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Use of Compounds That Are Effective As Selective (19) & (11) EP 1 505 974 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 31/445 (2006.01) A61K 31/40 (2006.01) 22.04.2009 Bulletin 2009/17 A61K 31/485 (2006.01) A61K 31/135 (2006.01) A61P 3/04 (2006.01) (21) Application number: 03752716.5 (86) International application number: (22) Date of filing: 28.04.2003 PCT/EP2003/004428 (87) International publication number: WO 2003/097051 (27.11.2003 Gazette 2003/48) (54) USE OF COMPOUNDS THAT ARE EFFECTIVE AS SELECTIVE OPIATE RECEPTOR MODULATORS VERWENDUNG VON VERBINDUNGEN, DIE ALS SELEKTIVE OPIAT-REZEPTOR- MODULATOREN WIRKSAM SIND UTILISATION DE COMPOSES S’AVERANT EFFICACES EN TANT QUE MODULATEURS SELECTIFS DES RECEPTEURS DES OPIACES (84) Designated Contracting States: (56) References cited: AT BE BG CH CY CZ DE DK EE ES FI FR GB GR WO-A-01/98267 WO-A-02/13801 HU IE IT LI LU MC NL PT RO SE SI SK TR WO-A-03/048113 US-A- 4 889 860 Designated Extension States: US-B1- 6 569 449 LT LV • MORLEY J E ET AL: "EFFECT OF (30) Priority: 17.05.2002 EP 02011047 BUTORPHANOL TARTRATE ON FOOD AND WATER CONSUMPTION IN HUMANS" (43) Date of publication of application: AMERICAN JOURNAL OF CLINICAL NUTRITION, 16.02.2005 Bulletin 2005/07 vol. 42, no. 6, 1985, pages 1175-1178, XP008022098 ISSN: 0002-9165 (73) Proprietor: Tioga Pharmaceuticals, Inc. • MENDELSON SCOTT D: "Treatment of anorexia San Diego, CA 92121 (US) nervosa with tramadol." AMERICAN JOURNAL OF PSYCHIATRY, vol. 158, no. 6, June 2001 (72) Inventors: (2001-06), pages 963-964, XP008022097 ISSN: • WEBER, Frank 0002-953X 63128 Dietzenbach/Hexenberg (DE) • JOHNSON R D: "OPIOID INVOLVEMENT IN • JACOB, Jutta FEEDING BEHAVIOUR AND THE 56323 Waldesch (DE) PATHOGENESIS OF CERTAIN EATING • BARBER, Andrew DISORDERS" MEDICAL HYPOTHESES, EDEN 64331 Weiterstadt (DE) PRESS, PENRITH, US, vol. 45, no. 5, November • GOTTSCHLICH, Rudolf 1995 (1995-11), pages 491-497, XP008016540 64354 Reinheim (DE) ISSN: 0306-9877 • MORLEY J.E. ET AL: ’An investigation of the role (74) Representative: Nobbe, Matthias of kappa opiate receptor agonists in the initiation Viering, Jentschura & Partner of feeding’ LIFE SCIENCES vol. 31, no. 23, 1982, Postfach 22 14 43 pages 2617 - 2626 80504 München (DE) • MORLEY J.E. ET AL: ’Involvement of dynorphin and the kappa opioid receptor in feeding’ PEPTIDES vol. 4, 1983, pages 797 - 800 Note: Within nine months of the publication of the mention of the grant of the European patent in the European Patent Bulletin, any person may give notice to the European Patent Office of opposition to that patent, in accordance with the Implementing Regulations. Notice of opposition shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention). EP 1 505 974 B1 Printed by Jouve, 75001 PARIS (FR) (Cont. next page) EP 1 505 974 B1 • TORTELLA F.C. ET AL: ’EEG spectral analysis of the neuroprotective kappa opioids enadoline and PD117302’ THE JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS vol. 282, no. 1, 1997, pages 286 - 293 2 EP 1 505 974 B1 Description [0001] The instant invention relates to the use of compounds that are effective as selective kappa opiate receptor modulators for the manufacture of pharmaceuticals for the diagnosis and/or the treatment of disorders, said disorders 5 being selected from eating disorders and digestive disorders, especially for psychogenic eating disorders, for the man- ufacture of a pharmaceutical effective for modulating the gastrointestinal tonus, and to pharmaceutical compositions, comprising one or more of said modulator compounds and one or more compounds that are effective as appetite depressant. [0002] In civilized societies, the working and living conditions are more and more associated with all kinds of stress 10 that lead in many cases to stress-related disorders. One major group of disorders that is believed to be at least partly induced or influenced by the modem living conditions and the stress associated there with is the group consisting of eating disorders and digestive disorders, especially psychogenic eating- and digestive disorders. Usually, this disorders are treated with psychotherapy and/or pharmaceutical preparations, that interact with the central nervous system. The treatment with such pharmaceutical preparations can lead to serious adverse effects such as habituation and addiction. 