Note: Descriptions are shown in the official language in which they were submitted.
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METHODS OF USING AND COMPOSITIONS
COMPRISING SELECTIVE CYTOKINE INFIIBITORY DRUGS FOR
TREATMENT AND MANAGEMENT OF MACULAR DEGENERATION
This application claims the benefit of U.S. provisional application no.
60/422,900
filed on October 31, 2002, the entirety of which is incorporated herein by
reference.
I. FIELD OF THE INVENTION
This invention relates to methods of treating, preventing and managing macular
degeneration (MD) and related syndromes, which comprise the administration of
selective
cytokine inhibitory drugs alone or in combination with known therapeutics. The
invention
also relates to pharmaceutical compositions and dosing regimens. In
particular, the
invention encompasses the use of selective cytokine inhibitory drugs in
conjunction with
surgical intervention, and/or other standard therapies for macular
degeneration.
2. BACKGROUND OF THE INVENTION
Z.1 PATHOBIOLOGY OF MACULAR DEGENERATION
Macular degeneration (MD) is an eye disease that destroys central vision by
damaging the macula. The macula is part of the retina, a thin Iayer of nerve
cells that lines
most of the inside of the eyeball. The nerve cells in the retina detect light
and send to the
brain signals about what the eye sees. The macula is near the center of the
retina at the back
of the eyeball and provides the clear, sharp central vision that an animal
uses for focusing
on what is in front of it. The rest of the retina provides side (peripheral)
vision.
There are two forms of MD: atrophic ("dry") and exudative ("wet"). Rioxdan-
Eva,
P., Eye, in Current Medical Diagnosis and Treatment, 41 ed. 210-211 (2002).
Ninety
percent of patients have the dry form, while only ten percent have the wet
form. However,
patients with the wet form can lose up to ninety percent of their vision.
DuBosar, R., J. of
Ophthalmic Nursing and Technology, 18: 60-64 (1998).
Macular degeneration results in the presence of choroidal neovascularisation
(CNVM) and/or geographic atrophy of retinal pigment epithelium (RPE) in an eye
with
drusen. Bird, A.C., Surv. Ophthamol. 39:367-74 (1995). Drusen are rounded
whitish-
yellowish spots in the fundus, located external to the neuroretina. Additional
symptoms of
MD include RPE detachment (PED) and submacular disciform scar tissue. Algvere,
P.V.,
Acta ~phthalmologica Scandinavica 80:136-143 (2002).
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Choroidal neovascularisation is a problem that is related to a wide variety of
retinal
diseases, but is most commonly associated with MD. CNVM is characterized by
abnormal
blood vessels stemming from the choroid (the blood vessel-rich tissue layer
just beneath the
retina) growing up through the retinal layers. These new vessels are very
fragile and break
easily, causing blood and fluid to pool within the layers of the retina. As
the vessels leak,
they disturb the delicate retinal tissue, causing the vision to deteriorate.
The severity of the
symptoms depends on the size of the CNVM and its proximity to the macula.
Patients'
symptoms may be very mild, such as a blurry or distorted area of vision, or
more severe,
such as a central blind spot.
Patients having drusen and possibly pigmentary abnormalities, but no CNVM or
geographic atrophy, are generally diagnosed as having age-related maculopathy
(ARM). Id.
The histopathological hallmark of ARM and MD is a continuous layer of fine
granular
material deposited in the inner part of Bruch's membrane at the base of the
RPE cells.
Sarks, J.P., et al., Eye 2(Pt. 5):552-77 (1988). These basal deposits are
though to be
accumulated as waste products from the continuing RPE phagocytosis or
photoreceptor
outer segment material. The basal deposits lead to a thickening and decreased
permeability
of Bruch's membrane. It has been hypothesized that decreased water
permeability impairs
an exchange of nutrients, traps water and enhances the development of soft
drusen and PED
and eventually leads to atrophy of RPE cells. Id. However, the current overall
understanding of ARM and MD pathogenesis is incomplete. Cour, M., et al.,
Drugs Aging
19:101-133 (2002).
Because MD is most prevalent in the elderly, the fastest growing segment of
the
population, MD is destined to become a major problem economically and
socially. Macular
degeneration is the most common cause of visual loss in developed countries in
individuals
over the age of 60. Macular degeneration has obliterated the central vision of
1.7 million
Americans and another 11 million are at risk. DuBosar, R., J. of Ophthalmic
Nu~~si~g and
Technology, 18: 60-64 (1998). Currently, there is no known cure. Rhoodhooft,
J., Bull.
Sac. belge OphtalrYCOI. 276:83-92 (2000). Thus, there is an urgent need for
effective
treatments for MD.
2.2 TREATMENTS OF AGE-RELATED
MACULAR DEGENERATION
Until recently, laser photocoagulation was the only treatment routinely used
for MD,
and it provides only modest results. Laser photocoagulation is a type of laser
surgery that
uses an intense beam of light to burn small areas of the retina and the
abnormal blood
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vessels beneath the macula. The burns form scar tissue and seal the blood
vessels, keeping
them from leaking under the macula. Laser photocoagulation is effective only
fox patients
having wet MD. Furthermore, laser photocoagulation is a viable option for only
about 13%
of those patients. Joffe, L. et al., Ihte~~natiohal Ophthalmology Clinics
36(2): 99-116
(1996). Laser photocoagulation does not cure wet MD, rather it sometimes slow
down or
prevent further loss of central vision. Without treatment, however, vision
loss from wet
MD may progress until a person has no remaining central vision.
The most serious drawback to laser surgery is that the laser damages some of
the
nerve cells in the macula that react to light, causing some vision loss.
Sometimes, the
vision loss resulting from surgery is as severe or worse than the vision loss
resulting from
no treatment. In some patients, however, laser surgery initially worsens
vision, but prevents
more severe loss of vision over time.
Verteporfin has recently been used to treat wet MD. Cour, M., et al., Drugs
Agihg
19:101-133 (2002). Verteporfin is a blood-vessel-blocking photoreactive dye
that is
I S administered via inj ection. The dye moves to the blood vessels that are
responsible for the
loss of sight and is then activated by shining a non-burning beam of light
into the eye in the
presence of oxygen. Verteporfm is transported in the plasma primarily by
lipoproteins.
Activated verteporfm generates highly reactive, short-lived singlet oxygen and
reactive
oxygen radicals, resulting in local damage to neovascular endothelium. This
causes vessel
occlusion. Damaged endothelium is known to release procoagulant and vasoactive
factors
through the lipo-oxygenase (leukotriene) and cyclo-oxygenase (eicosanoids such
as
thromboxane) pathways, resulting in platelet aggregation, fibrin clot
formation and
vasoconstriction. Verteporfin appears to somewhat preferentially accumulate in
neovasculature, including choroidal neocovasculature. However, animal models
indicate
that verteporfm also accumulates in the retina. Therefore, verteporfin
administration might
collaterally damage retinal structures, including the retinal pigmented
epithelium and outer
nuclear layer of the retina.
Another strategy currently being investigated for the treatment of MD is
pharmacological antiangiogenic therapy. Cour, M., et al., D~~ugs Agihg 19:101-
I33 (2002).
However, a first clinical trial with an antiangiogenic agent, interferon-c~
showed that it was
ineffective at treating MD and resulted in a high rate of adverse effects.
Arch. Ophthalmol.
115:865-72 (1997).
Intravitreal injection of triamcinolone reportedly inhibits the growth of
laser-induced
CNVM in monkeys, but fails to prevent severe visual loss over a one-year
period in patients
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with MD in a randomized trial. Gillies, M.C., et al., Invest. Uphthalmel. Vis.
~'ci. 42:5522
(2001). A number of other antiangiogenic drugs are in various stages of
development for
use in patients with MD, including angiostatic steroids (e.g., anecortave
acetate, Alcon) and
vascular epidermal growth factor (VEGF) antibodies or fragments thereof.
Guyer, D.R., et
al., Invest. Ophthalmol. Yis. Sci. 42:SS22 (2001). One such VEGF antibody is
rhuFab.
Additional new drugs for the treatment of MD include EYE101 (Eyetech
Pharmaceuticals),
LY333S31 (Eli Lilly), Miravant and RETISERT implant (Bausch & Lomb), which
exudes a
steroid into the eye for up to three years.
Although new and promising strategies for the treatment of MD and related
macular
degenerative diseases are being investigated, there is still no effective
treatment available.
Accordingly, there remains a need in the art for an effective treatment for
MD.
2.3 SELECTIVE CYTOKTNE INHIBITORY DRUGS
Compounds referred to as SeICIDsTM (Celgene Corporation) or Selective Cytokine
Inhibitory Drugs have been synthesized and tested. These compounds potently
inhibit
IS TNF-a production, and exhibit modest inhibitory effects on LPS induced
IL1J3 and IL12.
L.G. Corral, et al., Ahh. Rheum. Dis. 58:(Suppl I) 1107-1113 (1999).
Further characterization of the selective cytokine inhibitory drugs shows that
they
axe potent PDE4 inhibitors. PDE4 is one of the major phosphodiesterase
isoenzymes found
in human myeloid and lymphoid lineage cells. The enzyme plays a crucial part
in
regulating cellular activity by degrading the ubiquitous second messenger CAMP
and
maintaining it at low intracellular levels. Id. Inhibition of PDE4 activity
results in
increased cAMP levels leading to the modulation of LPS induced cytokines
including
inhibition of TNF-c~ production in monocytes as well as in lymphocytes.
3. SUMMARY OF THE INVENTION
This invention encompasses methods of treating and preventing macular
degeneration, which comprise administering to a patient in need thereof a
therapeutically or
prophylactically effective amount of a selective cytokine inhibitory drug, or
a
pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate or
prodrug
thereof. The invention also encompasses methods of managing MD (e.g.,
lengthening the
time of remission) which comprise administering to a patient in need of such
management a
therapeutically or prophylactically effective amount of a selective cytokine
inhibitory drug,
or a pharmaceutically acceptable salt, solvate, hydrate, stereoisomer,
clathrate, or prodrug
thereof
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Another embodiment of the invention encompasses the use of a selective
cytokine
inhibitory drag, or a pharmaceutically acceptable salt, solvate, hydrate,
stereoisomer,
clathrate or prodrug thereof, in combination with another therapeutic useful
to treat or
prevent MD such as, but not limited to, a steroid, a light sensitizes, an
integrin, an
antioxidant, an interferon, a xanthine derivative, a growth hormone, a
neutrotrophic factor, a
regulator of neovasculaxization, an anti-VEGF antibody, a prostaglandin, an
antibiotic, a
phytoestrogen, an anti-inflammatory compound or an antiangiogenesis compound,
or a
combination thereof.
Yet another embodiment of the invention encompasses methods for treating,
preventing or managing MD, comprising administering to a patient in need
thereof an
effective amount of a selective cytokine inhibitory drug, or a
pharmaceutically acceptable
salt, solvate, hydrate, stereoisomer, clathrate or prodrug thereof, in
combination with a
conventional therapy used to treat or prevent MD such as, but not limited to,
surgical
intervention (e.g., laser photocoagulation therapy and photodynamic therapy).
The invention fixrther encompasses pharmaceutical compositions, single unit
dosage
forms, and kits suitable for use in treating, preventing and/or managing MD,
which
comprise a selective cytokine inhibitory drug, or a pharmaceutically
acceptable salt, solvate,
hydrate, stereoisomer, clathrate, or prodrug thereof.
4. DETAILED DESCRIPTION OF THE INVENTION
A first embodiment of the invention encompasses methods of treating and
preventing MD, which comprise administering to a patient (e.g., a mammal such
as a
human) ili need thereof a therapeutically or prophylactically effective amount
of a selective
cytokine inhibitory drug or a pharmaceutically acceptable salt, solvate,
hydrate,
stexeoisomer, clathrate or prodrug thereof. The invention further relates to
the treatment or
prevention of specific types of MD and related syndromes including, but not
limited to,
atrophic (dry) MD, exudative (wet) MD, age-related maculopathy (ARM),
choroidal
neovascularisation (CNVM), retinal pigment epithelium detachment (PED), and
atrophy of
retinal pigment epithelium (RPE).
