HK40074427A - USE OF GLUTARIMIDE DERIVATIVES FOR OVERCOMING STEROID RESISTANCE AND TREATING DISEASES ASSOCIATED WITH ABERRANT INTERFERON γ SIGNALING - Google Patents

Description

Use of glutarimide derivatives for overcoming steroid resistance and treating diseases associated with aberrant interferon gamma signaling

The application is a divisional application of a Chinese patent application with the application number of 201980076564.4, and the original application is an application of entering the Chinese national stage at 20/5/2021 by PCT international application PCT/RU2019/050225 filed on 22/11/2019.

Technical Field

The present invention relates to medicaments, in particular to novel medicaments which are effective in the treatment of diseases associated with aberrant interferon gamma signalling (e.g. sjogren's syndrome, dermatomyositis, systemic lupus erythematosus or systemic sclerosis) and in the treatment of patients with cough and in steroid resistant patients for the treatment of conditions such as asthma, rheumatoid arthritis, systemic lupus erythematosus and gastrointestinal disease.

Background

The problem of treating chronic inflammatory diseases is one of the most practical and socially significant problems of modern medicine. Currently, the main drugs in the etiologic treatment of chronic inflammatory diseases are corticosteroids-prednisolone, dexamethasone, hydrocortisone, betamethasone, etc. [ Am J Respir Crit Care med.2017 Aug 15; 196(4): 414-424]. Glucocorticosteroids (GCS) are the most effective drugs for the treatment of bronchial asthma, chronic glomerulonephritis, interstitial nephritis, rheumatoid arthritis; they are used to a lesser extent in the treatment of chronic obstructive bronchitis, autoimmune pancreatitis and ulcerative necrotizing colitis. Their therapeutic effects are due to powerful anti-inflammatory effects associated with inhibition of inflammatory cells and Mediators produced by these cells, and include inhibition of cytokine (interleukins) and proinflammatory mediator production and their interaction with target cells [ Mediators inflamm.1998; 7(4): 229-37].

It is important to note that sensitivity to corticosteroid drugs is reduced in a significant proportion of patients during long-term treatment, i.e. resistance to steroids occurs. Low sensitivity to steroid treatment is shown in the absence of significant therapeutic effects and this requires an increase in corticosteroid dosage. However, in steroid resistant patients, an increase in steroid dose provides an increase in anti-inflammatory and therapeutic effects for only a short period of time. In addition to resistance during long-term corticosteroid therapy, the disease also appears in clinical practice in the form of steroid resistance, which greatly complicates the choice of drugs for etiological treatment and is a major problem in treating these patients [ Curr Allergy athma rep.2002 Mar; 2(2): 144-50].

Steroid resistance occurs in a variety of inflammatory and autoimmune diseases, including rheumatoid Arthritis, systemic lupus erythematosus, and bowel disease [ Arthritis Res ther 2016 Jun 14; 18(1): 139, and Clin rheumatol.2016 May; 35(5): 1367-75]. Steroid resistance is usually local in nature, i.e. it is observed in areas of chronic inflammation. The main possible mechanisms for the development of Steroid resistance include defects in the translocation of the hormone receptor complex from the cytoplasm into the nucleus, overproduction of "inflammatory" cytokines (in particular IL-2, IL-4, IL-13), increased expression of aberrant β -receptors in the cell, binding of the "hormone receptor" complex to transcription factors (e.g., AP-1), phosphorylation of Steroid receptors induced by p38 mitogen-activated protein kinase (p38 MAPK) and reduction of histone deacetylase activity [ J sterid Biochem Mol biol.2010 May 31; 120(2-3): 76-85].

A known method for increasing the therapeutic efficacy of the treatments used is to administer steroids in combination with cytostatic drugs to patients suffering from autoimmune diseases [ Kotter i., Duck h., Saal j.et. therapy of Behcet's disease// ger.j.ophthalmol-1996-vol.5, No. 2-p.92-97 ]. However, such complex treatments worsen the existing side effects (nephrotoxicity, hepatotoxicity and hemotoxicity) due to the fact that both groups of drugs (both corticosteroids and cytostatics) have significant side effects. When administered in combination, the common side effects are multiply increased. Sometimes, there may be an increase in side effects until a toxic crisis occurs. Therefore, in clinical practice, there is an urgent need for drugs that can overcome steroid resistance.

