve controlled release is described in WO 00/35298.
The compounds in the combination of the invention may also be administered directly into the blood stream, into muscle, or into an internal organ. Suitable means for parenteral administration include intravenous, intraarterial, intrapehtoneal, intrathecal, intraventricular, intraurethral, intrasternal, intracranial, intramuscular and subcutaneous. Suitable devices for parenteral administration include needle (including microneedle) injectors, needle-free injectors and infusion techniques.
Parenteral formulations are typically aqueous solutions which may contain excipients such as salts, carbohydrates and buffering agents (preferably to a pH of from 3 to 9), but, for some applications, they may be more suitably formulated as a sterile non-aqueous solution or as a dried form to be used in conjunction with a suitable vehicle such as sterile, pyrogen-free water.
The preparation of parenteral formulations under sterile conditions, for example, by lyophilisation, may readily be accomplished using standard pharmaceutical techniques well known to those skilled in the art.
The solubility of compounds used in the preparation of parenteral solutions may be increased by the use of appropriate formulation techniques, such as the incorporation of solubility-enhancing agents.
Formulations for parenteral administration may be formulated to be immediate and/or modified release. Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release. Thus compounds of the invention may be formulated as a solid, semi-solid, or thixotropic liquid for administration as an implanted depot providing modified release of the active compound. Examples of such formulations include drug- coated stents and PGLA microspheres.
The compounds in the combination of the invention may also be administered topically to the skin or mucosa, that is, dermally or transdermally. Typical formulations for this purpose include gels, hydrogels, lotions, solutions, creams, ointments, dusting powders, dressings, foams, films, skin patches, wafers, implants, sponges, fibres, bandages and microemulsions. Liposomes may also be used. Typical carriers include alcohol, water, mineral oil, liquid petrolatum, white petrolatum, glycerin, polyethylene glycol and propylene glycol. Penetration enhancers may be incorporated - see, for example, J Pharm Sci, 88 (10), 955-958 by Finnin and Morgan (October 1999).
Other means of topical administration include delivery by electroporation, iontophoresis, phonophoresis, sonophoresis and microneedle or needle-free (e.g. Powderject™, Bioject™, etc.) injection.
Formulations for topical administration may be formulated to be immediate and/or modified release. Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
The compounds in the combination of the invention can also be administered intranasally or by inhalation.
The combinations of the invention may be administered rectally or vaginally, for example, in the form of a suppository, pessary, or enema. Cocoa butter is a traditional suppository base, but various alternatives may be used as appropriate.
Formulations for rectal/vaginal administration may be formulated to be immediate and/or modified release. Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted and programmed release.
The combinations of the invention may also be administered directly to the eye or ear, typically in the form of drops of a micronised suspension or solution in isotonic, pH-adjusted, sterile saline. Other formulations suitable for ocular and aural administration include ointments, biodegradable (e.g. absorbable gel sponges, collagen) and non-biodegradable (e.g. silicone) implants, wafers, lenses and particulate or vesicular systems, such as niosomes or liposomes. A polymer such as crossed-linked pol acrylic acid, polyvinylalcohol, hyaluronic acid, a cellulosic polymer, for example, hydroxypropylmethylcellulose, hydroxyethylcellulose, or methyl cellulose, or a heteropolysaccharide polymer, for example, gelan gum, may be incorporated together with a preservative, such as benzalkonium chloride. Such formulations may also be delivered by iontophoresis.
Formulations for ocular/aural administration may be formulated to be immediate and/or modified release. Modified release formulations include delayed-, sustained-, pulsed-, controlled-, targeted, or programmed release.
The compounds in the combination of the invention may be combined with soluble macromolecular entities, such as cyclodextrin and suitable derivatives thereof or polyethylene glycol-containing polymers, in order to improve their solubility, dissolution rate, taste-masking, bioavailability and/or stability for use in any of the aforementioned modes of administration.