As used herein, the term macular degeneration (MD) encompasses all forms of
macular degenerative diseases regardless of a patient's age, although some
macular
degenerative diseases are more common in certain age groups. These include,
but are not
limited to, Best's disease or vitelliform (most common in patients under about
7 years of
age); Stargardt's disease, juvenile macular dystrophy or fundus flavimaculatus
(most
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common in patients between about 5 and about 20 years of age); ~'elit~'s
disease, Sorsby's
disease, Doyne's disease or honeycomb dystrophy (most common in patients
between about
30 and about 50 years of age); and age-related macular degeneration (most
common in
patients of about 60 years of age or older).
Causes of 1V>D include, but are not limited to, genetic, physical trauma,
diseases
such as diabetes, and infection, such as bacterial infection (e.g., leprosy
and ENL in
particular).
Another embodiment of the invention encompasses methods of managing MD
which comprise administering to a patient in need of such management a
prophylactically
effective amount of a selective cytokine inhibitory drug, or a
pharmaceutically acceptable
salt, solvate, hydrate, stereoisomer, clathrate, or prodrug thereof.
Another embodiment of the invention encompasses a pharmaceutical composition
comprising a selective cytokine inhibitory drug, or a pharmaceutically
acceptable salt,
solvate, hydrate, stereoisomer, clathrate, or prodrug thereof, and an optional
earner.
Also encompassed by the invention are single unit dosage forms comprising a
selective cytokine inhibitory drug, or a pharmaceutically acceptable salt,
solvate, hydrate,
stereoisomer, clathrate, or prodrug thereof, and an optional carrier.
Another embodiment of the invention encompasses a kit comprising: a
pharmaceutical composition comprising a selective cytokine inhibitory drug, or
a
pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate,
or prodrug
thereof The invention further encompasses kits comprising single unit dosage
forms. Kits
encompassed by this invention can further comprise additional active agents. A
specific kit
comprises an Arnsler grid useful for detecting or diagnosing MD.
Without being limited by theory, it is believed that certain selective
cytokine
inhibitory drugs and other medications that may be used to treat symptoms of
MD can act in
complementary or synergistic ways in the treatment or management of MD.
Therefore, one
embodiment of the invention encompasses a method of treating, preventing
and/or
managing MD, which comprises administering to a patient in need thereof a
therapeutically
or prophylactically effective amount of a selective cytokine inhibitory drug,
or a
pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate,
or prodrug
thereof, and a therapeutically or prophylactically effective amount of a
second active agent.
Examples of second active agents include, but are not limited to, conventional
therapeutics used to treat ox prevent MD such as steroids, light sensitizers,
integrins,
antioxidants, interferons, xanthine derivatives, growth hormones,
neutrotrophic factors,
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regulators of neovascularization, anti-VEGF antibodies, prostaglandins,
antibiotics,
phytoestrogens, anti-inflammatory compounds and antiangiogenesis compounds,
and other
therapeutics found, for example, in the Physician 's Desk Reference 2003.
Specific
examples of second active agents include, but are not limited to, verteporfin,
purlytin, an
angiostatic steroid, rhuFab, interferon-2a, an integrin, an antioxidant, and
pentoxifylline.
The invention also encompasses pharmaceutical compositions, single unit dosage
forms, and kits which comprise a selective cytokine inhibitory drug, or a
pharmaceutically
acceptable salt, solvate, hydrate, stereoisomer, clathrate, or prodrug
thereof, and a second
active agent. For example, a kit may contain a compound of the invention and a
steroid, a
light sensitizer, an integrin, an antioxidant, an interferon, a xanthine
derivative, a growth
hormone, a neutrotrophic factor, a regulator of neovascularization, an anti-
VEGF antibody,
a prostaglandin, an antibiotic, a phytoestrogen, an anti-inflammatory compound
or an
antiangiogenesis compound, or a combination thereof, or other drug capable of
relieving or
alleviating a symptom of MD.
It is believed that particular selective cytokine inhibitory drugs can reduce
or
eliminate adverse effects associated with the administration of therapeutic
agents used to
treat MD, thereby allowing the administration of larger amounts of the agents
to patients
aw.-~d/cr il~~creasing patient corr~pliance. onsequently, another em'dodiment
of the invention
encompasses a method of reversing, reducing or. avoiding an adverse effect
associated with
the administration of a second active agent in a patient suffering from MD,
which comprises
administering to a patient in need thereof a therapeutically or
prophylactically effective
amount of a selective cytokine inhibitory drug, or a pharmaceutically
acceptable salt,
solvate, hydrate, stereoisomer, clathrate, or prodrug thereof.
As discussed elsewhere herein, symptoms of MD can be treated with surgical
intervention, such as, but not limited to, light or laser therapy, radiation
therapy, retinal
pigment epithelium transplantation, and foveal translocation. Without being
limited by
theory, it is believed that the combined use of such conventional therapies
and a selective
cytokine inhibitory drug can be highly effective. Therefore, this invention
encompasses a
method of treating, preventing and/or managing MD, which comprises
administering to a
patient a selective cytokine inhibitory drug, or a pharmaceutically acceptable
salt, solvate,
hydrate, stereoisomer, clathrate, or prodrug thereof, before, during, or after
surgical
intervention, or other conventional, non-drug based therapies.
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4.1 SELECTIVE CYTOKINE IWB[~~~I~'~~~~~G~~
Compounds used in the invention include racemic, stereomerically pure and
stereomerically enriched selective cytokine inhibitory drugs, stereomerically
and
enantiomerically pure compounds that have selective cytokine inhibitory
activities, and
pharmaceutically acceptable salts, solvates, hydrates, stereoisomers,
clathrates, and
prodrugs thereof. Preferred compounds used in the invention are known
Selective Cytokine
Inhibitory Drugs (SelCmsT~ of Celgene Corporation, NJ.
As used herein and unless otherwise indicated, the terms "selective cytokine
inhibitory drugs" and "SeICIDsTM" encompass small molecule drugs, e.g., small
organic
molecules which are not peptides, proteins, nucleic acids, oligosaccharides or
other
macromolecules. Preferred compounds inhibit TNF-a production. Compounds may
also
have a modest inhibitory effect on LPS induced IL113 and IL12. More
preferably, the
compounds of the invention are potent PDE4 inhibitors.
Specific examples of selective cytokine inhibitory drugs include, but are not
limited
to, the cyclic imides disclosed in U.S. patent nos. 5,605,914 and 5,463,063;
the cycloalkyl
amides and cycloalkyl nitriles of U.S. patent nos. 5,728,844, 5,728,845,
5,968,945,
6,180,644 and 6,518,281; the aryl amides (for example, an embodiment being N-
benzoyl-3-
amino-3-(3',4'-dimethoxyphenyl)-propanamide) ofU.S. patent nos. 5,801,195,
5,736,570,
6,046,221 and 6,284,780; the imide/amide ethers and alcohols (for example, 3-
phthalimido-
3-(3',4'-dimethoxyphenyl)propan-1-ol) disclosed in U.S. patent no. 5,703,098;
the
succinimides and maleimides (for example methyl 3-(3',4',5'6'-
petrahydrophthalimdo)-3-
(3",4"-dimethoxyphenyl)propionate) disclosed in U.S. patent no. 5,658,940;
imido and
amido substituted alkanohydroxamic acids disclosed in U.S. patent no.
6,214,857 and WO
99/06041; substituted phenethylsulfones disclosed in U.S. patent nos.
6,011,050 and
6,020,358; substituted imides (for example, 2-phthalimido-3-(3',4'-
dimethoxyphenyl)
propane) disclosed in U.S. patent no. 6,429,221; substituted 1,3,4-oxadiazoles
(for example,
2-[1-(3-cyclopentyloxy-4-methoxyphenyl)-2-(1,3,4-oxadiazole-2-yl)ethyl]-5-
methylisoindoline-1,3-dione) disclosed in U.S. patent no. 6,326,388; cyano and
carboxy
derivatives of substituted styrenes (for example, 3,3-bis-(3,4-
dimethoxyphenyl)
acrylonitrile) disclosed in U.S. patent nos. 5,929,117, 6,130,226, 6,262,101
and 6,479,554;
isoindoline-1-one and isoindoline-1,3-dione substituted in the 2-position with
an a (3,4-
disubstituted phenyl)alkyl group and in the 4- andlor 5-position with a
nitrogen-containing
group disclosed in WO 01/34606; and imido and amido substituted acylhydroxamic
acids
(for example, (3-(1,3-dioxoisoindoline-2-yl)-3-(3-ethoxy 4-methoxyphenyl)
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propanoylamino) propanoate disclosed in WO
Ol/45'~'0~~;'i~"a~,i~~ii~'>f:~a~'~~:
patents and patent applications identified herein are incorporated.herein by
reference.
Additional selective cytokine inhibitory drugs belong to a family of
synthesized
chemical compounds of which typical embodiments include 3-(1,3-dioxobenzo-
[f~isoindol-
2-yl)-3-(3-cyclopentyloxy-4-methoxyphenyl)propionamide and 3-(1,3-dioxo-4-
azaisoindol-
2-yl)-3.-(3,4-damethoxyphenyl)-propionamide.
Other specific selective cytokine inhibitory drugs belong to a class of non-
polypeptide cyclic amides disclosed in U.S. patent nos. 5,698,579 and
5,877,200, both of
which are incorporated herein. Representative cyclic amides include compounds
of the
formula:
O
O
C
R \ /N- i H- ~CnH2n)- C- R~2
C R~
i ~
H H
wherein n has a value of 1, 2, or 3;
RS is o-phenylene, unsubstituted or substituted with 1 to 4 substituents each
selected
independently from the group consisting of vitro, cyano, trifluoromethyl,
carbethoxy,
carbomethoxy, caxbopropoxy, acetyl, carbamoyl, acetoxy, carboxy, hydroxy,
amino,
alkylamino, dialkylamino, acylamino, alkyl of 1 to 10 carbon atoms, alkyl of 1
to 10 carbon
atoms, and halo;
R' is (i) phenyl or phenyl substituted with one or more substituents each
selected
independently of the other from the group consisting of vitro, cyano,
trifluoromethyl,
carbethoxy, carbomethoxy, carbopropoxy, acetyl, carbamoyl, acetoxy, carboxy,
hydroxy,
amino, alkyl of 1 to 10 carbon atoms, alkoxy of 1 to 10 carbon atoms, and
halo, (ii) benzyl
unsubstituted or substituted with 1 to 3 substituents selected from the group
consisting of
' vitro, cyano, trifluoromethyl, carbothoxy, carbomethoxy, carbopropoxy,
acetyl, carbamoyl,
acetoxy, carboxy, hydroxy, amino, alkyl of 1 to 10 carbon atoms, alkoxy of 1
to 10 carbon
atoms, and halo, (iii) naphthyl, and (iv) benzyloxy;
R12 is -OH, alkoxy of 1 to 12 carbon atoms, or
R$
-N
~R9
R$ is hydrogen or alkyl of 1 to 10 carbon atoms; and
R9 is hydrogen, alkyl of 1 to 10 carbon atoms, -CORI°, or -
S02R1°, wherein Rl° is
hydrogen, alkyl of 1 to 10 carbon atoms, or phenyl.