Asthma and other chronic obstructive pulmonary diseases are diseases that cause several days to fail, are the cause of morbidity structural impairment and are ranked fourth among causes of death [ Clin Chest med.2014 Mar; 35(1): 7-16, Eur Respir j.2001 May; 17(5): 982-94.]. Daily administration of inhaled glucocorticosteroids remains the "gold standard" treatment for asthma and is effective in most patients. However, some patients with severe disease require the use of oral glucocorticosteroids. However, despite the use of high doses of oral glucocorticosteroids, some patients still did not respond to treatment [ lancet.2010.v.376.p.814-825 ]. These steroid insensitive patients typically have no evidence of eosinophilic inflammation [ Froidure Eur Respir J2016; 47: 304-319]. Patients with a non-eosinophilic asthma phenotype respond significantly worse to treatment with inhaled corticosteroids than patients with an eosinophilic asthma phenotype; this difference was confirmed in clinical studies [ thorax.2007 Dec; 62(12): 1043- & 1049], and allowed the authors to identify non-eosinophilic asthma as the sole steroid resistant phenotype of the disease [ Am J Respir Crit Care Med.2009.V.180.P.388-395 ]. It is important to note that the cost of steroid resistant asthma treatment accounts for about 50% of the total healthcare cost of asthma treatment [ Curr Drug targets.2010 Aug; 11(8): 957-70].

Accumulated clinical data have shown that the production of interferon gamma (IFN- γ) and interleukin 17A (IL-17A) by blood cells in asthmatic patients can be predictors of steroid resistance. In [ J Allergy Clin Immunol.2015 Sep; 136(3): 628-637.e4], the authors investigated the predictive potential of IFN-. gamma.and IL-17A levels for determining steroid resistance. Studies have shown that the levels of IFN-. gamma.IL-17A and IFN- + IL-17A correlate negatively with the response intensity of glucocorticoid therapy (prednisolone 40mg, for 2 weeks). In addition, peripheral blood mononuclear cells from steroid resistant asthma patients produced significantly more IFN- γ and IL-17A than blood cells from steroid sensitive asthma patients [ J Allergy Clin immunol.2015 Sep; 136(3): 628-637.e4 ]. Additional confirmation of the role of IFN- γ in the development of steroid-resistant asthma was obtained in a murine model of asthma induced by introduction of OVA-specific cells producing either Th1 cytokines (IL-2, IL-12, IFN- γ) or Th2 cytokines (IL-4, IL-5, IL-13). In the first case, the animals showed development of pulmonary corticosteroid-resistant hyperreactivity. However, the Th2 model showed eosinophilic inflammation that responded well to corticosteroid treatment [ J immunol.2009 Apr 15; 182(8): 5107-15].

Solving the problem of steroid resistance is one of the key challenges in the treatment of inflammatory bowel disease [ Am J Physiol Gastrointest Liver physiol.2013 Dec; 305(11): g763-85 ]. The occurrence of chronic inflammation in the tissues of the gastrointestinal tract results in the influx of interferon gamma-producing cells (mainly macrophages, T cells and NK cells) [ cytokine.2010 Apr; 50(1): 1 to 14; j immunol.1996 Aug 1; 157(3): 1261-70]. Clinical data confirm that IFN- γ levels are inversely correlated with the magnitude of response to glucocorticoid treatment. It is important to note that the use of antibodies against IFN- γ in steroid resistant patients did not fully restore response to treatment [ gut.2006 Aug; 55(8): 1131-7; inflamm Bowel Dis.2010 Feb; 16(2): 233-42], suggesting a complex and multifactorial pathogenesis of steroid resistance in inflammatory bowel disease. In particular, it was demonstrated that Th1 and Th17 cells producing excess cytokine IL-17 are involved in steroid resistance and the development of aberrant interferon gamma signaling [ Am J Physiol Gastrointest lever physiol.2013 Dec; 305(11): g763-85 ].

Thus, literature data enables conclusions to be drawn that: in clinical practice, there is a clear need for drugs that can overcome steroid resistance. Overcoming steroid resistance is of great interest for the treatment of chronic obstructive pulmonary disease, and in particular for the treatment of non-eosinophilic (steroid resistant) asthma and inflammatory bowel disease.

Another group of conditions for which new therapies are required to be developed are diseases associated with aberrant IFN- γ signalling. This group of diseases includes in particular the cough hypersensitivity syndrome that commonly occurs in the context of upper respiratory tract infections [ Allergy Asthma immunological res.2017 Sep; 9(5): 394-402; rev Alerg Mex.2019 Apr-Jun; 66(2): 217-231]. The immune response to respiratory tract infections results in the influx of T lymphocytes and abnormal IFN- γ production. Overproduction of IFN- γ has been associated with the development of chronic cough and cough-hypersensitive syndrome [ J Clin Pharm therm.2011 Jun; 36(3): 416-8], and therefore inhibition of aberrant IFN- γ signaling would be effective in suppressing cough hypersensitivity syndrome occurring in the context of upper respiratory tract infections.

