Mebeverine derivatives for the uses thereof in the treatment of autoimmune diseases

Abstract

The present invention relates to the use of a family of compounds, the compounds of formula (I), for use thereof in preventing and / or treating autoimmune diseases, in particular systemic lupus erythematosus (SLE), in a subject in need thereof. In particular, the invention relates to the prevention and / or treatment of organic lesions and relapses, exacerbation or flare-ups, and adverse consequences for the health in a subject with systemic lupus erythematosus (SLE).

Description

MEBEVERINE DERIVATIVES FOR THEIR USE IN THE TREATMENT OF AUTOIMMUNE DISEASES technical field

[0001] The present invention relates to the use of a family of compounds, namely mebeverine derivatives, for the prevention and / or treatment of autoimmune diseases, particularly systemic lupus erythematosus (SLE), in individuals in need. Specifically, the invention relates to the prevention and / or treatment of organ damage and flare-ups, exacerbation or worsening of the disease, or any adverse health consequences of SLE, in individuals with systemic lupus erythematosus (SLE). State of the art

[0002] Autoimmune diseases are a heterogeneous group of conditions characterized by an abnormal immune response directed against the body's own tissues. These diseases affect approximately 5 to 8% of the world's population and can affect virtually every organ and system in the human body. Among the best-known autoimmune diseases are rheumatoid arthritis, type 1 diabetes, Crohn's disease, and systemic lupus erythematosus (SLE).

[0003] Systemic lupus erythematosus (SLE) is a serious autoimmune disease affecting 2 million patients worldwide, with an annual incidence of approximately 3 per 100,000 in Europe and North America. The disease primarily affects young women, particularly those of childbearing age, with a typical onset at age 30 and a female-to-male ratio of 10:1. Although genetic and environmental risk factors have been reported to play a role, the etiology of SLE remains undetermined. SLE is characterized by multiple organ damage and episodic flares that exacerbate the disease and increase the risk of serious comorbidities, including kidney failure, heart disease, lung disease, blood disorders, neurological disorders, and psychiatric conditions. Some aspects of these conditions are related to both the disease itself and the aggressive treatments used to combat it.

[0004] However, there is currently no cure for SLE. Current therapeutic solutions rely primarily on treatments aimed at limiting the Disease exacerbations, such as the long-term use of hydroxychloroquine (HCQ), a synthetic antimalarial drug, as a primary treatment, are addressed. Corticosteroids aim to limit inflammatory manifestations and are administered either at high doses to manage acute flares or at lower doses to attenuate disease activity. Certain immunosuppressants, such as methotrexate, azathioprine, mecophenolic acid, and cyclophosphamide, serve as adjunctive, supplementary, or secondary treatments in patients with more severe disease. Other immunosuppressants used in autoimmune diseases are also used, off-label, when patients do not respond to immunosuppressants approved specifically for SLE.Belimumab, a human monoclonal antibody specifically targeting the BLyS protein, has also been approved for severe cases of SLE, particularly those with chronic kidney disease. Finally, multiple medications are prescribed to treat the disease's complications, whether organic and / or psychiatric, as lupus can damage virtually every organ and system in the human body.

[0005] As a result, despite existing treatments, SLE remains highly debilitating, with severe relapses and organ damage. More than 5% of mildly, moderately, or severely severe SLE cases require hospitalization each year for relapses or morbid consequences of the disease, increasing to 10% to 20% or more in more severe cases, including those with chronic organ failure, not counting hospitalizations required for the administration of certain treatments. Nearly 40% of SLE patients may face end-stage renal failure during their lifetime, requiring dialysis or transplantation, highlighting the ongoing need for advanced therapeutic options. Many others suffer from chronic heart failure, pulmonary insufficiency, extreme fatigue, or other systemic failures.

[0006] Thus, SLE remains to this day a very debilitating and serious condition, for which there is a need for new therapeutic solutions. This is the purpose of the present invention. Summary of the invention

[0007] To meet this need, the invention proposes a family of compounds, namely a compound of general formula I, for which the inventors have, surprisingly, demonstrated its efficacy in the prevention and / or treatment of autoimmune diseases, particularly systemic lupus erythematosus (SLE), in individuals in need. Specifically, the present invention proposes a compound of general formula I for the prevention and / or treatment of organic lesions and / or SLE flares, and / or exacerbations of SLE and / or worsening of the disease or any adverse health consequences of SLE, in individuals with SLE.