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Specific compounds of this class include, but 'i«n~t5~lii~~t"~ei:~
3-phenyl-2-(1-oxoisoindolin-2-yl)propionic acid;
3-phenyl-2-(1-oxoisoindolin-2-yl)propionamide;
3-phenyl-3-(1-oxoisoindolin-2-yl)propionic acid;
3-phenyl-3-(1-oxoisoindolin-2-yl)propionamide;
3-(4-methoxyphenyl)-3-(1-oxisoindolin-yl)propionic acid;
3-(4-methoxyphenyl)-3-( 1-oxisoindolin-yl)propionamide;
3-(3,4-dimethoxyphenyl)-3-(1-oxisoindolin-2-yl)propionic acid;
3-(3,4-dimethoxy-phenyl)-3-( 1-oxo-1, 3-dihydroisoindol-2-yl)propionamide;
3-(3,4-dimethoxyphenyl)-3-(1-oxisoindolin-2-yl)propionamide;
3-(3,4-diethoxyphenyl)-3-(1-oxoisoindolin-yl)propionic acid;
methyl 3-(1-oxoisoindolin-2-yl)-3-(3-ethoxy-4-methoxyphenyl)propionate;
3-(1-oxoisoindolin-2-yl)-3-(3-ethoxy-4-methoxyphenyl)propionic acid;
3-(1-oxoisoindolin-2-yl)-3-(3-propoxy-4-methoxyphenyl)propionic acid;
3-(1-oxoisoindolin-2-yl)-3-(3-butoxy-4-methoxyphenyl)propionic acid;
3-(1-oxoisoindolin-2-yl)-3-(3-propoxy-4-methoxyphenyl)propionamide;
3-( 1-oxoisoindolin-2-yl)-3-(3-butoxy-4-methoxyphenyl)propionamide;
methyl 3-(1-oxoisoindolin-2-yl)-3-(3-butoxy-4-methoxyphenyl)propionate; and
methyl 3-(1-oxoisoindolin-2-yl)-3-(3-propoxy-4-methoxyphenyl)propionate.
Other specific selective cytokine inhibitory drugs include the imido and amido
substituted alkanohydroxamic acids disclosed in W~ 99/06041, which is
incorporated
herein by reference. Examples of such compound include, but are not limited
to:
O
C R3
O
RZ R5 N- CH (CnH2n)-C- N- C- R4
R4.
wherein each of Rl and R2, when taken independently of each other, is
hydrogen,
lower alkyl, or Rl and R~, when taken together with the depicted carbon atoms
to which
each is bound, is o-phenylene, o-naphthylene, or cyclohexene-1,2-diyl,
unsubstituted or
substituted with 1 to 4 substituents each selected independently from the
group consisting
of vitro, cyano, trifluoromethyl, carbethoxy, carbomethoxy, carbopropoxy,
acetyl,
carbamoyl, acetoxy, carboxy, hydroxy, amino, alkylamino, dialkylamino,
acylamino, alkyl
of 1 to 10 carbon atoms, alkoxy of 1 to 10 carbon atoms, and halo;
to
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R3 is phenyl substituted with from one to fou~'~S'i~k~st'itu'ex~ ~s~l~~~e~d
frolri ~1~~'gi~'d~i
consisting of vitro, cyano, trifluoromethyl, carbethoxy, carbomethoxy,
caxbopropoxy,
acetyl, carbamoyl, acetoxy, carboxy, hydroxy, amino, alkyl of 1 to 10 carbon
atoms, allcoxy
of 1 to 10 carbon atoms, alkylthio of 1 to 10 carbon atoms, benzyloxy,
cycloalkoxy of 3 to 6
carbon atoms, C4-C6-cycloalkylidenemethyl, C3-Clo-alkylidenemethyl,
indanyloxy, and
halo;
R4 is hydrogen, alkyl of 1 to 6 carbon atoms, phenyl, or benzyl;
R4~ is hydrogen or alkyl of 1 to 6 carbon atoms;
RS is -CH2-, -CHZ-CO-,-S02-,-S-, or -NHCO-;
n has a value of 0, 1, or 2; and
the acid addition salts of said compounds which contain a nitrogen atom
capable of
being protonated.
Additional specific selective cytokine inhibitory drugs used in the invention
include,
but are not limited to:
3-(3-ethoxy-4-methoxyphenyl)-N-hydroxy-3-(1-oxoisoindolinyl)propionamide;
3-(3-ethoxy-4-methoxyphenyl)-N-methoxy-3-(1-oxoisoindolinyl)propionamide;
N-benzyloxy-3-(3-ethoxy-4-methoxyphenyl)-3-phthalimidopropionamide;
N-benzyloxy-3-(3-ethoxy-4-methoxyphenyl)-3-(3-nitrophthalimido)propionamide;
N-benzyloxy-3-(3-ethoxy-4-methoxyphenyl)-3-(1-oxoisoindolinyl)propionamide;
3-(3-ethoxy-4-methoxyphenyl)-N-hydroxy-3-phthalimidopropionamide;
N-hydroxy-3-(3,4-dimethoxyphenyl)-3-phthalimidopropionamide;
3-(3-ethoxy-4-methoxyphenyl)-N-hydroxy-3-(3-nitrophthalimido)propionamide;
N-hydroxy-3-(3,4-dimethoxyphenyl)-3-(1-oxoisoindolinyl)propionamide;
3-(3-ethoxy-4-methoxyphenyl)-N-hydroxy-3-(4-methyl-phthalimido)propionamide;
3-(3-cyclopentyloxy-4-methoxyphenyl)-N-hydroxy-3-phthalimidopropionamide;
3-(3-ethoxy-4-methoxyphenyl)-N-hydroxy 3-(1,3-dioxo-2,3-dihydro-1H-
benzo [f jisoindol-2-yl)propionamide;
N-hydroxy-3- ( 3-(2-propoxy)-4-methoxyphenyl} -3-phthalirnidopropionamide;
3-(3-ethoxy-4-methoxyphenyl)-3-(3,6-difluorophthalimido)-N-
hydroxypropionamide;
3-(4-aminophthalimido)-3-(3-ethoxy-4-methoxyphenyl)-N-hydroxypropionamide;
3-(3-aminophthalimido)-3-(3-ethoxy-4-methoxyphenyl)-N-hydroxypropionarnide;
N-hydroxy-3-(3,4-dimethoxyphenyl)-3-(1-oxoisoindolinyl)propionamide;
3-(3-cyclopentyloxy-4-methoxyphenyl)-N-hydroxy-3-(1-oxoisoindolinyl)
propionamide; and
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N-benzyloxy-3-(3-ethoxy-4-rnethoxyphenyl~~"~=~(3-
aitro~h~TT~~'~iY~'do)~'~o~ibiifihide.
Additional selective cytokine inhibitory drugs used in the invention include
the
substituted phenethylsulfones substituted on the phenyl group with a
oxoisoindine group.
Examples of such compounds include, but are not limited to, those disclosed in
U.S. patent
no. 6,020,358, which is incorporated herein, which include the following:
R5
R~
R6
R2
~N-CH\
Rs ~ Y CH2-S02-R~
R4
wherein the carbon atom designated * constitutes a center of chirality;
Y is C=O, CH2, 502, or CHIC=O; each of Rl, Ra, R3, and R~, independently of
the
others, is hydrogen, halo, alkyl of 1 to 4 carbon atoms, alkoxy of 1 to 4
carbon atoms, vitro,
cyano, hydroxy, or -NR8R9; or any two of Rl, RZ, R3, and R4 on adj acent
carbon atoms,
together with the depicted phenylene ring are naphthylidene;
each of RS and R6, independently of the other, is hydrogen, alkyl of 1 to 4
carbon
atoms, alkoxy of 1 to 4 carbon atoms, cyano, or cycloalkoxy of up to 18 carbon
atoms;
R7 is hydroxy, alkyl of 1 to 8 carbon atoms, phenyl, benzyl, or NR$'R9~;
each of R8 and R9 taken independently of the other is hydrogen, alkyl of 1 to
8
carbon atoms, phenyl, or benzyl, or one of R8 and R9 is hydrogen and the other
is -CORI° or
-SOzRI°, or R$ and R9 taken together are tetramethylene,
pentarnethylene, hexamethylene,
or -CHZCHZX1CHZCH2- in which Xl is -O-, -S- or -NH-; and
each of R8~ and R9' taken independently of the other is hydrogen, alkyl of 1
to 8
carbon atoms, phenyl, or benzyl, or one of R8~ and R9~ is hydrogen and the
other is -CORIO°
or -SOZRi°~, or R8~ and R9~ taken together are tetramethylene,
pentamethylene,
hexarnethylene, or -CH2CHZX2CHZCH2- in which X2 is -O-, -S-, or -NH-.
It will be appreciated that while for convenience the above compounds are
identified
as phenethylsulfones, they include sulfonamides when R' is NR$~R9~.
Specific groups of such compounds are those in which Y is C=O or CH2.
A further specific group of such compounds are those in which each of Rl, R2,
R3,
and R4 independently of the others, is hydrogen, halo, methyl, ethyl, methoxy,
ethoxy, vitro,
cyano, hydroxy, or -NRgR9 in which each of Rs and R9 taken independently of
the other is
hydrogen or methyl or one of R$ and R9 is hydrogen and the other is -COCH3.
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Particular compounds are those in which one of~R'~FEZR'';"did'"12''
i~"°-'N~Ta~~arid"die
remaining of Rl, R2, R3, and R4 are hydrogen.
Particular compounds are those in which one of Rl, R2, R3, and R4 is -NHCOCH3
and the remaining of Rl, RZ, R3, and R4 are hydrogen.
Particular compounds are those in which one of RI, R2, R3, and R4 is -N(CH3)a
and
the remaining of Rl, R2, R3, and R4 are hydrogen.
A further preferred group of such compounds are those in which one of Rl, Ra,
R3,
and R4 is methyl and the remaining of Rl, R2, R3, and R4 are hydrogen.
Particular compounds are those in which one of Rl, R2, R3, and R4 is fluoro
and the
remaining of Rl, R2, R3, and R4 are hydrogen.
Particular compounds are those in which each of RS and R6, independently of
the
other, is hydrogen, methyl, ethyl, propyl, methoxy, ethoxy, propoxy,
cyclopentoxy, or
cyclohexoxy.
Particular compounds are those in which RS is methoxy and R6 is
monocycloalkoxy,
polycycloalkoxy, and benzocycloalkoxy.
Particular compounds are those in which RS is methoxy and R6 is ethoxy.
Particular compounds are those in which R~ is hydroxy, methyl, ethyl, phenyl,
benzyl, or NR8~R9~ in which each of R8~ and R9' taken independently of the
other is
hydrogen or methyl.
Particular compounds are those in which R' is methyl, ethyl, phenyl, benzyl or
NR8~R9~ in which each of R$' and Rg~ taken independently of the other is
hydrogen or
methyl.
Particular compounds are those in which R' is methyl.
Particular compounds are those in which R' is NR$~R9~ in which each of R8~ and
R9~
taken independently of the other is hydrogen or methyl.
Other specific selective cytokine inhibitory drugs include fluoroalkoxy-
substituted
1,3-dihydro-isoindolyl compounds found in United States Provisional
Application No.
