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WO2002003992A2 - Use of substituted indole compounds for treating prosthesis-related bone degeneration - Google Patents

Use of substituted indole compounds for treating prosthesis-related bone degeneration Download PDF

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Publication number
WO2002003992A2
WO2002003992A2 PCT/US2001/021084 US0121084W WO0203992A2 WO 2002003992 A2 WO2002003992 A2 WO 2002003992A2 US 0121084 W US0121084 W US 0121084W WO 0203992 A2 WO0203992 A2 WO 0203992A2
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alkyl
pharmaceutically acceptable
acceptable salt
phenyl
hydroxy
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PCT/US2001/021084
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French (fr)
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WO2002003992A3 (en
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Simon Nicholas Jenkins
Barry Samuel Komm
Christopher Paul Miller
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Wyeth
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Publication of WO2002003992A3 publication Critical patent/WO2002003992A3/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/4025—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil not condensed and containing further heterocyclic rings, e.g. cromakalim
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/40—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil
    • A61K31/403—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with one nitrogen as the only ring hetero atom, e.g. sulpiride, succinimide, tolmetin, buflomedil condensed with carbocyclic rings, e.g. carbazole
    • A61K31/404—Indoles, e.g. pindolol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/439—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom the ring forming part of a bridged ring system, e.g. quinuclidine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
    • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
    • A61K31/445—Non condensed piperidines, e.g. piperocaine
    • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
    • A61K31/454—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a five-membered ring with nitrogen as a ring hetero atom, e.g. pimozide, domperidone
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
    • A61K31/5355—Non-condensed oxazines and containing further heterocyclic rings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/56—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids
    • A61K31/565—Compounds containing cyclopenta[a]hydrophenanthrene ring systems; Derivatives thereof, e.g. steroids not substituted in position 17 beta by a carbon atom, e.g. estrane, estradiol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00—Drugs for skeletal disorders
    • A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease

Definitions

  • This invention relates to methods of using substituted indole compounds optionally in combination with one or more estrogens for the treatment, prevention, inhibition or alleviation of bone prosthesis degeneration. More particularly, this invention provides such methods for treating the degeneration or other damage to tissues surrounding or interacting with prosthetic devices.
  • prosthetic devices has become common in replacement of damage tissues in various joints, including the hip and knee.
  • Prosthetic dental implants have also become quite common for individual or sequential teeth.
  • the use of such prosthetic devices has significantly improved the quality of life for many recipients.
  • estrogenic agents including the treatment of bone loss, cardiovascular disease, maladies associated with or resulting from the proliferation or abnormal development of endometrial or endometrial-like tissues, and disease states or syndromes associated with estrogen deficiency.
  • This invention comprises methods of treating, inhibiting, preventing, or alleviating bone prosthesis degeneration in a mammal, preferably in a human, the methods comprising administering to a mammal in need a pharmaceutically effective amount of a substituted indole compound of the formulae I or ⁇ , below:
  • Z is a moiety selected from the group of:
  • R ⁇ is selected from H, OH or the C1-C 1 2 esters (straight chain or branched) or
  • R 2 , R 3 , R 5 , and R 6 are independently selected from H, OH or the C1-C12 esters
  • R is selected from H, OH or the C1-C1 2 esters (straight chain or branched) or C,-C 12 alkyl ethers (straight chain or branched or cyclic) thereof, benzyloxy, halogens, or C ⁇ C 4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether, cyano, Ci-C ⁇ alkyl (straight chain or branched), or trifluoromethyl;
  • X is selected from H, Ci-C ⁇ alkyl, cyano, nitro, trifluoromethyl, halogen;
  • n is 1, 2 or 3;
  • Y is selected from: a) the moiety:
  • R7 and Rs are independently selected from the group of H, C1-C6 alkyl, or phenyl optionally substituted by CN, C ⁇ -C6 alkyl (straight chain or branched), Ci-C ⁇ alkoxy (straight chain or branched), halogen, -OH, -CF 3 , or -OCF 3 ; or R 7 and R 8 are combined by -(CH 2 )p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alko y, trihalomethoxy, Ci- C4alkylthio, C ⁇ -C4alkylsulfinyl, C ⁇ -C4alkylsulfonyl, hydroxy(C ⁇ -C4)alkyl, -CO 2 H, -CN
  • a five-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(C ⁇ _C4 alkyl)-, -N , and -S(O) m -, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, C ⁇ -C4acyloxy, C ⁇ -C4alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy(C ⁇ -C )alkyl, -CO 2 H-, -CN-, -CONHR,, -NH 2 , C ⁇ -C 4 alkylamino, di(C ⁇ -C 4 )
  • a six-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N( C4 alkyl)-, -N , and -S(O) m -, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C ⁇ -C4acyloxy, C ⁇ -C4alkylthio, C ⁇ -C 4 alkylsulfinyl, C ⁇ -C 4 alkylsulfonyl, hydroxy(C ⁇ -C 4 )alkyl, -CO 2 H, -CN, -CONHR,, -NH 2 , C ⁇ -C 4 alkylamino, di(C ⁇ -C4)alkylamino,
  • a seven-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(C ⁇ _C4alkyl)-, -N , and -S(O) m -, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, -C4 alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C ⁇ -C 4 acyloxy, C ⁇ -C4alkylthio, C ⁇ -C 4 alkylsulfinyl, C ⁇ -C 4 alkylsulfonyl, hydroxy(C ⁇ -C 4 )alkyl, -CO 2 H, -CN,
  • a bicyclic heterocycle containing from 6-12 carbon atoms either bridged or fused and containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(C ⁇ _C4alkyl)-, and -S(O) m -, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C ⁇ -C 4 acyloxy, C ⁇ -C4alkylthio,
  • substituted indole compounds for use in the methods of this invention are those having the general structures I or II, above, wherein:
  • R ! is selected from H, OH or the -C1 2 esters or alkyl ethers thereof, benzyloxy, or halogen;
  • R 2 , R 3 , R 5 , and R 6 are independently selected from H, OH or the -C 12 esters or alkyl ethers thereof, halogen, cyano, Ci-C ⁇ alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R 2 is not OH; R is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, halogen, cyano, Ci-C ⁇ alkyl, or trihalomethyl;
  • X is selected from H, Ci-C ⁇ alkyl, cyano, nitro, trifluoromethyl, halogen; Y is the moiety
  • R 7 and R 8 are selected independently from H, C ⁇ -C6 alkyl, or combined by -(CH 2 )p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, Ci-G ⁇ alkyl- thio, C ⁇ -C alkylsulfinyl, Ci- alkylsulf ⁇ nyl, hydroxy(C ⁇ - )alkyl, -CO H, -CN, -CONH(C ⁇ -C 4 )alkyl, -NH 2 , C ⁇ -C 4 alkylamino, di (C 1 -C4 )alkylamino, -NHSO 2 (C ⁇ - C 4 )alkyl, -NHCO(C ⁇ -C 4 )alkyl
  • the rings formed by a concatenated R7 and Rs, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.
  • the most preferred compounds of the present invention are those having the structural formulas I or II, above, wherein Ri is OH; R2 - R6 are as defined above; X is selected from the group of Cl, NO 2 , CN, CF3, or CH3; and Y is the moiety
  • R7 and Rs are concatenated together as -(CH 2 )r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C 1 -C4 alkoxy, trihalomethoxy, -C4 alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy (C ⁇ -C 4 )alkyl, -CO 2 H, -CN, -CONH(C ⁇ -C 4 )alkyl, -NH 2 , - alkylamino, di(C ⁇ - C 4 )alkylamino, -NHSO 2 (C ⁇ -C 4 )alkyl, -NHCO(C ⁇ -C 4 )alkyl, and -NO 2 ; and the pharmaceutically acceptable salts thereof.
  • R7 and Rs are concatenated together as -(CH 2 )p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
  • the invention includes sulfate, sulfamates and sulfate esters of phenolic groups in these compounds.
  • Sulfates can be readily prepared by the reaction of the free phenolic compounds with sulfur trioxide complexed with an amine such as pyridine, trimethylamine, triethylamine, etc.
  • Sulfamates can be prepared by treating the free phenolic compound with the desired arnino or alkylamino or dialkylamino sulfamyl chloride in the presence of a suitable base such as pyridine.
  • Sulfate esters can be prepared by reaction of the free phenol with the desired alkanesulfonyl chloride in the presence of a suitable base such as pyridine.
  • this invention includes compounds containing phosphates at the phenol as well as dialkyl phosphates.
  • Phosphates can be prepared by reaction of the phenol with the appropriate chlorophosphate.
  • the dialkylphosphates can be hydrolyzed to yield the free phosphates.
  • Phosphinates are also claimed where the phenol is reacted with the desired dialkylphosphinic chloride to yield the desired dialkylphosphinate of the phenol.
  • the invention includes acceptable salt forms of these compounds formed from the addition reaction with either inorganic or organic acids.
  • Inorganic acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, nitric acid useful as well as organic acids such as acetic acid, propionic acid, citric acid, maleic acid, malic acid, tartaric acid, phthalic acid, succinic acid, methanesulfonic acid, toluenesulfonic acid, napthalenesulfonic acid, camphorsulfonic acid, benzenesulfonic acid are useful.
  • this invention includes quaternary ammonium salts of the compounds herein. These can be prepared by reacting the nucleophilic amines of the side chain with a suitably reactive alkylating agent such as an alkyl halide or benzyl halide.
  • the methods of this invention include therapies and pharmaceutical regimens for treatment, prevention, inhibition or alleviation of bone prosthesis degeneration.
  • Such methods include the maintenance and enhancement of the bone and related tissues surrounding or operating in relation to or in contact with the orthopedic or dental prosthetic device in question to facilitate survival or maintenance of the usefulness and utility of the prosthesis over time.
  • the methods of this invention may be utilized remedially or prophylactically, as determined by a medical professional. These methods include maintenance of tissue and inhibition of degeneration associated with prosthetic replacement associated with various joints including, but not limited to, those of the knee, hip, shoulder (humeral), elbow, wrist and ankle.
  • prosthetic devices include those of various materials known in the art, including devices and implants comprised of metal, polymers, ceramics, or other materials.
  • a pharmaceutically effective amount of one or more of the compounds of this invention, or the pharmaceutically acceptable salts thereof is an amount sufficient to provide efficacious results in maintaining the bone and related tissues in question in a healthy state for interaction with the relevant prosthesis or to inhibit, delay, or otherwise counter degeneration or deterioration of the tissues to prolong the period in which the prosthesis may be used.
  • These methods each comprise administering to a mammal in need thereof a pharmaceutically effective amount of a pharmaceutically effective amount of one of the substituted indoles taught herein and optionally one or more estrogens. These administrations may be therapeutic or prophylactic.
  • preferred substituted indole compounds for use in these methods are l-[4-(2-azepan-lyl-ethoxy)-benzyl]-2- (4-hydroxy-phenyl)-3-methyl-lH-indol-5-ol, also known as TSE-424, and 2-(4- hy droxy-pheny l)-3-methyl- 1 -(4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H-indol-5-ol, also known as ERA-923, or a pharmaceutically acceptable salt of TSE-424 or ERA-923.
  • Estrogens useful in the formulations of this invention include estrone, estriol, equilin, estradiene, equilenin, ethinyl estradiol, 17 ⁇ -estradiol, 17 ⁇ -dihydroequilenin, 17 ⁇ -dihydroequilenin (U.S. Patent 2,834,712), 17 ⁇ -dihydroequilin, 17 ⁇ -dihydro- equilin, menstranol and conjugated estrogenic hormones, such as those in Wyeth- Ayerst Laboratories' Premarin ® products (P.O. Box 8299, Philadelphia, PA 19101, U.S.A.).
  • Phytoestrogens such as equol or enterolactone, may also be used in the present formulations and methods.
  • a preferred embodiment of this invention comprises pharmaceutical compositions and methods of treatment utilizing conjugated estrogenic hormones, such as those in Wyeth-Ayerst Laboratories' Premarin ® products, with one or more compounds of Formulas (I) or (III) listed herein.