Drug-cyclodextrin complexes, for example, are found to be generally useful for most dosage forms and administration routes. Both inclusion and non- inclusion complexes may be used. As an alternative to direct complexation with the drug, the cyclodextrin may be used as an auxiliary additive, i.e. as a carrier, diluent, or solubiliser. Most commonly used for these purposes are alpha-, beta- and gamma-cyclodextrins, examples of which may be found in International Patent Applications Nos. WO 91/11172, WO 94/02518 and WO 98/55148.
For administration to human patients, the total daily dose of the histamine H3 receptor ligand is typically in the range 0.1 mg to 100mg and the total daily dose of the leukotriene receptor antagonist is typically in the range of 1 mg to 10mg depending, of course, on the mode of administration. The total daily dose may be administered in single or divided doses.
These dosages are based on an average human subject having a weight of about 65kg to 70kg. The physician will readily be able to determine doses for subjects whose weight falls outside this range, such as infants and the elderly. Assays
To determine the activity of the histamine H3 receptor ligands of the invention the following assays were used
Binding to human H3 receptors
Cell pellets from HEK-293 cells stably expressing the human histamine H3 receptor were homogenised in ice-cold 50mM Tris-HCI buffer containing a protease inhibitor cocktail (Roche®, United Kingdom) using a ground glass homogeniser. Homogenates were centrifuged at 48000g for 30min at 4°C. The membrane pellet was resuspended in 50mM Tris-HCI in the same volume as the original cell pellet. Aliquots of membrane preparations were stored at - 80°C and were used for [3H]-Nα-methylhistamine binding experiments.
Cell membranes (20-40μg/well) were incubated for 90min shaking at room temperature with 1 nM [3H]-N -methylhistamine (82-85Ci/mmol) in 50mM Tris- HCI (pH 7.4), with or without competing H3 ligands. The reaction was terminated by rapid filtration through 0.5% polyethylenimine-soaked Unifilter GF/B plates (Packard) followed by three washes with 1 ml ice-cold 50mM Tris- HCI. Filters were dried for 45min at 45°C and bound radiolabel was determined using scintillation counting techniques. Non-specific binding was defined with 10μM Histamine. For competition binding studies, Ki values were calculated from the IC5o value (concentration of test compound which displaces 50% of the specific binding) based on an experimentally determined ligand Kd of 1.8nM and a ligand concentration of 1nM according to the Cheng- Prussoff equation (Biochem. Pharmacol. (1973), vol 22, p3099-3108) where; Kι = (IC50)/(1 +([L]/Kd))
Functional activity in vitro - EFS Guinea-pig ileum Hj preparation H3 activity was determined according to the methods of Menkveld et al, 1990, (Eur. J. Pharmacol., 186, 343-7) with modifications. Briefly, male guinea pigs (Dunkin Hartley, 350-450g) were killed by cervical dislocation. The ileum was removed and segments 3cm in length prepared and cleared of attached mesentery. The segments of ileum were suspended between a tissue hook and isometric strain gauge and placed under an initial tension of 1000mg. The segments were bathed in pre-warmed (37°C), pre-gassed (95%O2/5%CO2) Krebs-Henseleit solution containing 1μM Pyhlamine. The tissues were washed by over flow with fresh Krebs-Henseleit buffer at 15-20 min intervals for a period of 1 hour prior to the start of an experiment. Tissues were electrically field stimulated using platinum parallel wire electrodes positioned vertically at either side of the segment. Tissues were stimulated with single pulses of 5V and 1 ms pulse width every 10s beginning at the end of the equilibration period and continuing for the duration of the experiment. Responses to field stimulation were recorded as the average amplitude (maximum-minimum) of three twitch responses over a period of 30s. Cumulative dose response curves to R-α methyl histamine were generated over the concentration range 1x10"10M to 1x 10"5M in half-log increments, using a contact time of 2 min. The preparation described above was sufficiently robust to allow 4 reproducible RαMH curves to be generated in each tissue when a 1 hour gap was left between agonist dose response curves. To determine pKB values (point estimates of pA2, Arunlakshana & Schild, (1959), Brit. J. Pharmacol., vol 14, p48-57) antagonists were incubated with the tissue for 1 hour prior to the second agonist dose response curve.