60/436,975 to G. Muller et al., filed December 30, 2002, which is incorporated
herein in its
entirety by reference. Representative fluoroalkoxy-substituted 1,3-dihydro-
isoindolyl
compounds include compounds of the formula:
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Xa O
Xa ~ R2
~N
Y
2
X1
wherein:
Y is -C(O)-, -CHZ, -CHZC(O)-, -C(O)CHZ-, or SOZ;
Z is H, -C(O)R3, -(Co_1-alkyl)-SOZ-(Clue-alkyl), -Cl_8-alkyl, -CH20H,
CHZ(O)(Ci_$-
S alkyl) or -CN;
Ri and RZ are each independently -CHFa, -Cl_B-alkyl, -C3_l8-cycloalkyl, or -
(Cl_lo-
alkyl)(C3_1$-cycloalkyl), and at least one of Rl and R2 is CHFZ;
R3 is -NR4R5, -alkyl, -OH, -O-alkyl, phenyl, benzyl, substituted phenyl, or
substituted benzyl;
R4 and R5 are each independently H, -Cl_$-alkyl, -OH, -OC(O)R6;
R6 is -Cl_$-alkyl, -amino(Cl_$-alkyl), -phenyl, -benzyl, or -aryl;
Xl, XZ, X3, and X4 are each independent -H, -halogen, -nitro, -NH2, -CF3, -
Cl_6-alkyl,
-(Co_~.-alkyl)-(C3_6-cycloaLLyl), (Coy-alkyl)-2~R~R8, (Coy-alkyl)-N(H)C(O)-
(RB), (Coa.-
alkyl)-N(H)C(O)N(R~Rg), (Co_4-alkyl)-N(H)C(O)O(R~Rg), (Coy-alkyl)-ORB, (Co_4-
allcyl)-
imidazolyl, (Co_4-alkyl)-pyrrolyl, (Co_4-alkyl)-oxadiazolyl, or (Co_4-alkyl)-
triazolyl, or two of
Xl, X2, X3, and X4 may be joined together to form a cycloalkyl or
heterocycloalkyl ring,
(e.g., Xl and X2, XZ and X3, X3 and X4, Xl and X3, X~ and X4, or Xl and X4 may
form a 3,
4, 5, 6, or 7 membered ring which may be aromatic, thereby forming a bicyclic
system with
the isoindolyl ring); and
R' and R8 are each independently H, Cl_9-alkyl, C3_6-cycloalkyl, (Cl_6-alkyl)-
(C3_6-
cycloalkyl), (C1_6-alkyl)-N(R~RB), (Cl_6-alkyl)-ORB, phenyl, benzyl, or aryl;
or a pharmaceutically acceptable salt, solvate, hydrate, stereoisomer,
clathrate, or
prodrug thereof.
Preferred compounds of the invention include, but are not limited to:
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(3-cyclopropylinethoxy
4-difluoromethoxy-phenyl)-propionic acid;
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(3-cyclopropylmethoxy-
4-difluoromethoxy-phenyl)-N,N-dimethyl-propionamide;
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3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoi'ridbl-2-yI);~3=(~
~~~~~'o~ro~5yi~iett~o~~-4
difluoromethoxy-phenyl)-propionamide;
3-(3-Cyclopropylmethoxy-4-difluoromethoxy-phenyl)-3-(1,3-dioxo-1,3-dihydro-
isoindol-2-yl)-propionic acid;
3-(3-Cyclopropylinethoxy-4-difluoromethoxy-phenyl)-3-(1,3-dioxo-1,3-dihydro-
isoindol-2-yl)-N-hydroxy-propionamide;
3-(3-Cyclopropylinethoxy-4-difluoromethoxy-phenyl)-3-(7-vitro-1-oxo-1,3-
dihydro-isoindol-2-yl)-propionic acid methyl ester;
3-(3-Cyclopropylmethoxy-4-difluoromethoxy-phenyl)-3-(7-vitro-1-oxo-1,3-
dihydro-isoindol-2-yl)-propionic acid;
3-(3-Cyclopropylmethoxy-4-difluoromethoxy-phenyl -3-(7-vitro-1-oxo-1,3-dihydn
isoindol-2-yl)- )-N,N-dimethyl-propionamide;
3-(7-Amino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(3-cyclopropylinethoxy-4-
difluoromethoxy-phenyl)-N,N-dimethyl-propionamide;
3-(4-Difluoromethoxy-3-ethoxy-phenyl)-3-(7-vitro-1-oxo-1,3-dihydro-isoindol-2-
yl)-propionic acid methyl ester;
3-(7-Amino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-ethoxy-
phenyl)-propionic acid methyl ester;
3-[7-(Cyclopropanecarbonyl-amino)-1-oxo-1,3-dihydro-isoindol-2-yl]-3-(4-
difluoromethoxy-3-ethoxy-.phenyl)-propionic acid methyl ester;
3-(7-Acetylamino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-propionic acid methyl ester;
3-(7-Acetylarnino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-propionic acid;
3-[7-(Cyclopropanecarbonyl-amino)-1-oxo-1,3-dihydro-isoindol-2-yl]-3-(4-
difluoromethoxy-3-ethoxy-phenyl)-propionic acid;
Cyclopropanecarboxylic acid {2-[2-carbamoyl-1-(4-difluoromethoxy-3-ethoxy-
phenyl)-ethyl]-3-oxo-2,3-dihydro-1H-isoindol-4-yl~-amide;
Cyclopropanecarboxylic acid f2-[1-(4-difluoromethoxy-3-ethoxy-phenyl)-2-
dimethylcarbamoyl-ethyl]-3-oxo-2,3-dihydro-1H-isoindol-4-yl}-;
Cyclopropanecarboxylic acid f 2-[1-(4-difluoromethoxy-3-ethoxy-phenyl)-2-
hydroxycarbamoyl-ethyl]-3-oxo-2,3-dihydro-1H-isoindol-4-yl)-amide;
3-(7-Acetylamino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-propionamide;
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3-(7-Acetylarnino-1-oxo-1,3-dihydro-isoindol-~='y~)=3-~~#-duTuorbmethoxy-3-
ethoxy-phenyl)-N,N-dimethyl-propionamide;
3-(7-Acetylamino-1-oxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-N-hydroxy-propionamide;
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-propionic acid;
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-propionamide;
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-N,N-dimethyl-propionamide;
3-(4-Acetylamino-1,3-dioxo-1,3-dihydro-isoindol-2-yl)-3-(4-difluoromethoxy-3-
ethoxy-phenyl)-N-hydroxy-propionamide;
Cyclopropanecarboxylic acid {2-[1-(4-difluoromethoxy-3-ethoxy-phenyl)-2-
methanesulfonyl-ethyl]-3-oxo-2,3-dihydro-1H-isoindol-4-yl}-amide;
N-{2-[1-(4-Difluoromethoxy-3-ethoxy-phenyl)-2-methanesulfonyl-ethyl]-1,3-
dioxo~
2,3-dihydro-1H-isoindol-4-yl}-acetamide; and
Cyclopropanecarboxylic acid {2-[2-carbamoyl-1-(4-difluoromethoxy-3-ethoxy
phenyl)-ethyl]-7-chloro-3-oxo-2,3-dihydro-1H-isoindol-4-yl}-amide.
Other selective cytokine inhibitory drugs include 7-amido-substituted
isoindolyl
compounds found in United States Provisional Application No. 60/454,155 to G.
Muller et
al., filed March 12, 2003, which is incorporated herein in its entirety by
reference.
Representative 7-amido-substituted isoindolyl compounds include compounds of
the
formula:
C R~
O
R2
X
wherein:
Y is -C(O)-, -CH2, -CHZC(O)-or SO2;
X is H;
Z is (Coy.-alkyl)-C(O)R3, C1~.-alkyl, (Co_4-alkyl)-OH, (C1~-alkyl)-O(Cl.~-
alkyl),
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a=4 ° y 3~
(C1_4-alkyl)-S02(Cl_4-alkyl) (Co-4-~l)-SO(Ci-a-alk5'1)~=~~~o-~=t~~~~~~-C~ -
'~ii~ f
N(Cl_s-alkyl)Z, (Co_a-alkyl)-N(H)(OH), CHzN502(C1_4-alkyl);
Rl and R2 are independently Ci_s-alkyl, cycloalkyl, or(Cl~.-alkyl)cycloalkyl;
R3 is, NR~ R5, OH, or O-(Cl_s-allcyl);
R4 is H;
RS is -OH, or -OC(O)R6;
R6 is Cl_s-alkyl, amino-(Cl_s-alkyl), (Cl_s-alkyl)-(C3_6-cycloalkyl),
C3_6cycloalkyl,
phenyl, benzyl, or aryl;
or a pharmaceutically acceptable salt, solvate, hydrate, stereoisomer,
clathrate, or
prodrug thereof; or the formula:
wherein:
Y is -C(O)-, -CH2, -CH2C(O)-, or SO2;
X is halogen, -CN, -NR~RB, NOa, or -CF3,
W is
NR R NR~R$ \N/
7 8 , ~ , ~ ,
~N/ ~N/ N/
O J HN J ,
Rs
N (C°-4) ~N
R~ or R8
s
R9
Z is (Co_4alkyl)-S02(Cl_4-alkyl), -(Co~.alkyl)-CN, -(Co_4alkyl)-C(O)R3, C1_4-
alkyl,
(Co_a-alkyl)OH, (Coa.-alkyl)~(Cl~-alkyl), (Co-~-a~'1)SO(Cl_4-alkyl) (Co-4-
a~'1)~2a (Co-4-
alkyl)N(Cl_s-alkyl)Z, (Co_4-alkyl) N(H)(OH), or (Co_4-alkyl)NS02(Cl-4-alkyl);
W is -C3_6-cycloalkyl, -(Cl_8-alkyl)-(C3_6_cycloalkyl), -(Co_s-alkyl)-
(C3_6cycloalkyl)-
NR~Rs, (Co_g-alkyl)-NR~Ra~ (Co-4-a~'1)-CHRs-(Co_4-alkYl)-NR~Rs~
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Rl and R2 are independently C1_8-alkyl, cycl~~al~yl;~af ('~-
i_4=vl~~'l~cyc'loalky'1;""
R3 is Cl_s-alkyl, NR4 R5, OH, or O-(Cl_$-alkyl);
R4 and RS are independently H, Cl_s-alkyl, (Co_$-alkyl)-(C3_6-cycloalkyl), OH,
or
-OC(O)R6;
R6 is CI_$-alkyl, (Co_8-alkyl)-(C3_6-cycloalkyl), amino-(Cl_$-alkyl), phenyl,
benzyl, or
aryl;
R~. and R$ are each independently H, Cl_8-alkyl, (Co_8alkyl)-(C3_6-
cycloalkyl),
phenyl, benzyl, aryl, or can be taken together with the atom connecting them
to form a 3 to
7 membered heterocycloalkyl or heteroaryl ring;
R9 is Cl_4-alkyl, (Co-a-alkyl)arYl, (Co-a-~Yl)-(C3-s-cYcloalkyl), (Co-a-
alkyl)_
heterocylcle; or
a pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate,
or
prodrug thereof.
Still other selective cytokine inhibitory drugs include N-alkyl-hydroxamic
acid-
isoindolyl compounds found in United States Provisional Application No.
60/454,149 to G.
Muller et al., filed March 12, 2003, which is incorporated herein in its
entirety by reference.
Representative N-alkyl-hydroxamic acid-isoindolyl compounds include compounds
of the
formula:
X
X.
wherein:
Y is -C(O)-, -CH2, -CHZC(O)- or SOz;
Rl and Ra are independently Cl_g-alkyl, CFZH, CF3, CHaCHF2, cycloalkyl, or
(Cl_$-
alkyl)cycloalkyl;
Zl is H, C1_6-alkyl, -NH2 NR3R~ or ORS;
Zz is H or C(O)R5;
X 1, Xa, X3 and X4 are each independent H, halogen, NOa, OR3, CF3, Cl_6-alkyl,
(Co_
4-alkyl)-(C3_6-cycloalkyl), (Co_4-alkyl)-N-(RBR9)a (Co-a-~Yl)-NHC(O)-(R8),
(Coa-alkyl)_
NHC(O)CH(R8)(R9), (Co_4-alkyl)-NHC(O)N(R$R9), (Coy-alkyl)-NHC(O)O(R$), (Co_4-
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alkyl)-O-R&, (Co_4-alkyl)-imidazolyl, (Co_4-alkyl)-
pyrrol~l,'~(Co_4='a"1'ky~~=oxadiazolyl., (Co_4-
alkyl)-triazolyl or (Co_4-alkyl)-heterocycle;
R3, R4, and RS are each independently H, Ci_s-alkyl, O-C~_s-alkyl, phenyl,
benzyl, or
aryl;
. Rs and R~ are independently H or C 1 _6-alkyl;
R8 and R9 are each independently H, Cl_9-alkyl, C3_6-cycloalkyl, (Cl_s-alkyl)-
(C3_s-
cycloallcyl), (Co_s-allcyl)-N(R4R5), (Ci_s-alkyl)-ORS, phenyl, benzyl, aryl,
piperidinyl,
piperizinyl, pyrolidinyl, morpholino, or C3_~-heterocycloalkyl; or
a pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate,
or
prodrug thereof.