[0008] Thus, the invention relates to the compound with the following general formula (I):

[0009] [Formula I] or a pharmaceutically acceptable salt and / or solvate of such a compound, in which: RI is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3, or 4 carbons. R2 is chosen from the group consisting of a hydrogen, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons. R3 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, R4 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, X is an oxygen (O) or nitrogen (NH) atom, n is equal to 1, 2 or 3, m is between 0 and 6, p is equal to 0, 1, or 2, q is equal to 1, 2 or 3.

[0010] According to another object, the invention relates to a compound of the following general formula (II):

[0011] [Formula II] or a pharmaceutically acceptable salt and / or solvate of such a compound, in which: - RI is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - R2 is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - R3 is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - X is an oxygen (O) or nitrogen (NH) atom, - n is equal to 1, 2 or 3, - m is between 0 and 6, - p is equal to 0, 1, or 2.

[0012] According to a preferred object, group RI is a methyl group, group R2 is a methyl group, and group R3 is also a methyl group.

[0013] According to another favorite object, group X is an oxygen atom (O).

[0014] According to another definition, the OR1 group can be present at one or more positions on the corresponding aromatic ring, namely one of positions 1, 2, 3, 4, or 5; or alternatively, at several positions on the ring between 1, 2, 3, 4, and 5, particularly when n is equal to 2 or 3. Most preferably, the OR1 group is present on the aromatic ring at one of the positions chosen from the group consisting of positions 3, 4, 5, and their combinations. Even more preferably, n is equal to 2 and the OR1 group is at positions 3 and 4.

[0015] According to another object, the OR3 group can be present on one or more positions of the corresponding aromatic ring, namely one of positions 1, 2, 3, or 4; or alternately at several positions on the ring between 1, 2, 3, and 4, particularly when q is equal to 2 or 3. Most preferably, the OR3 group is present on the aromatic ring at one of the positions chosen from the group consisting of positions 2, 3, 4, and their combinations. Even more preferably, q is equal to 1 and the OR3 group is at position 3 or 4.

[0016] According to another particularly preferred object, the invention relates to a compound of formula III or a pharmaceutically acceptable salt and / or solvate of such a compound, for its use in the prevention and / or treatment of an autoimmune disease, in a subject in need.

[0017] [Formula III]

[0018] According to a preferred object of the invention, the compound of formula III, namely mebeverine or one of its known derivatives, is in the form of a salt.

[0019] When the compound according to the invention is in the form of a salt, it is very preferentially in the form of a hydrochloride salt.

[0020] According to a variant of the present invention, the compound of formula III, namely mebeverine or one of its known derivatives, is in the form of a solvate.

[0021] In the context of the present invention, the compound of formula I, formula II, or formula III is particularly suitable for preventing and / or treating systemic lupus erythematosus (SLE). More preferably, the compound of formula I, formula II, or formula III is intended for use in the secondary prevention and / or treatment of SLE. When said compound according to the invention is intended for use in the secondary prevention of SLE, it aims to prevent an exacerbation of the disease.

[0022] According to another object of the invention, the compound of formula I, of formula II, or of formula III is advantageously used to prevent and / or treat organic lesions and / or flares of SLE and / or exacerbation of SLE and / or worsening of the disease or any adverse health consequence of SLE.

[0023] Most preferably, the invention relates to said compound of formula I, of formula II, or of formula III for its use in LED, particularly for subjects with mild, moderate, moderately severe or severe LED.

[0024] According to another aspect, the invention also relates to a pharmaceutical composition comprising at least one compound according to any one of the embodiments and at least one pharmaceutically acceptable excipient, for its use in the prevention and / or treatment of an autoimmune disease, preferably in the prevention and / or treatment of systemic lupus erythematosus (SLE).

[0025] According to a preferred item, the pharmaceutical composition further includes another active ingredient chosen from the group consisting of an antimalarial agent, a corticosteroid, an immunosuppressant and a non-steroidal anti-inflammatory drug (NSAID).

[0026] When the composition according to the invention further comprises an antimalarial agent, this is preferably chosen from the group consisting of hydroxychloroquine, chloroquine and their derivatives.

[0027] When the composition according to the invention further comprises a corticosteroid, this is preferably a corticosteroid of ATC Class H02.

[0028] Preferably, the corticosteroid is chosen from the group consisting of prednisone, dexamethasone, triamcinolone, betamethasone, beclomethasone, flunisolide and fluticasone.

[0029] When the composition according to the invention further comprises an immunosuppressant, this is preferably an immunosuppressant of the ATC class L04.