Impaired IFN- γ signaling is a diverse range of autoimmune diseases such as sjogren' S syndrome (systemic autoimmune damage to connective tissue) [ Proc Natl Acad Sci U S a.2012 Oct 23; 109(43): 17609-14), systemic lupus erythematosus, dermatomyositis, and systemic sclerosis [ Discov med.2013 Sep; 16(87): 123-131 ]. The present invention is directed to solving the above problems.

Disclosure of Invention

The object of the present invention is to develop new drugs effective for the treatment of diseases associated with aberrant interferon gamma signaling (e.g. sjogren's syndrome, dermatomyositis, systemic lupus erythematosus or systemic sclerosis), for the treatment of patients suffering from cough and for the treatment of disorders in steroid resistant patients (e.g. asthma, rheumatoid arthritis, systemic lupus erythematosus and gastrointestinal diseases).

The technical result of the present invention is an increase in the effectiveness of baseline treatment with corticosteroids in steroid resistant patients.

The technical result specified is obtained by using the following compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof:

the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione is known and described in WO 2014/168522.

One embodiment of the present invention provides the use of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, of the formula:

another embodiment of the invention provides the use of compound 1 for the treatment of a disease associated with aberrant interferon gamma signaling. The disease associated with aberrant interferon gamma signaling is sjogren's syndrome, dermatomyositis, systemic lupus erythematosus or systemic sclerosis.

Another embodiment of the present invention provides the use of compound 1 for delaying or abrogating the development of resistance to steroid therapy.

Another embodiment of the present invention provides the use of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, of the formula:

the condition is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, or cough.

Another embodiment of the present invention provides a pharmaceutical composition for inhibiting aberrant interferon gamma signaling comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

another embodiment of the present invention provides a pharmaceutical composition for treating a disease associated with aberrant interferon gamma signaling. The disease associated with aberrant interferon gamma signaling is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, or cough.

Another embodiment of the present invention provides a pharmaceutical composition for preventing resistance to steroid treatment.

Another embodiment of the present invention provides a pharmaceutical composition for treating a disorder in a steroid resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

disorders associated with aberrant interferon gamma signaling and with the development of steroid resistance are asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, or cough.

Another embodiment of the present invention provides the use of compound 1 for the preparation of a pharmaceutical composition for inhibiting aberrant interferon gamma signaling.

Another embodiment of the present invention provides the use of compound 1 for the preparation of a pharmaceutical composition for the treatment of a disorder in a steroid resistant patient.

Another embodiment of the present invention provides a method for treating a disease associated with aberrant interferon gamma signaling, comprising administering to an organism a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, or a pharmaceutical composition comprising the same:

another embodiment of the present invention provides a method wherein compound 1 is administered at a dose of 10 to 200 mg/day, preferably 100 mg. Another embodiment of the present invention provides such a method wherein compound 1 is administered 1 to 2 times a day.

Another embodiment of the present invention provides a method for treating a disorder in a steroid resistant patient comprising administering to the body a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, or a pharmaceutical composition comprising the same, of the formula:

another embodiment of the present invention provides a method wherein compound 1 is administered at a dose of 10 to 200 mg/day, preferably 100 mg. Another embodiment of the present invention provides such a method wherein compound 1 is administered 1 to 2 times a day.

Another embodiment of the present invention provides a combination for treating a disorder in a steroid-resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, of the formula:

the steroid is a corticosteroid and the condition is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, or cough.

Another embodiment of the present invention provides a method for treating a disorder in a steroid-resistant patient comprising administering to the body a combination of compound 1 and a steroid.

Another embodiment of the invention is a method wherein compound 1 and the steroid are administered simultaneously or separately. Furthermore, the specified compounds are administered in a dose of 10 to 200 mg/day, preferably 100 mg. In addition, the compounds are administered 1 to 2 times a day.

Drawings

Figure 1 number of patients responding to baseline treatment with inhaled glucocorticosteroids in the context of compound 1 or placebo administration.

Figure 2. effect of IFN- γ levels upon admission (pg/ml) on absolute increase (L) of forced expiratory volume at 1 second (FEV1) (week 12 versus week 0) was tested in patients receiving baseline steroid treatment and compound 1 at a dose of 100mg (designated "baseline steroid treatment + compound 1, 100 mg") and in patients receiving baseline steroid treatment and placebo (designated "baseline steroid treatment + placebo"). Compound 1: for each point, n is the number of patients falling into a given subgroup depending on the type of treatment and the level of IFN- γ.

Figure 3. response to treatment depending on IFN- γ levels at inclusion (change in FEV1 (L) at week 12 versus week 0) in patients receiving baseline steroid treatment and compound 1 at a dose of 100mg (designated "baseline steroid treatment + compound 1, 100 mg") and in patients receiving baseline steroid treatment and placebo (designated "baseline steroid treatment + placebo").

