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WO 2009/154562 Al (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date 23 December 2009 (23.12.2009) WO 2009/154562 Al (51) International Patent Classification: [GB/GB]; AstraZeneca R&D Charnwood, Bakewell A61K 31/428 (2006.01) A61P 11/08 (2006.01) Road, Loughborough Leicestershire LEl 1 5RH (GB). A61P 11/06 (2006.01) (74) Agent: ASTRAZENECA AB; AstraZeneca Intellectual (21) International Application Number: Property, S-SE-15 1 85 Sδdertalje (SE). PCT/SE2009/050762 (81) Designated States (unless otherwise indicated, for every (22) International Filing Date: kind of national protection available): AE, AG, AL, AM, 18 June 2009 (18.06.2009) AO, AT, AU, AZ, BA, BB, BG, BH, BR, BW, BY, BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, DO, (25) Filing Language: English DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (26) Publication Language: English HN, HR, HU, ID, IL, IN, IS, JP, KE, KG, KM, KN, KP, KR, KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, (30) Priority Data: ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, 61/074,1 83 20 June 2008 (20.06.2008) US NO, NZ, OM, PE, PG, PH, PL, PT, RO, RS, RU, SC, SD, (71) Applicant (for all designated States except US): AS- SE, SG, SK, SL, SM, ST, SV, SY, TJ, TM, TN, TR, TT, TRAZENECA AB [SE/SE]; S-151 85 Sόdertalje (SE). TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (72) Inventors; and (84) Designated States (unless otherwise indicated, for every (75) Inventors/Applicants (for US only): CONNOLLY, kind of regional protection available): ARIPO (BW, GH, Stephen [GB/GB]; AstraZeneca R&D Charnwood, GM, KE, LS, MW, MZ, NA, SD, SL, SZ, TZ, UG, ZM, Bakewell Road, Loughborough Leicestershire LEI l 5RH ZW), Eurasian (AM, AZ, BY, KG, KZ, MD, RU, TJ, (GB). FISHER, Adrian [GB/GB]; AstraZeneca R&D TM), European (AT, BE, BG, CH, CY, CZ, DE, DK, EE, Charnwood, Bakewell Road, Loughborough Leicester ES, FI, FR, GB, GR, HR, HU, IE, IS, IT, LT, LU, LV, shire LEI l 5RH (GB). HUMPHRIES, Alexander [GB/ MC, MK, MT, NL, NO, PL, PT, RO, SE, SI, SK, TR), GB]; AstraZeneca R&D Charnwood, Bakewell Road, OAPI (BF, BJ, CF, CG, CI, CM, GA, GN, GQ, GW, ML, MR, NE, SN, TD, TG). Loughborough Leicestershire LEI l 5RH (GB). WATTS, Andrew James [GB/GB]; AstraZeneca R&D Charn Published: wood, Bakewell Road, Loughborough Leicestershire — with international search report (Art. 21(3)) LEI l 5RH (GB). WILEY, Katherine Elisabeth (54) Title: PHARMACEUTICAL COMPOSITION COMPRISING A 4-HYDROXY-2-OXO-2, 3- DIHYDRO-I, 3-BENZOTH- IAZOL-7-YL COMPOUND FOR MODULATION OF BETA2-ADRENORECEPTOR ACTIVITY (57) Abstract: The invention provides a pharmaceutical product, kit or composition comprising a first active ingredient which is N-Cyclohexyl- Λ/3-[2-(3-fluorophenyl)ethyl]- Λ/-(2-{[2-(4- hydroxy-2-oxo-2,3-dihydro- l,3-benzothiazol-7-yl)ethyl]amino} ethyl)-β-alaninamide or a salt thereof, and a second active ingredient selected from: a non-steroidal Glucocorticoid Receptor (GR Receptor) Agonist; an antioxidant; a CCRl antagonist; a chemokine antagonist (not CCRl); a corticosteroid; a CRTh2 antagonist; a DPI antagonist; an Histone Deacetylase Inducer; an IKK2 inhibitor; a COX inhibitor; a lipoxygenase inhibitor; a leukotriene re ceptor antagonist; an MPO inhibitor; a muscarinic antagonist; a p38 inhibitor; a PDE inhibitor; a PPARγ agonist; a protease in hibitor; a Statin; a thromboxane antagonist; a vasodilator; or, an ENAC blocker (Epithelial Sodium-channel blocker); and its use in the treatment of respiratory disease (for example chronic obstructive pulmonary disease (COPD) or asthma); to certain salts of A/-Cyclohexyl-N 3-[2-(3-fluorophenyl)ethyl]- N-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7-yl)ethyl]amino}ethyl)- β- alaninamide and to an intermediate useful in the manufacture of this pharmaceutically active substance and salts thereof. Pharmaceutical composition comprising a 4-hydroxy-2-oxo-2, 3 - dihydro-1, 3-benzothiazol-7-yl compound for modulation of beta2-adrenoreceptor activity The present invention relates to a combination of two or more pharmaceutically active substances for use in the treatment of respiratory diseases (for example chronic obstructive pulmonary disease (COPD) or asthma), to certain salts of -Cyclohexyl-Λ3-[2-(3- fluorophenyl)ethyl]-Λ/-(2-{[2-(4-hydroxy-2-oxo-2,3-dihydro-l,3-benzothiazol-7- yl)ethyl]amino}ethyl)-β-alaninamide and to an intermediate useful in the manufacture of this pharmaceutically active substance and salts thereof. The essential function of the lungs requires a fragile structure with enormous exposure to the environment, including pollutants, microbes, allergens, and carcinogens. Host factors, resulting from interactions