Kits for dhea and dhea-sulfate for the treatment of chronic obstructive pulmonary disease

Abstract

Kits for treating or preventing chronic obstructive pulmonary disease (COPD) by using as active agent a non-glucorticoid steroid, analogue thereof, such as dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfate (DHEA-S), or their salts, in an amount effective for preventing or treating COPD.

Description

[0001]This application is a continuation-in-part of International Application No. PCT / US02 / 12555, filed Apr. 21, 2002, published Oct. 31, 2002 under PCT Article 21(2) in English; which claims priority to U.S. Provisional Application Ser. No. 60 / 286,124, filed Apr. 24, 2001.BACKGROUND OF THE INVENTION[0002]1. Field of the Invention[0003]This invention concerns itself with an active agent that is suitable for trea chronic obstructive pulmonary disease (COPD). The present agents may be administered preventatively, prophylactically or therapeutically in conjunction with other therapies, or may be utilized as a substitute for therapies that have significant, negative side effects.[0004]2. Description of the Background[0005]Chronic obstructive pulmonary disease (COPD) causes a continuing obstruction of airflow in the airways. COPD is characterized by airflow obstruction that is generally caused by chronic bronchitis, emphysema, or both. Commonly, the airway obstruction is mostly irreversi...

AI Technical Summary

Benefits of technology

The present invention provides a pharmaceutical composition for the treatment and prevention of COPD and other respiratory diseases and conditions. The composition contains a non-glucocorticoid steroid or analogues thereof, or a ubiquinone, which are active agents that can reduce inflammation and improve lung function. The composition can be administered through various methods such as inhalation or injection. The invention also provides a delivery kit and a delivery device for the pharmaceutical composition.

Problems solved by technology

In emphysema, a structural element (elastin) in the terminal bronchioles is destroyed leading to the collapse of the airway walls and inability to exhale “stale” air.

If this continues for a long period, the right heart enlarges and functions poorly, and fluid collects in the ankles (edema) and belly.

Eventually the left heart begins to fail.

Both morbidity and mortality, however, are rising.

Long-term smoking is the most frequent cause of COPD.

This results in early disability and shortened survival time.

There is very little currently available to alleviate symptoms of COPD, prevent exacerbations, preserve optimal lung function, and improve daily living activities and quality of life.

Short and long acting inhaled β2 adrenergic agonists achieve short-term bronchodilation and provide some symptomatic relief in COPD patients, but show no meaningful maintenance effect on the progression of the disease.

In asthmatics, however, β2 adrenergic agonists have been linked to an increased risk of death, worsened control of asthma, and deterioration in lung function. β2-agonists, such as albuterol, help to open narrowed airways.

The use of β2-agonists can produce paradoxical bronchospasm, which may be life threatening to the COPD patient.

In addition, the use of β2-agonists can produce cardiovascular effects, such as altered pulse rate, blood pressure and electrocardiogram results.

Continuous treatment of asthmatic and COPD patients with the bronchodilators ipratropium bromide or fenoterol resulted in a faster decline in lung function, when compared with treatment provided on a need basis, therefore indicating that they are not suitable for maintenance treatment.

The most common immediate adverse effect of β2 adrenergic agonists, on the other hand, is tremors, which at high doses may cause a fall in plasma potassium, dysrhythmias, and reduced arterial oxygen tension.

Anti-cholinergic drugs achieve short-term bronchodilation and produce some symptom relief in people with COPD, but no improved long-term prognosis even with inhaled products.

Ipratropium bromide, however, produced serious adverse effects, such as cardiac symptoms, hypertension, skin rashes, and urinary retention.

The theophyllines' doses must be adjusted individually according to smoking habits, infection, and other treatments, which is cumbersome.

The adverse effects of theophyllines and the need for frequent monitoring limit their usefulness.

There is no evidence that anti-cholinergic agents affect the decline in lung function, and mucolytics have been shown to reduce the frequency of exacerbations but with a possible deleterious effect on lung function.

Oral corticosteroids elicit some improvement in baseline functional effective volume in stable COPD patients whereas systemic corticosteroids have been found to be harmful at least producing some osteoporosis and inducing overt diabetes.

Mucolytics have a modest beneficial effect on the frequency and duration of exacerbations but an adverse effect on lung function.

In women, however, oxygen decreased the rates of death throughout the study.

This latter list of medications help alleviate symptoms associated with COPD but do not treat COPD.

Thus, there is very little currently available to alleviate symptoms of COPD, prevent exacerbations, preserve optimal lung function, and improve daily living activities an quality of life.

While the increasing mortality of asthma in industrialized countries could be attributable to the reliance upon beta agonists in the treatment of this disease, the underlying causes of asthma remain poorly understood.

Other respiratory diseases such as asthma, allergic rhinitis, and Acute Respiratory Distress Syndrome (ARDS), including ARDS in pregnant mothers and Respiratory Distress Syndrome (RDS) in premature born infants, pulmonary fibrosis, and cystic fibrosis (CF), among others, are common diseases in industrialized countries, and in the United States alone account for extremely high health care costs.

In spite of this, their underlying causes still remain poorly understood.

Most of the drugs available for the treatment of asthma are, more importantly, barely effective in a small number of patients.

ARDS is believed to be caused by a failure of the respiratory system characterized by fluid accumulation within the lung that, in turn, causes the lung to stiffen.

In ARDS, the ability of the lungs to expand is severely decreased and damage to the air sacs and lining (endothelium) of the lung is extensive.