  • conjugated estrogenic hormones such as those in Wyeth-Ayerst Laboratories' Premarin ® products, with one or more compounds of Formulas (I) or (III) listed herein.
  • Esterified estrogens such as those sold by Solvay Pharmaceuticals, Inc. under the Estratab® tradename, may also be used with the present formulations.
  • the salts of the applicable estrogens most preferably the sodium salts.
  • Examples of these preferred salts are Sodium estrone sulfate, Sodium equilin sulfate, Sodium 17alpha-dihydroequilin sulfate, Sodium 17alpha-estradiol sulfate, Sodium Delta8,9- dehydroestrone sulfate, Sodium equilenin sulfate, Sodium 17beta-dihydroequilin sulfate, Sodium 17alpha- dihydroequilenin sulfate, Sodium 17beta-estradiol sulfate, Sodium 17beta- dihydroequilenin sulfate, Estrone 3-sodium sulfate, Equilin 3-sodium sulfate, 17alpha-Dihydroequilin 3-sodium sulfate, 3beta-Hydroxy-estra-5(10),7-dien-17-one 3-sodium sul
  • a substituted indole compound selected from l-[4-(2-azepan-lyl- ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH-indol-5-ol, also known as TSE- 424, and 2-(4-hydroxy-phenyl)-3-methyl-l-(4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol, also known as ERA-923, or a pharmaceutically acceptable salt of TSE-424 or ERA-923; and
  • the conjugated estrogenic hormones such as those of the Premarin ® brand products marketed by Wyeth-Ayerst Laboratories.
  • the present invention includes methods utilizing in conjunction with one or more estrogen, or a pharmaceutically acceptable salt thereof, a first subset or subgroup of substituted indole compounds of the formulas III or IN, below:
  • variable substituents including R, R 2 , R 3 , R 4 , R 5 , R 6 , n, X, and Y are as defined above, or a pharmaceutically acceptable salt thereof.
  • the more preferred compounds of this first subset of indole compounds are those having the general structures III or IV, above, wherein:
  • R j is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, or halogen;
  • R 2 , R 3 , R 5 , and R 6 are independently selected from H, OH or the C1-C1 2 esters or alkyl ethers thereof, halogen, cyano, C ⁇ -C6 alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R2 is not OH;
  • R 4 is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, halogen, cyano, Ci-C ⁇ alkyl, or trihalomethyl;
  • X is selected from H, Ci-C ⁇ alkyl, cyano, nitro, trifluoromethyl, halogen;
  • Y is the moiety
  • R 7 and R 8 are selected independently from H, alkyl, or combined by -(CH 2 )p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C ⁇ - C4alkylthio, - alkylsulfinyl, Ci- alkylsulfonyl, hydroxy(C ⁇ - )alkyl, -CO 2 H, -C ⁇ , -CO ⁇ H(C ⁇ -C 4 )alkyl, -NH 2 , C ⁇ -C 4 alkylamino, di(C ⁇ -C 4 )alkylamino, -NHSO 2 (C ⁇ -C 4 )alkyl, -NHCO(C ⁇ -C 4 )alkyl, and -NO
  • the most preferred compounds of this first subset of indole compounds are those having the structural formulas I or II, above, wherein Ri is OH; R 2 - Re are as defined above; X is selected from the group of Cl, NO 2 , CN, CF3, or CH3; and Y is the moiety
  • R s and R7 and Rs are concatenated together as -(CH 2 )r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alko y, trihalomethoxy, C ⁇ -C4alkylthio, C ⁇ -C4alkylsulfinyl, C ⁇ -C4alkylsulfonyl, hydroxy(C ⁇ -C 4 )alkyl, -CO 2 H, -CN, -CONH(C ⁇ -C 4 )alkyl, -NH 2 , C ⁇ -C 4 alkylamino, di(C ⁇ -C 4 )alkylamino, -NHSO 2 (C ⁇ -C 4 )alkyl, -NHCO(C ⁇ -C )alkyl, and -NO 2 ; and the
  • this first subset of compounds when R7 and Rs are concatenated together as -(CH 2 )p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
  • the compounds of this first subset or subgroup of indole compounds can be produced by the methods described in EP 0 802 183 Al, published October 22, 1997, and U.S. Patent No. 5,780,497, the subject matter of which is incorporated herein by reference, or by other methods known in the art.
  • Aryloxy-alkyl-dialkylamines or aryloxy-alkyl-cyclic amines useful as intermediates in the production of the compounds above can be produced and used as disclosed in WO 99/19293, published April 22, 1999, the subject matter of which is also incorporated herein by reference.
  • a second subset or subgroup of indole compounds useful with this invention includes those of formulas (V) or (VI), below:
  • variable substituents including R, R 2 , R 3 , R 4 , R 5 , R 6 , n, X, and Y are as defined above, or a pharmaceutically acceptable salt thereof.
  • a third subset of indole compounds useful with the present invention include those of the formulae Nil and NIII:
  • R t is selected from H, OH or the C ⁇ -C ⁇ esters or alkyl ethers thereof, halogen;
  • R 2 , R 3 , R 4 , R 5 , and R 6 are independently selected from H, OH or the -C12 esters or alkyl ethers thereof, halogen, cyano, C1-C6 alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R 2 is not OH;
  • X is selected from H, Ci-C ⁇ alkyl, cyano, nitro, trifluoromethyl, halogen; Y is the moiety
  • R 7 and R 8 are selected independently from H, C1-C6 alkyl, or combined by -(CH 2 )p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C ⁇ -C4alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C ⁇ - C alkylthio, C ⁇ -C alkylsulfinyl, C ⁇ -C4alkylsulfonyl, hydroxy(C ⁇ -C )aIkyl, -CO 2 H, -CN, -CONH(C ⁇ -C 4 )alkyl, -NH , C ⁇ -C4alkylamino, di(C ⁇ -C 4 )alkylamino, -NHSO 2 (C ⁇ -C 4 )alkyl, -NHCO(C ⁇ -C 4 )
  • the rings formed by a concatenated R7 and Rs, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.
  • indole compounds of the present invention are those having the structural formulas I through NIII, above, wherein Ri is OH; R 2 - R ⁇ are as defined above; X is selected from the group of Cl, ⁇ O 2 , CN, CF3, or CH3; and Y is the moiety
  • R 8 and R7 and Rs are concatenated together as -(CH 2 )r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, -C4 alkyl, trihalomethyl, C ⁇ -C4alkoxy, trihalomethoxy, C]-C4alkylthio, C]-C 4 alkylsulfinyl, C ⁇ -C4alkylsulfonyl, hydroxy(C ⁇ -C 4 )alkyl, -CO 2 H, -CN, -CONH(C ⁇ -C 4 )alkyl, -NH 2 , C ⁇ -C 4 alkylamino, di(C ⁇ -C 4 )alkylamino, -NHSO 2 (C ⁇ -C 4 )alkyl, -NHCO(C ⁇ -C )alkyl, and -NO 2 ; and the pharmaceutically acceptable salts
  • R7 and Rs are concatenated together as -(CH 2 )p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
  • the invention includes acceptable salt forms formed from the addition reaction with either inorganic or organic acids.
  • Inorganic acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, nitric acid useful as well as organic acids such as acetic acid, propionic acid, citric acid, maleic acid, malic acid, tartaric acid, phthalic acid, succinic acid, methanesulfonic acid, toluenesulfonic acid, napthalenesulfonic acid, camphorsulfonic acid, benzenesulfonic acid are useful.
  • this invention includes quaternary ammonium salts of the compounds herein. These can be prepared by reacting the nucleophilic amines of the side chain with a suitably reactive alkylating agent such as an alkyl halide or benzyl halide.
  • the dosage, regimen and mode of administration of these compounds will vary according to the malady and the individual being treated and will be subject to the judgement of the medical practitioner involved. It is preferred that the administration of one or more of the compounds herein begin at a low dose and be increased until the desired effects are achieved.
  • Effective administration of these compounds may be given at an effective dose of from about 0.1 mg/day to about 500 mg/day. Preferably, administration will be from about 1 mg/day to about 200 mg/day in a single dose or in two or more divided doses.
  • Such doses may be administered in any manner useful in directing the active compounds herein to the recipient's bloodstream, including orally, parenterally (including intravenous, intraperitoneal and subcutaneous injections), and transdermally.
  • transdermal administrations are understood to include all administrations across the surface of the body and the inner linings of bodily passages including epithelial and mucosal tissues. Such administrations may be carried out using the present compounds, or pharmaceutically acceptable salts thereof, in lotions, creams, foams, patches, suspensions, solutions, and suppositories (rectal and vaginal).
  • the active ingredient in the formulations and methods of this invention is l-[4-(2-Azepan-lyl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl- lH-indol-5-ol, also known as TSE-424, or a pharmaceutically acceptable salt thereof
  • the preferred daily dosage for oral delivery is from about 0.1 to about 50 mg, preferably from about 2.5 to about 40 mg per day.
  • the active ingredient in the formulations and methods of this invention is 2-(4-Hydroxy-phenyl)-3-methyl-l-(4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH-indol-
  • the preferred daily dosage for oral delivery is from about 0.1 to about 200 mg, preferably from about 2.5 to about 100 mg per day.
  • kits or packages of pharmaceutical formulations designed for use in the regimens and methods described herein.
  • These kits are preferably designed for daily oral administration over the specified term or cycle of administration, preferably for the number of prescribed oral administrations per day, and organized so as to indicate a single oral formulation or combination of oral formulations to be taken on each day of the regimen or cycle.
  • each kit will include oral tablets to be taken on each the days specified, in some embodiments one oral tablet will contain each of the combined daily dosages indicated and in other embodiments the administrations of the separate compounds will be present in separate formulations or compositions.
  • the package or kit shall have a calendar or days-of-the-week designation directing the administration of the appropriate compositions on the appropriate day or time.
  • Oral formulations containing the active compounds of this invention may comprise any conventionally used oral forms, including tablets, capsules, buccal forms, troches, lozenges and oral liquids, suspensions or solutions.
  • Capsules may contain mixtures of the active compound(s) with inert fillers and/or diluents such as the pharmaceutically acceptable starches (e.g. corn, potato or tapioca starch), sugars, artificial sweetening agents, powdered celluloses, such as crystalline and microcrystalline celluloses, flours, gelatins, gums, etc.
  • Useful tablet formulations may be made by conventional compression, wet granulation or dry granulation methods and utilize pharmaceutically acceptable diluents, binding agents, lubricants, disintegrants, suspending or stabilizing agents, including, but not limited to, magnesium stearate, stearic acid, talc, sodium lauryl sulfate, microcrystalline cellulose, carboxymethylcellulose calcium, polyvinylpyrrolidone, gelatin, alginic acid, acacia gum, xanthan gum, sodium citrate, complex silicates, calcium carbonate, glycine, dextrin, sucrose, sorbitol, dicalcium phosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride, talc, dry starches and powdered sugar.
  • pharmaceutically acceptable diluents including, but not limited to, magnesium stearate, stearic acid, talc, sodium lauryl sulfate, microcrystalline
  • Oral formulations herein may utilize standard delay or time release formulations to alter the absorption of the active compound(s).
  • Suppository formulations may be made from traditional materials, including cocoa butter, with or without the addition of waxes to alter the suppository's melting point, and glycerin.
  • Water soluble suppository bases such as polyethylene glycols of various molecular weights, may also be used.
  • a package or kit of this invention will include individual oral dosage formulations for each of the components of the invention.
  • one daily dosage tablet of an orally administerable formulation of a substituted indole compound of this invention preferably l-[4-(2-Azepan-lyl- ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl- lH-indol-5-ol or 2-(4-Hydroxy- phenyl)-3-methyl- 1 -(4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H-indol-5-ol or a pharmaceutically acceptable salt thereof, and a once daily dosage Premarin ® conjugated estrogen tablet, for each day of a specified regimen.
  • kit or package comprises a one month supply of the components described herein, i.e. from 28 to 31 daily administration amounts of each component.
  • the estrogens herein may be administered according to the regimens and doses known in the art.
