US 20100120733A1 (19) United States (12) Patent Application Publication (10) Pub. No.: US 2010/0120733 A1 Gant et al. (43) Pub. Date: May 13, 2010

(54) STEROID MODULATORS OF Publication Classification GLUCOCORTICOD RECEPTOR (51) Int. Cl. A6II 3/56 (2006.01) (75) Inventors: Thomas G. Gant, Carlsbad, CA Aik '', 3. (US); Manouchehr M. Shahbaz, A6IP 5/44 3. San Diego, CA (US) ( .01) s (52) U.S. Cl...... 514/171; 540/63; 514/174 (57) ABSTRACT Correspondence Address: GLOBAL PATENT GROUP - APX The present invention relates to new steroid modulators of 10411 Clayton Road, Suite 304 glucocorticoid receptor activity, pharmaceutical composi

ST. LOUIS9 MO 6131 (US) tions thereof, and methods of use thereof.

(73) Assignee: AUSPEX PHARMACEUTICALS, INC., Vista, CA (US)

(21) Appl. No.: 12/613,628

(22) Filed: Nov. 6, 2009

Related U.S. Application Data (60) Provisional application No. 61/112.268, filed on Nov. 7, 2008. US 2010/0120733 A1 May 13, 2010

STEROD MODULATORS OF CYP2C8 (Dhillon et al., Drugs, 2008, 68(6), 875-883). GLUCOCORTICOD RECEPTOR Pooled data indicate that the elimination half-life of ciclesonide (CIC) is 0.71 hours and that of des-CIC, is 3.5 hours (Reynolds et al., Drugs, 2004, 64(5), 511-519). 0001. This application claims the benefit of priority of Adverse effects associated with ciclesonide administration, U.S. provisional application No. 61/112.268, filed Nov. 7. include: bruising, cataracts, osteoporosis, candidiasis, and 2008, the disclosure of which is hereby incorporated by ref dysphonia. erence as if written herein in its entirety. 0002 Disclosed herein are new steroid compounds, phar Deuterium Kinetic Isotope Effect maceutical compositions made thereof, and methods modu 0005. In order to eliminate foreign substances such as late glucocorticoid receptor activity in a subject are also pro therapeutic agents, the animal body expresses various vided for the treatment of disorders such as asthma, chronic enzymes, such as the cytochrome Paso enzymes (CYPs), obstructive pulmonary disease, and allergic rhinitis. esterases, proteases, reductases, dehydrogenases, and 0003 Ciclesonide (Alvesco: Omnaris: Omniair; C13164: monoamine oxidases, to react with and convert these foreign RPR 251526: CAS # 126544-47-6), 16,17-(R)-cyclohexy Substances to more polar intermediates or metabolites for lmethylene bis(oxy)-11-hydroxy-21-(2-methyl-1-oxopro renal excretion. Such metabolic reactions frequently involve poxy)-(11-beta, 16-alpha)-pregna-1,4-diene-320-dione, is a the oxidation of a carbon-hydrogen (C H) bond to either a glucocorticoid receptor agonist. Ciclesonide is commonly carbon-oxygen (C-O) or a carbon-carbon (C-C) JU-bond. prescribed for the treatment of asthma, chronic obstructive The resultant metabolites may be stable or unstable under pulmonary disease, and allergic rhinitis (Drug Report for physiological conditions, and can have substantially different Ciclesonide (Metered Dose inhaler), Thompson Investiga pharmacokinetic, pharmacodynamic, and acute and long tional Drug Database, (2008); Drug Report for Ciclesonide term toxicity profiles relative to the parent compounds. For (Nasal Formulation), Thompson Investigational Drug Data most drugs, such oxidations are generally rapid and ulti base, (2008); Berger et al., Therapy 2005, 202), 167-178: mately lead to administration of multiple or high daily doses. Humbert et al., Exp. Opin. Invest. Drugs 2004, 13(10), 1349 0006. The relationship between the activation energy and 1360; Reynolds et al., Drugs 2004, 64(5), 511-519: Dhillonet the rate of reaction may be quantified by the Arrhenius equa al., Drugs 2008, 68(6), 875-883; and Christie et al., Drugs of tion, k=Ae'. The Arrhenius equation states that, at a Today 2004, 40(7), 569-576). given temperature, the rate of a chemical reaction depends exponentially on the activation energy (E). 0007. The transition state in a reaction is a short lived state along the reaction pathway during which the original bonds have stretched to their limit. By definition, the activation energy E for a reaction is the energy required to reach the transition state of that reaction. Once the transition state is reached, the molecules can either revert to the original reac tants, or form new bonds giving rise to reaction products. A catalyst facilitates a reaction process by lowering the activa tion energy leading to a transition state. Enzymes are examples of biological catalysts. 0008 Carbon-hydrogen bond strength is directly propor tional to the absolute value of the ground-state vibrational energy of the bond. This vibrational energy depends on the mass of the atoms that form the bond, and increases as the mass of one or both of the atoms making the bond increases. Since deuterium (D) has twice the mass of protium ("H), a Ciclesonide C-D bond is stronger than the corresponding C–H bond. If a C-H bond is broken during a rate-determining step in a 0004 Ciclesonide is administered as an inactive parent chemical reaction (i.e. the step with the highest transition compound to the lower airways, where it is converted to its state energy), then Substituting a deuterium for that protium pharmacologically active metabolite desisobutyryl will cause a decrease in the reaction rate. This phenomenon is ciclesonide by endogenous esterases (Nave et al., Int. J. Clin. known as the Deuterium Kinetic Isotope Effect (DKIE). The Pharmacol. Ther..., 2006, 44(1), 1-7). Within the lung cells, magnitude of the DKIE can be expressed as the ratio between desisobutyryl-ciclesonide undergoes reversible esterification the rates of a given reaction in which a C H bond is broken, with fatty acids at the C-21 position (Nave et al., Resp. Res., and the same reaction where deuterium is substituted for 2007, 8(65)). The formed fatty acid conjugates may serve as protium. The DKIE can range from about 1 (no isotope effect) a depot that slowly releases desisobutyryl-ciclesonide in the to very large numbers, such as 50 or more. Substitution of lung (Nave et al., Resp. Res., 2007, 8(65)). Desisobutyryl tritium for hydrogen results in yet a stronger bond than deu ciclesonide is subject to further metabolic oxidation at vari terium and gives numerically larger isotope effects. ous positions on the cyclohexane ring and at the 613 position 0009 Deuterium (2H or D) is a stable and non-radioactive (Nave et al., Biopharm. Drug Disp., 2006, 27(4), 197-207: isotope of hydrogen which has approximately twice the mass and Guo et al., Amer. J. Then, 2006, 13.(6), 490-501). of protium ("H), the most common isotope of hydrogen. CYP3A4 is believed to be largely responsible for these con Deuterium oxide (DO or “heavy water) looks and tastes like versions, with additional contributions by CYP2D6 and HO, but has different physical properties. US 2010/0120733 A1 May 13, 2010

0010 When pure DO is given to rodents, it is readily disorders are best treated when the subject is medicated absorbed. The quantity of deuterium required to induce tox around the clock or for an extended period of time. For all of icity is extremely high. When about 0-15% of the body water the foregoing reasons, a medicine with a longer half-life may has been replaced by D.O, animals are healthy but are unable result in greater efficacy and cost savings. Various deuteration to gain weight as fast as the control (untreated) group. When patterns can be used to (a) reduce or eliminate unwanted about 15-20% of the body water has been replaced with D.O. metabolites, (b) increase the half-life of the parent drug, (c) the animals become excitable. When about 20-25% of the decrease the number of doses needed to achieve a desired body water has been replaced with DO, the animals become effect, (d) decrease the amount of a dose needed to achieve a so excitable that they go into frequent convulsions when desired effect, (e) increase the formation of active metabo stimulated. Skin lesions, ulcers on the paws and muzzles, and lites, if any are formed, (f) decrease the production of delete necrosis of the tails appear. The animals also become very aggressive. When about 30% of the body water has been rious metabolites in specific tissues, and/or (g) create a more replaced with DO, the animals refuse to eat and become effective drug and/or a safer drug for polypharmacy, whether comatose. Their body weight drops sharply and their meta the polypharmacy be intentional or not. The deuteration bolic rates drop far below normal, with death occurring at approach has the strong potential to slow the metabolism of about 30 to about 35% replacement with D.O.The effects are ciclesonide and attenuate interpatient variability. reversible unless more than thirty percent of the previous 0014 Novel compounds and pharmaceutical composi body weight has been lost due to D.O. Studies have also tions, certain of which have been found to modulate gluco shown that the use of DO can delay the growth of cancer cells corticoid receptor have been discovered, together with meth and enhance the cytotoxicity of certain antineoplastic agents. ods of synthesizing and using the compounds, including methods for the treatment of glucocorticoid receptor-medi 0011 Deuteration of pharmaceuticals to improve pharma ated disorders in a patient by administering the compounds as cokinetics (PK), pharmacodynamics (PD), and toxicity pro disclosed herein. files has been demonstrated previously with some classes of 0015. In certain embodiments of the present invention, drugs. For example, the DKIE was used to decrease the hepa compounds have structural Formula I: totoxicity of halothane, presumably by limiting the produc tion of reactive species such as trifluoroacetylchloride. How ever, this method may not be applicable to all drug classes. (I) For example, deuterium incorporation can lead to metabolic Switching. Metabolic Switching occurs when Xenogens, sequestered by Phase I enzymes, bind transiently and re-bind in a variety of conformations prior to the chemical reaction (e.g., oxidation). Metabolic switching is enabled by the rela tively vast size of binding pockets in many Phase I enzymes and the promiscuous nature of many metabolic reactions. Metabolic switching can lead to different proportions of known metabolites as well as altogether new metabolites. This new metabolic profile may impart more or less toxicity. Such pitfalls are non-obvious and are not predictable a priori for any drug class. 0012 Ciclesonide is a glucocorticoid receptor agonist. The carbon-hydrogen bonds of ciclesonide contain a natu rally occurring distribution of hydrogen isotopes, namely "H or a salt, Solvate, or prodrug thereof, wherein: or protium (about 99.984.4%), H or deuterium (about 0016 R-R and Rs-R are independently selected 0.0156%), and H or tritium (in the range between about 0.5 from the group consisting of hydrogen and deuterium; and 67 tritium atoms per 10' protium atoms). Increased 0017 R-R are independently selected from the group levels of deuterium incorporation may produce a detectable consisting of —CH, —CHD, —CHD, and —CDs.; Deuterium Kinetic Isotope Effect (DKIE) that could effect 0018 R is the pharmacokinetic, pharmacologic and/or toxicologic pro files of ciclesonide in comparison with the compound having naturally occurring levels of deuterium. 0013 Based on discoveries made in our laboratory, as well as considering the literature, ciclesonide is metabolized in humans at various positions on the cyclohexane ring and the 6B position. The current approach has the potential to prevent metabolism at this site. Other sites on the molecule may also undergo transformations leading to metabolites with as-yet unknown pharmacology/toxicology. Limiting the production of these metabolites has the potential to decrease the danger of the administration of Such drugs and may even allow increased dosage and/or increased efficacy. All of these trans and formations can occur through polymorphically-expressed 0019 at least one of R-R and Rs-R is deuterium or enzymes, exacerbating interpatient variability. Further, some contains deuterium. US 2010/0120733 A1 May 13, 2010