Specific selective cytokine inhibitory drugs include, but are not limited to:
2-[ 1 (-3-ethoxy-4-methoxyphenyl)-2-methyl-sulfonylethyl] isoindolin-1-one;
2-[I-(3-ethoxy-4-methoxyphenyl)-2-(N,N-dimethyl-aminosulfonyl)ethyl]isoindolin-
1-one;
2-[1-(3-ethoxy-4-methoxyphenyl)-2-methyl-sulfonylethyl]isoindoline-I,3-dione;
2-[ 1-(3-ethoxy-4-methoxyphenyl)-2-methyl-sulfonylethyl]-5-vitro-isoindo line-
1,3-
dione;
2-[ 1-(3-ethoxy-4-methoxyphenyl)-2-methyl-sulfonylethyl]-4-nitroisoindoline-
1,3-
dione;
2-[1-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-4-aminoisoindoline-1,3-
dione;
2-[ 1-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-5-methylisoindoline-
1,3-
dione;
2-[ I-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-5-acetamidoisoindoline-
1,3-dione;
2-[ 1-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-4-
dimethylaminoisondoline-1,3-dione;
2-[1-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-5-
dimethylaminoisoindoline-I,3-dione;
2-[1-(3-ethoxy-4~methoxyphenyl)-2-methylsulfonylethyl]benzo[e]isoindoline-1,3-
dione;
2-[ 1-(3-ethoxy-4-methoxyphenyl)-2-methylsulfonylethyl]-4-methoxyisoindoline-
I,3-dione;
1-(3-cyclopentyloxy-4-methoxyphenyl)-2-methylsulfonylethyl-amine;
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2-[ 1-(3-cyclopentyloxy-4-methoxyphenyl)-2'~niethylsulforiylethyl]isomdoline-
1,3-
dione; and
2-[1-(3-cyclopentyloxy-4-methoxyphenyl)-2-methylsulfonylethyl]-4-
dimethylaminoisoindoline-1,3-dione.
Additional selective cytokine inhibitory drugs include the enantiomerically
pure
compounds disclosed in U.S. patent application no. 10/392,195 filed on March
19, 2003;
international patent application no. PCT/LTS0310873, filed on March 20, 2003;
U.S.
provisional patent application nos. 60/438,450 and 60/438,448 to G. Muller et
aC., both of
which were filed on January 7, 2003; and U.S. provisional patent application
no.
601452,460 to G. Muller et al. filed on March 5, 2003, all of which are
incorporated herein
by reference. Preferred compounds include an enantiomer of 2-[1-(3-ethoxy-4-
methoxyphenyl)-2-methylsulfonylethyl]-4-acetylaminoisoindoline-1,3-dione and
an
enantiomer of 3-(3,4-dimethoxy-phenyl)-3-(1-oxo-1,3-dihydro-isoindol-2-yl)-
propionamide.
Preferred selective cytokine inhibitory drugs used in the invention are 3-(3,4-
dimethoxy-phenyl)-3-(1-oxo-1,3-dihydro-isoindol-2-yl)-propionamide and
cyclopropanecarboxylic acid ~2-[1-(3-ethoxy-4-methoxy-phenyl)-2-
methanesulfonyl-
ethyl]-3-oxo-2,3-dihydro-1 H isoindol-4-yl}-amide, which are available from
Celgene
Corp., Warren, NJ. 3-(3,4-Dimethoxy-phenyl)-3-(1-oxo-1,3-dihydro-isoindol-2-
yl)-
propionamide has the following chemical structure:
JH2
Cyclopropanecarboxylic acid ~2-[1-(3-ethoxy-4-methoxy-phenyl)-methanesulfonyl-
ethyl]-3-
oxo-2,3-dihydro-1 H isoindol-4-yl~-amide has the following chemical structure:
O~
O ~ O~
'NH O
\N S02-
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Compounds of the invention can either be commercially purchased or prepared
according to the methods described in the patents or patent publications
disclosed herein.
Further, optically pure compositions can be asymmetrically synthesized or
resolved using
known resolving agents or chiral columns as well as other standard synthetic
organic
chemistry techniques.
As used herein and unless otherwise indicated, the term "pharmaceutically
acceptable salt" encompasses non-toxic acid and base addition salts of the
compound to
which the term refers. Acceptable non-toxic acid addition salts include those
derived from
organic and inorganic acids or bases known in the art, which include, for
example,
hydrochloric acid, hydrobromic acid, phosphoric acid, sulfuric acid,
methanesulphonic acid,
acetic acid, tartaric acid, lactic acid, succinic acid, citric acid, malic
acid, malefic acid, sorbic
acid, aconitic acid, salicylic acid, phthalic acid, embolic acid, enanthic
acid, and the like.
Compounds that are acidic in nature are capable of forming salts with various
pharmaceutically acceptable bases. The bases that can be used to prepare
pharmaceutically
acceptable base addition salts of such acidic compounds are those that form
non-toxic base
addition salts, i. e., salts containing pharmacologically acceptable cations
such as, but not
limited to, alkali metal or alkaline earth metal salts and the calcium,
magnesium, sodium or
pots.ssium salts in particular. suitable organic bases include, but are not
limited to,
N,N-dibenzylethylenediamine, chloroprocaine, choline, diethanolamine,
ethylenediamine,
meglumaine (N-methylglucamine), lysine, and procaine.
As used herein and unless otherwise indicated, the term "prodrug" means a
derivative of a compound that can hydrolyze, oxidize, or otherwise react under
biological
conditions (in vitro or in vivo) to provide the compound. Examples of prodrugs
include, but
are not limited to, derivatives of selective cytokine inhibitory drugs that
comprise
biohydrolyzable moieties such as biohydrolyzable amides, biohydrolyzable
esters,
biohydrolyzable carbamates, biohydrolyzable carbonates, biohydrolyzable
ureides, and
biohydrolyzable phosphate analogues. Other examples of prodrugs include
derivatives of a
selective cytokine inhibitory drug that comprise -NO, -N02, -ONO, or -ON02
moieties.
Prodrugs can typically be prepared using well-known methods, such as those
described in 1
Burger's Medicinal Chemistry and Drug Discovery, 172-178, 949-982 (Manfred E.
Wolff
ed., 5th ed. 1995), and Design of Prodrugs (H. Bundgaard ed., Elselvier, New
York 1985).
As used herein and unless otherwise indicated, the terms "biohydrolyzable
amide,"
"biohydrolyzable ester," "biohydrolyzable carbamate," "biohydrolyzable
carbonate,"
"biohydrolyzable ureide," and "biohydrolyzable phosphate" mean an amide,
ester,
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carbamate, carbonate, ureide, or phosphate, respectively, of a compound that
either: 1) does
not interfere with the biological activity of the compound but can confer upon
that
compound advantageous properties ire vivo, such as uptake, duration of action,
or onset of
action; or 2) is biologically inactive but is converted in vivo to the
biologically active
compound. Examples of biohydrolyzable esters include, but are not limited to,
lower alkyl
esters, lower acyloxyalkyl esters (such as acetoxylmethyl, acetoxyethyl,
aminocarbonyloxymethyl, pivaloyloxymethyl, and pivaloyloxyethyl esters),
lactonyl esters
(such as phthalidyl and thiophthalidyl esters), lower alkoxyacyloxyalkyl
esters (such as
methoxycarbonyloxymethyl, ethoxycarbonyloxyethyl and
isopropoxycarbonyloxyethyl
esters), alkoxyalkyl esters, choline esters, and acylamino alkyl esters (such
as
acetamidomethyl esters). Examples of biohydrolyzable amides include, but are
not limited
to, lower alkyl amides, a amino acid amides, alkoxyacyl amides, and
alkylaminoalkylcarbonyl amides. Examples of biohydrolyzable carbamates
include, but are
not limited to, lower alkylamines, substituted ethylenediaxnines, aminoacids,
hydroxyalkylamines, heterocyclic and heteroaromatic amines, and polyether
amines.
Various selective cytokine inhibitory drugs contain one or more chiral
centers, and
can exist as racemic mixtures of enantiomers or mixtures of diastereomers.
This invention
encompasses the use of stereoxr~eizcally pure forxr~s of such compounds, as
well as the use of
mixtures of those forms. For example, mixtures comprising equal or unequal
amounts of
the enantiomers of selective cytokine inhibitory drugs may be used in methods
and
compositions of the invention. The purified (R) or (S) enantiomers of the
specific
compounds disclosed herein may be used substantially free of its other
enantiomer.
As used herein and unless otherwise indicated, the term "stereomerically pure"
means a composition that comprises one stereoisomer of a compound and is
substantially
free of other stereoisomers of that compound. For example, a stereomerically
pure
composition of a compound having one chiral center will be substantially free
of the
opposite enantiomer of the compound. A stereomerically pure composition of a
compound
having two chiral centers will be substantially free of other diastereomers of
the compound.
A typical stereomerically pure compound comprises greater than about 80% by
weight of
one stereoisomer of the compound and less than about 20% by weight of other
stereoisomers of the compound, more preferably greater than about 90% by
weight of one
stereoisomer of the compound and less than about 10% by weight of the other
stereoisomers
of the compound, even more preferably greater than about 95% by weight of one
stereoisomer of the compound and less than about 5% by weight of the other
stereoisomers
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of the compound, and most preferably greater than about 97% by weight of one
stereoisomer of the compound and less than about 3% by weight of the other
stereoisomers
of the compound.
As used herein and unless otherwise indicated, the term "stereomerically
enriched"
means a composition that comprises greater than about 60% by weight of one
stereoisomer
of a compound, preferably greater than about 70% by weight, more preferably
greater than
about 80% by weight of one stereoisomer of a compound.
As used herein and unless otherwise indicated, the term "enantiomerically
pure"
means a stereomerically pure composition of a compound having one chiral
center.
Similarly, the term "enantiomerically enriched" means a stereomerically
enriched
composition of a compound having one chiral center.
It should be noted that if there is a discrepancy between a depicted structure
and a
name given that structure, the depicted structure is to be accorded more
weight. In addition,
if the stereochemistry of a structure or a portion of a structure is not
indicated with, for
example, bold or dashed lines, the structure or portion of the structure is to
be interpreted as
encompassing all stereoisomers of it.
4.2 SECOND ACTIVE AGENTS
A second active agent can be used in the methods and compositions of the
invention
together with a selective cytokine inhibitory drug. In a preferred embodiment,
the second
active agent is capable of inhibiting or relieving macular damaging
conditions, providing
antiangiogenesis or anti-inflammatory effects, or ensuring patient comfort.
Examples of second active agents include, but are not limited to, steroids,
light
sensitizers, integrins, antioxidants, interferons, xanthine derivatives,
growth hormones,
neutrotrophic factors, regulators of neovascularization, anti-VEGF antibodies,
prostaglandins, antibiotics, phytoestrogens, anti-inflammatory compounds,
antiangiogenesis
compounds, other therapeutics known to inhibit or relieve a symptom of MD, and
pharmaceutically acceptable salts, solvates, hydrates, stereoisomers,
clathrates, prodrugs
and pharmacologically active metabolites thereof. In certain embodiments, the
second
active agent is verteporfm, purlytin, an angiostatic steroid, rhuFab,
interferon-2a, or
pentoxifylline.
Examples of light sensitizers include, but are not limited to, verteporfin,
tin
etiopurpurin and motexafm lutetium. Verteporfin can be used to treat wet MD.
Cour, M.,
et al., Drugs Aging 19:101-133 (2002). Verteporfin is a blood-vessel-blocking
photoreactive dye that may be administered via injection.
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Examples of xanthine derivatives include, but are not limited to,
pentoxyfylline.
Examples of anti-VEGF antibodies include, but are not limited to, rhuFab.