Figure 4. during administration of compound 1 or placebo in combination with baseline steroid treatment, the concentration of interferon gamma-dependent cytokine CXCL10 (interferon gamma-induced protein IP10) in the plasma of patients was varied (difference between levels at week 12 and week 0) depending on IFN-gamma levels at inclusion.

Figure 5. during administration of compound 1 or placebo in combination with baseline steroid treatment, the concentration of interferon gamma in the plasma of patients varied depending on IFN-gamma levels at inclusion (difference between levels at week 12 and week 0).

Detailed Description

The preparation of compound 1, the subject of the present invention, and a number of other chemical compounds is described in WO 2014/168522. The present patent application describes glutarimide derivatives with antiviral action, their use for the treatment of sinusitis and other diseases of the upper respiratory tract.

WO 2015/072893 describes the use of compound 1 for the treatment of diseases associated with the development of eosinophilic inflammation, including eosinophilic asthma. However, the development of eosinophilic inflammation is a major feature of steroid-sensitive asthma, whereas bronchoalveolar lavage (BAL) in treatment-resistant patients receiving treatment with high doses of systemic corticosteroids shows a high number of neutrophils, i.e. steroid-resistant patients mainly suffer from neutrophilic inflammation [ turto g., Baraldo s, Zuin r.the laus of infection: chemokines, neutrophiles and eosinophiles in severe exaaerations of asthma.Thorax.2007; 62(6): 465-466].

In clinical studies of the activity of compound 1, the subject of the present invention, it was unexpectedly found that compound 1 is effective in increasing the number of responders to standard corticosteroid treatment and also in inhibiting aberrant interferon gamma signaling for therapeutic use. Overcoming corticosteroid resistance cannot be predicted or demonstrated by the ability of compound 1 to exert an antiviral effect or inhibit eosinophilic inflammation.

Thus, compound 1 has a previously unknown pharmacological activity associated with aberrant interferon gamma signaling and enhances patient response to corticosteroid treatment, indicating the potential applicability of compound 1 for the treatment of diseases associated with aberrant interferon gamma signaling (e.g., sjogren's syndrome, dermatomyositis, systemic lupus erythematosus, or systemic sclerosis), for the treatment of patients with cough, and for the treatment of conditions (e.g., asthma, rheumatoid arthritis, systemic lupus erythematosus, and gastrointestinal disease) in steroid resistant patients.

Terms and definitions

The term "glucocorticoid (Γ ю kappak · ci iaci ы)" or "glucocorticoid (Γ pi ю ja chi ci ei di ы)" means a steroid hormone from the subclass of corticosteroids and/or synthetic analogs thereof.

The term "corticosteroid" encompasses a subclass of steroid hormones and/or synthetic analogs thereof.

The term "compound 1" refers to the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, which is also represented by the following structural formula:

the term "steroid resistance" means a disease state in which steroid therapy is ineffective, which steroid therapy is generally effective in the treatment of patients suffering from the disease. Steroid resistant patients include, but are not limited to, patients who do not respond or respond poorly or inadequately to treatment with systemic or oral corticosteroids based on conventional parameters of response.

The term "pharmaceutically acceptable salts" or "salts" include salts of the active compounds prepared with relatively nontoxic acids. Some examples of pharmaceutically acceptable non-toxic salts include salts formed with inorganic acids (e.g., hydrochloric, hydrobromic, phosphoric, sulfuric, and perchloric acids) or organic acids (e.g., acetic, oxalic, maleic, tartaric, succinic, citric, or malonic acids), or salts prepared by other methods used in the art. Additional pharmaceutically acceptable salts include adipates, alginates, ascorbates, aspartates, benzenesulfonates, benzoates, bisulfates, borates, butyrates, camphorates, camphorsulfonates, citrates, cyclopentanepropionates, digluconates, dodecylsulfates, ethanesulfonates, formates, fumarates, glucoheptonates, glycerophosphates, gluconates, hemisulfates, heptanoates, hexanoates, hydroiodides, 2-hydroxy-ethanesulfonates, lactobionates, lactates, laurates, malates, maleates, malonates, methanesulfonates (methanesulfonates), 2-naphthalenesulfonates, nicotinates, nitrates, oleates, oxalates, palmitates, pamoates, pectinates, persulfates, 3-phenylpropionates, salts of benzoic acid, bisulfates, salts of acid, salts of hydrogen, salts of 2-hydroxy-ethanesulfonates, salts of lactobionates, salts of acid, salts of malonic acid, salts of malonic acid, salts of malonic acid, salts of benzoic acid, salts of salts, Phosphates, picrates, pivalates, propionates, hemifumarates, stearates, succinates, sulfates, tartrates, thiocyanates, p-toluenesulfonates (tosylates), undecanoates, valerates, and the like.