  • the preferred Premarin ® conjugated estrogen tablets may be administered as described in pages 3302-3305 of the Physicians' Desk Reference, 54 Edition, 2000, Medical Economics Company, Inc., Montvale, NJ 07645-1742.
  • estrogens useful with the present invention include OGEN ® (estropipate tablets), ESTRATAB ® (esterified estrogens tablets), ESTRACE ® estradiol vaginal cream, CLIMARA ® (estradiol transdermal system), ESTRADERM ® (transdermal system), MENESTTM (esterified estrogens tablets), ORTHO-EST ® (estropipate tablets), CENES ⁇ NTM (synthetic conjugated estrogens), ALORA ® (estradiol transdermal system), ESTINYL ® (ethynil estradiol), and the VINELLE ® and VIVELLE-DOT ® (estradiol transdermal systems).
  • OGEN ® estropipate tablets
  • ESTRATAB ® estradiol vaginal cream
  • CLIMARA ® estradiol transdermal system
  • ESTRADERM ® transdermal system
  • MENESTTM esterified estrogens tablets
  • ORTHO-EST ® estropi
  • Esterified estrogens 75-80% estrone sulfate Estratab 0.3, 0.625, 1.25, 2.5 mg
  • Estradiol Alora (twice weekly) 0.025, 0.0375, 0.05, 0.075,
  • Estradiol Fematrix 25 50, 75, 100 ⁇ g
  • Estradiol Ortho dienestrol cream 0.625 mg/g
  • Estrace vaginal cream 1.5 mg g . 1.0 mg/g
  • the joint administration of the two groups of compounds in these methods will be determined by a medical professional based upon the condition of the recipient and the malady for which the prophylaxis or treatment is provided. Administration of the two compounds may begin simultaneously or one may be introduced into an ongoing regimen of the other.
  • Solid oral formulations preferably in the form of a film coated tablet or capsule, useful for this invention include the active pharmacological agents disclosed herein in combination with carrier or excipient systems having the components: a) a filler and disintegrant component comprising from about 5% to about 82% by weight (wght) of the total formulation, preferably between about 30% and about 80% of the formulation, of which from about 4% to about 40% by weight of the total formulation comprises one or more pharmaceutically acceptable disintegrants; b) optionally, a wetting agent comprising from about 0.2 to about 5% of the composition (wght), such as selected from the group of sodium lauryl sulfate, polyoxyethylene sorbitan fatty acid esters, polyoxyethylene alkyl ethers, sorbitan fatty acid esters, polyethylene glycols, polyoxyethylene castor oil derivatives, docusate sodium, quaternary ammonium compounds, sugar esters of fatty acids and glycerides of fatty acids; c) a fill
  • fatty acid esters e.g. sodium stearyl fumarate
  • fatty acids e.g. stearic acid
  • fatty alcohols e.g. glyceryl behenate, mineral oil, parrafins, hydrogenated vegetable oils, leucine, polyethylene glycols, metallic lauryl sulfates and sodium chloride; and d) optionally, a glidant comprising from about 0.1% to about 10% (wght) of the composition, the glidant selected from those known in the art, including from the group of silicon dioxide, talc, metallic stearates, calcium silicate, or metallic lauryl sulfates.
  • compositions described herein may be used in an uncoated or non- encapsulated solid form, preferably the final compositions are coated or encapsulated.
  • the pharmacological compositions may be optionally coated with a film coating, preferably comprising from about 0.3% to about 8% by weight of the overall composition.
  • Film coatings useful with the present formulations are known in the art and generally consist of a polymer (usually a cellulosic type of polymer), a colorant and a plasticizer. Additional ingredients such as wetting agents, sugars, flavors, oils and lubricants may be included in film coating formulations to impart certain characteristics to the film coat.
  • the compositions and formulations herein may also be combined and processed as a solid, then placed in a capsule form, such as a gelatin capsule.
  • the filler component listed above may utilize the filler or binder components known in the art for solid oral formulations.
  • Pharmaceutically acceptable fillers or binding agents selected from those known in the art including, but not limited to, lactose, microcrystalline cellulose, sucrose, mannitol, calcium phosphate, calcium carbonate, powdered cellulose, maltodextrin, sorbitol, starch, or xylitol.
  • disintegrant agents may be selected from those known in the art, including pregelatinized starch and sodium starch glycolate.
  • Other useful disintegrants include croscarmellose sodium, crospovidone, starch, alginic acid, sodium alginate, clays (e.g.
  • veegum or xanthan gum cellulose floe
  • ion exchange resins or effervescent systems, such as those utilizing food acids (such as citric acid, tartaric acid, malic acid, fumaric acid, lactic acid, adipic acid, ascorbic acid, aspartic acid, erythorbic acid, glutamic acid, and succinic acid) and an alkaline carbonate component (such as sodium bicarbonate, calcium carbonate, magnesium carbonate, potassium carbonate, ammonium carbonate, etc.).
  • the disintegrant(s) useful herein will comprise from about 4% to about 40% of the composition by weight, preferably from about 15% to about 35%, more preferably from about 20% to about 35%.
  • the pharmaceutical formulations and carrier or excipient systems herein preferably also contain an antioxidant or a mixture of antioxidants, most preferably ascorbic acid.
  • antioxidants which may be used include sodium ascorbate and ascorbyl palmitate, preferably in conjunction with an amount of ascorbic acid.
  • a preferable range for the antioxidant(s) is from about 0.5% to about 15% by weight, most preferably from about 0.5% to about 5% by weight.
  • formulations of this invention are pharmaceutical formulations containing a pharmaceutically effective amount of an active pharmacological agent and a carrier or excipient system comprising: a) a filler and disintegrant component comprising between about 50% and about 87% of the formulation, with from about 4% to about 40% of the formulation comprising one or more disintegrant agents; b) a wetting agent comprising between about 0.5% and about 2.7% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; and d) a glidant comprising between about 0.1% and about 5.5% of the formulation.
  • the percentages listed in the formulations above indicate percentages by weight of the total weight of the components listed from a) to d).
  • the formulations above also preferably contain an optional antioxidant component, preferably ascorbic acid, at a concentration of from about 0.5% to about 5.5% by weight of the formulation.
  • the formulations are also preferably contained within a pharmaceutically acceptable capsule, such as a gel capsule, or coated with a film coating comprising from about 0.3% to about 8% by weight of the formulation.
  • This invention also comprises a pharmaceutical carrier or excipient systems useful in pharmaceutical compositions utilizing as an active ingredient one or more of the compounds described herein, or a pharmaceutically acceptable salt thereof, as described herein.
  • These pharmaceutical carrier or excipient systems may comprise, by weight: a) a filler and disintegrant component comprising between about 54% and about 80% of the formulation, with the disintegrant agent(s) therein comprising from about 4% to about 40% by weight of the overall formulation; b) a wetting agent comprising between about 0.55% and about 2.5% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; and d) a glidant comprising between about 0.1% and about 5.0% of the formulation.
  • the more preferred carrier or excipient systems above also optionally and preferably contain an antioxidant component, preferably ascorbic acid, at a concentration of from about 0.1% to about 5.0% by weight.
  • an antioxidant component preferably ascorbic acid
  • the carrier or excipient systems of this invention are those comprising: a) a filler and disintegrant component, as described above, comprising between about 50% and about 87% of the formulation, the disintegrant(s) therein comprising from about 25% to about 35% of the formulation, by weight; b) a wetting agent comprising between about 0.55% and about 2.7% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; d) a glidant comprising between about 0.1% and about 5.5% of the formulation; and e) an antioxidant component, preferably ascorbic acid, at a concentration of from about 0.1% to about 5.5% by weight.
  • a filler and disintegrant component as described above, comprising between about 50% and about 87% of the formulation, the disintegrant(s) therein comprising from about 25% to about 35% of the formulation, by weight
  • this invention provides a product or kit of parts comprising a compound of formula I or II as defined above or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof for administration as a combined preparation for simultaneous, separate or sequential use for inhibiting bone prosthesis degeneration in a mammal.
  • This invention also provides a pharmaceutical composition comprising a compound of formula I or II as defined above or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
  • this invention also provides use of a substituted indole compound of the formulae I or II as defined above or a pharmaceutically acceptable salt thereof and optionally one or more estrogens in the preparation of a medicament for inhibiting bone prosthesis degeneration in a mammal.
  • Wet granulation of the formulations as described in Table 1 may be carried out by mixing the drug and ascorbic acid with a portion of the lactose, microcrystalline cellulose, pregelatinized starch and sodium starch glycolate.
  • the sodium lauryl sulfate is dissolved in the water and used to granulate the mixture of powders in a high shear mixer.
  • the granulation is dried in a fluid bed dryer to a moisture of 2-3%.
  • the particle size of the dried granulation is controlled by passing through a mill equipped with knife-edged blades and using a 20- or 30-mesh screen.
  • the silicon dioxide and remaining lactose, microcrystalline cellulose, pregelatinized starch, and sodium starch glycolate are mixed with the milled granulation in a tumble- type mixer.
  • the final blend is prepared by adding magnesium stearate to the tumble- type mixer and mixing. Compression is carried out on a rotary tablet press using appropriate size tooling. Coating is performed in conventional coating pans and applying the coating suspension to achieve a suitable film coat.
  • Amount in formula is adjusted for actual potency of TSE-424 as free base. Corresponding adjustment made with Lactose.
  • ERA-923 tablets are compressed to a tablet weight of up to 640 mg to achieve the target dose (up to 100 mg). Tablets may then be film coated.
  • a preferred carrier or excipient system for formulating a granulation of from about 2 to about 8% by weight of one of the active pharmacological agents of this invention, preferably about 5%, may be produced utilizing the carrier or excipient components on a weight percentage; lactose from about 32% to about 38%, microcrystalline cellulose from about 32% to about 38%, pregelatinized starch from about 12% to about 16%, ascorbic acid from about 1% to about 2%, sodium lauryl sulfate from about 1% to about 2%, sodium starch glycolate from about 4% to about 8%, silicon dioxide from about 0.1% to about 0.2% and magnesium stearate from about 0.3% to about 0.7%.
  • a formulation of this invention utilizing TSE-424 as the active ingredient at a 5% granulation was prepared utilizing the components listed below in a granulation part of components and a dry part.
  • TSE-424 tablet weight mg m of film coat applied/tablet

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Abstract

This invention comprises methods of treating bone prosthesis degeneration comprising administration of a compound of formulae (I) or (II), wherein Z is a moiety selected from the group of formulae (a, b or c), wherein: R1 is selected from H, OH or the C1-C12 esters or C1-C12 alkyl ethers thereof, or halogens; or C1-C4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether; R2, R3, R4, R5, and R6 are H, OH or C1-C12 esters or C1-C12 alkyl ethers thereof, halogens, or C1-C4 halogenated ethers, cyano, C1-C6 alkyl, or trifluoromethyl, with the proviso that, when R1 is H, R2 is not OH; Y is the moiety of formulae (d), R7 and R8 are alkyl or concatenated together to form an optionally substituted, nitrogen-containing ring; or a pharmaceutically acceptable salt thereof, and optionally an estrogen.

Description

THERAPYFORPROSTHESIS-RELATEDBONEDEGENERATION
This invention relates to methods of using substituted indole compounds optionally in combination with one or more estrogens for the treatment, prevention, inhibition or alleviation of bone prosthesis degeneration. More particularly, this invention provides such methods for treating the degeneration or other damage to tissues surrounding or interacting with prosthetic devices.
Background of the Invention
The use of various prosthetic devices has become common in replacement of damage tissues in various joints, including the hip and knee. Prosthetic dental implants have also become quite common for individual or sequential teeth. The use of such prosthetic devices has significantly improved the quality of life for many recipients.
While the initial success of such techniques is notable, however, many prosthesis prove to have a limited life due to weakening of the bond between the prosthesis and the surrounding bone tissues. It is, therefore desirable to provide means of maintaining the health of the relevant tissues and prolonging the effective life of the prosthesis in question.