[0030] According to another preferred item, the immunosuppressant is chosen from the group consisting of cyclophosphamide, methotrexate, mycophenolic acid, azathioprine and belimumab.

[0031] In the context of the invention, the pharmaceutical composition can be in any form suitable for oral or injectable administration.

[0032] Thus, the present pharmaceutical composition is preferably presented in the form of a tablet, a capsule, a liquid dose, a gel or a powder.

[0033] The scope of the present invention is not limited by the specific embodiments described herein. These embodiments are illustrative only. Compounds, including known derivatives of the compound according to the invention, pharmaceutical compositions, and any equivalents, fall within the scope of the present invention as described herein.

[0034] Other features and advantages will become apparent from the detailed description of the invention, the examples and figures that follow. Brief description of the Figures

[0035] Figure 1 represents the patient selection for the study in the form of a "Flowchart" (Flow Diagram), namely a patient selection flowchart in the MELUSINE study

[0036] Figure 2 presents the results of the main analysis and stratified analyses in the form of a "Forest Plot".

[0037] Figure 3 presents the results on markers of inflammation. Detailed description of the invention

[0038] Definition

[0039] In the context of the present invention, the term "pharmaceutically acceptable" or "physiologically acceptable" means that which is useful for the preparation of a pharmaceutical composition and that which is generally safe, compatible, stable, non-irritating, non-allergic and non-toxic, for pharmaceutical use with a reasonable benefit / risk ratio.

[0040] For the purposes of this invention, "pharmaceutically acceptable salt and / or solvate" means a salt and / or solvate of a pharmaceutically acceptable compound, as defined above, and which has the pharmacological activity of the corresponding compound.

[0041] Pharmaceutically acceptable salts include those prepared from pharmaceutically acceptable, non-toxic acids, such as hydrochloric, hydrobromic, phosphoric, and sulfuric acids. The most preferred salt is the hydrochloride salt (mebeverine hydrochloride).

[0042] Acceptable solvates for the therapeutic use of the compounds of the present invention include conventional solvates such as those formed during the final stage of the preparation of the compounds of the invention due to the presence of solvents. Examples include solvates resulting from the presence of water (these solvates are also called hydrates) or ethanol.

[0043] By "prevention," or "preventing" in the sense of the invention, is meant the reduction to a lesser degree of the risk or probability of occurrence of a given phenomenon, that is to say, in the context of the present invention, the partial or complete prevention or at least a delay in the onset of organic lesions, flare-ups, or exacerbations or worsening of the disease or any adverse health consequences of SLE in a subject, or prevention of worsening of the severity of the disease including clinical symptoms characterizing the different clinical stages of SLE.

[0044] For the purposes of this invention, "treatment" means a reduction in disease progression, stabilization, reversal or regression, or even an interruption or inhibition of the progression of an autoimmune disease, particularly SLE. Specifically, in the context of this invention, it means the production of a desired pharmacological and / or physiological effect on a subject. The treatment may be therapeutic in terms of: preventing the onset of organic lesions, disease flares, exacerbation or worsening of the disease, or any adverse health consequences of SLE, in a subject suffering from SLE.

[0045] For the purposes of this invention, "subject" or "patient" refers to a human subject. Therefore, this invention is intended for human pharmaceutical uses.

[0046] For the purposes of this invention, "therapeutically effective quantity" means the administration of a quantity of a compound according to the present invention, namely the compound of formula I, formula II, or formula III, namely a derivative of mebeverine, in particular mebeverine and / or one of its salts or one of its solvates, enabling a desired therapeutic response to be obtained, for example, to prevent and / or combat SLE, in particular its organic lesions and / or flares, exacerbation or aggravation of the disease or any adverse health consequence of SLE in a subject with SLE.It is understood that the specific therapeutically effective amount will vary from a multitude of factors such as the particular condition being treated, the severity of the condition, the subject's physical condition and clinical history, the duration of treatment, the nature of concomitant treatment (if any), the specific formulations used, and the composition structure. As an example, the therapeutically effective amount may be between 0.01 and 100 mg / kg of the subject's body weight, for example 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80, 90 mg / kg of body weight, and values ​​in between.

[0047] The invention described herein may include one or more ranges of values, for example, the administered quantity. A range of values ​​includes all values ​​within the range, including the values ​​defining the range, and values ​​adjacent to it. the range that leads to the same or substantially the same result as the values ​​immediately adjacent to the value that defines the range boundary. In this description, unless the context otherwise requires, the word "includes" or variants such as "comprises" or "comprising" shall be interpreted as implying the inclusion of an integer or group of integers, but not the exclusion of another integer or group of integers.