Functional activity in vitro - Human Saphenous Vein H3 preparation.
H3 activity was determined according to the methods of Valentine et al, 1999,
(Eur. J. Pharmacol., 366, 73-8) with modifications. Briefly, segments of human saphenous vein 3-7mm in diameter were cleared of connective tissue and cut into rings 5mm in length. The rings were mounted in 15ml tissue baths between a stainless steel hook and an isometric strain gauge. Tissues were bathed in Krebs solution containing 1μM chlorpheniramine and 1 μM cimetidine maintained at 37°C and gassed with 95%O2/5%CO2 and placed under an initial tension of 1000mg. The tissues were allowed to equilibrate for 2-3 h with washes at 20min intervals. Vessels responsive to 100μM noradrenaline and 60mM KCI were subjected to repeated field stimulation (12- 20V, 16Hz, 1 ms pulse width, 30s train) at 15 min intervals. R-α-methyl histamine cumulative dose/response curves were generated over the concentration range 1x10"10M to 1x 10'5M in half-log increments, using a contact time of 10 min. For antagonist studies separate tissues were pre- incubated with the antagonist for 1 h prior to the r-α-methyl histamine dose response curve and pKB values calculated.
Animal study
The efficacy of the combinations of the invention can be demonstrated in an animal model of airway inflammation or nasal congestion
Sephadex-induced pulmonary eosinophilia
Compounds were administered by various routes (e.g. sub-cutaneously) before or after a suspension of Sephadex G-200 superfine (BioChemika) was instilled directly into the lungs of rats to induce a pulmonary eosinophilia 24-72 hours later. Under brief Isoflurane anaesthesia 100μl of a suspension of Sephadex (20 mg/ml) was instilled into the trachea of male Sprague-Dawley rats (Charles River, 350-400 g) by the oro-laryngeal route from a microsyringe (Hamilton, 725RN fitted with a blunt 125 mm 22G needle). Twenty-four hours later the rats were overdosed with sodium pentobarbitone and bronchoalveolar lavage (BAL) was performed. The trachea was exposed by a mid-ventral incision caudal to the larynx followed by blunt dissection. A cut- down Portex leur-fitting cannula (2.0 mm outside diameter) was inserted into the trachea and tied-in securely. Using a 2.5 ml syringe, 2.5 ml of room temperature PBS (pH 7.4) containing 2.6 mM EDTA was slowly instilled into the lungs via the cannula and the BAL fluid (BALf) was immediately aspirated and stored on ice. This process was repeated a further three times until a total volume of 10 ml was instilled. The total leukocyte numbers in the BALf samples were evaluated using an Ac.T5Diff haematology analyser (Beckman Coulter). Aliquots of the BALf samples were then diluted in PBS to give approximately 0.5x106 cells/ml. Cytospins prepared from these diluted aliquots (200μl per slide) by centrifugation at 2000 rpm for 5 min at room temperature were allowed to air-dry before staining using the DiffQuik stain system (Dade Behring). Differential leukocyte counts were determined from cytospins under light microscopy using standard morphological criteria and the numbers of eosinophils per ml of BALf were enumerated. Activities of H3 antagonists and LT antagonists, dosed alone or in combination, and given as pre- or post-treatments, were determined.
Nasal congestion in anaesthetized cats
Nasal congestion, as measured by rhinomanometry, was determined in anesthetized cats according to the method of McLeod et al 1999 (Am. J. Rhonil., 13, 391-99). Briefly, pentobarbitone anesthetized cats were mechanically ventilated with ambient air. One nostril was sealed externally and a cuffed endotracheal tube inserted in a retrograde manner via the oesophagus into the nasopharynx. Using a constant air flow through the tube, the pressure (and thus resistance) was determined and modulated by nasal exposure to the mast cell degranulating agent 48/80, and pre or post treatment with H3 or LT antagonists, or a combination of these agents.