PCT publication WO 96/05824 (Cullinan) teaches the use of raloxifene and its analogs in methods for inhibiting bone prosthesis degeneration. U.S. Patent No. 5,534,527 (Black et al.) teaches methods for inhibiting bone loss by treatment with aroylbenzothiophenes, including raloxifene, and estrogen. U.S. Patent No. 5,646,137 (Black et al.) teaches combination treatments for osteoporosis utilizing aroylbenzothiophenes, including raloxifene, and progestins. EP 0 802 183 Al and U.S. Patent No. 5,780,497 describe substituted indole compounds of the formulae below:
Figure imgf000004_0001
as well as their use as estrogenic agents, including the treatment of bone loss, cardiovascular disease, maladies associated with or resulting from the proliferation or abnormal development of endometrial or endometrial-like tissues, and disease states or syndromes associated with estrogen deficiency.
EP 0 802 184 Al, published October 22, 1997, describes comparable uses for substituted indole compounds of the formulae below.
Figure imgf000004_0002
Analogous indole compounds having the general structures:
Figure imgf000004_0003
are described in U.S. Patent No. 5,880,137 (Miller et al.). Description of the Invention
This invention comprises methods of treating, inhibiting, preventing, or alleviating bone prosthesis degeneration in a mammal, preferably in a human, the methods comprising administering to a mammal in need a pharmaceutically effective amount of a substituted indole compound of the formulae I or π, below:
Figure imgf000005_0001
wherein Z is a moiety selected from the group of:
Figure imgf000005_0002
or -(CH2)n Y ; wherein:
R} is selected from H, OH or the C1-C12 esters (straight chain or branched) or
Cj-C12 (straight chain or branched or cyclic) alkyl ethers thereof, benzyloxy, or halogens; or C,-C4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether.
R2, R3, R5, and R6 are independently selected from H, OH or the C1-C12 esters
(straight chain or branched) or C,-C12 alkyl ethers (straight chain or branched or cyclic) thereof, halogens, or C C4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether, cyano, C1-C6 alkyl (straight chain or branched), or trifluoromethyl, with the proviso that, when Ri is H, R2 is not OH;
R is selected from H, OH or the C1-C12 esters (straight chain or branched) or C,-C12 alkyl ethers (straight chain or branched or cyclic) thereof, benzyloxy, halogens, or CΓC4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether, cyano, Ci-Cβalkyl (straight chain or branched), or trifluoromethyl; X is selected from H, Ci-Cβ alkyl, cyano, nitro, trifluoromethyl, halogen; n is 1, 2 or 3;
Y is selected from: a) the moiety:
\ /R7
\ Rs wherein R7 and Rs are independently selected from the group of H, C1-C6 alkyl, or phenyl optionally substituted by CN, Cχ-C6 alkyl (straight chain or branched), Ci-Cβ alkoxy (straight chain or branched), halogen, -OH, -CF3, or -OCF3; or R7 and R8 are combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alko y, trihalomethoxy, Ci- C4alkylthio, Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di-(Cι- C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C )alkyl and -NO2;
b) a five-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4 alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, Cι-C4acyloxy, Cι-C4alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy(Cι-C )alkyl, -CO2H-, -CN-, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl,
-NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl;
c) a six-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N( C4 alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Cι-C4acyloxy, Cι-C4alkylthio, Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, -NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl;
d) a seven-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, -C4 alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Cι-C4acyloxy, Cι-C4alkylthio, Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN,
-CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, -NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl; or
e) a bicyclic heterocycle containing from 6-12 carbon atoms either bridged or fused and containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4alkyl)-, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Cι-C4acyloxy, Cι-C4alkylthio,
Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H-, -CN, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(C1-C4)alkyl, -NHCO(Cι-C4)alkyl, -NO2, and phenyl optionally substituted with 1-3 (C1-C4) alkyl; and the pharmaceutically acceptable salts thereof, and optionally a pharmaceutically effective amount of one or more estrogens, or a pharmaceutically acceptable salt thereof.
The more preferred substituted indole compounds for use in the methods of this invention are those having the general structures I or II, above, wherein:
R! is selected from H, OH or the -C12 esters or alkyl ethers thereof, benzyloxy, or halogen;
R2, R3, R5, and R6 are independently selected from H, OH or the -C12 esters or alkyl ethers thereof, halogen, cyano, Ci-Cβ alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R2 is not OH; R is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, halogen, cyano, Ci-Cβ alkyl, or trihalomethyl;
X is selected from H, Ci-Cβ alkyl, cyano, nitro, trifluoromethyl, halogen; Y is the moiety
\ /R7 \ Rδ ;
R7 and R8 are selected independently from H, Cχ-C6 alkyl, or combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Ci-G^alkyl- thio, Cι-C alkylsulfinyl, Ci- alkylsulfαnyl, hydroxy(Cι- )alkyl, -CO H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di (C1-C4 )alkylamino, -NHSO2(Cι- C4)alkyl, -NHCO(Cι-C4)alkyl, and -NO2; and the pharmaceutically acceptable salts thereof.
The rings formed by a concatenated R7 and Rs, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.
The most preferred compounds of the present invention are those having the structural formulas I or II, above, wherein Ri is OH; R2 - R6 are as defined above; X is selected from the group of Cl, NO2, CN, CF3, or CH3; and Y is the moiety
\
Rs and R7 and Rs are concatenated together as -(CH2)r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, -C4 alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy (Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, - alkylamino, di(Cι- C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, and -NO2; and the pharmaceutically acceptable salts thereof.
In another embodiment of this invention, when R7 and Rs are concatenated together as -(CH2)p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
The invention includes sulfate, sulfamates and sulfate esters of phenolic groups in these compounds. Sulfates can be readily prepared by the reaction of the free phenolic compounds with sulfur trioxide complexed with an amine such as pyridine, trimethylamine, triethylamine, etc. Sulfamates can be prepared by treating the free phenolic compound with the desired arnino or alkylamino or dialkylamino sulfamyl chloride in the presence of a suitable base such as pyridine. Sulfate esters can be prepared by reaction of the free phenol with the desired alkanesulfonyl chloride in the presence of a suitable base such as pyridine. Additionally, this invention includes compounds containing phosphates at the phenol as well as dialkyl phosphates. Phosphates can be prepared by reaction of the phenol with the appropriate chlorophosphate. The dialkylphosphates can be hydrolyzed to yield the free phosphates. Phosphinates are also claimed where the phenol is reacted with the desired dialkylphosphinic chloride to yield the desired dialkylphosphinate of the phenol.
The invention includes acceptable salt forms of these compounds formed from the addition reaction with either inorganic or organic acids. Inorganic acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, nitric acid useful as well as organic acids such as acetic acid, propionic acid, citric acid, maleic acid, malic acid, tartaric acid, phthalic acid, succinic acid, methanesulfonic acid, toluenesulfonic acid, napthalenesulfonic acid, camphorsulfonic acid, benzenesulfonic acid are useful. It is known that compounds possessing a basic nitrogen can be complexed with many different acids (both protic and non-protic) and usually it is preferred to administer a compound of this invention in the form of an acid addition salt. Additionally, this invention includes quaternary ammonium salts of the compounds herein. These can be prepared by reacting the nucleophilic amines of the side chain with a suitably reactive alkylating agent such as an alkyl halide or benzyl halide.
The methods of this invention include therapies and pharmaceutical regimens for treatment, prevention, inhibition or alleviation of bone prosthesis degeneration. Such methods include the maintenance and enhancement of the bone and related tissues surrounding or operating in relation to or in contact with the orthopedic or dental prosthetic device in question to facilitate survival or maintenance of the usefulness and utility of the prosthesis over time. The methods of this invention may be utilized remedially or prophylactically, as determined by a medical professional. These methods include maintenance of tissue and inhibition of degeneration associated with prosthetic replacement associated with various joints including, but not limited to, those of the knee, hip, shoulder (humeral), elbow, wrist and ankle. They also include maintenance of tissues surrounding implants, plates, screws and pins secured to or inserted into or through bone tissues, including dental implants and the conventional devices utilized to secure bone, particularly including long bone fractures, carpal arthrodeses cases, distal radial fractures, proximal tibial fractures, pelvic fractures, etc. The prosthetic devices contemplated in this description include those of various materials known in the art, including devices and implants comprised of metal, polymers, ceramics, or other materials. It will be understood that a pharmaceutically effective amount of one or more of the compounds of this invention, or the pharmaceutically acceptable salts thereof, is an amount sufficient to provide efficacious results in maintaining the bone and related tissues in question in a healthy state for interaction with the relevant prosthesis or to inhibit, delay, or otherwise counter degeneration or deterioration of the tissues to prolong the period in which the prosthesis may be used.
These methods each comprise administering to a mammal in need thereof a pharmaceutically effective amount of a pharmaceutically effective amount of one of the substituted indoles taught herein and optionally one or more estrogens. These administrations may be therapeutic or prophylactic. Among the preferred substituted indole compounds for use in these methods are l-[4-(2-azepan-lyl-ethoxy)-benzyl]-2- (4-hydroxy-phenyl)-3-methyl-lH-indol-5-ol, also known as TSE-424, and 2-(4- hy droxy-pheny l)-3-methyl- 1 -(4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H-indol-5-ol, also known as ERA-923, or a pharmaceutically acceptable salt of TSE-424 or ERA-923.
Estrogens useful in the formulations of this invention include estrone, estriol, equilin, estradiene, equilenin, ethinyl estradiol, 17β-estradiol, 17α-dihydroequilenin, 17β-dihydroequilenin (U.S. Patent 2,834,712), 17α-dihydroequilin, 17β-dihydro- equilin, menstranol and conjugated estrogenic hormones, such as those in Wyeth- Ayerst Laboratories' Premarin® products (P.O. Box 8299, Philadelphia, PA 19101, U.S.A.). Phytoestrogens, such as equol or enterolactone, may also be used in the present formulations and methods. When an estrogen is utilised a preferred embodiment of this invention comprises pharmaceutical compositions and methods of treatment utilizing conjugated estrogenic hormones, such as those in Wyeth-Ayerst Laboratories' Premarin® products, with one or more compounds of Formulas (I) or (III) listed herein. Esterified estrogens, such as those sold by Solvay Pharmaceuticals, Inc. under the Estratab® tradename, may also be used with the present formulations. Also preferred for use with the present invention are the salts of the applicable estrogens, most preferably the sodium salts. Examples of these preferred salts are Sodium estrone sulfate, Sodium equilin sulfate, Sodium 17alpha-dihydroequilin sulfate, Sodium 17alpha-estradiol sulfate, Sodium Delta8,9- dehydroestrone sulfate, Sodium equilenin sulfate, Sodium 17beta-dihydroequilin sulfate, Sodium 17alpha- dihydroequilenin sulfate, Sodium 17beta-estradiol sulfate, Sodium 17beta- dihydroequilenin sulfate, Estrone 3-sodium sulfate, Equilin 3-sodium sulfate, 17alpha-Dihydroequilin 3-sodium sulfate, 3beta-Hydroxy-estra-5(10),7-dien-17-one 3-sodium sulfate, 5alpha-Pregnan-3beta-20R-diol 20-sodium sulfate, 5alpha-Pregnan- 3beta,16alpha-diol-20-one 3-sodium sulfate, delta(8,9)-Dehydroestrone 3-sodium sulfate, Estra-3beta, 17alpha-diol 3-sodium sulfate, 3beta-Hydroxy-estr-5(10)-en-17- one 3-sodium sulfate or 5alpha-Pregnan-3beta,16alpha,20R-triol 3-sodium sulfate. Preferred salts of estrone include, but are not limited to, the sodium and piperate salts. Among the most preferred estrogens for use with this invention are the conjugated estrogens of the Premarin® brand products.
When an estrogen is utilised among the most preferred embodiments of this invention are methods combining the administration in a mammal of pharmaceutically effective amounts of:
a) a substituted indole compound selected from l-[4-(2-azepan-lyl- ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH-indol-5-ol, also known as TSE- 424, and 2-(4-hydroxy-phenyl)-3-methyl-l-(4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol, also known as ERA-923, or a pharmaceutically acceptable salt of TSE-424 or ERA-923; and
b) the conjugated estrogenic hormones, such as those of the Premarin® brand products marketed by Wyeth-Ayerst Laboratories. The present invention includes methods utilizing in conjunction with one or more estrogen, or a pharmaceutically acceptable salt thereof, a first subset or subgroup of substituted indole compounds of the formulas III or IN, below:
Figure imgf000012_0001
(HI) (IV) wherein the variable substituents including R,, R2, R3, R4, R5, R6, n, X, and Y are as defined above, or a pharmaceutically acceptable salt thereof.