0020. In certain embodiments of the present invention, embodiments also provide pharmaceutical compositions compounds have structural Formula II: comprising one or more compounds disclosed herein together with a pharmaceutically acceptable carrier, as well as meth (II) ods of making and using the compounds and compositions. Certain embodiments provide methods for modulating glu cocorticoid receptors. Other embodiments provide methods

for treating a glucocorticoid receptor-mediated disorder in a

patient in need of Such treatment, comprising administering R4 R18 R24 to said patient a therapeutically effective amount of a com pound or composition according to the present invention. s/ III R23 Also provided is the use of certain compounds disclosed O R15 R22 herein for use in the manufacture of a medicament for the R16 R17 prevention or treatment of a disorder ameliorated by the modulation of glucocorticoid receptors. 0031. The compounds as disclosed herein may also con tain less prevalent isotopes for other elements, including, but not limited to, 'Cor'C for carbon, S.S, or S for sulfur, 'N for nitrogen, and ''O or "O for oxygen. or a salt, Solvate, or prodrug thereof, wherein: 0032. In certain embodiments, the compound disclosed 0021 R-R are independently selected from the group herein may expose a patient to a maximum of about consisting of hydrogen and deuterium; 0.000005% DO or about 0.00001% DHO, assuming that all 0022 R-Rs are independently selected from the group of the C-D bonds in the compound as disclosed herein are metabolized and released as DO or DHO. In certain embodi consisting of —CH, —CHD, —CHD, and —CDs.; ments, the levels of DO shown to cause toxicity in animals is 0023 R is selected from the group consisting of —OD much greater than even the maximum limit of exposure and —OH; and caused by administration of the deuterium enriched com 0024 at least one of R-R is deuterium or contains deu pound as disclosed herein. Thus, in certain embodiments, the terium. deuterium-enriched compound disclosed herein should not 0025. In certain embodiments of the present invention, cause any additional toxicity due to the formation of DO or compounds have structural Formula III: DHO upon drug metabolism. 0033. In certain embodiments, the deuterated compounds disclosed herein maintain the beneficial aspects of the corre R20 R21 sponding non-isotopically enriched molecules while Substan R25 tially increasing the maximum tolerated dose, decreasing tox R24 icity, increasing the half-life (T), lowering the maximum plasma concentration (C) of the minimum efficacious R23 dose (MED), lowering the efficacious dose and thus decreas R22 ing the non-mechanism-related toxicity, and/or lowering the R16 R17 probability of drug-drug interactions. 0034. In certain embodiments, disclosed herein is a deu terium-enriched compound, an isolated deuterium-enriched compound, or a mixture of deuterium-enriched compounds of formula IV, or a pharmaceutically acceptable salt thereof. R. R4 R5 (IV) or a salt, Solvate, or prodrug thereof, wherein: 0026 R-R are independently selected from the group consisting of hydrogen and deuterium; 0027 R-R are independently selected from the group consisting of —CH, —CHD, —CHD, and —CDs.; 0028 R is R42

O O, wherein R is an alkyl group; and 0029 at least one of R-R is deuterium or contains deu terium. 0030 Certain compounds disclosed herein may possess useful glucocorticoid receptor modulating activity, and may be used in the treatment or prophylaxis of a disorder in which glucocorticoid receptors play an active role. Thus, certain US 2010/0120733 A1 May 13, 2010

wherein R-R- and Rs-R are independently selected from the group consisting of H and D. R-Rs are independently -continued selected from the group consisting of —CH, —CHD, 2 R37 —CHD, and —CDs; and the abundance of deuterium in R R 36 R-R and Rs-R is at least 2%. 38 R. R39 R35 0035. In further embodiments, the abundance of deute rium in R-R- and Rs-R is selected from the group con R40 sisting of at least 2%, at least 5%, at least 9%, at least 14%, at O O least 18%, at least 23%, at least 27%, at least 32%, at least R19 R20 36%, at least 41%, at least 45%, at least 50%, at least 55%, at O R27 R18 R21 R26 least 59%, at least 64%, at least 68%, at least 73%, at least R14 R25 77%, at least 80%, at least 84%, at least 89%, at least 93%, at s? IIIR15 R24, least 97%, and 100%. O 0036. In further embodiments, the abundance of deute R R13 rium in R is selected from 100%. R17 R22 0037. In further embodiments, the abundance of deute rium in Ra-Rs, R-R-7, and R is selected from the group O consisting of at least 20%, at least 40%, at least 60%, at least R. R4 Rs 80%, and 100%. 0038. In further embodiments, the abundance of deute 3 rium in Ra-Rs and Ras-Rao is selected from the group con R37 R sisting of at least 6%, at least 11%, at least 17%, at least 22%, R * D. 36 at least 28%, at least 33%, at least 39%, at least 44%, at least R39 R35 50%, at least 56%, at least 61%, at least 67%, at least 72%, at least 78%, at least 83%, at least 89%, at least 94%, and 100%. R40 O

0039. In further embodiments, the abundance of deute O rium in Ras-Ra is selected from the group consisting of at R19 R20 least 14%, at least 29%, at least 43%, at least 57%, at least O D7 R18 R21 D26 71%, at least 86%, and 100%. R14 R25 0040. In further embodiments, the abundance of deute s? IIIR1s R24, rium in Ris-Rs is selected from the group consisting of at O least 9%, at least 18%, at least 27%, at least 36%, at least 45%, R at least 56%, at least 64%, at least 73%, at least 82%, at least R13 91%, and 100%. R17 R22 0041. In further embodiments, the compound is selected O from the group consisting of compounds 1-6: R. D4 Ds

4 D37 D37 D38 D41 D36 D D 36 38 R. D39 D35 D40 O O D19 D20 O R27 D2 R26 D14 D25

2.D15 D24,

US 2010/0120733 A1 May 13, 2010

-continued -continued

H37 H38 H41

I I I III s? H5

R. R4 R5 0042. In further embodiments, the compound is selected from the group consisting of compounds 7-12:

7

D37 D38 D41 D36 D39 D35 D35 D40 O

O D19 D 20 D19 D20 D27 D2 O

D26 H26 O D14 D25 O D14 D25 II I I I I IIII 2: D24, s? D15 D24, O O

US 2010/0120733 A1 May 13, 2010

0048. The term “about’, as used herein, is intended to -continued qualify the numerical values which it modifies, denoting Such 11 a value as variable within a margin of error. When no particu lar margin of error, such as a standard deviation to a mean value given in a chart or table of data, is recited, the term “about’ should be understood to mean that range which would encompass the recited value and the range which would be included by rounding up or down to that figure as well, taking into account significant figures. 0049. When ranges of values are disclosed, and the nota tion “from n ... to n' or “n-n” is used, where n and n are the numbers, then unless otherwise specified, this notation is intended to include the numbers themselves and the range between them. This range may be integral or continuous between and including the end values. 0050. The term “deuterium enrichment” refers to the per centage of incorporation of deuterium at a given position in a molecule in the place of hydrogen. For example, deuterium enrichment of 1% at a given position means that 1% of mol ecules in a given sample contain deuterium at the specified position. Because the naturally occurring distribution of deu terium is about 0.0156%, deuterium enrichment at any posi tion in a compound synthesized using non-enriched starting materials is about 0.0156%. The deuterium enrichment can be determined using conventional analytical methods known to one of ordinary skill in the art, including mass spectrometry and nuclear magnetic resonance spectroscopy. 0051. The term “is/are deuterium, when used to describe a given position in a molecule such as R-R or the symbol “D. when used to represent a given position in a drawing of