Examples of steroids include, but are not limited to, 9-fluoro-11,21-dihydroxy
-16,17-1-methylethylidinebis(oxy)pregna-1,4-dime-3,20-dione.
Examples of prostaglandin F2a derivatives include, but are not limited to,
latanoprost (see U.S. Patent No. 6,225,348, which is incorporated by reference
herein in its
entixety).
Examples of antibiotics include, but are not limited to, tetracycline and its
derivatives, rifarnycin and its derivatives, macrolides, and metronidazole
(see U.S. Patent
Nos. 6,218,369 and 6,015,803, the entireties of which are incorporated by
reference herein).
Examples of phytoestrogens include, but are not limited to, genistein,
genistin,
6'-O-Mal genistin, 6'-O-Ac genistin, daidzein, daidzin, 6'-O-Mal daidzin, 6'-O-
Ac daidzin,
glycitein, glycitin, 6'-O-MaI glycitin, biochanin A, formononetin, and a
mixture thereof
(see U.S. Patent No. 6,001,368, which is incorporated by reference herein in
its entirety).
Examples of anti-inflammatory agents include, but are not limited to,
triamcinolone
acetomide and dexamethasone (see U.S. Patent No. 5,770,589, which is
incorporated by
reference herein in its entirety).
Examples of antiangiogenesis compounds include, but are not limited to,
thalidomide and immunomodulatory compounds (IMiDsTM, Celgene Corp., N.J.).
Examples of interferons include, but are not limited to, interferon-2a.
In another embodiment, the second active agent is glutathione (see U.S. Patent
No.
5,632,984, which is incorporate by reference herein in its entirety).
Examples of growth hormones include, but are not limited to, basic fibroblast
growth factor (bFGF) and transforming growth factor b (TGF-b).
Examples of neurotrophic factors include, but are not limited to, brain-
derived
neurotrophic factor (BDNF).
Examples of regulators of neovascularization include, but axe not limited to,
plasminogen activator factor type 2 (PAI-2).
Additional drugs which may be used fox the treatment of MD include, but are
not
limited to, EYE101 (Eyetech Pharmaceuticals), LIr333531 (Eli Lilly), Miravant
and
RETISERT implant (Bausch & Lomb).
4.3 METHODS FOR TREATMENT AND PREVENTION
This invention encompasses methods of preventing, treating and/or managing
various types of MD.
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As used herein, unless otherwise specified, the terms "preventing MD,"
"treating
MD" and "managing MD" include, but are not limited to, inhibiting or reducing
the severity
of one or more symptoms associated with MD. Symptoms associated with MD and
related
syndromes include, but are not limited to, drusen rounded whitish-yellowish
spots in the
fundus, submacular disciform scar tissue, choroidal neovascularisation,
retinal pigment
epithelium detachment, atrophy of retinal pigment epithelium, abnormal blood
vessels
stemming from the choroid (the blood vessel-rich tissue layer just beneath the
retina), a
blurry or distorted area of vision, a central blind spot, pigmentary
abnormalities, a
continuous layer of fine granular material deposited in the inner part of
Bruch's membrane,
and a thickening and decreased permeability of Bruch's membrane.
As used herein, unless otherwise specified, the term "treating MD" refers to
the
administration of a compound or other additional active agent after the onset
of symptoms
of MD, whereas "preventing" refers to the administration prior to the onset of
symptoms,
particularly to patients at risk of MD. Examples of patients at risk of MD
include, but are
not limited to, the elderly over the age of 60, and patients suffering from
diseases such as,
but not limited to, diabetes and leprosy (e.g., ENL). Patients with a familial
history of MD
are also preferred candidates for preventive regimens. As used herein and
unless otherwise
i:dicated, tire term "rr~anagil~g MD" encompasses preventing the rECUrrence of
MD in a
patient who had suffered from MD, and/or lengthening the time that a patient
who had
suffered from MD remains in remission.
The invention encompasses methods of treating, preventing and managing MD and
related syndromes in patients with various stages and specific types of the
disease,
including, but not limited to, those referred to as wet MD, dry MD, age-
related maculopathy
(ARM), choroidal neovascularisation (CNVM), retinal pigment epithelium
detachment
(PED), and atrophy of retinal pigment epithelium (RPE). It further encompasses
methods
of treating patients who have been previously treated for MD, are non-
responsive to
standard drug and non-drug-based MD treatments, as well as patients who have
not
previously been treated for MD. Because patients with MD have heterogenous
clinical
manifestations and varying clinical outcomes, the treatment given to a patient
may vary,
depending on his/her prognosis. The skilled clinician will be able to readily
determine
without undue experimentation specific secondary agents and treatments that
can be
effectively used to treat an individual patient.
Methods encompassed by this invention comprise administering one or more
selective cytokine inhibitory drugs, or a pharmaceutically acceptable salt,
solvate, hydrate,
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stereoisomer, clathrate, or prodrug thereof to a patient suffering, or likely
to suffer, from
MD.
In one embodiment, the recommended daily dose range of a selective cytokine
inhibitory drug is from about I mg to about 10,000 mg per day, given as a
single once-a-
day dose, or preferably in divided doses throughout a day. More specifically,
the daily dose
is administered twice daily in equally divided doses. Specific daily dose
ranges are from
about 1 mg to about 5,000 mg per day, from about 10 mg to about 2,500 mg per
day, from
about 100 mg to about 800 mg per day, from about 100 mg to about 1,200 mg per
day, or
from about 25 mg to about 2,500 mg per day. In managing a patient, the therapy
should be
initiated at a lower dose, perhaps about 1 mg to about 2,500 mg, and increased
if necessary
up to about 200 mg to about 5,000 mg per day as either a single dose or
divided doses,
depending on the patient's global response. In a particular embodiment,
3-(3,4-dimethoxy-phenyl)-3-(I-oxo-1,3-dihydro-isoindol-2-yl)-propionamide is
administered in an amount of about 400, 800, 1,200, 2,500, 5,000 or 10,000 mg
a day as
two divided doses. The treatment lasts about two to about twenty weeks, about
four to
about sixteen weeks, about eight to about twelve weeks, until the desired
therapeutic effect
is achieved, or chronically to maintain the desired effect.
4.3.1 Combination Therany With A Second Active Agent
Specific methods of the invention comprise administering a selective cytokine
inhibitory drug, or a pharmaceutically acceptable salt, solvate, hydrate,
stereoisomer,
clathrate, or prodrug thereof, in combination with a second active agent or
active ingredient.
Examples of selective cytokine inhibitory drugs are disclosed herein (see,
e.g., section 4.1);
and examples of second active agents are also disclosed herein (see, e.g.,
section 4.2).
Administration of a selective cytokine inhibitory drug and an optional second
active
agent to a patient can occur simultaneously or sequentially by the same or
different routes
of administration. The suitability of a particular route of administration
employed for a
particular active agent will depend on the active agent itself (e.g., whether
it can be
administered orally without decomposing prior to entering the blood stream)
and the disease
being treated. A preferred route of administxation for selective cytokine
inhibitory drugs is
oral or ophthalmic. Preferred routes of administration for the second active
agents or
ingredients of the invention are known to those of ordinary skill in the art,
for example in
Physicians' Desk Reference (57~' ed., 2003).
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In one embodiment, the second active agent is administered orally,
intravenously,
intramuscularly, subcutaneously, mucosally, topically, or transdermally and
once or twice
daily in an amount of from about 1 to about 2,500 mg, from about 1 mg to about
2,000 mg,
from about 10 mg to about 1,500 mg, from about 50 mg to about 1,000 mg, from
about 100
mg to about 750 mg, or from about 250 mg to about 500 mg.
In further embodiments, the second active agent is administered weekly,
monthly,
bi-monthly or yearly. The specific amount of the second active agent can
depend on the
specific agent used, the type of MD being treated or prevented, the severity
and stage of
MD, and the amounts of selective cytokine inhibitory drugs and any optional
other agents)
concurrently administered to the patient. In a particular embodiment, the
second active
agent is a steroid, a light sensitizer, an integrin, an antioxidant, an
interferon, a xanthine
derivative, a growth hormone, a neutrotrophic factor, a regulator of
neovascularization, an
anti-VEGF antibody, a prostaglandin, an antibiotic, a phytoestrogen, an anti-
inflammatory
compound or an antiangiogenesis compound, or a combination thereof.
4.3.2 Use With Surgical Intervention
This invention encompasses a method of treating, preventing and/or managing
IVID,
which comprises administering a selective cytokine inhibitory drug, or a
pharmaceutically
acceptable salt, solvate, hydrate, stereoisomer, clathrate, or prodrug
thereof, in conjunction
with (e.g. before, during, or after) surgical intervention. Examples of
surgical intervention
include, but are not limited to, light or laser therapy, radiation therapy,
retinal pigment
epithelium transplantation, and foveal translocation.
The combined use of the selective cytokine inhibitory drugs and surgical
intervention provides a unique treatment regimen that can be unexpectedly
effective in
certain patients. Without being limited by theory, it is believed that
selective cytokine
inhibitory drugs may provide additive or synergistic effects when given
concurrently with
surgical intervention.
In a specific embodiment, the invention encompasses methods for treating,
preventing, andlor managing MD, comprising administering to a patient in need
thereof an
effective amount of a selective cytokine inhibitory drug, or a
pharmaceutically acceptable
salt, solvate, hydrate, stereoisomer, clathrate or prodrug thereof, in
combination with light
or laser therapy. Examples of light or laser therapy include, but are not
limited to, laser
photocoagulation therapy or photodynamic therapy.
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The selective cytokine inhibitory drug can be admunstered simuttaneousiy or
sequentially with the surgical intervention, In one embodiment, the selective
cytokine
inhibitory drug is administered prior to light or laser therapy. In another
embodiment, the
selective cytokine inhibitory drug is administered after light or laser
therapy. In one
embodiment, the selective cytokine inhibitory drug is administered during
light or laser
therapy. The compound may be administered at least four weeks prior, two weeks
prior,
one week prior, or just prior to laser surgery, or at the time or just after
the surgery for a
total treatment of about 12-16 weeks.
4.3.3 C~clin~ Therany
In certain embodiments, the prophylactic or therapeutic agents are cyclically
administered to a patient. Cycling therapy involves the administration of a
first agent for a
period of time, followed by the administration of the agent and/or a second
agent for a
period of time and repeating this sequential administration. Cycling therapy
can reduce the
development of resistance to one or more of the therapies, avoid or reduce the
side effects
of one of the therapies, and/or improves the efficacy of the treatment.
In a specific embodiment, prophylactic or therapeutic agents are administered
in a
cycle of about six months, about once or twice every day. One cycle can
comprise the
administration of a therapeutic or prophylactic agent and at least one or
three weeks of rest.
The number of cycles administered can be from about one to about 12 cycles,
about two to
about 10 cycles, or about two to about eight cycles.
4.4 PHARMACEUTICAL COMPOSITIONS
AlVID SINGLE UNIT DOSAGE FORMS
Pharmaceutical compositions can be used in the preparation of individual,
single
unit dosage forms. Pharmaceutical compositions and dosage forms of the
invention
comprise selective cytokine inhibitory drugs, or pharmaceutically acceptable
salts, solvates,
hydrates, stereoisomers, clathrates, or prodrugs thereof. Pharmaceutical
compositions and
dosage forms of the invention can further comprise one or more excipients.
Pharmaceutical compositions and dosage forms of the invention can also
comprise
one or more additional active agents. Consequently, pharmaceutical
compositions and
dosage forms of the invention comprise the active agents disclosed herein
(e.g., selective
cytokine inhibitory drugs, or a pharmaceutically acceptable salt, solvate,
hydrate,
stereoisomer, clathrate, or prodrug thereof, and a second active agent).
Examples of
optional additional active agents are disclosed herein (see, e.g., section
4.2).
