United States Patent (19) 11 Patent Number: 5,981,594 Okamoto Et Al

USOO5981594A United States Patent (19) 11 Patent Number: 5,981,594 Okamoto et al. (45) Date of Patent: Nov. 9, 1999 54 METHOD OF TREATMENT FOR DIABETIC 4,062,950 12/1977 Frommer et al. ......................... 514/35 NEUROPATHY FOREIGN PATENT DOCUMENTS 75 Inventors: Tasuku Okamoto, Tokyo; Masaharu Shiga, Kanagawa; Koji Miyata, Kanagawa; Yuji Kuwabara, Saitama; 0248999 12/1987 European Pat. Off.. Shigeru Aoki, Tokyo; Hajimu. Kurumatani, Kanagawa, all of Japan OTHER PUBLICATIONS 73 Assignee: Toray Industries, Inc., Japan Windholz et al., The Merck Index, 10th Ed. (1983) p. 723-724 ab.No. 4866 21 Appl. No.: 09/037,400 22 Filed: Mar 10, 1998 Primary Examiner Kevin E. Weddington 30 Foreign Application Priority Data Attorney, Agent, or Firm Austin R. Miller Mar. 11, 1997 JP Japan .................................... 9-0S6019 57 ABSTRACT 51) Int. Cl. ........................ A61K 31/557; A61K 38/28; A61K 31/70; A61K 31/135 A method of treatment for diabetic neuropathy using com 52 U.S. Cl. ................................. 514/573; 514/3; 514/35; bined administration of a formulation including as an active 514/654, 514/866 ingredient a prostaglandin I derivative, especially a proStag 58 Field of Search .............................. 514/573, 35, 654, landin I derivative with an anti-diabetic agent is applied to 514/866, 3 hypofunction of motor nerve and Sensory nerve to which conventional anti-diabetic agents do not provide Sufficient 56) References Cited treatments, with nerve conduction Velocities improved. U.S. PATENT DOCUMENTS 2.961,377 11/1960 Shapiro et al. ......................... 514/654 10 Claims, 1 Drawing Sheet U.S. Patent Nov. 9, 1999 5,981,594 Fig. 1 Changes in Nerve Conduction Velocity (median nerve) S.on 1 O9 Sodium peraprost N1 hypoglycemic agent 8 g 7 9 6 S 5 4 Sodium beraprost 5 O C 2 OD 1 2 O Odministrationbefore Odministrationofter . Fig. 2 Changes in Nerve Conduction Velocity (tibial nerve) 4 Sodium peraprost hypoglycemic agent 3 2 Sodium 1 beraprost O before ofter Odministration administration 5,981594 1 2 METHOD OF TREATMENT FOR DIABETIC of objectively evaluating Severity of diabetic neuropathy. NEUROPATHY For motor nerves, two different locations at a nerve are Selected to be Stimulated with intensities Selected to induce BACKGROUND OF THE INVENTION the largest peak for each of the corresponding controlling muscles in electromyograms. Then the distance between the 1. Field of the Invention two locations is divided by the balance between the obtained The present invention relates to a method of treatment of latencies in the two electromyograms. The Sensory nerve is diabetic neuropathy, which is a complication of diabetes. electrically Stimulated in the orthodromic direction at an 2. Description of the Related Art intensity Selected to obtain the largest action potential, and Diabetic neuropathy occupies an important place as one then the distance between the Stimulated location and the of three major complications of diabetes, along with retin induced location is divided by the latency. opathy and nephropathy, because it develops at relatively AS methods of treatment of diabetic neuropathy, it has earlier Stages of diabetes among various other complications been reported that Some trial treatments have been con of diabetes. It occurs very frequently, ruins patients’ quality ducted during the 1970s and 1980s based upon the hypoth of life, and leads to distinctively poor prognosis in cases 15 esis that abnormality of metabolic factors is viewed as a where an autonomic disorder develops as a complication. cause, Greene DA, DeJesus PVJr., et al. (Effects of insulin Diabetic neuropathy is currently categorized into three and dietary myoinositol on impaired peripheral motor nerve groups comprising mononeuropathy, Symmetrical peripheral conduction Velocity in acute StreptoZatocin diabetes, J. Clin. polyneuropathy and autonomic neuropathy (Williams Text Invest., 1975, 55, 6, 1326-36.) and Yagihashi S., Nishihira Book of Endocrinology, 8th Edition, p. 1301, Harrison's M., et al. (Morphometrical analysis of the peripheral nerve Principles of Internal Medicine, 12th Edition, p. 1754). lesions in experimental diabetes rats, Tohoku J. Exp. Med., Mononeuropathy is a focal or multifocal mononeural 129, 2, 139-49, 1979). These confirmed that peripheral disorder which appears as lesions of the cerebral nerve or nerve fibers of model rats for diabetic neuropathy were affects Soma and/or extremities. Its major Symptom emerges morphologically impaired and NCV was reduced. In addi 25 tion to that, they reported that when insulin was adminis as dyskinesia in many cases. It is known to develop more tered to the rats, improvements in NCV could been often in elder patients. observed, thus finding that control