The more preferred compounds of this first subset of indole compounds are those having the general structures III or IV, above, wherein:
Rj is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, or halogen;
R2, R3, R5, and R6 are independently selected from H, OH or the C1-C12 esters or alkyl ethers thereof, halogen, cyano, Cχ-C6 alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R2 is not OH;
R4 is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, halogen, cyano, Ci-Cβ alkyl, or trihalomethyl;
X is selected from H, Ci-Cβ alkyl, cyano, nitro, trifluoromethyl, halogen;
Y is the moiety
R7
R7 and R8 are selected independently from H,
Figure imgf000012_0002
alkyl, or combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, C\- C4alkylthio, - alkylsulfinyl, Ci- alkylsulfonyl, hydroxy(Cι- )alkyl, -CO2H, -CΝ, -COΝH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, and -NO2; and the pharmaceutically acceptable salts thereof. The rings formed by a concatenated R7 and Rs, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.
The most preferred compounds of this first subset of indole compounds are those having the structural formulas I or II, above, wherein Ri is OH; R2 - Re are as defined above; X is selected from the group of Cl, NO2, CN, CF3, or CH3; and Y is the moiety
\ Rs and R7 and Rs are concatenated together as -(CH2)r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alko y, trihalomethoxy, Cι-C4alkylthio, Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C )alkyl, and -NO2; and the pharmaceutically acceptable salts thereof.
In another embodiment of this first subset of compounds, when R7 and Rs are concatenated together as -(CH2)p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
Among the preferred compounds of this first subset of indole compounds are the following:
5-Benzyloxy-2-(4-ethoxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl] - 1 H-indole ;
5-Benzyloxy-2-phenyl-3-methyl-l-[4-(2-azepan-l-yl-ethoxy)-benzyl]-lH- indole; 5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-[4-(2-azepan-l-yl-ethoxy)- benzy 1]- 1 H-indole ;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-[4-(2-diisopropylamino-l- yl-ethoxy)-benzyl] - 1 H-indole ; 5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl- 1 -[4-(2-butyl-methylamino- 1 - ylethoxy)-benzyl]- lH-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-{4-dimethylamino)ethoxy]- benzyl } - 1 H-indole ; 5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-{4-[2-(2-methyl-piperidin-
1 -yl)-ethoxy]-benzyl } -lH-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-{4-[2-(3-methyl-piperidin- 1 -yl)-ethoxy ] -benzyl } - 1 H-indole ;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-{4-[2-(4-methyl-piperidin- l-yl)-ethoxy]-benzyl}-lH-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l{4-[2-((cis)-2,6-Dimethyl- piperidin- 1 -yl)-ethoxy] -benzyl } - 1 H-indole ;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-{4-[2-(l,3,3-trimethyl-6-aza- bicyclo[3.2.1]oct-6-yl)-ethoxy]-benzyl}-lH-indole; (lS,4R)-5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl{4-[2-(2-Aza-bicyclo
[2.2.1] hept-2-yl)-ethoxy]-benzyl}-lH-indole;
5-Benzyloxy-2-(4-fluoro-phenyl)-3-methyl-l-[4-(2-azepan-l-yl-ethoxy)- benzyl] - lH-indole;
5-Benzyloxy-2-(4-fluoro-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indole;
5-Benzyloxy-2-(4-chloro-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]- lH-indole;
5-B enzyloxy-2- [3 ,4-methylenedioxy-phenyl] -3 -methyl- 1 - [4-(2-piperidin- 1 -yl- ethoxy)-benzyl]-lH-indole; 5-B enzyloxy-2- [4-isopropoxy-phenyl]-3 -methyl- 1 - [4-(2-piperidin- 1 -yl- ethoxy)-benzyl] - 1 H-indole ;
5-Benzyloxy-2-[4-methyl-phenyl]-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]- lH-indole; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-5-benzyloxy-2-(3-benzyloxy-phenyl)-3- methyl- 1 H-indole;
5-Benzyloxy-2-(4-benzyloxy-3-fluoro-phenyl)-3-methyl-l-[4-(2-piperidin-l- yl-ethoxy)-benzyl]- lH-indole; 5-Benzyloxy-2-(4-benzyloxy-3-fluoro-phenyl)-3-methyl- 1 -[4-(2-azepan- 1 -yl- ethoxy)-benzyl]-lH-indole;
5-Benzyloxy-2-(3-methoxy-phenyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-3- methyl-1 H-indole; 5-Benzyloxy-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-2-(4-trifluoro- methoxy-phenyl)- lH-indole;
(2-{4-[5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-indol-l-ylmethyl]- phenoxy } -ethyl)-cyclohexyl-amine;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-{4-methylpiperazin-l-yl)- ethoxy]-benzyl}-lH-indole; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-5-benzyloxy-2-(3-methoxy-phenyl)-3- methyl- 1 H-indole ;
4- { 3 -Methyl- 1 - [4-(2-piperidin- 1 -yl-ethoxy)-benzyl] - 1 H-indole } ;
4-{3-Methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH-indol-2-yl}-phenol; 3-Methyl-2-phenyl-l-[4-(2-piperidine-l-yl-ethoxy)-benzyl]-lH-indol-5-ol;
4- { 5-Methoxy-3-methyl- 1 - { 4- [2-(piperidin- 1 -yl)-ethoxy]-benzyl } - 1 H-indol-2- yl} -phenol;
2-(4-methoxy-phenyl)-3-methyl- 1 - { 4-[2-(piperidin- 1 -yl)-ethoxy]-benzyl } - 1 H- indol-5-ol; 5-Methoxy-2-(4-methoxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl] - 1 H-indole; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-5-methoxy-2-(4-methoxy-phenyl)-3- methyl- 1 H-indole;
2-(4-Ethoxy-phenyl)-3-methyl- l-[4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1H- indol-5-ol; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-2-(4-ethoxy-phenyl)-3-methyl-lH-indol- 5-ol;
4- { 5-Fluoro-3-methyl- 1 - [4-(2-piperidin- 1 -yl-ethoxy )-benzyl] - 1 H-indol-2-yl } - phenol; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-3-methyl-2-phenyl-lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-[4-(2-pyrollidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH- indol-5-ol; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH- indol-5-ol; 1 - [4-(2- Azocan- 1 -yl-ethoxy)-benzyl] -2-(4-hy droxy-pheny l)-3 -methyl- 1 H- indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-[4-(2-dimethyl-l-yl-ethoxy)-benzyl]-lH- indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-[4-(2-diethyl-l-yl-ethoxy)-benzyl]-lH- indol-5-ol; l-[4-(2-Dipropylamino-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH- indol-5-ol; l-[4-(2-Dibutylamino-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl-lH- indol-5-ol; 1 - [4-(2-Diisopropylamino-ethoxy)-benzyl]-2-(4-hy droxy-pheny l)-3-methyl- lH-indol-5-ol; l-{4-[2-(Butyl-methyl-amino)-ethoxy]-benzyl}-2-(4-hydroxy-phenyl)-3- methyl- 1 H-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-{4-[2-(2-methyl-piperidin-l-yl)-ethoxy]- benzyl}-lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl- 1 - { 4- [2-(3-methyl-piperdin- 1 -yl)-ethoxy]- benzyl } - lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-{4-[2-(4-methyl-piperidin-l-yl)-ethoxy]- benzyl } - 1 H-indol-5-ol; 1 - { 4- [2-(3 ,3-Dimethyl-piperidin- 1 -yl)-ethoxy] -benzyl } -2-(4-hy droxy-pheny 1)-
3-methyl- 1 H-indol-5-ol;
1 - { 4-[2-((cis)-2,6-Dimethyl-piperidin- 1 -yl)-ethoxy]-benzyl } -2-(4-hydroxy- phenyl)-3-methyl-lH-indol-5-ol;
2-(4-Hy droxy-phenyl)- 1 - { 4- [2-(4-hydroxy-piperidin- 1 -yl)-ethoxy] -benzyl } -3- methyl- lH-indol-5-ol;
( 1 S ,4R)- 1 - { 4-[2-(2-Aza-bicyclo [2.2.1] hept-2-yl)-ethoxy]-benzyl } -2-(4- hydroxy-phenyl)-3-methyl-lH-indol-5-ol; 2-(4-Hydroxy-phenyl)-3-methyl-l-{4-[2-(l,3,3-trimethyl-6-azabicyclo[3.2.1]- oct-6-yl)-ethoxy]-benzyl } - lH-indol-5-ol;
2-(4-Fluoro-phenyl)-3-methyl- 1 - [4-(2-piperidine- 1 -yl-ethoxy)-benzyl]- 1 H- indol-5-ol; 1 -[4-(2-Azepan- 1 -yl-ethoxy)-benzyl]-2-(4-fluoro-phenyl)-3-methyl- 1 H-indol-
5-ol;
2-(3-Methoxy-4-hydroxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl] - 1 H-indol-5-ol ;
2-Benzo[l,3]dioxol-5-yl-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol;
2-(4-Isopropoxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol; l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-2-(4-isopropoxy-ρhenyl)-3-methyl-lH- indol-5-ol; 2-(4-Cyclopentyloxy-phenyl)-3-methyl- 1 -[4-(2-piperidin- 1 -yl-ethoxy)- benzyl]-lH-indol-5-ol;
3-Methyl- 1 -[4-(2-piperidin- 1 -yl-ethoxy)~benzyl]-2-(4-trifluoromethylphenyl)- lH-indol-5-ol;
3-Methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-2-p-tolyl-lH-indol-5-ol; 2-(4-Chloro-phenyl)-3-methyl- 1 - [4-(2-piρeridin- l-yl-ethoxy)-benzyl]- 1 H- indol-5-ol;
2-(2,4-Dimethoxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]- lH-indol-5-ol;
2-(3-Hydroxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol;
1 - [4-(2- Azepan- 1 -yl-ethoxy)-benzyl] -2-(3 -hydroxy-phenyl)-3 -methyl- 1 H- indole-5-ol;
2-(3-Fluoro-4-hydroxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indol-5-ol; 2-(3-Fluoro-4-hydroxy-phenyl)-3-methyl-l-[4-(azepan-l-yl-ethoxy)-benzyl]- lH-indol-5-ol;
2-(3-Methoxy-phenyl)-3-methyl- 1 -[4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H- indole-5-ol; 3-Methyl- 1 -[4-(2-piperidin- 1 -yl-ethoxy)-benzyl]-2-(4-trifluoromethoxy- phenyl)- lH-indole-5-ol;
3-Chloro-2-(4-hy droxy-phenyl)- 1 - [4-(2-pyrrolidin- 1 -yl-ethoxy)-benzyl]- 1 H- indol-5-ol; 3-Chloro-2-(4-hy droxy-phenyl)- 1 - [4-(2-piperidin- l-yl-ethoxy)-benzyl]- 1 H- indol-5-ol;
3-Chloro-2-(4-hydroxy-phenyl)- 1 -[4-(2-azepan- l-yl-ethoxy)-benzyl]- 1H- indol-5-ol;
3-Chloro-2-(4-hydroxy-2-methyl-phenyl)-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-ethyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol;
5-Hy droxy-2-(4-Hy droxy-phenyl)- 1 -[4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H- indole-3-carbonitrile; 1 - [4-(2- Azepan- 1 -yl-ethoxy )-benzyl] -5-hydroxy-2-(4-hy droxy-pheny 1)- 1 H- indole-3-cabonitrile;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-chloro-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]- lH-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-chloro-l-[4-(2-azepan-l-yl-ethoxy)- benzyl]- 1 H-indole;
5-Benzyloxy-2-(2-methyl-4-benzyloxy-phenyl)-3-chloro-l-[4-(2-piperidin-l- yl-ethoxy)-benzyl]- 1 H-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-ethyl-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indole; 5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-cyano-l-[4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-cyano-l-[4-(2-azepan-l-yl-ethoxy)- benzyl] - 1 H-indole ;
Di-propionate of l-[4-(2-Azepan-l-yl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)- 3-methyl-lH-indol-5-ol;
Di-pivalate of l-[4-(2- Azepan- 1 -yl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3- methyl-lH-indol-5-ol; 5-Benzyloxy-2-(4-benzyloxy-phenyl)-l-[4-(3-piperidin-l-yl-propoxy)benzyl]- 3 -methyl- 1 H-indole ;
2-(4-Hy droxy-pheny l)-3-methyl- 1 - { 4- [3-(piperidin- 1 -yl)-propoxy]-benzyl } - lH-indol-5-ol;
2-(4-Hy droxy-phenyl)- 1 - [3-methoxy-4-(2-piperidin- 1 -yl-ethoxy)-benzyl]-3- methyl- lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-l-[3-methoxy-4-(2-azepan-l-yl-ethoxy)-benzyl]-3- methyl- lH-indol-5-ol;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-[3-Methoxy-4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H-indole;
5-Benzyloxy-2-(4-benzyloxy-phenyl)-3-methyl-l-[2-Methoxy-4-(2-azepan-l- yl-ethoxy)-benzyl]- lH-indole;
2-(4-Hydroxy-phenyl)-3-methyl-l-[4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH- indol-5-ol; or the pharmaceutically acceptable salts thereof.