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Single unit dosage forms of the invention are suitable for oral, mucosal
(e.g., nasal,
sublingual, vaginal, buccal, or rectal), or parenteral (e.g., subcutaneous,
intravenous, bolus
injection, intramuscular, or intraarterial), topical (e.g., eye drops),
ophthalmic, transdermal
or transcutaneous administration to a patient. Examples of dosage forms
include, but are
not limited to: tablets; caplets; capsules, such as soft elastic gelatin
capsules; cachets;
troches; lozenges; dispersions; suppositories; powders; aerosols (e.g., nasal
sprays or
inhalers); eye drops; gels; liquid dosage forms suitable for oral or mucosal
administration to
a patient, including suspensions (e.g., aqueous or non-aqueous liquid
suspensions, oil-in-
water emulsions, or a water-in-oil liquid emulsions), solutions, and elixirs;
liquid dosage
forms suitable for parenteral administration to a patient; and sterile solids
(e.g., crystalline
or amorphous solids) that can be reconstituted to provide liquid dosage forms
suitable for
parenteral administration to a patient.
The composition, shape, and type of dosage forms of the invention will
typically
vary depending on their use. For example, a dosage form used in the acute
treatment of a
disease may contain larger amounts of one or more of the active agents it
comprises than a
dosage form used in the chronic treatment of the same disease. Similarly, a
parenteral
dosage form may contain smaller amounts of one or more of the active agents it
comprises
than an oral dosage fo,~n used to treat the same disease. These and other ways
iri which
specific dosage forms encompassed by this invention will vary from one another
will be
readily apparent to those skilled in the art. See, e.g., Remihgtoh's
Pharmaceutical Sciences,
1 ~th ed., Mack Publishing, Easton PA (1990).
Typical pharmaceutical compositions and dosage forms comprise one or more
excipients. Suitable excipients are well known to those skilled in the art of
pharmacy, and
non-limiting examples of suitable excipients are provided herein. Whether a
particular
excipient is suitable for incorporation into a pharmaceutical composition or
dosage form
depends on a variety of factors well known in the art including, but not
limited to, the way
in which the dosage form will be administered to a patient. For example, oral
dosage forms
such as tablets may contain excipients not suited for use in parenteral dosage
forms. The
suitability of a particular excipient may also depend on the specific active
agents in the
dosage form. For example, the decomposition of some active agents may be
accelerated by
some excipients such as lactose, or when exposed to water. Active agents that
comprise
primary or secondary amines are particularly susceptible to such accelerated
decomposition.
Consequently, this invention encompasses pharmaceutical compositions and
dosage forms
that contain little, if any, lactose other mono- or di-saccharides. As used
herein, the term
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"lactose-free" means that the amount of lactose present, if any, is
insufficient to
substantially increase the degradation rate of an active agent.
Lactose-free compositions of the invention can comprise excipients that are
well
known in the art and are listed, for example, in the U.S. Pharmacopeia (IJSP)
25-NF20
(2002). In general, lactose-free compositions comprise active agents, a
binder/filler, and a
lubricant in pharmaceutically compatible and pharmaceutically acceptable
amounts.
Preferred lactose-free dosage forms comprise active agents, microcrystalline
cellulose, pre-
gelatinized starch, and magnesium stearate.
This invention further encompasses anhydrous pharmaceutical compositions and
dosage forms comprising active agents, since water can facilitate the
degradation of some
compounds. For example, the addition of water (e.g., 5%) is widely accepted in
the
pharmaceutical arts as a means of simulating long-term storage in order to
determine
characteristics such as shelf life or the stability of formulations over time.
See, e.g., Jens T.
Carstensen, Drug Stability: Principles & Practice, 2d. Ed., Marcel Dekker, NY,
NY, 1995,
pp. 379-80. In effect, water and heat accelerate the decomposition of some
compounds.
Thus, the effect of water on a formulation can be of great significance since
moisture and/or
humidity are commonly encountered during manufacture, handling, packaging,
storage,
shipment, and use of formulations.
Anhydrous pharmaceutical compositions and dosage forms of the invention can be
prepared using anhydrous or low moisture containing ingredients and low
moisture or low
humidity conditions. Pharmaceutical compositions and dosage forms that
comprise lactose
and at least one active agent that comprises a primary or secondary amine are
preferably
anhydrous if substantial contact with moisture and/or humidity during
manufacturing,
packaging, andlor storage is expected.
An anhydrous pharmaceutical composition should be prepared and stored such
that
its anhydrous nature is maintained. Accordingly, anhydrous compositions are
preferably
packaged using materials known to prevent exposure to water such that they can
be
included in suitable formulary kits. Examples of suitable packaging include,
but are not
limited to, hermetically sealed foils, plastics, unit dose containers (e.g.,
vials), blister packs,
and strip packs.
The invention further encompasses pharmaceutical compositions and dosage forms
that comprise one or more compounds that reduce the rate by which an active
agent will
decompose. Such compounds, which are referred to herein as "stabilizers,"
include, but are
not limited to, antioxidants such as ascorbic acid, pH buffers, or salt
buffers.
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Like the amounts and types of excipients, the amounts and specific types of
active
agents in a dosage form may differ depending on factors such as, but not
limited to, the
route by which it is to be administered to patients. However, typical dosage
forms
comprise a selective cytokine inhibitory drug, or a pharmaceutically
acceptable salt, solvate,
hydrate, stereoisomer, clathrate, or prodrug thereof in an amount of from
about 1 to about
10,000 mg. Typical dosage forms comprise a selective cytokine inhibitory drug,
or a
pharmaceutically acceptable salt, solvate, hydrate, stereoisomer, clathrate,
or prodrug
thereof in an amount of about 1, 2, 5, 10, 25, 50, 100, 200, 400, 800, 1,200,
2,500, 5,000 or
10,000 mg. In a particular embodiment, a preferred dosage form comprises 3-
(3,4-
dimethoxy-phenyl)-3-(1-oxo-1,3-dihydro-isoindol-2-yl)-propionamide in an
amount of
about 400, 800 or 1,200 mg. Typical dosage forms comprise the second active
agent in an
amount of form about 1 to about 2,500 mg, from about 1 mg to about 2,000 mg,
from about
10 mg to about 1,500 mg, from about 50 mg to about 1,000 mg, from about 100 mg
to
about 750 mg, or from about 250 mg to about 500 mg. Of course, the specific
amount of
the second active agent will depend on the specific agent used, the type of MD
being treated
or managed, and the amounts) of selective cytokine inhibitory drug and any
optional
additional active agents concurrently administered to the patient.
4.4.1 Oral Dosage Forms
Pharmaceutical compositions of the invention that are suitable for oral
administration can be presented as discrete dosage forms, such as, but are not
limited to,
tablets (e.g., chewable tablets), caplets, capsules, and liquids (e.g.,
flavored syrups). Such
dosage forms contain predetermined amounts of active agents, and may be
prepared by
methods of pharmacy well known to those skilled in the art. See generally,
Remington 's
Pharmaceutical Sciences, 18th ed., Mack Publishing, Easton PA (1990).
Typical oral dosage forms are prepared by combining the active agents in an
intimate admixture with at least one excipient according to conventional
pharmaceutical
compounding techniques. Excipients can take a wide variety of forms depending
on the
form of preparation desired for administration. For example, excipients
suitable for use in
oral liquid or aerosol dosage forms include, but are not limited to, water,
glycols, oils,
alcohols, flavoring agents, preservatives, and coloring agents. Examples of
excipients
suitable for use in solid oral dosage forms (e.g., powders, tablets, capsules,
and caplets)
include, but are not limited to, starches, sugars, micro-crystalline
cellulose, diluents,
granulating agents, lubricants, binders, and disintegrating agents.
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Because of their ease of administration, tablets and capsules represent the
most
advantageous oral dosage unit forms, in which case solid excipients are
employed. If
desired, tablets can be coated by standard aqueous or nonaqueous techniques.
Such dosage
forms can be prepared by any of the methods of pharmacy. In general,
pharmaceutical
compositions and dosage forms are prepared by uniformly and intimately
admixing the
active agents with liquid carriers, finely divided solid carriers, or both,
and then shaping the
product into the desired presentation if necessary.
For example, a tablet can be prepared by compression or molding. Compressed
tablets can be prepared by compressing in a suitable machine the active agents
in a free-
flowing form such as powder or granules, optionally mixed with an excipient.
Molded
tablets can be made by molding in a suitable machine a mixture of the powdered
compound
moistened with an inert liquid diluent.
Examples of excipients that can be used in oral dosage forms include, but are
not
limited to, binders, fillers, disintegrants, and lubricants. Binders suitable
for use in
pharmaceutical compositions and dosage forms include, but are not limited to,
corn starch,
potato starch, or other starches, gelatin, natural and synthetic gums such as
acacia, sodium
alginate, alginic acid, other alginates, powdered tragacanth, guar gum,
cellulose and its
derivatives (e.g., ethyl cellulose, cellulose aceiate, carboxymethyl cellulose
calcium; sadiron
carboxymethyl cellulose), polyvinyl pyrrolidone, methyl cellulose, pre-
gelatinized starch,
hydroxypropyl methyl cellulose, (e.g., nos. 2208, 2906, 2910),
microcrystalline cellulose,
and mixtures thereof.
Suitable forms of microcrystalline cellulose include, but are not limited to,
the
materials sold as AVICEL-PH-101, AVICEL-PH-103 AVICEL RC-581, AVICEL-PH-105
(available from FMC Corporation, American Viscose Division, Avicel Sales,
Marcus Hook,
PA), and mixtures thereof. An specific binder is a mixture of microcrystalline
cellulose and
sodium carboxymethyl cellulose sold as AVICEL RC-581. Suitable anhydrous or
low
moisture excipients or additives include AVICEL-PH-103TM and Starch 1500 LM.
Examples of fillers suitable for use in the pharmaceutical compositions and
dosage
forms disclosed herein include, but are not limited to, talc, calcium
carbonate (e.g., granules
or powder), microcrystalline cellulose, powdered cellulose, dextrates, kaolin,
mannitol,
silicic acid, sorbitol, starch, pre-gelatinized starch, and mixtures thereof.
The binder or
filler in pharmaceutical compositions of the invention is typically present in
from about 50
to about 99 weight percent of the pharmaceutical composition or dosage form.
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Disintegrants are used in the compositions of the invention to provide tablets
that
disintegrate when exposed to an aqueous environment. Tablets that contain too
much
disintegrant may disintegrate in storage, while those that contain too little
may not
disintegrate at a desired rate or under the desired conditions. Thus, a
sufficient amount of
disintegrant that is neither too much nor too little to detrimentally alter
the release of the
active agents should be used to form solid oral dosage forms of the invention.
The amount
of disintegrant used varies based upon the type of formulation, and is readily
discernible to
those of ordinary skill in the art. Typical pharmaceutical compositions
comprise from about
0.5 to about 15 weight percent of disintegrant, preferably from about 1 to
about 5 weight
percent of disintegrant.
Disintegrants that can be used in pharmaceutical compositions and dosage forms
include, but are not limited to, agar-agar, alginic acid, calcium carbonate,
microcrystalline
cellulose, croscannellose sodium, crospovidone, polacrilin potassium, sodium
starch
glycolate, potato or tapioca starch, other starches, pre-gelatinized starch,
other starches,
clays, other algins, other celluloses, gums, and mixtures thereof.
Lubricants that can be used in pharmaceutical compositions and dosage forms
include, but are not limited to, calcium stearate, magnesium stearate, mineral
oil, light
mineral oil, glycerin, sorbitoi, manrutol, polyethylene glycol, other glycols,
stearic~acid,
sodium lauryl sulfate, talc, hydrogenated vegetable oil (e.g., peanut oil,
cottonseed oil,
sunflower oil, sesame oil, olive oil, corn oil, and soybean oil), zinc
stearate, ethyl oleate,
ethyl laureate, agar, and mixtures thereof. Additional lubricants include, for
example, a
syloid silica gel (AEROSIL200, manufactured by W.R. Grace Co. of Baltimore,
MD), a
coagulated aerosol of synthetic silica (marketed by Degussa Co. of Plano, TX),
CAB-O-SIL
(a pyrogenic silicon dioxide product sold by Cabot Co. of Boston, MA), and
mixtures
thereof. If used at all, lubricants are typically used in an amount of less
than about 1 weight
percent of the pharmaceutical compositions or dosage forms into which they are
incorporated.