a molecular structure, means that the specified position is H14 D25 I I III enriched with deuterium above the naturally occurring distri s? D15 D24. bution of deuterium. In one embodiment deuterium enrich O ment is no less than about 1%, in another no less than about H 5%, in another no less than about 10%, in another no less than H13 about 20%, in another no less than about 50%, in another no less than about 70%, in another no less than about 80%, in another no less than about 90%, or in another no less than about 98% of deuterium at the specified position. 0.052 The term “isotopic enrichment” refers to the per centage of incorporation of a less prevalent isotope of an element at a given position in a molecule in the place of the 0043. In further embodiments, disclosed herein is a phar more prevalent isotope of the element. maceutical composition, comprising: a pharmaceutically 0053. The term “non-isotopically enriched’ refers to a acceptable carrier and a therapeutically effective amount of a molecule in which the percentages of the various isotopes are compound of formula IV or a pharmaceutically acceptable Substantially the same as the naturally occurring percentages. salt form thereof. 0054 Asymmetric centers exist in the compounds dis 0044. In further embodiments, disclosed herein is a closed herein. These centers are designated by the symbols method for treating persistent asthma comprising: adminis “R” or “S”, depending on the configuration of substituents tering, to a patient in need thereof, a therapeutically effective around the chiral carbon atom. It should be understood that amount of a compound of formula I or a pharmaceutically the invention encompasses all Stereochemical isomeric acceptable salt form thereof. forms, including diastereomeric, enantiomeric, and epimeric forms, as well as D-isomers and L-isomers, and mixtures 0045 All publications and references cited herein are thereof. Individual stereoisomers of compounds can be pre expressly incorporated herein by reference in their entirety. pared synthetically from commercially available starting However, with respect to any similar or identical terms found materials which contain chiral centers or by preparation of in both the incorporated publications or references and those mixtures of enantiomeric products followed by separation explicitly put forth or defined in this document, then those such as conversion to a mixture of diastereomers followed by terms definitions or meanings explicitly put forthin this docu separation or recrystallization, chromatographic techniques, ment shall control in all respects. direct separation of enantiomers on chiral chromatographic 0046. As used herein, the terms below have the meanings columns, or any other appropriate method known in the art. indicated. Starting compounds of particular Stereochemistry are either 0047. The singular forms “a”, “an', and “the may refer to commercially available or can be made and resolved by tech plural articles unless specifically stated otherwise. niques known in the art. Additionally, the compounds dis US 2010/0120733 A1 May 13, 2010 closed herein may exist as geometric isomers. The present 0061 The term “glucocorticoid receptor, also known as invention includes all cis, trans, syn, anti, entgegen (E), and NR3C1 (nuclear receptor subfamily 3, group C, member 1), Zusammen (Z) isomers as well as the appropriate mixtures refers to a ligand-activated transcription factor that binds with thereof. Additionally, compounds may exist as tautomers; all high affinity to cortisol and other glucocorticoids. tautomeric isomers are provided by this invention. Addition 0062. The term “glucocorticoid receptor-mediated disor ally, the compounds disclosed herein can exist in unsolvated der, refers to a disorder that is characterized by abnormal as well as Solvated forms with pharmaceutically acceptable allergic, inflammatory, or autoimmune function. A glucocor Solvents such as water, ethanol, and the like. In general, the ticoid receptor-mediated disorder may be completely or par Solvated forms are considered equivalent to the unsolvated tially mediated by modulating glucocorticoid receptors. In forms. particular, a glucocorticoid receptor-mediated disorder is one 0055. The term “bond” refers to a covalent linkage in which modulation of glucocorticoid receptors results in between two atoms, or two moieties when the atoms joined by Some effect on the underlying disorder e.g., administration of the bond are considered to be part of larger substructure. A a glucocorticoid receptor modulator results in some improve bond may be single, double, or triple unless otherwise speci ment in at least Some of the patients being treated. fied. A dashed line between two atoms in a drawing of a 0063. The term “glucocorticoid receptor modulator, molecule indicates that an additional bond may be present or refers to the ability of a compound disclosed hereinto alter the absent at that position. function of glucocorticoid receptors. A glucocorticoid recep tor modulator may activate the activity of a glucocorticoid 0056. The term “disorder as used herein is intended to be receptor, may activate or inhibit the activity of a glucocorti generally synonymous, and is used interchangeably with, the coid receptor depending on the concentration of the com terms “disease”, “syndrome', and “condition' (as in medical pound exposed to the glucocorticoid receptor, or may inhibit condition), in that all reflect an abnormal condition of the the activity of a glucocorticoid receptor. Such activation or human or animal body or of one of its parts that impairs inhibition may be contingent on the occurrence of a specific normal functioning, is typically manifested by distinguishing event, such as activation of a signal transduction pathway, signs and Symptoms. and/or may be manifest only in particular cell types. The term 0057 The terms “treat”,99 “treating,&g and “treatment” are “glucocorticoid receptor modulator also refers to altering meant to include alleviating or abrogating a disorder or one or the function of a glucocorticoid receptors by increasing or more of the symptoms associated with a disorder, or allevi decreasing the probability that a complex forms between a ating or eradicating the cause(s) of the disorder itself. As used glucocorticoid receptor and a natural binding partner. A glu herein, reference to “treatment of a disorder is intended to cocorticoid receptor modulator may increase the probability include prevention. The terms “prevent”, “preventing, and that Such a complex forms between the glucocorticoid recep “prevention” refer to a method of delaying or precluding the tor and the natural binding partner, may increase or decrease onset of a disorder; and/or its attendant symptoms, barring a the probability that a complex forms between the glucocorti Subject from acquiring a disorder or reducing a subject's risk coid receptor and the natural binding partner depending on of acquiring a disorder. the concentration of the compound exposed to the glucocor 0058. The term “therapeutically effective amount” refers ticoid receptor, and or may decrease the probability that a to the amount of a compound that, when administered, is complex forms between the glucocorticoid receptor and the sufficient to prevent development of, or alleviate to some natural binding partner. In some embodiments, modulation of extent, one or more of the symptoms of the disorder being the glucocorticoid receptor may be assessed using the method treated. The term “therapeutically effective amount” also described in Stoeck et al., J. Pharmacol. Exp. Ther. 2004, refers to the amount of a compound that is sufficient to elicit 309(1), 249-258. the biological or medical response of a cell, tissue, system, 0064. The term “modulation of glucocorticoid receptors’ animal, or human that is being sought by a researcher, Veteri or “modulate glucocorticoid receptors’ refers to altering the narian, medical doctor, or clinician. function of glucocorticoid receptors by administering anglu 0059. The term “subject” refers to an animal, including, cocorticoid receptor modulator. but not limited to, a primate (e.g., human, monkey, chimpan 0065. The terms “alkyl group' and “substituted alkyl Zee, gorilla, and the like), rodents (e.g., rats, mice, gerbils, group' are interchangeable and include Substituted, option hamsters, ferrets, and the like), lagomorphs, Swine (e.g., pig, ally Substituted and unsubstituted C-Cio Straight chain Satu miniature pig), equine, canine, feline, and the like. The terms rated aliphatic hydrocarbon groups, Substituted, optionally “subject' and “patient” are used interchangeably herein in Substituted and unsubstituted C-Co straight chain unsatur reference, for example, to a mammalian Subject, such as a ated aliphatic hydrocarbon groups, Substituted, optionally human patient. Substituted and unsubstituted C-Cobranched saturated ali 0060. The term “combination therapy’ means the admin phatic hydrocarbon groups, Substituted and unsubstituted istration of two or more therapeutic agents to treat a thera C-C branched unsaturated aliphatic hydrocarbon groups, peutic disorder described in the present disclosure. Such Substituted, optionally Substituted and unsubstituted C-Cs administration encompasses co-administration of these cyclic Saturated aliphatic hydrocarbon groups, Substituted, therapeutic agents in a Substantially simultaneous manner, optionally Substituted and unsubstituted Cs-Cs cyclic unsat Such as in a single capsule having a fixed ratio of active urated aliphatic hydrocarbon groups having the specified ingredients or in multiple, separate capsules for each active number of carbon atoms. For example, the definition of ingredient. In addition, Such administration also encom “alkyl shall include but is not limited to: methyl (Me), tri passes use of each type of therapeutic agent in a sequential deuteromethyl ( CD), ethyl (Et), propyl (Pr), butyl (Bu), manner. In either case, the treatment regimen will provide pentyl, hexyl, heptyl, octyl, nonyl, decyl, undecyl ethenyl, beneficial effects of the drug combination in treating the propenyl, butenyl, penentyl, hexenyl, heptenyl, octenyl, non disorders described herein. enyl, decenyl, undecenyl, isopropyl (i-Pr), isobutyl (i-Bu), US 2010/0120733 A1 May 13, 2010

tert-butyl (t-Bu), sec-butyl (s-Bu), isopentyl, neopentyl, place of release of the active Substance from a dosage form as cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cyclohep compared with a conventional immediate release dosage tyl, cyclooctyl, cyclopentenyl, cyclohexenyl, cycloheptenyl, form. cyclooctenyl, methylcyclopropyl, ethylcyclohexenyl, bute 0071. The term “nonrelease controlling excipient” refers nylcyclopentyl, adamantyl, norbornyl and the like. Alkyl Sub to an excipient whose primary function do not include modi stituents are independently selected from the group consist fying the duration or place of release of the active Substance ing of hydrogen, deuterium, halogen, —OH, -SH, -NH2, from a dosage form as compared with a conventional imme —CN, NO. —O, —CH, trihalomethyl, carbamoyl, diate release dosage form. arylCo-oalkyl, heteroarylCo-oalkyl, Coalkyloxy, arylCo 0072 The term “prodrug” refers to a compound functional loalkyloxy, Coalkylthio, arylCo-oalkylthio, arylCo-oalky derivative of the compound as disclosed herein and is readily lamino, N-aryl-N-Co-oalkylamino, Coalkylcarbonyl, convertible into the parent compound in vivo. Prodrugs are arylCo-oalkylcarbonyl, Coalkylcarboxy, arylCo-oalkyl often useful because, in Some situations, they may be easier to carboxy, Coalkylcarbonylamino, arylCo-alkylcarbony administer than the parent compound. They may, for instance, lamino, tetrahydrofuryl, morpholinyl, piperazinyl, hydroxy be bioavailable by oral administration whereas the parent pyronyl, -Co-oalkylCOORs and—Co-alkylCONRR compound is not. The prodrug may also have enhanced solu wherein Rs. Rs and Rs are independently selected from the bility in pharmaceutical compositions over the parent com group consisting of hydrogen, deuterium, alkyl, aryl, or Rs pound. A prodrug may be converted into the parent drug by and Rs are taken together with the nitrogen to which they are various mechanisms, including enzymatic processes and attached forming a saturated cyclic or unsaturated cyclic sys metabolic hydrolysis. See Harper, Progress in Drug Research tem containing 3 to 8 carbon atoms with at least one substitu 1962, 4, 221–294; Morozowich et al. in “Design of Biophar ent as defined herein. maceutical Properties through Prodrugs and Analogs. Roche 0066. The term “therapeutically acceptable” refers to Ed., APHA Acad. Pharm. Sci. 1977: “Bioreversible Carriers those compounds (or salts, prodrugs, tautomers, Zwitterionic in Drug in Drug Design, Theory and Application. Roche Ed., forms, etc.) which are suitable for use in contact with the APHA Acad. Pharm. Sci. 1987: “Design of Prodrugs.” Bund tissues of patients without excessive toxicity, irritation, aller gaard, Elsevier, 1985; Wang et al., Curr: Pharm. Design 1999, gic response, immunogenecity, are commensurate with a rea 5,265-287: Pauletti et al., Adv. Drug. Delivery Rev. 1997,27, sonable benefit/risk ratio, and are effective for their intended 235-256; Mizen et al., Pharm. Biotech. 1998, 11, 345-365; U.S. Gaignault et al., Pract. Med. Chem. 1996, 671-696; 0067. The term “pharmaceutically acceptable carrier, Asgharnejad in “Transport Processes in Pharmaceutical Sys “pharmaceutically acceptable excipient”, “physiologically tems. Amidon et al., Ed., Marcell Dekker, 185-218, 2000; Balant et al., Eur: J. Drug Metab. Pharmacokinet. 1990, 15, acceptable carrier, or “physiologically acceptable excipi 143-53; Balimane and Sinko, Adv. Drug Delivery Rev. 1999, ent” refers to a pharmaceutically-acceptable material, com 39, 183-209: Browne, Clin. Neuropharmacol. 1997, 20, 1-12; position, or vehicle, such as a liquid or Solid filler, diluent, Bundgaard, Arch. Pharm. Chem. 1979, 86, 1-39: Bundgaard, excipient, solvent, or encapsulating material. Each compo Controlled Drug Delivery 1987, 17, 179–96: Bundgaard, Adv. nent must be “pharmaceutically acceptable' in the sense of Drug Delivery Rev. 1992, 8, 1-38; Fleisher et al., Adv. Drug being compatible with the other ingredients of a pharmaceu Delivery Rev. 1996, 19, 115-130; Fleisher et al., Methods tical formulation. It must also be suitable for use in contact Enzymol. 1985, 112,360-381: Farquhar et al., J. Pharm. Sci. with the tissue or organ of humans and animals without exces 1983, 72, 324-325; Freeman et al., J. Chem. Soc., Chem. sive toxicity, irritation, allergic response, immunogenecity, or Commun. 1991, 875-877: Friis and Bundgaard, Eur: J. other problems or complications, commensurate with a rea Pharm. Sci. 1996, 4, 49-59; Gangwar et al., Des. Biopharm. sonable benefit/risk ratio. See, Remington. The Science and Prop. Prodrugs Analogs, 1977, 409–421; Nathwani and Practice of Pharmacy, 21st Edition; Lippincott Williams & Wood, Drugs 1993, 45,866-94: Sinhababu and Thakker, Adv. Wilkins: Philadelphia, Pa., 2005, Handbook of Pharmaceu Drug Delivery Rev. 1996, 19, 241-273; Stella et al., Drugs tical Excipients, 5th Edition; Rowe et al., Eds. The Pharma 1985, 29, 455-73; Tan et al., Adv. Drug Delivery Rev. 1999, ceutical Press and the American Pharmaceutical Association: 39, 117-151; Taylor, Adv. Drug Delivery Rev. 1996, 19, 131 2005; and Handbook of Pharmaceutical Additives, 3rd Edi 148; Valentino and Borchardt, Drug Discovery Today 1997.2, tion; Ash and Ash Eds. Gower Publishing Company: 2007; 148-155; Wiebe and Knaus, Adv. Drug Delivery Rev. 1999, Pharmaceutical Preformulation and Formulation, Gibson 39, 63-80; Waller et al., Br. J. Clin. Pharmac. 1989, 28, Ed., CRC Press LLC: Boca Raton, Fla., 2004). 497-507. 0068. The terms “active ingredient”, “active compound', 0073. The compounds disclosed herein can exist as thera and “active Substance' refer to a compound, which is admin peutically acceptable salts. The term “pharmaceutically istered, alone or in combination with one or more pharma acceptable salt, as used herein, represents salts or Zwitteri ceutically acceptable excipients or carriers, to a Subject for onic forms of the compounds disclosed herein which are treating, preventing, or ameliorating one or more symptoms therapeutically acceptable as defined herein. The salts can be of a disorder. prepared during the final isolation and purification of the 0069. The terms “drug”,99 “therapeutic&g agent, and “chemo compounds or separately by reacting the appropriate com therapeutic agent” refer to a compound, or a pharmaceutical pound with a suitable acid or base. Therapeutically accept composition thereof, which is administered to a subject for able salts include acid and basic addition salts. For a more treating, preventing, or ameliorating one or more symptoms complete discussion of the preparation and selection of salts, of a disorder. refer to “Handbook of Pharmaceutical Salts, Properties, and 0070 The term “release controlling excipient” refers to an Use.” Stah and Wermuth, Ed. (Wiley-VCH and VHCA, Zur excipient whose primary function is to modify the duration or ich, 2002) and Berge et al., J. Pharm. Sci. 1977, 66, 1-19. US 2010/0120733 A1 May 13, 2010