In general, however, ARDS appears to be associated with traumatic injury, severe blood infections such as sepsis, or other systemic illness, high dose radiation therapy and chemotherapy, and inflammatory responses which lead to multiple organ failure, and in many cases death.

Moreover, lung surfactant, a material critical for normal respiration, is generally not yet present in sufficient amounts at this early stage of life; however, premies often hyper-express the adenosine A, receptor and / or underexpress the adenosine A2a receptor and are, therefore, susceptible to respiratory problems including bronchoconstriction, lung inflammation and ARDS, among others.

When Respiratory Distress Syndrome (RDS) occurs in premies, it is an extremely serious problem.

When premies survive RDS, they frequently develop bronchopulmonary dysplasia (BPD), also called chronic lung disease of early infancy, which is often fatal.

Adenosine adminstered by inhalation, however, is known to cause bronchoconstriction in asthmatics, possibly due to mast cell degranulation and histamine release, effects which have not been observed in normal subjects.

Adenosine infusion has caused respiratory compromise, for example, in patients with COPD.

Because many people mislabel their symptoms as persistent colds or sinus problems, allergic rhinitis is probably underdiagnosed.

Symptoms include nasal congestion, discharge, sneezing, and itching, as well as itchy, watery, swollen eyes.

Sufferers may also become hyperreactive to nonspecific triggers such as cold air or strong odors.

In addition, pregnancy, hypothyroidism, and exposure to occupational factors or medications can cause rhinitis, as well.

The sedating-type anti-histamines help induce night sleep, but they cause sleepiness and compromise performance if taken during the day.

These agents, however, cause hypertension, palpitations, tachycardia, restlessness, insomnia and headache.

The interaction of phenylpropanolamine with caffeine, in doses of two to three cups of coffee, may significantly raise blood pressure.

In addition, medications such as pseudoephedrine may cause hyperactivity in children.

Topical decongestants are recommended for a limited period of time, as their over use results in nasal dilatation.

However, sometimes the Cromolyn spray produces sneezing, transient headache, and even nasal burning.

Topical and nasal spray corticosteroids such as Vancenase are effective agents in the treatment of rhinitis, especially for symptoms of congestion, sneezing, and runny nose, but often cause irritation, stinging, burning, sneezing, local bleeding and septal perforation.

Topical steroids are generally more effective than Cromolyn Sodium, particularly in the treatment of NARES, but side effects limit their usefulness except for temporary therapy in patients with severe symptoms.

Immunotherapy, while expensive and inconvenient, often can provide substantial benefits, especially the use of drugs that produce blocking antibodies, alter cellular histamine release, and result in decreased IgE.

In addition, verapamil readily crosses the placenta and has been shown to cause fetal bradycardia, heart block, depression of contractility, and hypotension.

This fibrosis or scarring of the lung tissue results in permanent loss of its ability to breathe and carry oxygen, and the amount of scarring determines the level of disability a person experiences because of the destruction by the scar tissue of the air sacs and lung tissue between and surrounding the air sacs and the lung capillaries.

Since many lung diseases show this symptom, making a correct diagnosis is often difficult.

Eventually resulting in shortness of breath even at rest.

Glucocorticosteroids are usually administered to treat inflammation present in pulmonary fibrosis, with inconclusive results.

Other drugs, however, are not usually added until it is clear that the steroids are not effective in reversing the disease.

In approximately 50% of the cases, the disease is chronic with loss of lung function, and although glucocorticosteroid therapy is often prescribed, there is no evidence that it is effective.

Many jobs, particularly those that involve mining or that expose workers to asbestos or metal dusts, may cause pulmonary fibrosis by inhalation of small particulate matter, e.g., dust or asbestos fibers that damage the lungs, especially the small airways and air sacs, and cause scarring (fibrosis).

Agricultural workers are also affected by some particulate organic substances, such as moldy hay, which cause an allergic reaction in the lung called “Farmer's Lung”, and may cause pulmonary fibrosis as well.

Asbestosis is caused by small needle-like particles of asbestos inhaled into the lungs, and cause lung scarring or pulmonary fibrosis that may lead to lung cancer.

Large silica particles are stopped in the upper airways, but the tiniest specks of silica are carried down to the lung alveoli, where they lead to pulmonary fibrosis.

The use of glucocorticosteroids alone, or combined drug therapy, and the hope of lung transplant are three treatment approaches that are currently being tested, but up to the present time there is no good therapy for this disease.

Two of the most damaging characteristics of carcinomas and other types of malignancies are their uncontrolled growth and their ability to create metastases in distant sites of the host, particularly a human host.

It is usually these distant metastases that may cause serious consequences to the host since, frequently, the primary carcinoma is removed by surgery.

It has long been known that patients receiving steroid hormones of adrenocortical origin at pharmacologically appropriate doses show increased incidence of infectious disease.

Such lovastatin-induced depletion of ubiquinone has been shown to lead to chronic heart failure, or to a shift from low heart failure into life-threatening high grade heart failure.

However, DHEA's indirect inhibition of HMG CoA reductase suffices to deplete intracellular mevalonate, and may result in depletion of ubiquinone, and in chronic heart failure following long term usage.

Adenosine has also been shown to cause adverse effects, including death, when administered therapeutically for other diseases and conditions in subjects with previously undiagnosed hyper reactive airways.

However, these patents do not teach using DHEA or DHEA-related compounds to prevent or treat COPD.

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