A preferred solid oral dosage form comprises a selective cytokine inhibitory
drug,
anhydrous lactose, microcrystalline cellulose, polyvinylpyrrolidone, stearic
acid, colloidal
anhydrous silica, and gelatin.
4.4.2 Delayed Release Dosage Forms
Active agents of the invention can be administered by controlled release means
or
by delivery devices that are well known to those of ordinary skill in the art.
Examples
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WO 2004/041181 PCT/US2003/034535
include, but are not limited to, those described in U.S. Patent Nos.:
3,845,770; 3,916,899;
3,536,809; 3,598,123; an14,008,719, 5,674,533, 5,059,595, 5,591,767,
5,120,548,
5,073,543, 5,639,476, 5,354,556, and 5,733,566, each of which is incorporated
herein by
reference. Such dosage forms can be used to provide slow or controlled-release
of one or
more active agents using, for example, hydropropylmethyl cellulose, other
polymer
matrices, gels, permeable membranes, osmotic systems, multilayer coatings,
microparticles,
liposomes, microspheres, or a combination thereof to provide the desired
release profile in
varying proportions. Suitable controlled-release formulations known to those
of ordinary
skill in the art, including those described herein, can be readily selected
for use with the
active agents of the invention. The invention thus encompasses single unit
dosage forms
suitable for oral administration such as, but not limited to, tablets,
capsules, gelcaps, and
caplets that are adapted for controlled-release.
All controlled-release pharmaceutical products have a common goal of improving
drug therapy over that achieved by their non-controlled counterparts. Ideally,
the use of an
optimally designed controlled-release preparation in medical treatment is
characterized by a
minimum of drug substance being employed to cure or control the condition in a
minimum
amount of time. Advantages of controlled-release formulations include extended
activity of
the drug, reduced dosage frequency, and i~icreased patient compliance. In
addition,
controlled-release formulations can be used to affect the time of onset of
action or other
characteristics, such as blood levels of the drug, and can thus affect the
occurrence of side
(e.g., adverse) effects.
Most controlled-release formulations are designed to initially release an
amount of
drug (active agent) that promptly produces the desired therapeutic effect, and
gradually and
continually release of other amounts of drug to maintain this level of
therapeutic or
prophylactic effect over an extended period of time. In order to maintain this
constant level
of drug in the body, the drug must be released from the dosage form at a rate
that will
replace the amount of drug being metabolized and excreted from the body.
Controlled-
release of an active agent can be stimulated by various conditions including,
but not limited
to, pH, temperature, enzymes, water, or other physiological conditions or
compounds.
4.4.3 Parenteral Dosage Forms
Parenteral dosage forms can be administered to patients by various routes
including,
but not limited to, intravitreal, subcutaneous, intravenous (including bolus
injection),
intramuscular, and intraarterial. Because their administration typically
bypasses patients'
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WO 2004/041181 PCT/US2003/034535
natural defenses against contaminants, parenteral dosage forms are preferably
sterile or
capable of being sterilized prior to administration to a patient. Examples of
parenteral
dosage forms include, but are not limited to, solutions ready for inj ection,
dry products
ready to be dissolved or suspended in a pharmaceutically acceptable vehicle
for injection,
suspensions ready for inj ection, and emulsions.
Suitable vehicles that can be used to provide parenteral dosage forms of the
invention are well known to those skilled in the art. Examples include, but
axe not limited
to: Water for Injection USP; aqueous vehicles such as, but not limited to,
Sodium Chloride
Injection, Ringer's Injection, Dextrose Injection, Dextrose and Sodium
Chloride Injection,
and Lactated Ringer's Inj ection; water-miscible vehicles such as, but not
limited to, ethyl
alcohol, polyethylene glycol, and polypropylene glycol; and non-aqueous
vehicles such as,
but not limited to, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl
oleate, isopropyl
myristate, and benzyl benzoate.
Compounds that increase the solubility of one or more of the active agents
disclosed
herein can also be incorporated into the parenteral dosage forms of the
invention. For
example, cyclodextrin and its derivatives can be used to increase the
solubility of selective
cytokine inhibitory drugs and its derivatives. See, e.g., U.S. Patent No.
5,134,127, which is
incorporated herein by reference.
4.4.4 Touical And Mucosal Dosage Forms
Topical and mucosal dosage forms of the invention include, but are not limited
to,
eye drops, sprays, aerosols, solutions, emulsions, suspensions, or other forms
known to one
of skill in the art. See, e.g., Remington's Pharmaceutical Sciences, 16th and
18th eds., Mack
Publishing, Easton PA (1980 & 1990); and Introduction to
Pharmaceutical.I)osage Forms,
4th ed., Lea & Febiger, Philadelphia (1985). Dosage forms suitable for
treating mucosal
tissues within the oral cavity can be formulated as mouthwashes or as oral
gels.
Suitable excipients (e.g., carriers and diluents) and other materials that can
be used
to provide topical and mucosal dosage forms encompassed by this invention are
well known
to those skilled in the pharmaceutical arts, and depend on the particular
tissue to which a
given pharmaceutical composition or dosage form will be applied. With that
fact in mind,
typical excipients include, but are not limited to, water, acetone, ethanol,
ethylene glycol,
propylene glycol, butane-1,3-diol, isopropyl myristate, isopropyl palinitate,
mineral oil, and
mixtures thereof to form solutions, emulsions or gels, which are non-toxic and
pharmaceutically acceptable. Moisturizers or humectants can also be added to
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pharmaceutical compositions and dosage forms if desired. Examples of such
additional
ingredients are well known in the art. See, e.g., Remington's PhaYmaceutical
Sciences, 16th
and 18th eds., Mack Publishing, Easton PA (1980 & 1990).
The pH of a pharmaceutical composition or dosage form may also be adjusted to
improve delivery of one or more active agents. Similarly, the polarity of a
solvent carrier,
its ionic strength, or tonicity can be adjusted to improve delivery. Compounds
such as
stearates can also be added to pharmaceutical compositions or dosage forms to
advantageously alter the hydrophilicity or lipophilicity of one or more active
agents so as to
improve delivery. In this regard, stearates can serve as a lipid vehicle for
the formulation,
as an emulsifying agent or surfactant, and as a delivery-enhancing or
penetration-enhancing
agent. Different salts, hydrates or solvates of the active agents can be used
to further adjust
the properties of the resulting composition.
4.4.5 Kits
Typically, active agents of the invention are preferably not administered to a
patient
at the same time or by the same route of administration. This invention
therefore
encompasses kits which, when used by the medical practitioner, can simplify
the
administration of appropriate amounts of active agents to a patient.
A typical kit of the invention comprises a dosage form of a selective cytokine
inhibitory drug, or a pharmaceutically acceptable salt, solvate, hydrate,
stereoisomer,
prodrug, or clathrate thereof. Kits encompassed by this invention can further
comprise one
or more additional active agents or a combination thereof. Examples of the
additional
active agents are disclosed herein. (See, e.g., section 4.2).
Kits of the invention can further comprise devices that axe used to administer
the
active agents. Examples of such devices include, but are not limited to,
syringes, drip bags,
patches, and inhalers. A kit of the invention can further comprise an Amsler
grid useful for
detecting or diagnosing MD.
Fits of the invention can further comprise pharmaceutically acceptable
vehicles that
can be used to administer one or more active agents. For example, if an active
agent is
provided in a solid form that must be reconstituted for parenteral
administration, the kit can
comprise a sealed container of a suitable vehicle in which the active agent
can be dissolved
to form a particulate-free sterile solution that is suitable for parenteral
administration.
Examples of pharmaceutically acceptable vehicles include, but are not limited
to: Water for
Inj ection USP; aqueous vehicles such as, but not limited to, Sodium Chloride
Inj ection,
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Ringer's Injection, Dextrose Injection, Dextrose and SodW m Lhlonde lnlection,
and
Lactated Ringer's Injection; water-miscible vehicles such as, but not limited
to, ethyl
alcohol, polyethylene glycol, and polypropylene glycol; and non-aqueous
vehicles such as,
but not limited to, corn oil, cottonseed oil, peanut oil, sesame oil, ethyl
oleate, isopropyl
myristate, and benzyl benzoate.
EXAMPLES
The following examples are intended to further illustrate the invention
without
limiting its scope.
5.1 IlV VITRO PHARMACOLOGY STUDIES
One of the biological effects typically exerted by selective cytokine
inhibitory drugs
is the reduction of synthesis of TNF-a. Specific selective cytokine inhibitory
drugs enhance
the degradation of TNF-a mRNA. TNF-a may play a pathological role in macular
degeneration.
In a specific embodiment, the pharmacological properties of 3-(3,4-dimethoxy
-phenyl)-3-(1-oxo-1,3-dihydro-isoindol-2-yl)-propionamide are characterized in
in vitro
studies. Studies examine the effects of the compound on the production of
various
cytokines. Inhibition of TNF-a production following LPS-stimulation of human
PBMC and
human whole blood by the compound is investigated in vitro. In vitro studies
suggest a
pharmacological activity profile for 3-(3,4-dimethoxy-phenyl)-3-(1-oxo-1,3-
dihydro
-isoindol-2-yl)-propionamide is five to fifty times more potent than
thalidomide. The
pharmacological effects of 3-(3,4-dimethoxy-phenyl)-3-(1-oxo-1,3-dihydro-
isoindol-2
-yl)-propionamide may derive from its action as an inhibitor of the generation
of
inflammatory cytokines.
5.2 CLINICAL STUDIES IN PATIENTS WITH MD
Selective cytokine inhibitory drugs of the invention are administered in an
amount
of about 20 to about 1,200 mg per day to patients with macular degeneration.
In a specific
embodiment, clinical studies are performed with forty patients with macular
degeneration,
who are divided into two groups. The first group receives conventional
treatment for
closing the leaking choroidal vessels (characteristic of this disease) by
photodynanuc
therapy with verteporfin. Ophthalmol 1999 (117) : 1329-1345. The second group
receives
the same conventional therapy with verteporfin and (+)-2-[1-(3-ethoxy-4
methoxyphenyl)-
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2-methylsulfonylethyl]-4 acetylaminoisoindoline I,3-dione in an amount of
about 20
mg/day as an adjuvant for 20 weeks.
The neovascular cascade is sufficiently hindered in the group receiving (+)-2-
[1-(3-
ethoxy-4 methoxyphenyl)-2-methylsulfonylethyl]-4 acetylaminoisoindoline 1,3-
dione to
indefinitely prolong the effects of the photodynamic therapy. However, the
first group
without (+)-2-[1-(3-ethoxy-4 methoxyphenyl)-2-methylsulfonylethyl]-4
acetylaminoisoindoline 1,3-dione experiences progressive reperfusion of the
ablated vessels
several weeks after treatment. Progressive visual loss follows which requires
the
photodynamic therapy to be repeated.
In another preferred embodiment, (+)-2-[1-(3-ethoxy-4 methoxyphenyl)-2-
methylsulfonylethyl]-4 acetylaminoisoindoLine 1,3-dione is administered in an
amount of
about 1 to about 200 mg/day, preferably about IO to about 50 mg/day, or a
greater dose,
generally about I.5 to 2.5 times the daily dose every other day. The adjuvant
therapy is
applicable to other types of conventional therapy used to treat or prevent MD
including, but
not limited to, surgical intervention including laser photocoagulation.
Embodiments of the invention described herein are only illustrative of the
scope of
the invention. A number of references have been cited herein, the entire
contents of which
have been incorporated by reference herein.
38