over blood glucose level Symmetrical peripheral polyneuropathy is the most fre led to improvements in NCV. quent form of diabetic neuropathy. It generally makes slow Since then, tests measuring NCV have been always con progreSS, So that patients tend to become aware of the ducted to evaluate the therapeutic efficacy of diabetic neu Symptoms only after it has reached an advanced Stage. The ropathy. Afterward, no adequate results, however, have been initial Symptoms are often a reduced Achilles refleX and a practically provided by the treatments for diabetic neuropa decline or absence of vibratory sensibility. Urtication rep thy targeting improvements of NCV. In detail, Pietri A, et al. resented as a Smarting feeling and then numbness on both feet follow. (Changes in nerve conduction velocity after six weeks of 35 glucoregulation with portable insulin infusion pumps. With autonomic neuropathy, patients show representative Diabetes, 29, 8, 668, 1980) and Graf RJ, et al. (Glycemic Symptoms for autonomic disorder, Such as orthoStatic control and nerve conduction abnormalities in non-insulin hypotension, cardiac rate alteration, dyshidrosis, atony of dependent diabetic subjects: Ann. Intern. Med., 94, 3, 307, esophagus or gastric atony, diabetic diarrhea, impotence and 1981) separately gave drug therapies using insulin to others. 40 patients with insulin-dependent diabetes and patients with AS mechanisms for development of these Symptoms, non-insulin-dependent diabetes in 1980 and 1981, metabolic hypothesis and vascular/ischemic hypothesis have respectively, in order to treat diabetic neuropathy. It was been implied. For the former hypothesis, hyperegasia of consequently reported that motor nerve conduction Velocity polyol metabolic pathway, a pathway where Sorbitol and (MCV) was improved by controlling blood glucose level. It fructose are produced from glucose provided due to hyper 45 was also reported, however, that only by controlling blood glycemia is considered to be the major contributing factor. glucose level, improvements in Sensory nerve conduction Another theory involving a reduced content of myoinositol velocity (SCV) could not be observed, and that treatments is related to peripheral nerve disorder. In the latter mainly proposing to control blood glucose level, hypothesis, neuro-microvascular occlusion and/or destruc accordingly, only provided very limited improvements of tion of blood-nerve barrier are thought to be related to the 50 functions Such as thermal Sensitivity and Vibratory Sensibil nerve disorders. ity. For diagnosis and follow-up of diabetic neuropathy a Although Pfeifer M A (Effects of glycemic control and variety of neurologic tests are required. In the first place, aldose reductase inhibition on nerve conduction Velocity: Achilles refleX, knee refleX, biceps refleX and triceps refleX Am. J. Med., 79, 5A, 18–23, 1985) and Yoshio Goto, et al. are usually examined as deep reflexes. Other than that, tests 55 (Clinical research for diabetic neuropathy using epalrestat are performed wherein thermal Sensitivity is examined (ONO-2235)-Inter-group double-blind placebo (including through unmyelinated fibers (C-fibers), cold Sensation a trace amount of a curative medicine)-controlled trial: through small (thinly) myelinated fibers (Aö-fibers), heat Igaku-no-Ayumi, 152, 6, 405, 1990) tested treatments using pain through Aö-fibers and C-fibers, and cold pain through aldose reductase inhibitors (ARIs) based upon a hypothesis C-fibers. Accordingly, for testing Sensory nerve functions, 60 of abnormality in polyol metabolic pathway as one of the Vibratory Sensibility, pain Sensation and thermal Sensation candidates of the cause of the disease in 1985 and 1990, (using both warm tests and cold tests) are examined respectively, the effects of aldose reductase inhibitors (Clinical Medicine for Diabetic Neuropathy, edited by (ARIs) on improving motor nerve conduction Velocity Masatada Hirata and Norihei Matsuoka, 1992, Gendai (MCV) and sensory nerve conduction velocity (SCV) Iryou-sha, p. 95). 65 remained low. Among various neurologic tests, nerve conduction Veloc Accordingly, current methods of treatment for diabetic ity (NCV) examination is the most widely used as a method neuropathy, dietary therapy and administration of insulin, 5,981594 3 4 both mainly proposing to control blood glucose level, FIG. 2 represents therapeutic efficacy of combined use of administration of aldose reductase inhibitors and Sodium beraprost with an oral hypoglycemic agent on tibial aminoguanidine, both mainly proposing to improve abnor nerve conduction Velocity. mal glucose metabolism, administration of troglitaZone, and administration of agents for limb ischemia mainly proposing DESCRIPTION OF THE PREFERRED to improve blood flow, have been

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