The compounds of this first subset or subgroup of indole compounds can be produced by the methods described in EP 0 802 183 Al, published October 22, 1997, and U.S. Patent No. 5,780,497, the subject matter of which is incorporated herein by reference, or by other methods known in the art. Aryloxy-alkyl-dialkylamines or aryloxy-alkyl-cyclic amines useful as intermediates in the production of the compounds above can be produced and used as disclosed in WO 99/19293, published April 22, 1999, the subject matter of which is also incorporated herein by reference.
A second subset or subgroup of indole compounds useful with this invention includes those of formulas (V) or (VI), below:
Figure imgf000019_0001
wherein the variable substituents including R,, R2, R3, R4, R5, R6, n, X, and Y are as defined above, or a pharmaceutically acceptable salt thereof.
Among the preferred compounds of this second subset or subgroup of indoles are the following:
(E)-N,N-Diethyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl] -phenyl } -acrylamide; l(E)-N-tert-butyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl] -phenyl } -acrylamide; (E)-Pyrollidino-3- { 4- [5-hydroxy-2-(4-hy droxy-pheny l)-3-methyl-indol- 1 - ylmethyl]-phenyl}-acrylamide;
(E)-N,N-Dimethyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl]-phenyl } -acrylamide;
(E)-N,N-Dibutyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl] -phenyl} -acrylamide;
(E)-N-Butyl,N'-methyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl- indol- 1 -ylmethyl] -phenyl } -acrylamide;
(E)-Morpholinino-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl] -phenyl }-acrylamide; (E)-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l-ylmethyl]- phenyl } -acrylamide;
(E)-N,Methyl-3-{4-[5-hydroxy-2-(4-hydroxy-phenyl)-3-methyl-indol-l- ylmethyl]-phenyl } -acrylamide;
(E)-N,N-Dibutyl-3-{4-[5-hydroxy-2-(4-fluoro-ρhenyl)-3-methyl-indol-l- ylmethyl]-phenyl}-acrylamide;
(E)-N-Butyl,N'-Methyl-3-{4-[5-hydroxy-2-(4-fluoro-phenyl)-3-methyl-indol- 1 -ylmethyl]-phenyl } -acrylamide; as well as the pharmaceutically acceptable salts and esters thereof.
The compounds of this second subset or subgroup of compounds can be produced by the methods described in EP 0 802 184 Al, published October 22, 1997, which is incorporated herein by reference, or by other methods known in the art. A third subset of indole compounds useful with the present invention include those of the formulae Nil and NIII:
Figure imgf000021_0001
(VII) (Nπi) wherein n is 2 or 3 and the variable substituents including R,, R2, R3, R4, R5, R6, n, X, and Y are as defined above, or a pharmaceutically acceptable salt thereof.
Among the preferred compounds of this third subset are: 2-(4-Hy droxy-pheny l)-3-methyl- 1 -[4-(3-Ν,Ν-dimethyl- 1 -yl-prop- 1 -ynyl)- benzyl]- lH-indol-5-ol;
2-(4-Hydroxy-phenyl)-3-methyl-l-[4-(3-piperidin-l-yl-prop-l-ynyl)-benzyl]- lH-indol-5-ol; and
2-(4-Hydroxy-phenyl)-3-methyl- 1 - [4-(3-pyrrolidin- 1 -yl-prop- 1 -ynyl)-benzyl]- 1 H-indol-5 -ol; or pharmaceutically acceptable salts or esters thereof.
The compounds of this third subset or subgroup of indole compounds can be produced by the methods described in U.S. Patent No. 5,880,137 (Miller et al.), which is incorporated herein by reference, or by other methods known in the art.
Within each of the first, second and third subsets of compounds of this invention are further subdivisions of more preferred compounds having the general structures I through NIII, above, wherein: Rt is selected from H, OH or the Cι-Cι esters or alkyl ethers thereof, halogen;
R2, R3, R4, R5, and R6 are independently selected from H, OH or the -C12 esters or alkyl ethers thereof, halogen, cyano, C1-C6 alkyl, or trihalomethyl, preferably trifluoromethyl, with the proviso that, when Ri is H, R2 is not OH;
X is selected from H, Ci-Cβ alkyl, cyano, nitro, trifluoromethyl, halogen; Y is the moiety
\ /R7
\
R8 •
R7 and R8 are selected independently from H, C1-C6 alkyl, or combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, C\- C alkylthio, Cι-C alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C )aIkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH , Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)aIkyl, and -NO2; and the pharmaceutically acceptable salts thereof.
The rings formed by a concatenated R7 and Rs, mentioned above, may include, but are not limited to, aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine rings.
The most preferred indole compounds of the present invention are those having the structural formulas I through NIII, above, wherein Ri is OH; R2 - Rβ are as defined above; X is selected from the group of Cl, ΝO2, CN, CF3, or CH3; and Y is the moiety
\ /R7 \
R8 and R7 and Rs are concatenated together as -(CH2)r, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, -C4 alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, C]-C4alkylthio, C]-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C )alkyl, and -NO2; and the pharmaceutically acceptable salts thereof. In another embodiment of this invention, when R7 and Rs are concatenated together as -(CH2)p-, wherein p is an integer of from 2 to 6, preferably 4 to 6, the ring so formed is optionally substituted with 1-3 substituents selected from a group containing C1-C3 alkyl, trifluoromethyl, halogen, hydrogen, phenyl, nitro, -CN.
The invention includes acceptable salt forms formed from the addition reaction with either inorganic or organic acids. Inorganic acids such as hydrochloric acid, hydrobromic acid, hydroiodic acid, sulfuric acid, phosphoric acid, nitric acid useful as well as organic acids such as acetic acid, propionic acid, citric acid, maleic acid, malic acid, tartaric acid, phthalic acid, succinic acid, methanesulfonic acid, toluenesulfonic acid, napthalenesulfonic acid, camphorsulfonic acid, benzenesulfonic acid are useful. It is known that compounds possessing a basic nitrogen can be complexed with many different acids (both protic and non-protic) and usually it is preferred to administer a compound of this invention in the form of an acid addition salt. Additionally, this invention includes quaternary ammonium salts of the compounds herein. These can be prepared by reacting the nucleophilic amines of the side chain with a suitably reactive alkylating agent such as an alkyl halide or benzyl halide.
It is understood that the dosage, regimen and mode of administration of these compounds will vary according to the malady and the individual being treated and will be subject to the judgement of the medical practitioner involved. It is preferred that the administration of one or more of the compounds herein begin at a low dose and be increased until the desired effects are achieved.
Effective administration of these compounds may be given at an effective dose of from about 0.1 mg/day to about 500 mg/day. Preferably, administration will be from about 1 mg/day to about 200 mg/day in a single dose or in two or more divided doses. Such doses may be administered in any manner useful in directing the active compounds herein to the recipient's bloodstream, including orally, parenterally (including intravenous, intraperitoneal and subcutaneous injections), and transdermally. For the purposes of this disclosure, transdermal administrations are understood to include all administrations across the surface of the body and the inner linings of bodily passages including epithelial and mucosal tissues. Such administrations may be carried out using the present compounds, or pharmaceutically acceptable salts thereof, in lotions, creams, foams, patches, suspensions, solutions, and suppositories (rectal and vaginal).
When the active ingredient in the formulations and methods of this invention is l-[4-(2-Azepan-lyl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl- lH-indol-5-ol, also known as TSE-424, or a pharmaceutically acceptable salt thereof, the preferred daily dosage for oral delivery is from about 0.1 to about 50 mg, preferably from about 2.5 to about 40 mg per day.
When the active ingredient in the formulations and methods of this invention is 2-(4-Hydroxy-phenyl)-3-methyl-l-(4-(2-piperidin-l-yl-ethoxy)-benzyl]-lH-indol-
5-ol, also known as ERA-923, or a pharmaceutically acceptable salt form thereof, the preferred daily dosage for oral delivery is from about 0.1 to about 200 mg, preferably from about 2.5 to about 100 mg per day.
This invention also includes kits or packages of pharmaceutical formulations designed for use in the regimens and methods described herein. These kits are preferably designed for daily oral administration over the specified term or cycle of administration, preferably for the number of prescribed oral administrations per day, and organized so as to indicate a single oral formulation or combination of oral formulations to be taken on each day of the regimen or cycle. Preferably each kit will include oral tablets to be taken on each the days specified, in some embodiments one oral tablet will contain each of the combined daily dosages indicated and in other embodiments the administrations of the separate compounds will be present in separate formulations or compositions. It is most preferable that the package or kit shall have a calendar or days-of-the-week designation directing the administration of the appropriate compositions on the appropriate day or time.
Oral formulations containing the active compounds of this invention may comprise any conventionally used oral forms, including tablets, capsules, buccal forms, troches, lozenges and oral liquids, suspensions or solutions. Capsules may contain mixtures of the active compound(s) with inert fillers and/or diluents such as the pharmaceutically acceptable starches (e.g. corn, potato or tapioca starch), sugars, artificial sweetening agents, powdered celluloses, such as crystalline and microcrystalline celluloses, flours, gelatins, gums, etc. Useful tablet formulations may be made by conventional compression, wet granulation or dry granulation methods and utilize pharmaceutically acceptable diluents, binding agents, lubricants, disintegrants, suspending or stabilizing agents, including, but not limited to, magnesium stearate, stearic acid, talc, sodium lauryl sulfate, microcrystalline cellulose, carboxymethylcellulose calcium, polyvinylpyrrolidone, gelatin, alginic acid, acacia gum, xanthan gum, sodium citrate, complex silicates, calcium carbonate, glycine, dextrin, sucrose, sorbitol, dicalcium phosphate, calcium sulfate, lactose, kaolin, mannitol, sodium chloride, talc, dry starches and powdered sugar. Oral formulations herein may utilize standard delay or time release formulations to alter the absorption of the active compound(s). Suppository formulations may be made from traditional materials, including cocoa butter, with or without the addition of waxes to alter the suppository's melting point, and glycerin. Water soluble suppository bases, such as polyethylene glycols of various molecular weights, may also be used.
In a preferred embodiment, a package or kit of this invention will include individual oral dosage formulations for each of the components of the invention. For instance one daily dosage tablet of an orally administerable formulation of a substituted indole compound of this invention, preferably l-[4-(2-Azepan-lyl- ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3-methyl- lH-indol-5-ol or 2-(4-Hydroxy- phenyl)-3-methyl- 1 -(4-(2-piperidin- 1 -yl-ethoxy)-benzyl]- 1 H-indol-5-ol or a pharmaceutically acceptable salt thereof, and a once daily dosage Premarin® conjugated estrogen tablet, for each day of a specified regimen. It will be understood that any or each of these components may be divided in the kit or package into multiple doses to be administered over the course of each day. In another preferred embodiment, the kit or package comprises a one month supply of the components described herein, i.e. from 28 to 31 daily administration amounts of each component.