The terms "treatment" and "therapy" encompass the treatment of pathological conditions in mammals, preferably in humans, and include: a) reduction, b) blocking (inhibiting) the course of the disease, c) lessening the severity of the disease (i.e., inducing regression of the disease), d) reversing the disease or condition to which the term applies or one or more symptoms of the disease or condition.

The term "prevention" encompasses the elimination of risk factors and the prophylactic treatment of a sub-clinical stage of a disease in a mammal, preferably a human, with the aim of reducing the likelihood of the occurrence of the clinical stage of the disease. The choice of patients for prophylactic treatment is based on factors known to be associated with an increased risk of disease progression to the clinical stage compared to the general population. Prophylactic treatment includes a) primary prevention and b) secondary prevention. Primary prevention is defined as prophylactic treatment of patients with a disease that has not reached clinical stage. Secondary prevention is the prevention of recurrence of the same or similar clinical condition of the disease.

Methods for therapeutic use of compounds

The subject of the invention is also the administration of a therapeutically effective amount of a compound according to the invention to a subject in need of appropriate treatment. A therapeutically effective amount means the amount of a compound that, when administered or delivered to a patient, is most likely to provide the patient with the desired response to treatment (prophylaxis). The precise amount required may vary from subject to subject depending on the age, weight and general condition of the patient, the severity of the disease, the method of drug administration, use in combination with other drugs, and the like.

The compound according to the invention or a pharmaceutical composition comprising said compound may be administered to a patient in any amount effective for the treatment or prevention of a disease (preferably a daily dose of the active substance of up to 0.2 g/patient/day, most preferably a daily dose of 10 to 200 mg/day, preferably 100mg) and by any route of administration (preferably by oral route of administration) effective for the treatment or prevention of a disease.

The compositions according to the invention may be administered to humans or other animals orally, parenterally, topically, etc., after mixing the drug with a particular suitable pharmaceutically acceptable carrier in the desired dosage.

Administration may be performed both once and several times a day, week (or any other time interval), or from time to time. In addition, the compound may be administered to the patient daily for a specified number of days (e.g., 2 to 10 days), followed by a period of non-administration (e.g., 1 to 30 days).

When the compounds according to the invention are used as part of a combination therapy, the dose of each of the combination therapy components is administered within the desired treatment period. The compounds of the combination therapy may be administered to the body of the patient both in a dosage form comprising all the components and in separate component dosage forms.

Use of Compound 1 in combination therapy

Although compound 1 according to the present invention may be administered as the sole active agent, it may also be used in combination with one or more other agents; in particular, the other agent may be a glucocorticosteroid, a leukotriene receptor antagonist, a bronchodilator, a monoclonal antibody, or the like. When administered in combination, the therapeutic agents may be administered simultaneously or sequentially in different dosage forms at different times, or the therapeutic agents may be combined in a single dosage form.

The phrase "combination therapy" when referring to a compound of the present invention for use in combination with other agents means that all agents are administered simultaneously or sequentially such that the beneficial effects of the combination of agents will be provided in any manner. Co-administration means in particular co-delivery, for example in one tablet, capsule, injection or other form with a fixed ratio of active substances, and simultaneous delivery in several separate dosage forms for each compound, respectively.

Accordingly, compound 1 of the present invention may be administered in combination with additional therapies known to those skilled in the prevention and treatment of the corresponding diseases, including the use of antibacterial, cytostatic, and cytotoxic agents, medical preparations for inhibiting symptoms or side effects of one of the drugs.

If the dosage form is a fixed dose, such a combination comprises a compound according to the invention within an acceptable dosage range. If these drugs cannot be combined, compound 1 of the present invention may also be administered to a patient sequentially with other agents. The present invention is not limited to a particular order of administration; the compounds of the invention may be administered to a patient simultaneously with the administration of another drug or at any time before or after the administration of another drug.

Examples

Preparation of the Compounds according to the invention

The preparation of compound 1, the subject of the present invention, and a number of other chemical compounds is described in WO 2014/168522. The present patent application describes glutarimide derivatives with antiviral action, their use for the treatment of sinusitis and other diseases of the upper respiratory tract.

Characterization of the biological Activity of the Compounds according to the invention

The biological activity of compound 1, the subject of the present invention, has been studied in extensive preclinical trials as well as in multicenter, double-blind, randomized phase II clinical trials (12 weeks treatment period) in patients with bronchial asthma. The therapeutic use of compound 1 has been shown to effectively increase the number of responders to standard treatment with inhaled corticosteroids. Overcoming resistance to inhaled corticosteroids cannot be predicted or demonstrated by the ability of compound 1 to exert antiviral effects or inhibit eosinophilic inflammation.