0074 Suitable acids for use in the preparation of pharma gastric retention dosage forms. These dosage forms can be ceutically acceptable salts include, but are not limited to, prepared according to conventional methods and techniques acetic acid, 2,2-dichloroacetic acid, acylated amino acids, known to those skilled in the art (see, Remington. The Science adipic acid, alginic acid, ascorbic acid, L-aspartic acid, ben and Practice of Pharmacy, supra; Modified-Release Drug Zenesulfonic acid, benzoic acid, 4-acetamidobenzoic acid, Deliver Technology, Rathbone et al., Eds. Drugs and the boric acid, (+)-camphoric acid, camphorsulfonic acid, (+)- Pharmaceutical Science, Marcel Dekker, Inc.: New York, (1S)-camphor-10-Sulfonic acid, capric acid, caproic acid, N.Y., 2002; Vol. 126). caprylic acid, cinnamic acid, citric acid, cyclamic acid, cyclo 0077. The compositions include those suitable for oral, hexanesulfamic acid, dodecylsulfuric acid, ethane-1,2-disul parenteral (including Subcutaneous, intradermal, intramuscu fonic acid, ethanesulfonic acid, 2-hydroxy-ethanesulfonic lar, intravenous, intraarticular, and intramedullary), intraperi acid, formic acid, fumaric acid, galactaric acid, gentisic acid, toneal, transmucosal, transdermal, rectal and topical (includ glucoheptonic acid, D-gluconic acid, D-glucuronic acid, ing dermal, buccal, Sublingual and intraocular) L-glutamic acid, C-OXO-glutaric acid, glycolic acid, hippuric administration although the most Suitable route may depend acid, hydrobromic acid, hydrochloric acid, hydroiodic acid, upon for example the condition and disorder of the recipient. (+)-L-lactic acid, (t)-DL-lactic acid, lactobionic acid, lauric The compositions may conveniently be presented in unit dos acid, maleic acid, (-)-L-malic acid, malonic acid, (+)-DL age form and may be prepared by any of the methods well mandelic acid, methanesulfonic acid, naphthalene-2-sulfonic known in the art of pharmacy. Typically, these methods acid, naphthalene-1,5-disulfonic acid, 1-hydroxy-2-naph include the step of bringing into association a compound of thoic acid, nicotinic acid, nitric acid, oleic acid, orotic acid, the Subject invention or a pharmaceutically salt, prodrug, or oxalic acid, palmitic acid, pamoic acid, perchloric acid, phos solvate thereof (“active ingredient') with the carrier which phoric acid, L-pyroglutamic acid, Saccharic acid, salicylic constitutes one or more accessory ingredients. In general, the acid, 4-amino-salicylic acid, sebacic acid, Stearic acid, suc compositions are prepared by uniformly and intimately cinic acid, Sulfuric acid, tannic acid, (+)-L-tartaric acid, thio bringing into association the active ingredient with liquid cyanic acid, p-toluenesulfonic acid, undecylenic acid, and carriers or finely divided solid carriers or both and then, if Valeric acid. necessary, shaping the product into the desired formulation. 0075 Suitable bases for use in the preparation of pharma 0078 Formulations of the compounds disclosed herein ceutically acceptable salts, including, but not limited to, inor Suitable for oral administration may be presented as discrete ganic bases, such as magnesium hydroxide, calcium hydrox units such as capsules, cachets or tablets each containing a ide, potassium hydroxide, zinc hydroxide, or sodium predetermined amount of the active ingredient; as a powder or hydroxide; and organic bases, such as primary, secondary, granules; as a solution or a suspension in an aqueous liquid or tertiary, and quaternary, aliphatic and aromatic amines, a non-aqueous liquid; or as an oil-in-water liquid emulsion or including L-arginine, benethamine, benzathine, choline, a water-in-oil liquid emulsion. The active ingredient may also deanol, diethanolamine, diethylamine, dimethylamine, be presented as a bolus, electuary or paste. dipropylamine, diisopropylamine, 2-(diethylamino)-ethanol, 0079 Pharmaceutical preparations which can be used ethanolamine, ethylamine, ethylenediamine, isopropy orally include tablets, push-fit capsules made of gelatin, as lamine, N-methyl-glucamine, hydrabamine, 1H-imidazole, well as Soft, sealed capsules made of gelatin and a plasticizer, L-lysine, morpholine, 4-(2-hydroxyethyl)-morpholine, Such as glycerol or Sorbitol. Tablets may be made by com methylamine, piperidine, piperazine, propylamine, pyrroli pression or molding, optionally with one or more accessory dine, 1-(2-hydroxyethyl)-pyrrolidine, pyridine, quinuclidine, ingredients. Compressed tablets may be prepared by com quinoline, isoquinoline, secondary amines, triethanolamine, pressing in a suitable machine the active ingredient in a free trimethylamine, triethylamine, N-methyl-D-glucamine, flowing form such as a powder or granules, optionally mixed 2-amino-2-(hydroxymethyl)-1,3-propanediol. and with binders, inert diluents, or lubricating, surface active or tromethamine. dispersing agents. Molded tablets may be made by molding in 0076 While it may be possible for the compounds of the a suitable machine a mixture of the powdered compound Subject invention to be administered as the raw chemical, it is moistened with an inert liquid diluent. The tablets may also possible to present them as a pharmaceutical composi optionally be coated or scored and may be formulated so as to tion. Accordingly, provided herein are pharmaceutical com provide slow or controlled release of the active ingredient positions which comprise one or more of certain compounds therein. All formulations for oral administration should be in disclosed herein, or one or more pharmaceutically acceptable dosages suitable for Such administration. The push-fit cap salts, prodrugs, or Solvates thereof, together with one or more Sules can contain the active ingredients in admixture with pharmaceutically acceptable carriers thereof and optionally filler Such as lactose, binders such as starches, and/or lubri one or more other therapeutic ingredients. Proper formulation cants such as talc or magnesium Stearate and, optionally, is dependent upon the route of administration chosen. Any of stabilizers. In soft capsules, the active compounds may be the well-known techniques, carriers, and excipients may be dissolved or Suspended in Suitable liquids, such as fatty oils, used as Suitable and as understood in the art; e.g., in Reming liquid paraffin, or liquid polyethylene glycols. In addition, ton's Pharmaceutical Sciences. The pharmaceutical compo stabilizers may be added. Dragee cores are provided with sitions disclosed herein may be manufactured in any manner Suitable coatings. For this purpose, concentrated Sugar Solu known in the art, e.g., by means of conventional mixing, tions may be used, which may optionally contain gum arabic, dissolving, granulating, dragee-making, levigating, emulsi talc, polyvinyl pyrrolidone, carbopol gel, polyethylene gly fying, encapsulating, entrapping or compression processes. col, and/or titanium dioxide, lacquer Solutions, and Suitable The pharmaceutical compositions may also be formulated as organic solvents or solvent mixtures. Dyestuffs or pigments a modified release dosage form, including delayed-, may be added to the tablets or dragee coatings for identifica extended-, prolonged-, Sustained-, pulsatile-, controlled tion or to characterize different combinations of active com accelerated- and fast-, targeted-, programmed-release, and pound doses. US 2010/0120733 A1 May 13, 2010

0080. The compounds may be formulated for parenteral I0087. For administration by inhalation, compounds may administration by injection, e.g., by bolus injection or con be delivered from an insufflator, nebulizer pressurized packs tinuous infusion. Formulations for injection may be presented or other convenient means of delivering an aerosol spray. in unit dosage form, e.g., in ampoules or in multi-dose con Pressurized packs may comprise a suitable propellant Such as tainers, with an added preservative. The compositions may dichlorodifluoromethane, trichlorofluoromethane, dichlo take Such forms as Suspensions, solutions or emulsions in oily rotetrafluoroethane, carbon dioxide or other suitable gas. In or aqueous vehicles, and may contain formulatory agents the case of a pressurized aerosol, the dosage unit may be Such as Suspending, stabilizing and/or dispersing agents. The determined by providing a valve to deliver a metered amount. formulations may be presented in unit-dose or multi-dose Alternatively, for administration by inhalation or insufflation, containers, for example sealed ampoules and vials, and may the compounds according to the invention may take the form be stored in powder form or in a freeze-dried (lyophilized) ofa dry powder composition, for example a powder mix of the condition requiring only the addition of the sterile liquid compound and a suitable powder base such as lactose or carrier, for example, saline or sterile pyrogen-free water, starch. The powder composition may be presented in unit immediately prior to use. Extemporaneous injection solu dosage form, in for example, capsules, cartridges, gelatin or tions and Suspensions may be prepared from sterile powders, blister packs from which the powder may be administered granules and tablets of the kind previously described. with the aid of an inhalator or insufflator. 0081 Formulations for parenteral administration include I0088 Preferred unit dosage formulations are those con aqueous and non-aqueous (oily) sterile injection Solutions of taining an effective dose, as herein below recited, oran appro the active compounds which may contain antioxidants, buff priate fraction thereof, of the active ingredient. ers, bacteriostats and solutes which render the formulation I0089 Compounds may be administered orally or via isotonic with the blood of the intended recipient; and aqueous injection at a dose of from 0.1 to 500 mg/kg per day. The dose and non-aqueous sterile Suspensions which may include Sus range for adult humans is generally from 5 mg to 2 g/day. pending agents and thickening agents. Suitable lipophilic Tablets or other forms of presentation provided in discrete Solvents or vehicles include fatty oils such as sesame oil, or units may conveniently contain an amount of one or more synthetic fatty acid esters, such as ethyl oleate or triglycer compounds which is effective at Such dosage or as a multiple ides, or liposomes. Aqueous injection Suspensions may con of the same, for instance, units containing 5 mg to 500 mg. tain Substances which increase the Viscosity of the Suspen usually around 10 mg to 200 mg. Sion, such as Sodium carboxymethyl cellulose, Sorbitol, or 0090 The amount of active ingredient that may be com dextran. Optionally, the suspension may also contain suitable bined with the carrier materials to produce a single dosage stabilizers or agents which increase the solubility of the com form will vary depending upon the host treated and the par pounds to allow for the preparation of highly concentrated ticular mode of administration. Solutions. 0091. The compounds can be administered in various 0082 In addition to the formulations described previously, modes, e.g. orally, topically, or by injection. The precise the compounds may also be formulated as a depot prepara amount of compound administered to a patient will be the tion. Such long acting formulations may be administered by responsibility of the attendant physician. The specific dose implantation (for example Subcutaneously or intramuscu level for any particular patient will depend upon a variety of larly) or by intramuscular injection. Thus, for example, the factors including the activity of the specific compound compounds may be formulated with Suitable polymeric or employed, the age, body weight, general health, sex, diets, hydrophobic materials (for example as an emulsion in an time of administration, route of administration, rate of excre acceptable oil) or ion exchange resins, or as sparingly soluble tion, drug combination, the precise disorder being treated, derivatives, for example, as a sparingly soluble salt. and the severity of the disorder being treated. Also, the route 0083. Forbuccal or sublingual administration, the compo of administration may vary depending on the disorder and its sitions may take the form of tablets, lozenges, pastilles, or severity. gels formulated in conventional manner. Such compositions 0092. In the case wherein the patient's condition does not may comprise the active ingredient in a flavored basis such as improve, upon the doctor's discretion the administration of Sucrose and acacia or tragacanth. the compounds may be administered chronically, that is, for 0084. The compounds may also be formulated in rectal an extended period of time, including throughout the duration compositions such as Suppositories or retention enemas, e.g., of the patient's life in order to ameliorate or otherwise control containing conventional Suppository bases such as cocoa but or limit the symptoms of the patient’s disorder. ter, polyethylene glycol, or other glycerides. 0093. In the case wherein the patient's status does 0085 Certain compounds disclosed herein may be admin improve, upon the doctor's discretion the administration of istered topically, that is by non-systemic administration. This the compounds may be given continuously or temporarily includes the application of a compound disclosed herein Suspended for a certain length of time (i.e., a "drug holiday'). externally to the epidermis or the buccal cavity and the instil 0094. Once improvement of the patient's conditions has lation of Sucha compound into the ear, eye and nose, such that occurred, a maintenance dose is administered if necessary. the compound does not significantly enter the blood stream. Subsequently, the dosage or the frequency of administration, In contrast, Systemic administration refers to oral, intrave or both, can be reduced, as a function of the symptoms, to a nous, intraperitoneal and intramuscular administration. level at which the improved disorder is retained. Patients can, I0086 Formulations suitable for topical administration however, require intermittent treatment on a long-term basis include liquid or semi-liquid preparations Suitable for pen upon any recurrence of symptoms. etration through the skin to the site of inflammation Such as 0.095 Disclosed herein are methods of treating a glucocor gels, liniments, lotions, creams, ointments or pastes, and ticoid receptor-mediated disorder comprising administering drops Suitable for administration to the eye, ear or nose. to a Subject having or Suspected of having Such a disorder, a US 2010/0120733 A1 May 13, 2010