The estrogens herein may be administered according to the regimens and doses known in the art. For instance, the preferred Premarin® conjugated estrogen tablets may be administered as described in pages 3302-3305 of the Physicians' Desk Reference, 54 Edition, 2000, Medical Economics Company, Inc., Montvale, NJ 07645-1742. Other commercially available estrogens useful with the present invention include OGEN® (estropipate tablets), ESTRATAB® (esterified estrogens tablets), ESTRACE® estradiol vaginal cream, CLIMARA® (estradiol transdermal system), ESTRADERM® (transdermal system), MENEST™ (esterified estrogens tablets), ORTHO-EST® (estropipate tablets), CENESΗN™ (synthetic conjugated estrogens), ALORA® (estradiol transdermal system), ESTINYL® (ethynil estradiol), and the VINELLE® and VIVELLE-DOT® (estradiol transdermal systems). Each of these commercially available estrogen products can be administered as described in their relevant portions of the Physicians' Desk Reference, 54 Edition, 2000.
The following table lists estrogen replacement therapies and dosage strengths available in the United States and/or Europe.
Generic Name Brand Name Strength
Oral estrogens
Conjugated equine estrogens (natural) Premarin 0.3, 0.625, 0.9, 1.25, 2.5 mg
Conjugated estrogens (synthetic) Cenestin 0.625, 0.9 mg
Esterified estrogens (75-80% estrone sulfate Estratab 0.3, 0.625, 1.25, 2.5 mg
6-15% equilin sulfate derived from plant sterols)
Estropipate (Piperazine estrone sulfate) Ogen Ortho-Est 0.625, 1.25, 2.5 mg
Micronized estradiol Estrace 0.5, 1.0, 2.0 mg
Raloxifene (selective estrogen receptor modulator) Evista 60 mg
Esterified estrogens and methylestosterone Estratest 1.25 mg esterified estrogen and 2.5 mg methylestosterone
Estratest HS 0.625 mg esterified estrogen and 1.25 mg methylestosterone
Estradiol valerate Climaval 1 mg, 2 mg
Estradiol Elleste Solo 1 mg, 2 mg
Estradiol Estrofem 2 mg
Estradiol Estrofem Forte 4 mg
Piperazine esterone sulfate Harmogen 1.5 mg
Combination: Estrone Hormonin 1.4 mg
Estradiol 0.6 mg
Estriol 0.27 mg
Estradiol valerate Progynova 1 mg, 2 mg
Estradiol Zumenon 1 mg, 2 mg
Transdermal estrogens
Estradiol Alora (twice weekly) 0.025, 0.0375, 0.05, 0.075,
Climara (weekly) 0.1 mg of estradiol released
Estraderm (2x weekly) daily (dose options for
Fern Patch (weekly) various
Vivelle (twice weekly) products)
Estradiol Dermestril
Estradiol Estraderm 25, 50, 100 μg
Estradiol Evorel (Systen) 25, 50, 100 μg
Estradiol Fematrix 25, 50, 75, 100 μg
Estradiol Menorest 40, 80 μg
Progynova TS 25, 37.5, 50, 75 μg
Estradiol And TS Forte
(Climara) 50, 100 μg
Vaginal estrogens
Conjugated equine estrogens Premarin vaginal
Dienestrol cream
Estradiol Ortho dienestrol cream 0.625 mg/g
Estropipate Estring 0.1 mg/g
Micronized estradiol Ogen vaginal cream 7-5 μg
Estrace vaginal cream 1.5 mg g . 1.0 mg/g The joint administration of the two groups of compounds in these methods will be determined by a medical professional based upon the condition of the recipient and the malady for which the prophylaxis or treatment is provided. Administration of the two compounds may begin simultaneously or one may be introduced into an ongoing regimen of the other.
Solid oral formulations, preferably in the form of a film coated tablet or capsule, useful for this invention include the active pharmacological agents disclosed herein in combination with carrier or excipient systems having the components: a) a filler and disintegrant component comprising from about 5% to about 82% by weight (wght) of the total formulation, preferably between about 30% and about 80% of the formulation, of which from about 4% to about 40% by weight of the total formulation comprises one or more pharmaceutically acceptable disintegrants; b) optionally, a wetting agent comprising from about 0.2 to about 5% of the composition (wght), such as selected from the group of sodium lauryl sulfate, polyoxyethylene sorbitan fatty acid esters, polyoxyethylene alkyl ethers, sorbitan fatty acid esters, polyethylene glycols, polyoxyethylene castor oil derivatives, docusate sodium, quaternary ammonium compounds, sugar esters of fatty acids and glycerides of fatty acids; c) a lubricant comprising from about 0.2% to about 10% of the composition (wght), such as selected from the group of magnesium stearate or other metallic stearates (e.g. calcium stearate or zinc stearate), fatty acid esters (e.g. sodium stearyl fumarate), fatty acids (e.g. stearic acid), fatty alcohols, glyceryl behenate, mineral oil, parrafins, hydrogenated vegetable oils, leucine, polyethylene glycols, metallic lauryl sulfates and sodium chloride; and d) optionally, a glidant comprising from about 0.1% to about 10% (wght) of the composition, the glidant selected from those known in the art, including from the group of silicon dioxide, talc, metallic stearates, calcium silicate, or metallic lauryl sulfates.
While the formulations described herein may be used in an uncoated or non- encapsulated solid form, preferably the final compositions are coated or encapsulated. The pharmacological compositions may be optionally coated with a film coating, preferably comprising from about 0.3% to about 8% by weight of the overall composition. Film coatings useful with the present formulations are known in the art and generally consist of a polymer (usually a cellulosic type of polymer), a colorant and a plasticizer. Additional ingredients such as wetting agents, sugars, flavors, oils and lubricants may be included in film coating formulations to impart certain characteristics to the film coat. The compositions and formulations herein may also be combined and processed as a solid, then placed in a capsule form, such as a gelatin capsule.
The filler component listed above may utilize the filler or binder components known in the art for solid oral formulations. Pharmaceutically acceptable fillers or binding agents selected from those known in the art including, but not limited to, lactose, microcrystalline cellulose, sucrose, mannitol, calcium phosphate, calcium carbonate, powdered cellulose, maltodextrin, sorbitol, starch, or xylitol.
In conjunction with or in place of the materials listed above for the filler component, the present formulations utilize disintegrant agents. These disintegrants may be selected from those known in the art, including pregelatinized starch and sodium starch glycolate. Other useful disintegrants include croscarmellose sodium, crospovidone, starch, alginic acid, sodium alginate, clays (e.g. veegum or xanthan gum), cellulose floe, ion exchange resins, or effervescent systems, such as those utilizing food acids (such as citric acid, tartaric acid, malic acid, fumaric acid, lactic acid, adipic acid, ascorbic acid, aspartic acid, erythorbic acid, glutamic acid, and succinic acid) and an alkaline carbonate component (such as sodium bicarbonate, calcium carbonate, magnesium carbonate, potassium carbonate, ammonium carbonate, etc.). The disintegrant(s) useful herein will comprise from about 4% to about 40% of the composition by weight, preferably from about 15% to about 35%, more preferably from about 20% to about 35%. Some components may have multiple functions in the formulations of this invention, acting e.g. as both a filler and a disintegrant, such a component may be referred to as a filler disintegrant and its function in a specific formulation may be singular even though its properties may allow multiple functionality. The pharmaceutical formulations and carrier or excipient systems herein preferably also contain an antioxidant or a mixture of antioxidants, most preferably ascorbic acid. Other antioxidants which may be used include sodium ascorbate and ascorbyl palmitate, preferably in conjunction with an amount of ascorbic acid. A preferable range for the antioxidant(s) is from about 0.5% to about 15% by weight, most preferably from about 0.5% to about 5% by weight.
Among the formulations of this invention are pharmaceutical formulations containing a pharmaceutically effective amount of an active pharmacological agent and a carrier or excipient system comprising: a) a filler and disintegrant component comprising between about 50% and about 87% of the formulation, with from about 4% to about 40% of the formulation comprising one or more disintegrant agents; b) a wetting agent comprising between about 0.5% and about 2.7% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; and d) a glidant comprising between about 0.1% and about 5.5% of the formulation.
The percentages listed in the formulations above indicate percentages by weight of the total weight of the components listed from a) to d). The formulations above also preferably contain an optional antioxidant component, preferably ascorbic acid, at a concentration of from about 0.5% to about 5.5% by weight of the formulation. The formulations are also preferably contained within a pharmaceutically acceptable capsule, such as a gel capsule, or coated with a film coating comprising from about 0.3% to about 8% by weight of the formulation.
This invention also comprises a pharmaceutical carrier or excipient systems useful in pharmaceutical compositions utilizing as an active ingredient one or more of the compounds described herein, or a pharmaceutically acceptable salt thereof, as described herein. These pharmaceutical carrier or excipient systems may comprise, by weight: a) a filler and disintegrant component comprising between about 54% and about 80% of the formulation, with the disintegrant agent(s) therein comprising from about 4% to about 40% by weight of the overall formulation; b) a wetting agent comprising between about 0.55% and about 2.5% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; and d) a glidant comprising between about 0.1% and about 5.0% of the formulation.
The more preferred carrier or excipient systems above also optionally and preferably contain an antioxidant component, preferably ascorbic acid, at a concentration of from about 0.1% to about 5.0% by weight.
Among the carrier or excipient systems of this invention are those comprising: a) a filler and disintegrant component, as described above, comprising between about 50% and about 87% of the formulation, the disintegrant(s) therein comprising from about 25% to about 35% of the formulation, by weight; b) a wetting agent comprising between about 0.55% and about 2.7% of the formulation; c) a lubricant comprising between about 0.2% and about 5.5% of the formulation; d) a glidant comprising between about 0.1% and about 5.5% of the formulation; and e) an antioxidant component, preferably ascorbic acid, at a concentration of from about 0.1% to about 5.5% by weight.
Accordingly this invention provides a product or kit of parts comprising a compound of formula I or II as defined above or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof for administration as a combined preparation for simultaneous, separate or sequential use for inhibiting bone prosthesis degeneration in a mammal. This invention also provides a pharmaceutical composition comprising a compound of formula I or II as defined above or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
In a further aspect this invention also provides use of a substituted indole compound of the formulae I or II as defined above or a pharmaceutically acceptable salt thereof and optionally one or more estrogens in the preparation of a medicament for inhibiting bone prosthesis degeneration in a mammal.
Example 1. TSE-424 Acetate -Rapid Dissolution Formulations
Figure imgf000031_0001
* Amount in formula is adjusted for actual potency of TSE-424 as free base. Corresponding adjustment made with Lactose.
The formulations given above in Table 1 were prepared by incorporating a portion of the excipients in the granulation and a portion is also added in the final blending steps as dry powders. A dissolution profile generated for the formulations demonstrated almost 90% release of the drug in 30 minutes. Thus, the unique combination of disintegrants and soluble diluents plus the incorporation of both granulated and powdered solids into the composition ensures the fastest release of drug.
Wet granulation of the formulations as described in Table 1 may be carried out by mixing the drug and ascorbic acid with a portion of the lactose, microcrystalline cellulose, pregelatinized starch and sodium starch glycolate. The sodium lauryl sulfate is dissolved in the water and used to granulate the mixture of powders in a high shear mixer. The granulation is dried in a fluid bed dryer to a moisture of 2-3%. The particle size of the dried granulation is controlled by passing through a mill equipped with knife-edged blades and using a 20- or 30-mesh screen. The silicon dioxide and remaining lactose, microcrystalline cellulose, pregelatinized starch, and sodium starch glycolate are mixed with the milled granulation in a tumble- type mixer. The final blend is prepared by adding magnesium stearate to the tumble- type mixer and mixing. Compression is carried out on a rotary tablet press using appropriate size tooling. Coating is performed in conventional coating pans and applying the coating suspension to achieve a suitable film coat.