Nasal congestion in guinea-pigs
Nasal congestion, as measured by acoustic rhinomanonmetry, was determined in anesthetized guinea-pigs, according to the method of Joynson et al 2003 (proceedings of the World Inflammation Congress, Vancouver). Briefly, male Dunkin-Hartley guinea-pigs were anaesthetized with urethane (50mg/kg i.p.) and placed in a supine position. The trachea was cannulated through which the animals breathed spontaneously. An acoustic rhinomter (GJ Electronik, Denmark) was used to measure cross-sectional area of the nasal cavity as a function of distance, and was modulated by various stimuli including nasal allergen (ovalbumin) in previously actively sensitized animals. Test compounds were administered alone or in combination as pre- or post- treatments.

Claims

Claims
1. A pharmaceutical composition containing a combination of a leukotriene receptor antagonist and a histamine H3 receptor ligand.
2. The pharmaceutical composition according to claim 1 , wherein the leukotriene receptor antagonist is selected from montelukast, pranlukast and zafirlukast and pharmaceutically acceptable salts thereof.
3. The pharmaceutical composition according to claim 2, wherein the leukotriene receptor antagonist is montelukast sodium.
4. The pharmaceutical composition according to claim 1 or 2, wherein the histamine H3 receptor ligand has a Ki of 10 nM or less.
5. The pharmaceutical composition according to any one of claims 1 to 4, wherein the histamine H3 receptor ligand is selected from compounds described in WO00/64884, WO03/004480, US2002/0058659, US2003/0130253, US2003/0135056, US6417218, US6437147,
WO03/06441 1 , WO03/066604, WO02/24657, WO02/24658, WO02/24659, WO02/244141 , WO99/42458, US6407132, WOOO/06254, WO01/74773, WO01/74810, WO01/74813, WO01/7814, WO01/7815, US6436939, US6489337, WO02/12214, WO02/24695, WO03/044059, WO02/079168, WO02/12190, WO02/12224, WO02/40461 , WO02/4074758, WO02/06223, WO01/66534, US2002/01 1 1340, US2002/0169188, US2002/0183309, WO03/059341 , US2002/0082272, US2002/0082278, US2002/0103235, WO02/32893, WO02/072570, WO02/24657, WO02/24658, WO02/24659, WO02/44141 , WO02/076925, WO04/018432, US6448282.
6. The pharmaceutical composition according to any one of claims 1 to 5, wherein the H3 receptor ligand is selected from: A-317920, A-320436, A-331440, ABT-239, A-431404, A-304121 , Cipralisant, iproxifan, FUB-181 , FUB-407, GR-175737, GT-2016, GT-2394, Impentamine, JNJ-5207852, SCH-49648, SCH-50971 , SCH-79687, Verongamine, NCC-0028- 1049.
7. The pharmaceutical composition according to any one of claims 1 to 6 for use as a medicament.
8. A method for treating a patient suffering from a H3 mediated disease and/or leukotriene mediated disease, by administering to said patient an effective amount of a leukotriene antagonist and an effective amount of a histamine H3 receptor ligand.
9. The method according to claim 8, for treating a patient suffering from an allergic and/or inflammatory condition.
10. The method according to claim 9, wherein the allergic and/or inflammatory condition is selected from the group consisting of seasonal and perennial allergic rhinits, non-allergic rhinitis, asthma, sinusitis, colds, dermatitis and uriticaria,
11. Kit containing a leukotriene antagonist and a histamine H3 receptor ligand for sequential, separate or simultaneous use in the treatment of inflammatory diseases
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EP2158911A1 (en) * 2006-02-09 2010-03-03 Teva Pharmaceutical Industries Ltd Stable pharmaceutical formulations of montelukast sodium
WO2013151982A1 (en) 2012-04-03 2013-10-10 Arena Pharmaceuticals, Inc. Methods and compounds useful in treating pruritus, and methods for identifying such compounds
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