therapeutically effective amount of a compound as disclosed CYP11B2, CYP17, CYP19, CYP21, CYP24, CYP26A1, herein or a pharmaceutically acceptable salt, Solvate, or pro CYP26B1, CYP27A1, CYP27B1, CYP39, CYP46, and drug thereof. CYP51. 0096. Glucocorticoid receptor-mediated disorders, 0101 Examples of monoamine oxidase isoforms in a mammalian Subject include, but are not limited to, MAO include, but are not limited to, asthma, chronic obstructive and MAO. pulmonary disease, allergic rhinitis, and/or any disorder 0102 The inhibition of the cytochrome Paso isoform is which can lessened, alleviated, or prevented by administering measured by the method of Ko et al., British Journal of a glucocorticoid receptor modulator. Clinical Pharmacology, 2000, 49,343-351. The inhibition of 0097. In certain embodiments, a method of treating a glu the MAO isoform is measured by the method of Weyler et cocorticoid receptor-mediated disorder comprises adminis al., J. Biol. Chem. 1985, 260, 13199-13207. The inhibition of tering to the Subject a therapeutically effective amount of a the MAO isoform is measured by the method of Uebelhack compound as disclosed herein, or a pharmaceutically accept et al., Pharmacopsychiatry, 1998, 31, 187-192. able salt, Solvate, or prodrug thereof, so as to affect: (1) 0103 Examples of polymorphically-expressed cyto decreased inter-individual variation in plasma levels of the chrome Paso isoforms in a mammalian Subject include, but are compound or a metabolite thereof (2) increased average not limited to, CYP2C8, CYP2C9, CYP2C19, and CYP2D6. plasma levels of the compound or decreased average plasma 0104. The metabolic activities of liver microsomes, cyto levels of at least one metabolite of the compound per dosage chrome Paso isoforms, and monoamine oxidase isoforms are unit; (3) decreased inhibition of, and/or metabolism by at measured by the methods described herein. least one cytochrome Paso or monoamine oxidase isoform in 0105 Examples of improved disorder-control and/or dis the Subject; (4) decreased metabolism via at least one poly order-eradication endpoints, or improved clinical effects morphically-expressed cytochrome Paso isoform in the Sub include, but are not limited to, improved lung function, reduced asthma symptoms, reduced need for rescue medica ject; (5) at least one statistically-significantly improved dis tion, improved Forced Expiratory Volume in 1 second order-control and/or disorder-eradication endpoint; (6) an (FEV1), increased Forced Vital Capacity (FVC), time to first improved clinical effect during the treatment of the disorder, moderate or severe exacerbation of asthma Symptoms, (7) prevention of recurrence, or delay of decline or appear improvement in the overall Asthma Quality-of-Life Ques ance, of abnormal alimentary or hepatic parameters as the tionnaire (AQLQ) score, increased percentage of asthma-free primary clinical benefit, or (8) reduction or elimination of days, increased peak expiratory flow, and improved total deleterious changes in any diagnostic hepatobiliary function nasal symptoms scores (TNSS). Drug Report for endpoints, as compared to the corresponding non-isotopi C-clesonide (Metered Dose inhaler), Thompson Investiga cally enriched compound. tional Drug Database, (2008); Drug Report for Ciclesonide 0098. In certain embodiments, inter-individual variation (Nasal Formulation), Thompson Investigational Drug Data in plasma levels of the compounds as disclosed herein, or base, (2008); and Berger et al., Therapy 2005, 2(2), 167-178. metabolites thereof, is decreased; average plasma levels of 0106 Examples of diagnostic hepatobiliary function end the compound as disclosed herein are increased; average points include, but are not limited to, alanine aminotrans plasma levels of a metabolite of the compound as disclosed ferase (ALT), serum glutamic-pyruvic transaminase herein are decreased; inhibition of a cytochrome Paso or (“SGPT), aspartate aminotransferase (“AST' or “SGOT), monoamine oxidase isoform by a compound as disclosed ALT/AST ratios, serum aldolase, alkaline phosphatase herein is decreased; or metabolism of the compound as dis (ALP), ammonia levels, bilirubin, gamma-glutamyl closed herein by at least one polymorphically-expressed transpeptidase (“GGTP” “Y-GTP or “GGT), leucine ami cytochrome Paso isoform is decreased; by greater than about nopeptidase (“LAP), liver biopsy, liver ultrasonography, 5%, greater than about 10%, greater than about 20%, greater liver nuclear Scan, 5'-nucleotidase, and blood protein. Hepa than about 30%, greater than about 40%, or by greater than tobiliary endpoints are compared to the stated normal levels about 50% as compared to the corresponding non-isotopi as given in “Diagnostic and Laboratory Test Reference', 4' cally enriched compound. edition, Mosby, 1999. These assays are run by accredited 0099 Plasma levels of the compound as disclosed herein, laboratories according to standard protocol. or metabolites thereof, may be measured using the methods 0107 Besides being useful for human treatment, certain described by Li et al. Rapid Communications in Mass Spec compounds and formulations disclosed herein may also be trometry 2005, 19, 1943-1950; Sato et al., BMC Pharmacol useful for veterinary treatment of companion animals, exotic ogy 2007, 7(7): Nonaka et al., BMC Pharmacology 2007, animals and farm animals, including mammals, rodents, and 7(12); Nave et al., Pulmonary Pharmacology & Therapeutics the like. More preferred animals include horses, dogs, and 2005, 18(6), 390-396; Guo et al., American journal of thera Cats. peutics 2006, 13.(6), 490-501; and any references cited therein and any modifications made thereof. Combination Therapy 0100 Examples of cytochrome Paso isoforms in a mam 0108. The compounds disclosed herein may also be com malian subject include, but are not limited to, CYP1A1, bined or used in combination with other agents useful in the CYP1A2, CYP1B1, CYP2A6, CYP2A13, CYP2B6, treatment of glucocorticoid receptor-mediated disorders. Or, CYP2C8, CYP2C9, CYP2C18, CYP2C19, CYP2D6, by way of example only, the therapeutic effectiveness of one CYP2E1, CYP2G1 CYP2J2, CYP2R1, CYP2S1, CYP3A4, of the compounds described herein may be enhanced by CYP3A5, CYP3A5P1, CYP3A5P2, CYP3A7, CYP4A11, administration of an adjuvant (i.e., by itself the adjuvant may only have minimal therapeutic benefit, but in combination with another therapeutic agent, the overall therapeutic benefit to the patient is enhanced). US 2010/0120733 A1 May 13, 2010