15 [0003] The following substances are known in the state of the art for the treatment of some or all indications as previously described. WO 02/13801 discloses for example the use of loperamide, a peripherally active mu-receptor agonist for the treatment of conditions included within the Coronary Heart Disease Risk Factor syndrome, e.g. Diabetes and obesity. [0004] US-A-4 889 860 discloses O-aryl and O-aralkyl compounds being mu-opioid receptor agonists and delta-opioid 20 receptor antagonists. Moreover, this document relates to the use of delta-opioid receptor antagonists to suppress appetite. [0005] WO 01/98267 relates to 3-azabicyclohexane compounds that bind to opioid receptors and are useful for the treatment of eating disorders. These compounds were tested in receptor binding assays for P, δ and κ receptor binding in dog brain and were found to have Ki values of 4000 nM or less for the P-receptor. [0006] WO 03/048113 relates to the use of tramadol analogues in the treatment of eating disorders. Tramadol and its 25 analogues are known in the art to be centrally acting specific P receptor agonists. [0007] Morley, J.E., Parker, J. and Levine, A.S. ("Effect of Butorphanol Tartrate On Food and Water Consumption in Humans" American Journal of Clinical Nutrition, Vol.42, No.6, 1985, p.1175-1178) suggest the use of butorphanol in the treatment of anorexia, as in the reported studies it significantly increased food, but not water, intake. Butorphanol is known in the art to be a mixed opiate agonist/antagonist, functioning as a kappa-sigma opiate receptor agonist and a 30 mu opiate receptor antagonist. [0008] Mendelson S.D. ("Treatment of anorexia nervosa with tramadol" American Journal of Psychiatry, Vol.158, No. 6, June 2001 p.963-964) reports the use of tramadol, a P receptor agonist, in the treatment of anorexia nervosa. [0009] It was therefore object of the instant invention to make available pharmaceutically active compounds which can be used for the successful treatment of eating disorders and digestive disorders, especially psychogenic eating 35 disorders and psychogenic digestive disorders. These pharmaceutically active compounds should be advantageous over prior art and, in particular, show little or no negative interaction with the central nervous system of the patient treated therewith. [0010] Surprisingly, it was found that compounds that are effective as selective kappa opiate receptor modulators and especially compounds that are effective as peripherally selective kappa opiate receptor modulators can be successfully 40 used for the manufacture of a pharmaceutical for the treatment of eating disorders and digestive disorders. More sur- prisingly it was found that these compounds are capable of modulating the tonus of the gastrointestinal (GI) tract of the patient treated therewith highly effective, especially after GI-surgery. Even more surprisingly, it was found that the modulation the tonus of the GI tract of the patient can be advantageously controlled dosis dependent, i. e. the desired relaxation or activation of the GI tract, respectively, can be achieved depending on the dosis of the respective compound 45 administered to the patient. [0011] Accordingly, subject of the present invention is the use of a compound that is effective as selective kappa opiate receptor modulator, preferably as selective kappa opiate receptor agonist, for the manufacture of a pharmaceutical for diagnosis and/or the treatment of disorders, said disorders being selected from eating disorders and digestive disorders. Preferably, said receptor modulator is peripherally selective to the receptor. 50 [0012] A preferred aspect of the instant invention therefore relates to the use of a compound that is effective as peripherally selective kappa opiate receptor modulator for the manufacture of a pharmaceutical for diagnosis and/or the treatment of disorders, said disorders being selected from eating disorders and digestive disorders. A more preferred aspect of the instant invention relates to the use as described above, further characterized in that the compound is effective as peripherally selective kappa opiate receptor agonist. 55 [0013] The compounds for use according to the invention preferably show one or more of the following advantageous properties: • the compounds for use according to the invention are effective to modulate the tonus of the GI tract; especially they 3 EP 1 505 974 B1 can be used to induce a relaxation or activation of the GI tonus; in general the modulation of the tonus of the GI tract is dosis dependent; • the compounds for use according to the invention are effective to modulate satiety and/or postprandial symptoms, i. e , for example the amount of bloating, and the sensation of fullness, nausea and/or pain after ingestion of food; 5 • the effect on satiety and/or postprandial symptoms is preferably dosis dependent; in general lower doses lead to a decrease of symptoms, whereas higher doses can increase the symptoms; • the compounds for use according to the invention are effective to modulate the fasting volume and/or the compliance of the GI tract and especially of the
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