of lifestyle choices and genetic composition, influence the response to this exposure. Damage or infection to the lungs can give rise to a wide range of diseases of the respiratory system (or respiratory diseases). A number of these diseases are of great public health importance. Respiratory diseases include Acute Lung Injury, Acute Respiratory Distress Syndrome (ARDS), occupational lung disease, lung cancer, tuberculosis, fibrosis, pneumoconiosis, pneumonia, emphysema, Chronic Obstructive Pulmonary Disease (COPD) and asthma. Among the most common of the respiratory diseases is asthma. Asthma is generally defined as an inflammatory disorder of the airways with clinical symptoms arising from intermittent airflow obstruction. It is characterised clinically by paroxysms of wheezing, dyspnea and cough. It is a chronic disabling disorder that appears to be increasing in prevalence and severity. It is estimated that 15% of children and 5% of adults in the population of developed countries suffer from asthma. Therapy should therefore be aimed at controlling symptoms so that normal life is possible and at the same time provide basis for treating the underlying inflammation. COPD is a term which refers to a large group of lung diseases which can interfere with normal breathing. Current clinical guidelines define COPD as a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles and gases. The most important contributory source of such particles and gases, at least in the western world, is tobacco smoke. COPD patients have a variety of symptoms, including cough, shortness of breath, and excessive production of sputum; such symptoms arise from dysfunction of a number of cellular compartments, including neutrophils, macrophages, and epithelial cells. The two most important conditions covered by COPD are chronic bronchitis and emphysema. Chronic bronchitis is a long-standing inflammation of the bronchi which causes increased production of mucous and other changes. The patients' symptoms are cough and expectoration of sputum. Chronic bronchitis can lead to more frequent and severe respiratory infections, narrowing and plugging of the bronchi, difficult breathing and disability. Emphysema is a chronic lung disease which affects the alveoli and/or the ends of the smallest bronchi. The lung loses its elasticity and therefore these areas of the lungs become enlarged. These enlarged areas trap stale air and do not effectively exchange it with fresh air. This results in difficult breathing and may result in insufficient oxygen being delivered to the blood. The predominant symptom in patients with emphysema is shortness of breath. Therapeutic agents used in the treatment of respiratory diseases include corticosteroids. Corticosteroids (also known as glucocorticosteroids or glucocorticoids) are potent anti- inflammatory agents. Whilst their exact mechanism of action is not clear, the end result of corticosteroid treatment is a decrease in the number, activity and movement of inflammatory cells into the bronchial submucosa, leading to decreased airway responsiveness. Corticosteroids may also cause reduced shedding of bronchial epithelial lining, vascular permeability, and mucus secretion. Whilst corticosteroid treatment can yield important benefits, the efficacy of these agents is often far from satisfactory, particularly in COPD. Moreover, whilst the use of steroids may lead to therapeutic effects, it is desirable to be able to use steroids in low doses to minimise the occurrence and severity of undesirable side effects that may be associated with regular administration. Recent studies have also highlighted the problem of the acquisition of steroid resistance amongst patients suffering from respiratory diseases. For example, cigarette smokers with asthma have been found to be insensitive to short term inhaled corticosteroid therapy, but the disparity of the response between smokers and non-smokers appears to be reduced with high dose inhaled corticosteroid (Tomlinson et al., Thorax 2005;60:282-287). A further class of therapeutic agent used in the treatment of respiratory diseases are bronchodilators. Bronchodilators may be used to alleviate symptoms of respiratory diseases by relaxing the bronchial smooth muscles, reducing airway obstruction, reducing lung hyperinflation and decreasing shortness of breath. Types of bronchodilators in clinical β use include 2 adrenoceptor agonists, muscarinic receptor antagonists and methylxanthines. Bronchodilators are prescribed mainly for symptomatic relief and they are not considered to alter the natural history of respiratory diseases. -Cyclohexyl-Λ^-[2-(3-fluorophenyl)ethyl]-
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