0109 Such other agents, adjuvants, or drugs, may be nium iodide, tiemonium iodide, pri?inium bromide, time administered, by a route and in an amount commonly used pidium bromide, ipratropium bromide, and fempiverinium. therefor, simultaneously or sequentially with a compound as 0117. In certain embodiments, the compounds disclosed disclosed herein. When a compound as disclosed herein is herein can be combined with a B-adrenoreceptor agonist used contemporaneously with one or more other drugs, a selected from the group consisting of salbutamol, levosalb pharmaceutical composition containing such other drugs in utamol, terbutaline, pirbuterol, procaterol, metaproterenol, addition to the compound disclosed herein may be utilized, fenoterol, bitolterol mesylate, reproterol, salmeterol, formot but is not required. erol, bambuterol, clenbuterol, and indacaterol. 0110. In certain embodiments, the compounds disclosed herein can be combined with one or more B-adrenoreceptor 0118. In certain embodiments, the compounds disclosed agonists, antimuscarinics, anticholinergics, Xanthines, gluco herein can be combined with mesalazine. corticoid receptor antagonists, T-cell function modulators, 0119 The compounds disclosed herein can also be admin leukotriene receptor antagonists, antihistamines, sympatho istered in combination with other classes of compounds, mimetics, 5-amino Salicylates, and immunosuppressants. including, but not limited to, anti-retroviral agents; CYP3A 0111. In certain embodiments, the compounds disclosed inducers; mast cell stabilizers; local or general anesthetics; herein can be combined with a glucorticoid receptor antago non-steroidal anti-inflammatory agents (NSAIDs). Such as nist selected from the group consisting of beclometaSone, naproxen; antibacterial agents, such as amoxicillin; choles budesonide, flunisolide, betamethasone, fluticaSone, triamci teryl ester transfer protein (CETP) inhibitors, such as anace nolone, and mometasone. trapib; anti-fungal agents, such as isoconazole; sepsis treat 0112. In certain embodiments, the compounds disclosed herein can be combined with a leukotriene receptor antago ments, such as drotrecogin-C: steroidals, such as nist selected from the group consisting of montelukast, pran hydrocortisone; local or general anesthetics, such as ket lukast, and Zafirlukast. amine; norepinephrine reuptake inhibitors (NRIs) such as 0113. In certain embodiments, the compounds disclosed atomoxetine; dopamine reuptake inhibitors (DARIs). Such as herein can be combined with an antihistamine selected from methylphenidate; serotonin-norepinephrine reuptake inhibi the group consisting of bromazine, carbinoxamine, clemas tors (SNRIs), such as milnacipran; sedatives. Such as diaz tine, chlorphenoxamine, diphenylpyraline, diphenhy epham; norepinephrine-dopamine reuptake inhibitor dramine, doxylamine, brompheniramine, chlorphenamine, (NDRIs), Such as bupropion; serotonin-norepinephrine dexbrompheniramine, dexchlorpheniramine, dimetindene, dopamine-reuptake-inhibitors (SNDRIs), such as Venlafax pheniramine, talastine, chloropyramine, histapyrrodine, ine; monoamine oxidase inhibitors, such as selegiline; hypo mepyramine, methapyrilene, tripelennamine, alimemazine, thalamic phospholipids; endothelin converting enzyme hydroxyethylpromethazine, isothipendyl, meduitazine, methdilazine, oxomemazine, promethazine, buclizine, ceti (ECE) inhibitors, such as phosphoramidon; opioids, Such as rizine, chlorcyclizine, cinnarizine, cyclizine, hydroxy Zine, tramadol; thromboxane receptor antagonists, such as levocetirizine, meclizine, niaprazine, oxatomide, antazoline, ifetroban; potassium channel openers; thrombin inhibitors, aZatadine, bamipine, cyproheptadine, deptropine, dimebon, Such as hirudin; hypothalamic phospholipids; growth factor ebastine, epinastine, ketotifen, mebhydrolin, mizolastine, inhibitors, such as modulators of PDGF activity; platelet acti phenindamine, pimethixene, pyrrobutamine, rupatadine, Vating factor (PAF) antagonists; anti-platelet agents, such as triprolidine, acrivastine, astemizole, azelastine, deslorata GPIb/IIIa blockers (e.g., abdximab, eptifibatide, and dine, feXofenadine, loratadine, terfenadine, antazoline, tirofiban), P2Y (AC) antagonists (e.g., clopidogrel, ticlopi aZelastine, emedastine, epinastine, ketotifen, olopatadine, dine and CS-747), and aspirin; anticoagulants, such as war cromylin Sodium and theophylline. farin; low molecular weight heparins, such as enoxaparin; 0114. In certain embodiments, the compounds disclosed Factor VIIa Inhibitors and Factor Xa Inhibitors; renin inhibi herein can be combined with a xanthine selected from the group consisting of diprophylline, choline theophyllinate, tors; neutral endopeptidase (NEP) inhibitors; vasopepsidase proxyphylline, theophylline, aminophylline, etamiphylline, inhibitors (dual NEP-ACE inhibitors), such as omapatrilat paraxanthine, caffeine, theobromine, bamifylline, acefylline and gemopatrilat; HMG CoA reductase inhibitors, such as piperazine, bufylline, and doxofylline. pravastatin, lovastatin, atorvastatin, simvastatin, NK-104 0115. In certain embodiments, the compounds disclosed (a.k.a. itavastatin, nis vastatin, or nisbastatin), and ZD-4522 herein can be combined with a sympathomimetic selected (also known as rosuvastatin, or atavastatin or visastatin); from the group consisting of cyclopentamine, ephedrine, phe squalene synthetase inhibitors; fibrates; bile acid seques nylephrine, oxymetazoline, tetry Zoline, Xylometazoline, nap trants. Such as questran; niacin; anti-atherosclerotic agents, haZoline, tramaZoline, metizoline, tuaminoheptane, fenox such as ACAT inhibitors; MTP Inhibitors; calcium channel aZoline, tymazoline, epinephrine, phenylpropanolamine, and blockers, such as amlodipine besylate; potassium channel pseudoephedrine. activators; alpha-muscarinic agents; beta-muscarinic agents, 0116. In certain embodiments, the compounds disclosed Such as carvedilol and metoprolol; antiarrhythmic agents; herein can be combined with an anticholinergic selected from the group consisting of oxyphencyclimine, camylofin, diuretics, such as chlorothlazide, hydrochlorothiazide, flu mebeverine, trimebutine, rociverine, dicycloverine, dihex methiazide, hydroflumethiazide, bendroflumethiazide, meth yverine, difemerine, piperidolate, benzilone, glycopyrro ylchlorothiazide, trichloromethiazide, polythiazide, benzoth nium, oxyphenonium, penthienate, propantheline, otilonium lazide, ethacrynic acid, tricrynafen, chlorthalidone, bromide, methantheline, tridihexethyl, isopropamide, hexo furosenilde, musolimine, bumetanide, triamterene, cyclium, poldine, mepenZolate, bevonium, pipenZolate, amiloride, and spironolactone; thrombolytic agents, such as biphemanil, (2-benzhydryloxyethyl)diethyl-methylammo tissue plasminogen activator (tPA), recombinant tRA, strep US 2010/0120733 A1 May 13, 2010

tokinase, urokinase, prourokinase, and anisoylated plasmino I0120 Thus, in another aspect, certain embodiments pro gen streptokinase activator complex (APSAC); anti-diabetic vide methods for treating glucocorticoid receptor-mediated agents, such as biguanides (e.g. metformin), glucosidase disorders in a human or animal Subject in need of Such treat inhibitors (e.g., acarbose), insulins, meglitinides (e.g., repa ment comprising administering to said Subject an amount of a glinide), Sulfonylureas (e.g., glimepiride, glyburide, and glip compound disclosed herein effective to reduce or prevent said izide), thioZolidinediones (e.g. troglitaZone, rosiglitaZone disorder in the subject, in combination with at least one addi and pioglitaZone), and PPAR-gamma agonists; mineralocor tional agent for the treatment of said disorder. In a related ticoid receptor antagonists, such as Spironolactone and aspect, certain embodiments provide therapeutic composi eplerenone; growth hormone secretagogues; aP2 inhibitors; tions comprising at least one compound disclosed herein in phosphodiesterase inhibitors, such as PDE III inhibitors (e.g., combination with one or more additional agents for the treat cilostazol) and PDE V inhibitors (e.g., sildenafil, tadalafil. ment of glucocorticoid receptor-mediated disorders. Vardenafil); protein tyrosine kinase inhibitors; antiinflamma tories; antiproliferatives, such as methotrexate, FK506 (tac General Synthetic Methods for Preparing Compounds rolimus, Prograf), mycophenolate mofetil: chemotherapeutic I0121) Isotopic hydrogen can be introduced into a com agents; anticancer agents and cytotoxic agents (e.g., alkylat pound as disclosed herein by synthetic techniques that ing agents, such as nitrogen mustards, alkyl Sulfonates, employ deuterated reagents, whereby incorporation rates are nitrosoureas, ethylenimines, and triaZenes); antimetabolites, pre-determined; and/or by exchange techniques, wherein Such as folate antagonists, purine analogues, and pyrridine incorporation rates are determined by equilibrium conditions, analogues; antibiotics, such as anthracyclines, bleomycins, and may be highly variable depending on the reaction condi mitomycin, dactinomycin, and plicamycin; enzymes, such as tions. Synthetic techniques, where tritium or deuterium is L-asparaginase; farnesyl-protein transferase inhibitors; hor directly and specifically inserted by tritiated or deuterated monal agents, such as glucocorticoids (e.g., cortisone), estro reagents of known isotopic content, may yield high tritium or gens/antiestrogens, androgens/antiandrogens, progestins, deuterium abundance, but can be limited by the chemistry and luteinizing hormone-releasing hormone anatagonists, required. Exchange techniques, on the other hand, may yield and octreotide acetate; microtubule-disruptor agents, such as lower tritium or deuterium incorporation, often with the iso ecteinascidins; microtubule-stablizing agents. Such as paci tope being distributed over many sites on the molecule. taxel, docetaxel, and epothilones A-F. plant-derived prod 0.122 The compounds as disclosed herein can be prepared ucts, such as Vinca alkaloids, epipodophyllotoxins, and tax by methods known to one of skill in the art and routine anes; and topoisomerase inhibitors; prenyl-protein modifications thereof, and/or following procedures similar to transferase inhibitors; and cyclosporins; steroids, such as those described in the schemes below and routine modifica prednisone and dexamethasone; cytotoxic drugs, such as aza tions made thereof, and/or procedures found in WO 2008/ 035066: WO 2008/015696; WO 2007/056181; WO98/ thiprine and cyclophosphamide; TNF-alpha inhibitors, such 09982; and US 2007/01 17974, which are hereby as tenidap; anti-TNF antibodies or soluble TNF receptor, such incorporated in their entirety, and references cited therein and as etanercept, rapamycin, and leflunimide; and cyclooxyge routine modifications thereof. Compounds as disclosed nase-2 (COX-2) inhibitors, such as celecoxib and rofecoxib; herein can also be prepared as shown in any of the following and miscellaneous agents such as, hydroxyurea, procarba schemes and routine modifications thereof. Zine, mitotane, hexamethylmelamine, gold compounds, plati I0123. The following schemes can be used to practice the num coordination complexes, such as cisplatin, satraplatin, present invention. Any position shown as hydrogen may and carboplatin. optionally be replaced with deuterium.

US 2010/0120733 A1 May 13, 2010 14

-continued

0.124 Compound 1 is reacted sodium metabisulphite in an replaced with deuterium selectively or non-selectively appropriate solvent, Such as ethanol, to give compound 2. through a proton-deuterium exchange method known in the art. Compound 2 is reacted with compound 3 in the presence of an I0127. The following compounds can generally be made appropriate acid. Such as perchloric acid, in an appropriate using the methods described above. It is expected that these Solvent, such as dichloromethane, to give compound 4. Com compounds when made will have activity similar to those pound 4 is reacted with compound 5, in the presence of an described in the examples above.

appropriate base, such as triethylamine, in an appropriate Solvent, such as dichloromethane, to give compound 6 of formula I. 0.125 Deuterium can be incorporated to different posi tions synthetically, according to the synthetic procedures as shown in Scheme I, by using appropriate deuterated interme diates. For example, to introduce deuterium at one or more positions of Ra-Rs, compound 1 with the corresponding deuterium substitutions can be used. To introduce deuterium at one or more positions of RI-R, R2-R27, Ras-R-7, and Re-Ra, compound 3 with the corresponding deuterium Sub stitutions can be used. To introduce deuterium at one or more positions of Ras-Ra, compound 5 with the corresponding deuterium Substitutions can be used. 0126 Deuterium can be incorporated to various positions having an exchangeable proton, Such as the hydroxyl O—H and various exchangeable C-H positions, via proton-deute rium equilibrium exchange. For example, to introduce deu terium at R--Rs, R-R-7, and Rs. these protons may be US 2010/0120733 A1 May 13, 2010 15