EXAMPLE 1 study of the Activity of Compound 1 in clinical trials

In a multicenter, double-blind, randomized, parallel group phase II clinical trial study (PULM-XC8-02, NCT03450434) on evaluating the effectiveness and safety of different doses of compound 1 relative to placebo in 12-week treatment of patients with bronchial asthma, it was unexpectedly found that the therapeutic use of compound 1 effectively increased the number of responders to standard treatment with inhaled corticosteroids. Thus, compound 1 is potentially useful for the treatment of diseases associated with the development of steroid resistance, in particular for the treatment of steroid resistant asthma.

In clinical trials, eligible patients were randomized 1: 1 into one of four groups:

compound 1 at a dose of 2 mg/day;

-compound 1 at a dose of 10 mg/day;

-compound 1 at a dose of 100 mg/day; and

-a placebo.

During the study treatment period, patients received compound 1 or placebo in the context of baseline steroid treatment with low dose inhaled corticosteroids for 12 weeks. Compound 1 or placebo was administered orally 30 minutes before breakfast once a day.

Clinically significant effects were obtained at a dose of compound 1 of 100 mg/day.

Exploratory analysis of clinical trial results for patients with bronchial asthma showed that compound 1 effectively increased the number of responders to standard treatment. For example, use of baseline steroid treatment and placebo resulted in an increase of 100ml or more in FEV1 in only 13 of 29 patients, while use of baseline steroid treatment and compound 1 resulted in a response in 20 of 29 patients, thus resulting in a significant increase in the number of patients who had a response to baseline steroid treatment (fig. 1). Thus, one of the effects of using compound 1 is to overcome resistance to corticosteroids, which is the basis of baseline treatment of patients incorporated in clinical trials.

To investigate the effect of baseline IFN- γ levels in asthmatic patients, the results obtained in clinical studies were additionally analyzed; patient response to treatment was studied based on baseline IFN- γ levels in the blood of patients at the time of enrollment (determined by Bio-Plex Pro Human Chemokine Panel Assay (Bio-Rad)).

In the baseline steroid treatment and placebo groups, the patient's response to baseline treatment decreased with increasing baseline levels of IFN- γ (figure 2). Treatment with baseline steroid did not result in positive changes in respiratory function as determined by FEV1 changes (0.1L or more reduction observed, fig. 2) in patients with IFN- γ levels > 100pg/ml, i.e. these patients exhibited resistance to steroid treatment (lack of positive response to treatment). The use of compound 1 administered at a dose of 100 mg/day provides a significantly greater and clinically significant response to treatment in patients, particularly in patients with IFN- γ levels greater than 100pg/ml, in the context of baseline steroid therapy (figure 3). This fact suggests overcoming steroid resistance, which may be caused in particular by abnormal IFN- γ signalling.

In addition, the effect of compound 1 on IFN- γ signaling was also analyzed in clinical trials. It was shown that compound 1 administered in the context of baseline steroid treatment inhibited the concentration of the interferon-gamma dependent cytokine CXCL10 (interferon-gamma induced protein IP10) in patients with IFN-gamma baseline levels > 100pg/ml, whereas the CXCL10 level was slightly increased in the group of patients receiving placebo in the context of baseline steroid treatment (fig. 4). In addition, the therapeutic use of compound 1 in the context of baseline treatment also resulted in a negative dynamic of IFN- γ concentration in the plasma of patients, independent of IFN- γ levels upon admission, compared to the use of baseline treatment and placebo only (fig. 5). Thus, inhibition of steroid resistance induced by the use of compound 1 could potentially be correlated with an effect on the aberrant activity (signaling) of IFN- γ.

Example 2 Compound 1 in acuteStudy of Activity in oxazolone-induced intestinal inflammation model

Standard methods were used [ immunity.2002.P.629-638]Study of Compound 1 in acuteActivity in a model of oxazolone-induced ulcerative colitis.

In this study, female balb/c mice (6 to 8 weeks old) were used. Compound I was administered intragastrically 3 times: administration in the rectum1 hour, 25 hours, and 49 hours after the oxazolone. In application ofPrior to and administration of oxazoloneBody weights of the animals were measured 24, 48 and 72 hours after the oxazolone. In application of72 hours after oxazolone, intestinal wall damage was evaluated microscopically according to the following scoring scale:

0 is not damaged, and the medicine is not damaged,

congestion, no ulcer,

congestion, thickening of the intestinal wall, absence of ulcers,

3-1 ulcer, no thickening of intestinal wall,

2 or more sites of ulceration or inflammation,

2 or more severe ulcerations and inflammation sites, or >1 along the length of the colon

cm at 1 ulcer/inflammation site, and

lesions covering > 2cm long of colon length, increasing score by 1 every additional 1cm included.