Example 2. Modified TSE-424 formulation
%w/w
Figure imgf000032_0001
Amount in formula is adjusted for actual potency of TSE-424 as free base. Corresponding adjustment made with Lactose.
Used in process but does not appear in the final product. Example 3. ERA-923 formulations
%w/w
Figure imgf000033_0001
As the Hydrochloride Monohydrate. Quantity is adjusted based on the actual potency (theory = 89.34%).
Used in process but does not appear in the final product.
ERA-923 tablets are compressed to a tablet weight of up to 640 mg to achieve the target dose (up to 100 mg). Tablets may then be film coated.
Example 4. TSE-424 at 5 % Granulation
A preferred carrier or excipient system for formulating a granulation of from about 2 to about 8% by weight of one of the active pharmacological agents of this invention, preferably about 5%, may be produced utilizing the carrier or excipient components on a weight percentage; lactose from about 32% to about 38%, microcrystalline cellulose from about 32% to about 38%, pregelatinized starch from about 12% to about 16%, ascorbic acid from about 1% to about 2%, sodium lauryl sulfate from about 1% to about 2%, sodium starch glycolate from about 4% to about 8%, silicon dioxide from about 0.1% to about 0.2% and magnesium stearate from about 0.3% to about 0.7%.
A formulation of this invention utilizing TSE-424 as the active ingredient at a 5% granulation was prepared utilizing the components listed below in a granulation part of components and a dry part.
Item No. Ingredients Mg Unit
Granulation Part:
1 TSE-424 acetate 5.00
2 Lactose NF 26.60
3 Microcrystalline Cellulose NF 25.00 4 Pregelatinized Starch NF 10.00
55 AAssccoorrbbiicc AAcciidd UUSSPP 1.50
6 Sodium Lauryl Sulfate NF 1.50
7 Sodium Starch Glycolate NF 4.00 8 Water, Purified USP Q.S.
73.60
Dry Part:
9 Lactose NF (fast flo) 9.75 10 Microcrystalline Cellulose NF 10.00 11 Pregelatinized Starch NF 4.00
12 Sodium Starch Glycolate NF 2.00 13 Silicon Dioxide NF 0.15
14 Magnesium Stearate NF 0.50
100.00
A film coat of White Opadry I (YS-1-18027-A) was applied to the tablets, which were compressed as follows:
Dose of TSE-424 tablet weight. mg m of film coat applied/tablet
5 mg 100 6.0
10 mg 200 8.0
20 mg 400 13.0

Claims

CLAIMS:
1. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of a substituted indole compound of the formulae I or II:
Figure imgf000035_0001
π wherein Z is a moiety selected from the group of:
Figure imgf000035_0002
or •(CH2)n Y wherein:
R1 is selected from H, OH or the C1- 2 esters or Cj-Cj., alkyl ethers thereof, benzyloxy, or halogen; or C C4 halogenated ethers including trifluoromethyl ether and trichloromethyl ether;
R2, R3, R5 and R6 are independently selected from H, OH or the C1-C12 esters or C^CJJ alkyl ethers thereof, halogens, or C,-C4 halogenated ethers, cyano, Ci-Cβ alkyl, or trifluoromethyl, with the proviso that, when R\ is H, R2 is not OH;
R4 is selected from H, OH or the C1-C12 esters or C,-C12 alkyl ethers thereof, halogens, or Cj-C4 halogenated ethers, benzyloxy, cyano, Ci-Cβ alkyl, or trifluoromethyl;
X is selected from H, Ci-Cό alkyl, cyano, nitro, trifluoromethyl, halogen; n is 1, 2 or 3; Y is selected from: a) the moiety:
Figure imgf000036_0001
wherein R7 and Rs are independently selected from the group of H, C1-C6 alkyl, or phenyl optionally substituted by CN, C1-C6 alkyl, C1-C6 alkoxy (straight chain or branched), halogen, -OH, -CF3, or -OCF3; ;or R7 and
R8 are combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydroxyl, halo, Cι-C4alkyl, trihalomethyl, C\- C4alkoxy, trihalomethoxy, Cι-C4alkylthio, Cι-G4alkylsulfinyl, Cι~C4alkyl- sulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di-(Cι-C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι- C4)alkyl and -NO2;
b) a five-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4 alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, -G^acyloxy, Cχ-C4alkylthio,
Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN-, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C )alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, -NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl;
c) a six-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4 alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, C2-C4acyloxy, Cι-C4alkyϊthio, Cι-C4alkylsulfinyl, C^alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(C1-C4)alkyl, -NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl; d) a seven-membered saturated, unsaturated or partially unsaturated heterocycle containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(Cι_C4 alkyl)-, -N=, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, C2-C4acyloxy, Cι-C4alkylthio, C1-C4 alkylsulfinyl, C1-C4 alkylsulfonyl, hydroxy (Cι-C4)alkyl, -CO2H-, -CN-, -CONHR,, -NH2, Cι-C4alkylamino, di(Cι-C )alkylamino, -NHSO2R,-, -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl,
-NO2, and phenyl optionally substituted with 1-3 (Cι-C4)alkyl; or
e) a bicyclic heterocycle containing from 6-12 carbon atoms either bridged or fused and containing up to two heteroatoms selected from the group consisting of -O-, -NH-, -N(CιC4 alkyl)-, and -S(O)m-, wherein m is an integer of from 0-2, optionally substituted with 1-3 substituents independently selected from the group consisting of hydrogen, hydroxyl, halo, C1-C4 alkyl, trihalomethyl, C1-C4 alkoxy, trihalomethoxy, Cι-C4acyloxy, Cι-G4alkylthio, C1-C4 alkylsulfinyl, Ci- C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H-, -CN-, -CONHR,-, -NH2-, C1-C4 alkylamino, di(Cι-C4)alkylamino, -NHSO2R„ -NHCOR,, -CONH(Cι-C4)alkyl, -NHSO2(Cι-C )alkyl, -NHCO(Cι-C )alkyl, -NO2, and phenyl optionally substituted with 1-3 (C1-C4) alkyl; or a pharmaceutically acceptable salt thereof; and optionally a pharmaceutically effective amount of one or more estrogens, or a pharmaceutically acceptable salt thereof.
2. The method of Claim 1 wherein in the substituted indole compound of the formulae I or II:
R! is selected from H, OH or the C1-C12 esters or alkyl ethers thereof, benzyloxy, or halogen; R2, R3, R5, and R6 are independently selected from H, OH or the C1-C12 esters or alkyl ethers thereof, halogen, cyano, C1-C6 alkyl, or trihalomethyl; with the proviso that, when Ri is H, R2 is not OH;
R4 is selected from H, OH or the -C12 esters or alkyl ethers thereof, benzyloxy, halogen, cyano, C]-C6 alkyl, or trihalomethyl; X is selected from H, C1-C6 alkyl, cyano, nitro, trifluoromethyl, halogen; Y is the moiety
\
R8 •
R7 and R8 are selected independently from H, C1-C6 alkyl, or combined by -(CH2)p-, wherein p is an integer of from 2 to 6, so as to form a ring, the ring being optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4al yl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Ci-G^alkyl- thio, Cι-C4alkylsulfinyl, Cι-C4alkylsulfonyl, hydroxy(Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di (Cι-C4)alkylamino, -NHSO2(Cι- C4)alkyl, -NHCO(Cι-C4)alkyl, and -NO2; or a pharmaceutically acceptable salt thereof.
3. The method of Claim 2 wherein, in the substituted indole compound of the formulae I or π, the ring formed by a the combination of R7 and Rs by -(CH2)p- is selected from aziridine, azetidine, pyrrolidine, piperidine, hexamethyleneamine or heptamethyleneamine.
4. The method of Claim 1 utilizing a substituted indole compound of the formulae I or II, wherein Rj is OH; R2 - R6 are as defined in Claim 1; X is selected from the group of Cl, NO2, CN, CF3, or CH3; and Y is the moiety
\ Rs and R7 and Rs are concatenated together as -(CH2)r-, wherein r is an integer of from 4 to 6, to form a ring optionally substituted by up to three substituents selected from the group of hydrogen, hydroxyl, halo, Cι-C4alkyl, trihalomethyl, Cι-C4alkoxy, trihalomethoxy, Cι-C4alkylthio, Cι-C4alkylsulfinyl, Ci-Gψalkylsulfonyl, hydroxy (Cι-C4)alkyl, -CO2H, -CN, -CONH(Cι-C4)alkyl, -NH2, Cι-C4alkylamino, di(Cι- C4)alkylamino, -NHSO2(Cι-C4)alkyl, -NHCO(Cι-C4)alkyl, and -NO2; or a pharmaceutically acceptable salt thereof.
5. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of a substituted indole compound of the formulae III or IV:
Figure imgf000039_0001
(HI) (IN) wherein R,, Rj, Rj, R4, R3, R6, n, X, and Y are as defined in Claim 1, or a pharmaceutically acceptable salt thereof and optionally a pharmaceutically effective amount of one or more estrogens, or a pharmaceutically acceptable salt thereof.
6. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of a substituted indole compound of the formulae (V) or (VI):
Figure imgf000039_0002
(N) (VI) wherein R,, Rj, R3, R4, R3, R6, X, and Y are as defined in Claim 1, or a pharmaceutically acceptable salt thereof and optionally a pharmaceutically effective amount of one or more estrogens, or a pharmaceutically acceptable salt thereof.
7. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a substituted indole compound of the formulae VII and VIII:
Figure imgf000040_0001
(NH) (VIII) wherein R,, R2, Rj, R4, R3, R6, n, X, and Y are as defined in Claim 1, or a pharmaceutically acceptable salt thereof and optionally a pharmaceutically effective amount of one or more estrogens, or a pharmaceutically acceptable salt thereof..
8. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of l-[4-(2-Azepan-lyl-ethoxy)-benzyl]-2-(4-hydroxy-phenyl)-3- methyl-lH-indol-5-ol, or a pharmaceutically effective salt thereof, and optionally one or more estrogens, or a pharmaceutically acceptable salt thereof.
9. A method for inhibiting bone prosthesis degeneration in a mammal, the method comprising administering to a mammal in need thereof a pharmaceutically effective amount of 2-(4-Hydroxy-phenyl)-3-methyl-l-(4-(2-piperidin-l-yl-ethoxy)- benzyl]-lH-indol-5-ol, or a pharmaceutically effective salt thereof, and optionally one or more estrogens, or a pharmaceutically acceptable salt thereof.
10. A method according to any one of claims 1 to 9 wherein the one or more estrogens are utilised selected from the group of estrone, estriol, equilin, estradiene, equilenin, ethinyl estradiol, 17β-estradiol, 17 -dihydroequilenin, 17β- dihydroequilenin, 17α-dihydroequilin, 17β-dihydroequilin, menstranol, conjugated estrogenic hormones, equol, enterolactone, or a pharmaceutically acceptable salt thereof.
11. A method according to Claim 10 wherein the one or more estrogens are conjugated estrogenic hormones.
12. A method according to Claim 11 wherein the conjugated estrogenic hormones are the conjugated estrogens of the Premarin® brand products.
13. A method according to any one of claims 1 to 12 wherein the prosthesis is a dental prosthesis.
14. A method according to any one of claims 1 to 12 wherein wherein the prosthesis is a hip prosthesis.
15. A method according to any one of claims 1 to 12 wherein the prosthesis is a knee prosthesis.
16. A product comprising a compound of formula I or II as defined in any one of claims 1 to 9 or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof for administration as a combined preparation for simultaneous, separate or sequential use for inhibiting bone prosthesis degeneration in a mammal.
17. A pharmaceutical composition comprising a compound of formula I or II as defined in any one of claims 1 to 9 or a pharmaceutically acceptable salt thereof, and one or more estrogens, or a pharmaceutically acceptable salt thereof; and a pharmaceutically acceptable carrier.
18. Use of a substituted indole compound of the formulae I or II as defined in any one of claims 1 to 9 or a pharmaceutically acceptable salt thereof and optionally one or more estrogens in the preparation of a medicament for inhibiting bone prosthesis degeneration in a mammal.
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