-continued -continued

. . I I III s

US 2010/0120733 A1 May 13, 2010 16

-continued -continued

US 2010/0120733 A1 May 13, 2010 17

-continued -continued

US 2010/0120733 A1 May 13, 2010 18

-continued -continued

US 2010/0120733 A1 May 13, 2010 19

-continued -continued

US 2010/0120733 A1 May 13, 2010 20

-continued Cytochrome P4so Standard

CYP1A2 Phenacetin CYP2A6 Coumarin CYP2B6 'C-(S)-mephenytoin CYP2C8 Paclitaxel CYP2C9 Diclofenac CYP2C19 'C-(S)-mephenytoin CYP2D6 (+/-)-Bufuralol CYP2E1 ChlorZoxazone CYP3A4 Testosterone CYP4A 'C-Lauric acid

Monoamine Oxidase a Inhibition and Oxidative Turnover I0131 The procedure is carried out using the methods described by Weyler et al., Journal of Biological Chemistry 1985, 260, 13199-13207, which is hereby incorporated by 0128 Changes in the metabolic properties of the com reference in its entirety. Monoamine oxidase A activity is pounds disclosed herein as compared to their non-isotopi measured spectrophotometrically by monitoring the increase cally enriched analogs can be shown using the following in absorbance at 314 nm on oxidation of kynuramine with assays. Compounds listed above which have not yet been formation of 4-hydroxyquinoline. The measurements are car made and/or tested are predicted to have changed metabolic ried out, at 30°C., in 50 mM sodium phosphate buffer, pH 7.2. properties as shown by one or more of these assays as well. containing 0.2% Triton X-100 (monoamine oxidase assay buffer), plus 1 mM kynuramine, and the desired amount of Biological Activity Assays enzyme in 1 mL total Volume. Monooamine Oxidase B Inhibition and Oxidative Turnover In Vitro Liver Microsomal Stability Assay 0.132. The procedure is carried out as described in Uebel 0129. Liver microsomal stability assays are conducted at 1 hacket al., Pharmacopsychiatry 1998, 31(5), 187-192, which mg per mL liver microsome protein with an NADPH-gener is hereby incorporated by reference in its entirety. ating system in 2% sodium bicarbonate (2.2 mM NADPH, 25.6 mM glucose 6-phosphate, 6 units per mL glucose Ciclesonide Disposition and Metabolism: Pharmacokinetics, 6-phosphate dehydrogenase and 3.3 mM magnesium chlo Metabolism, and Excretion in the Mouse, Rat, Rabbit, and ride). Test compounds are prepared as Solutions in 20% aceto Dog nitrile-water and added to the assay mixture (final assay con I0133. The procedure is carried out as described in Guo et centration 5 microgram per mL) and incubated at 37°C. Final al., American journal of therapeutics 2006, 13.(6), 490-501, concentration of acetonitrile in the assay should be <1%. which is hereby incorporated by reference in its entirety. Aliquots (50 uL) are taken out at times 0, 15, 30, 45, and 60 minutes, and diluted with ice cold acetonitrile (200 uL) to Detection of Fatty Acid Conjugates of Ciclesonide Active stop the reactions. Samples are centrifuged at 12,000 RPM Metabolite in the Rat Lung for 10 minutes to precipitate proteins. Supernatants are trans I0134. The procedure is carried out as described in Naveet ferred to microcentrifuge tubes and stored for LC/MS/MS al., Pulmonary Pharmacology & Therapeutics 2005, 18(6), analysis of the degradation half-life of the test compounds. 390-396, which is hereby incorporated by reference in its entirety. In Vitro Metabolism Using Human Cytochrome Paso Enzymes Measuring Ciclesonide Uptake and Metabolism in Human 0130. The cytochrome Paso enzymes are expressed from Alveolar Type II Epithelial Cells (A549) the corresponding human cDNA using a baculovirus expres 0.135 The procedure is carried out as described in Nonaka sion system (BD Biosciences, San Jose, Calif.). A 0.25 mil et al., BMC Pharmacology 2007, 7(12), which is hereby liliter reaction mixture containing 0.8 milligrams per millili incorporated by reference in its entirety. ter protein, 1.3 millimolar NADP", 3.3 millimolar glucose 6-phosphate, 0.4U/mL glucose-6-phosphate dehydrogenase, Detecting Uptake and Metabolism of Ciclesonide and Reten 3.3 millimolar magnesium chloride and 0.2 millimolar of a tion of Desisobutyryl-Ciclesonide for up to 24 Hours in Rab compound of Formula I, the corresponding non-isotopically bit Nasal Mucosa enriched compound or standard or control in 100 millimolar 0.136 The procedure is carried out as described in Sato et potassium phosphate (pH 7.4) is incubated at 37° C. for 20 al., BMC Pharmacology 2007, 7(7), which is hereby incor minutes. After incubation, the reaction is stopped by the addi porated by reference in its entirety. tion of an appropriate solvent (e.g., acetonitrile, 20% trichlo roacetic acid, 94% acetonitrile/6% glacial acetic acid, 70% Rat Lung Glucocorticoid Receptor Binding Assay perchloric acid, 94% acetonitrile/6% glacial acetic acid) and 0.137 The procedure is carried out as described in Stoeck centrifuged (10,000 g) for 3 minutes. The supernatant is ana et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which lyzed by HPLC/MS/MS. is hereby incorporated by reference in its entirety. US 2010/0120733 A1 May 13, 2010

Inhibition of CD3-Induced Release of IL-4 and IL-5 from R34 is Murine T2-Lymphocytes 0.138. The procedure is carried out as described in Stoeck R38 R37 et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which R39 R4 R36 is hereby incorporated by reference in its entirety. R40 R35: Inhibition of ConA-Induced Proliferation of Human Periph eral Blood Mononuclear Cells (PBMCs) O O 0.139. The procedure is carried out as described in Stoeck et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which is hereby incorporated by reference in its entirety. and at least one of R-R- and Rs-R is deuterium or contains Inhibition of CD3-Induced Proliferation and Cytokine Pro deuterium. duction by Purified Human CD4 Lymphocytes 2. The compound as recited in claim 1 wherein at least one of R-R- and Rs-R independently has deuterium enrich 0140. The procedure is carried out as described in Stoeck ment of Roless thanabolos. et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which 3. The compound as recited in claim 1 wherein at least one is hereby incorporated by reference in its entirety. mentof R-R of holessand Rs-R than about independently 50%. has deuterium enrich Bradykinin-Induced Mucosal Leakage Assay 4. The compound as recited in claim 1 wherein at least one ofment R-R- of Rolessand Rs-R than about independently 50%. has deuterium enrich 0141. The procedure is carried out as described in Stoeck 5. The compound as recited in claim 1 wherein at least one et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which of R-R- and Rs-R independently has deuterium enrich is hereby incorporated by reference in its entirety. ment of no less than about 98%. 6. The compound as recited in claim 1 wherein said com Rat Cotton Pellet Granuloma Model pound has a structural formula selected from the group con 0142. The procedure is carried out as described in Stoeck sisting of et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which is hereby incorporated by reference in its entirety. Antigen-Induced Late Inflammatory Response Assay 0143. The procedure is carried out as described in Stoeck et al., J. Pharmacol. Exp. Ther: 2004,309(1), 249-258, which is hereby incorporated by reference in its entirety. 0144. From the foregoing description, one skilled in the art can ascertain the essential characteristics of this invention, and without departing from the spirit and scope thereof, can make various changes and modifications of the invention to adapt it to various usages and conditions. What is claimed is: 1. A compound of structural Formula I

(I)

R4 R18 R24 s IIII R23 O R15 R22

R16 R17

or a pharmaceutically acceptable salt thereof, wherein: R-R and Rs-R are independently selected from the group consisting of hydrogen and deuterium; R-Rs are independently selected from the group consist ing of —CH, —CHD, —CHD, and —CDs.; US 2010/0120733 A1 May 13, 2010 22

-continued -continued D D D D D D D D D D D D

US 2010/0120733 A1 May 13, 2010 23

-continued -continued

US 2010/0120733 A1 May 13, 2010 24

-continued -continued

H

H US 2010/0120733 A1 May 13, 2010 25

-continued -continued

US 2010/0120733 A1 May 13, 2010 26

-continued -continued US 2010/0120733 A1 May 13, 2010 27

7. The compound as recited in claim 1 wherein said com poundsisting hasof a structural formula selected from the group con- -continued

O

8. The compound as recited in claim 7 wherein each posi tion represented as D has deuterium enrichment of no less than about 10%. US 2010/0120733 A1 May 13, 2010 28

9. The compound as recited in claim 7 wherein each posi 15. The compound as recited in claim 7 wherein said com tion represented as D has deuterium enrichment of no less pound has the structural formula: than about 50%. 10. The compound as recited in claim 7 wherein each position represented as Dhas deuterium enrichment of no less than about 90%. 11. The compound as recited in claim 7 wherein each

position represented as Dhas deuterium enrichment of no less than about 98%. 12. The compound as recited in claim 7 wherein said com pound has the structural formula:

16. The compound as recited in claim 7 wherein said com pound has the structural formula:

D D 13. The compound as recited in claim 7 wherein said com

pound has the structural formula:

O 17. The compound as recited in claim 7 wherein said com 14. The compound as recited in claim 7 wherein said com pound has the structural formula: pound has the structural formula:

US 2010/0120733 A1 May 13, 2010 29

18. A pharmaceutical composition comprising a com ethyl-methylammonium iodide, tiemonium iodide, pri?inium pound as recited in claim 1 together with a pharmaceutically bromide, timepidium bromide, ipratropium bromide, and acceptable carrier. fenpiverinium. 19. A method of treatment of a glucocorticoid receptor 30. The method as recited in claim 23 wherein said mediated disorder comprising the administration of a thera B-adrenoreceptoragonist is selected from the group consist peutically effective amount of a compound as recited in claim ing of salbutamol, levosalbutamol, terbutaline, pirbuterol, 1 to a patient in need thereof. procaterol, metaproterenol, fenoterol, bitolterol mesylate, 20. The method as recited inclaim 19 wherein said disorder reproterol, salmeterol, formoterol, bambuterol, clenbuterol, is selected from the group consisting of asthma, chronic and indacaterol. obstructive pulmonary disease, and allergic rhinitis. 31. The method as recited in claim 19, further resulting in 21. The method as recited in claim 19 further comprising at least one effect selected from the group consisting of: the administration of an additional therapeutic agent. a. decreased inter-individual variation in plasma levels of 22. The method as recited in claim 21 wherein said addi said compound or a metabolite thereofas compared to tional therapeutic agent is mesalazine. the non-isotopically enriched compound; 23. The method as recited in claim 21 wherein said addi b. increased average plasma levels of said compound per tional therapeutic agent is selected from the group consisting dosage unit thereofas compared to the non-isotopically of B-adrenoreceptor agonists, antimuscarinics, anticholin enriched compound; ergics, Xanthines, glucocorticoid receptor antagonists, T-cell c. decreased average plasma levels of at least one metabo function modulators, leukotriene receptor antagonists, anti lite of said compound per dosage unit thereofas com histamines, sympathomimetics, 5-aminosalicylates, and pared to the non-isotopically enriched compound; immunosuppressants. d. increased average plasma levels of at least one metabo 24. The method as recited in claim 23 wherein said glucor lite of said compound per dosage unit thereofas com ticoid receptor antagonist is selected from the group consist pared to the non-isotopically enriched compound; and ing of beclometaSone, budesonide, flunisolide, betametha e. an improved clinical effect during the treatment in said Sone, fluticaSone, triamcinolone, and mometasone. Subject per dosage unit thereofas compared to the non 25. The method as recited in claim 23 wherein said leukot isotopically enriched compound. riene receptor antagonist is selected from the group consist 32. The method as recited in claim 19, further resulting in ing of montelukast, pranlukast, and Zafirlukast. at least two effects selected from the group consisting of 26. The method as recited in claim 23 wherein said anti a. decreased inter-individual variation in plasma levels of histamine is selected from the group consisting of bromazine, said compound or a metabolite thereofas compared to carbinoxamine, clemastine, chlorphenoxamine, diphe nylpyraline, diphenhydramine, doxylamine, bromphe the non-isotopically enriched compound; niramine, chlorphenamine, dexbrompheniramine, dexchlor b. increased average plasma levels of said compound per pheniramine, dimetindene, pheniramine, talastine, dosage unit thereofas compared to the non-isotopically chloropyramine, histapyrrodine, mepyramine, methapy enriched compound; rilene, tripelennamine, alimemazine, hydroxyethylpromet c. decreased average plasma levels of at least one metabo hazine, isothipendyl, meduitazine, methdilazine, oXome lite of said compound per dosage unit thereofas com mazine, promethazine, buclizine, cetirizine, chlorcyclizine, pared to the non-isotopically enriched compound; cinnarizine, cyclizine, hydroxy Zine, levocetirizine, mecliz d. increased average plasma levels of at least one metabo ine, niaprazine, Oxatomide, antazoline, azatadine, bamipine, lite of said compound per dosage unit thereofas com cyproheptadine, deptropine, dimebon, ebastine, epinastine, pared to the non-isotopically enriched compound; and ketotifen, mebhydrolin, mizolastine, phenindamine, pime e. an improved clinical effect during the treatment in said thixene, pyrrobutamine, rupatadine, triprolidine, acrivastine, Subject per dosage unit thereofas compared to the non astemizole, azelastine, desloratadine, fexofenadine, lorata isotopically enriched compound. dine, terfenadine, antazoline, azelastine, emedastine, epinas 33. The method as recited in claim 19, wherein the method tine, ketotifen, olopatadine, cromylin Sodium, and theophyl effects a decreased metabolism of the compound per dosage line. unit thereof by at least one polymorphically-expressed cyto 27. The method as recited in claim 23 wherein said Xan chrome Paso isoform in the Subject, as compared to the cor thine is selected from the group consisting of diprophylline, responding non-isotopically enriched compound. choline theophyllinate, proxyphylline, theophylline, amino 34. The method as recited in claim 33, wherein the cyto phylline, etamiphylline, paraxanthine, caffeine, theobro chrome Paso isoform is selected from the group consisting of mine, bamifylline, acefylline piperazine, bufylline, and dox CYP2C8, CYP2C9, CYP2C19, and CYP2D6. ofylline. 35. The method as recited claim 19, wherein said com 28. The method as recited in claim 23 wherein said sym pound is characterized by decreased inhibition of at least one pathomimetic is selected from the group consisting of cyclo cytochrome Paso or monoamine oxidase isoform in said Sub pentamine, ephedrine, phenylephrine, oxymetazoline, ject per dosage unit thereofas compared to the non-isotopi tetry Zoline, Xylometazoline, naphazoline, tramaZoline, meti cally enriched compound. Zoline, tuaminoheptane, fenoxazoline, tymazoline, epineph 36. The method as recited in claim 35, wherein said cyto rine, phenylpropanolamine, and pseudoephedrine. chrome Paso or monoamine oxidase isoform is selected from 29. The method as recited in claim 23 wherein said anti the group consisting of CYP1A1, CYP1A2, CYP1B1, cholinergic is selected from the group consisting of oxyphen CYP2A6, CYP2A13, CYP2B6, CYP2C8, CYP2C9, cyclimine, camylofin, mebeverine, trimebutine, rociverine, CYP2C18, CYP2C19, CYP2D6, CYP2E1, CYP2G1. dicycloverine, dihexyverine, difemerine, piperidolate, ben CYP2J2, CYP2R1, CYP2S1, CYP3A4, CYP3A5, Zilone, glycopyrronium, oxyphenonium, penthienate, pro pantheline, otilonium bromide, methantheline, tridihexethyl, isopropamide, hexocyclium, poldine, mepenZolate, bevo nium, pipenZolate, biphemanil. (2-benzhydryloxyethyl)di US 2010/0120733 A1 May 13, 2010 30

CYP19, CYP21, CYP24, CYP26A1, CYP26B1, CYP27A1, selected from the group consisting of at least 20%, at least CYP27B1, CYP39, CYP46, CYP51, MAO and MAO. 40%, at least 60%, at least 80%, and 100%. 37. The method as recited in claim 19, wherein the method 45. A deuterium-enriched compound of claim 41, wherein reduces a deleterious change in a diagnostic hepatobiliary the abundance of deuterium in Ra-Rs and Rs-Rao is function endpoint, as compared to the corresponding non selected from the group consisting of at least 6%, at least isotopically enriched compound. 11%, at least 17%, at least 22%, at least 28%, at least 33%, at 38. The method as recited in claim 37, wherein the diag least 39%, at least 44%, at least 50%, at least 56%, at least nostic hepatobiliary function endpoint is selected from the 61%, at least 67%, at least 72%, at least 78%, at least 83%, at group consisting of alanine aminotransferase (ALT), serum least 89%, at least 94%, and 100%. glutamic-pyruvic transaminase (“SGPT), aspartate ami 46. A deuterium-enriched compound of claim 41, wherein notransferase (AST,” “SGOT), ALT/AST ratios, serum the abundance of deuterium in Ras-R is selected from the aldolase, alkaline phosphatase (ALP), ammonia levels, group consisting of at least 14%, at least 29%, at least 43%, at bilirubin, gamma-glutamyl transpeptidase (“GGTP least 57%, at least 71%, at least 86%, and 100%. “Y-GTP “GGT), leucine aminopeptidase (“LAP), liver 47. A deuterium-enriched compound of claim 41, wherein biopsy, liver ultrasonography, liver nuclear Scan, 5'-nucleoti the abundance of deuterium in Ris-Rs is selected from the dase, and blood protein. group consisting of at least 9%, at least 18%, at least 27%, at 39. A compound as recited in claim 1 for use as a medica least 36%, at least 45%, at least 56%, at least 64%, at least ment. 73%, at least 82%, at least 91%, and 100%. 40. A compound as recited in claim 1 for use in the manu 48. A deuterium-enriched compound of claim 41, wherein facture of a medicament for the prevention or treatment of a the compound is selected from the group consisting of com disorder ameliorated by the modulation of glucocorticoid pounds 1-6: receptor activity. 41. A deuterium-enriched compound of formula IV or a pharmaceutically acceptable salt thereof:

(IV)

wherein R-R- and Rs-R are independently selected from the group consisting of H and D. R-Rs are independently selected from the group consisting of —CH, -CHD, —CHD, and —CD; and the abundance of deuterium in R-R and Rs-R is at least 2%. 42. A deuterium-enriched compound of claim 41, wherein the abundance of deuterium in R-R- and Rs-R is selected from the group consisting of at least 2%, at least 5%, at least 9%, at least 14%, at least 18%, at least 23%, at least 27%, at least 32%, at least 36%, at least 41%, at least 45%, at least 50%, at least 55%, at least 59%, at least 64%, at least 68%, at least 73%, at least 77%, at least 80%, at least 84%, at least 89%, at least 93%, at least 97%, and 100%. 43. A deuterium-enriched compound of claim 41, wherein the abundance of deuterium in R is selected from 100%. 44. A deuterium-enriched compound of claim 41, wherein the abundance of deuterium in Ra-Rs, R-R-7, and R is US 2010/0120733 A1 May 13, 2010

-continued -continued 3 6 R37 R38 R 36 D41 R39 R35 R40 O O D7 Rio R

O D6 R 19 20 R R 2 14 R25 III R24, () R-15 R R R23 2 R13 R.17 R.R22 R12

O R. D. Ds 4

D37 D D38 R4 36 D39 D35 D40 O

O R 49. A deuterium-enriched compound of claim 41, wherein O R2627 D19 D20 the compound is selected from the group consisting of com Dis D2 pounds 7-12: 14 D25 II

D24,

US 2010/0120733 A1 May 13, 2010 33

50. An isolated deuterium-enriched compound of formula IV or a pharmaceutically acceptable salt thereof: -continued (IV)

R. R4 Rs thewherein group R-Rs consisting and RR of Hahd are D, independently R-R are independently selected from selected from the group consisting "C , —CHD, —CHD, and —CDs; and the abundance of deuterium in R-R and Rs-R is at least 2%. 51. An isolated deuterium-enriched compound of claim 50, wherein the abundance of deuterium in R-R- and Rs-R is selected from the group consisting of at least 2%, at least 5%, at least 9%, at least 14%, at least 18%, at least 23%, at least 27%, at least 32%, at least 36%, at least 41%, at least 45%, at least 50%, at least 55%, at least 59%, at least 64%, at least 68%, at least 73%, at least 77%, at least 80%, at least 84%, at least 89%, at least 93%, at least 97%, and 100%. 52. An isolated deuterium-enriched compound of claim 50, wherein the abundance of deuterium in R is selected from 100%. 53. An isolated deuterium-enriched compound of claim 50, wherein the abundance of deuterium in Ra-Rs, R-R-7, and Ra is selected from at least 20%, at least 40%, at least 60%, at least 80%, and 100%. 54. An isolated deuterium-enriched compound of claim 50, wherein the compound is selected from the group consisting of compounds 1-6: 1 D37 D38 36

D41 US 2010/0120733 A1 May 13, 2010

-continued 5

D37 D D D, 36

and

6 14 R37 R R38 R4 36 R39 R35

R40 O O R27 O R Dio19 D 20 26 D18 D2 Hs 14

. . . I s H38 D41 H H40

O

14

55. An isolated deuterium-enriched compound of claim 50, wherein the compound is selected from the group consisting of compounds 7-12: US 2010/0120733 A1 May 13, 2010 35

56. A mixture of deuterium-enriched compounds of for -continued mula IV or a pharmaceutically acceptable salt thereof: 10 D37 D36 D38 D41 (IV)

H27 wherein R-R- and Rs-R are independently selected from O H26 H19 H20 the group consisting of H and D. R-Rs are independently it. H2 selected from the group consisting of —CH, —CHD, 14 H25 —CHD, and —CDs; and the abundance of deuterium in S/, H R-R and Rs-R is at least 2%. (). H15 24s and 57. A mixture of deuterium-enriched compound of claim 56, wherein the compound is selected from the group con H, H.7 H.22 sisting of compounds 1-6: 2

O H. H. His 12 1

D37 D D38 D41 36 D D35 D40 O O

Do D

O D26 D 19 20 D D, 2 14 D25 II D24, Ó D15

D6 D23 US 2010/0120733 A1 May 13, 2010 36

-continued -continued

58. A mixture of deuterium-enriched compound of claim 56, wherein the compound is selected from the group con sisting of compounds 7-12:

US 2010/0120733 A1 May 13, 2010 38

59. A pharmaceutical composition, comprising: a pharma ceutically acceptable carrier and a therapeutically effective amount of a compound of claim 1 or a pharmaceutically acceptable salt form thereof. 60. A method for treating persistent asthma comprising: administering, to a patient in need thereof, a therapeutically effective amount of a compound of claim 1 or a pharmaceu tically acceptable salt form thereof.

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