All data were statistically represented by descriptive: the arithmetic mean (M) and the standard error of the arithmetic mean (M) were analyzed. The obtained experimental data distribution was checked for normality using the Shapiro-Wilk test. The normal distribution was analyzed with one-way ANOVA (with Dunnett's post hoc analysis) to assess inter-group differences. The non-normal distribution was analyzed with one-way ANOVA (with Tukey post hoc analysis) to compare several groups. Differences were determined at a confidence level of 5%. The results of the study are shown in tables 1 and 2.

TABLE 1. in acute stageEffect of Compound 1 on damage to the colonic wall in murine models of oxazolone-induced ulcerative colitis (M + -M, n-10)

Note that:

statistical significance relative to the complete group (P < 0.05)

Statistical significance of & -relative to control (P < 0.05)

TABLE 2. in acute stageEffect of Compound I on animal body weight in the mouse model of oxazolone-induced ulcerative colitis (M + -M, n ═ 10)

Note that:

statistical significance relative to the complete group (P < 0.05)

Statistical significance of & -relative to control (P < 005)

The results of the study show that when administered intragastrically, compound I reduces the extent of colonic wall damage and prevents weight loss in animals. Thus, compound I has a therapeutic effect in murine models of ulcerative colitis. Compound 1 has a potency not inferior to that of prednisolone.

Example 3 study of the activity of Compound 1 in a cough guinea pig model induced by inhaled citric acid and IFN-. gamma..

The activity of compound I in a cough guinea pig model induced by inhaled citric acid and IFN- γ was studied according to the method [ Am J Respir Crit Care med.2018.v.198(7). p.868-879 ].

In this study, Aguti-line guinea pigs were used. All experimental animals were inhaled in a citric acid solution (0.3M) prepared in physiological saline for 8 minutes. The pathological control group and the treatment-receiving group were allowed to inhale IFN-. gamma.10. mu.g/kg for 3 minutes 7 hours before the citrate inhalation. Compound 1 was administered intragastrically once immediately after IFN- γ inhalation, i.e., 7 hours prior to inhalation of the citric acid solution. Antitussive activity was assessed by counting the number of cough episodes within 8 minutes from inhalation of citric acid. All data were statistically represented by descriptive: the arithmetic mean (M) and the standard error of the arithmetic mean (M) were analyzed. The obtained experimental data distribution was checked for normality using the Shapiro-Wilk test. The normal distribution was analyzed with one-way ANOVA (with Dunnett's post hoc analysis) to assess the differences between groups. The non-normal distribution was analyzed with one-way ANOVA (with Tukey post hoc analysis) to compare several groups. Differences were determined at a confidence level of 5%. The results of the study are shown in tables 1 and 2.

The results of the study are given in table 3.

The results of the study show that compound 1 reduces the number of cough episodes when administered intragastrically. Thus, compound I has a therapeutic effect in the acute and subacute viral cough guinea pig model induced by inhaled citric acid and IFN- γ. Table 3. effect of compound I on the number of cough actions in a viral cough guinea pig model induced by inhaled citric acid and IFN- γ (M ± M, n ═ 5).

Note that:

and statistical significance relative to control (P < 0.05)

The following corresponds to the original claims in the parent application, which are now incorporated as part of the specification:

1. use of a compound of the formula 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, for inhibiting aberrant interferon gamma signaling:

2. the use according to item 1 for the treatment of a disease associated with aberrant interferon gamma signaling.

3. The use according to item 2, wherein the disease associated with aberrant interferon gamma signaling is sjogren's syndrome, dermatomyositis, systemic lupus erythematosus or systemic sclerosis.

4. The use according to item 1 for reducing or eliminating the occurrence of resistance to steroid therapy.

5. Use of a compound of the formula 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, for treating a disorder in a steroid-resistant patient:

6. the use according to item 5, wherein the disorder is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, and cough.

7. A pharmaceutical composition for inhibiting aberrant interferon gamma signaling, wherein said pharmaceutical composition comprises a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

8. the pharmaceutical composition of item 7 for use in treating a disease associated with aberrant interferon gamma signaling.

9. The pharmaceutical composition of item 8, wherein the disease associated with aberrant interferon-gamma signaling is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease, and cough.

10. The pharmaceutical composition according to item 7, for use in the prevention of resistance to steroid treatment.

11. A pharmaceutical composition for treating a disorder in a steroid-resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

12. the pharmaceutical composition according to item 11, wherein the disorders associated with aberrant interferon gamma signaling and with the development of steroid resistance are asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease and cough.

13. Use of a compound as defined in item 1 for the preparation of a pharmaceutical composition according to item 7.

14. Use of a compound as defined in item 5 for the preparation of a pharmaceutical composition according to item 11.

15. A method of treating a disease associated with aberrant interferon gamma signaling comprising administering to a body a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione of the following formula or a pharmaceutically acceptable salt thereof or a pharmaceutical composition according to item 7:

16. the method of item 15, wherein the compound is administered at a dose of 10 to 200 mg/day.

17. The method of any one of claims 15 to 16, wherein the compound is administered 1 to 2 times a day.

18. A method for treating a disorder in a steroid-resistant patient comprising administering to the body a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione of the formula:

19. the method of item 18, wherein the compound is administered at a dose of 10 to 200 mg/day.

20. The method of any one of claims 18-19, wherein the compound is administered 1 to 2 times a day.

21. A combination for treating a condition in a steroid-resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, of the formula:

22. the combination of clause 21, wherein the steroid is a corticosteroid.

23. The combination according to item 21, wherein the disorder is asthma, rheumatoid arthritis, systemic lupus erythematosus, gastrointestinal disease and cough.

24. A method for treating a disorder in a steroid-resistant patient comprising administering to the body a combination according to item 21.

25. The method of claim 24, wherein the compound and steroid are administered simultaneously or separately.

26. The method of any one of claims 24 to 25, wherein the compound is administered at a dose of 10 to 200 mg/day.

27. The method of any one of claims 24 to 26, wherein the compound is administered 1 to 2 times a day.

Claims (23)

1. Use of a compound of the formula 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, for the preparation of a pharmaceutical composition for inhibiting aberrant interferon gamma signaling:

wherein the pharmaceutical composition comprises a therapeutically effective amount of the compound and at least one pharmaceutically acceptable carrier.

2. The use according to claim 1, wherein the pharmaceutical composition is for the treatment of a disease associated with aberrant interferon gamma signaling.

3. The use of claim 2, wherein the disease associated with aberrant interferon gamma signaling is sjogren's syndrome, dermatomyositis, systemic lupus erythematosus, systemic sclerosis, or asthma.

4. The use according to claim 1, wherein the pharmaceutical composition is for reducing or eliminating the occurrence of resistance to steroid therapy, with the proviso that the steroid therapy does not involve the treatment of cough.

5. Use of a compound of the formula 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, for the manufacture of a pharmaceutical composition for treating a condition in a steroid resistant patient, with the proviso that the condition does not relate to the treatment of cough:

wherein the pharmaceutical composition comprises a therapeutically effective amount of the compound and at least one pharmaceutically acceptable carrier.

6. Use according to claim 5, wherein the condition is asthma, rheumatoid arthritis, systemic lupus erythematosus or gastrointestinal disease.

7. A pharmaceutical composition for inhibiting aberrant interferon gamma signaling, wherein said pharmaceutical composition comprises a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

8. the pharmaceutical composition according to claim 7 for use in the treatment of a disease associated with aberrant interferon gamma signaling.

9. The pharmaceutical composition of claim 8, wherein the disease associated with aberrant interferon gamma signaling is asthma, sjogren's syndrome, dermatomyositis, systemic lupus erythematosus or systemic sclerosis.

10. The pharmaceutical composition according to claim 7 for use in the prevention of resistance to steroid treatment, with the proviso that the steroid treatment does not involve the treatment of cough.

11. A pharmaceutical composition for treating a condition in a steroid-resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, having the formula:

12. the pharmaceutical composition of claim 11, wherein the disorder associated with the development of steroid resistance is asthma, rheumatoid arthritis, systemic lupus erythematosus or gastrointestinal disease.

13. The use of claim 2, wherein the compound is administered at a dose of 10 to 200 mg/day.

14. The use of claim 2, wherein the compound is administered from 1 to 2 times a day.

15. The use of claim 5, wherein the compound is administered at a dose of 10 to 200 mg/day.

16. The use of claim 5, wherein the compound is administered from 1 to 2 times a day.

17. A combination for treating a condition in a steroid-resistant patient comprising a therapeutically effective amount of the compound 1- (2- (1H-imidazol-4-yl) ethyl) piperidine-2, 6-dione, or a pharmaceutically acceptable salt thereof, of the formula:

18. the combination of claim 17, wherein the steroid is a corticosteroid.

19. The combination according to claim 17, wherein the disorder is asthma, rheumatoid arthritis, systemic lupus erythematosus or gastrointestinal disease.

20. Use of a combination according to claim 17 for the preparation of a medicament for the treatment of a disorder in a steroid resistant patient, wherein the treatment comprises administration of the combination to the body.

21. The use of claim 20, wherein the compound and steroid are administered simultaneously or separately.

22. The use of any one of claims 20-21, wherein the compound is administered at a dose of 10 to 200 mg/day.

23. The use of any one of claims 20-22, wherein the compound is administered 1 to 2 times a day.