[0048] Compound according to the invention

[0049] Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by a poorly understood inflammatory cascade that contributes to its pathogenesis. Despite advances in therapeutic interventions, the specific triggers of inflammation and the autoimmune response in SLE remain largely enigmatic. The complexity of the pathological process, marked by an aberrant immune response against the body's own tissues, leads to a diverse range of clinical manifestations and an unpredictable disease course.

[0050] However, the inventors of the present invention have surprisingly discovered that the administration of an agent used as an antispasmodic within the family of compounds including the compound according to the invention, in particular the compound of formula I, makes it possible to prevent and / or treat autoimmune diseases, preferentially systemic lupus erythematosus (SLE).

[0051] Thus, the present invention relates to a compound with the following general formula I:

[0052] [Formula I] or a pharmaceutically acceptable salt and / or solvate of such a compound, in which: RI is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3, or 4 carbons. R2 is chosen from the group consisting of a hydrogen, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons. R3 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, R4 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, X is an oxygen (O) or nitrogen (NH) atom, n is equal to 1, 2 or 3, m is between 0 and 6, p is equal to 0, 1, or 2, q is equal to 1, 2 or 3.

[0053] According to another object, the present invention relates to a compound of the following general formula II:

[0054] [Formula II] or a pharmaceutically acceptable salt and / or solvate of such a compound, in which: - RI is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - R2 is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - R3 is a group chosen from the group consisting of a methyl, ethyl, propyl, isopropyl, and butyl, - X is an oxygen (O) or nitrogen (NH) atom, - n is equal to 1, 2 or 3, - m is between 0 and 6, p is equal to 0, 1, or 2,

[0055] Advantageously, the RI group(s) is / are in the ortho and / or para and / or meta positions on the corresponding aromatic ring. For the purposes of this invention, the "ortho" position is understood to be position 2, that is, the position immediately adjacent to the first substituent on the ring. The "para" position, for the purposes of this invention, is understood to be position 3. The "meta" position, for the purposes of this invention, is understood to be position 4. Thus, when n equals 1, the RI group is advantageously located in positions 2, 3, or 4. When n equals 2, the RI groups are advantageously located in positions 2 and 3, or 2 and 4, or 3 and 4. When n equals 3, the RI groups are advantageously located in positions 2, 3, and 4.

[0056] Thus, according to a preferred object, the OR1 group can be present at one or more positions on the corresponding aromatic ring, namely one of positions 1, 2, 3, 4, or 5; or alternatively, at several positions on the ring between 1, 2, 3, 4, and 5, particularly when n is equal to 2 or 3. Most preferably, the OR1 group is present on the aromatic ring at one of the positions chosen from the group consisting of positions 3, 4, 5, and their combinations. Even more preferably, n is equal to 2 and the OR1 group is at positions 3 and 4.

[0057] Advantageously the R3 group(s) is in ortho and / or para and / or meta position on the corresponding aromatic ring, very advantageously in para and / or meta position.

[0058] Preferably, the OR3 group may be present on one or more positions of the corresponding aromatic ring, namely one of the positions 1, 2, 3, or 4; or alternatively on several positions of the ring between 1, 2, 3, and 4, in particular when q is equal to 2 or 3. Most preferably, the OR3 group is present on the aromatic ring on one of the positions chosen from the group consisting of positions 2, 3, 4 and their combination.

[0059] Even more preferably, when q is equal to 1 and the OR3 group is in position 3. Alternatively, when q is equal to 2 and the OR3 group is in positions 2 and 3.

[0060] According to another favorite object, group RI is a methyl group, group R2 is a methyl group, and group R3 is also a methyl group.

[0061] Group X is an oxygen atom (O) or a nitrogen atom (NH), most preferably the compound of formula I, or of formula II includes an oxygen atom (O).

[0062] Preferably, the compound is mebeverine with the following formula III:

[0063] [Formula III]

[0064] "Mebeverine" is well known for its pharmacological activity as an antispasmodic agent and therefore designates compounds of the formula 3,4-dimethoxybenzoic acid 4-(ethyl(2-(4-methoxyphenyl)-l-methylethyl)amino)butyl ester, its salts, solvates, tautomers, derivatives, enantiomers, isomers, hydrates, prodrugs or pharmaceutically acceptable polymorphs.

[0065] The invention also relates, very advantageously, to a compound of formula I, of formula II, or of formula III, its pharmaceutically acceptable salts and / or solvates of such a compound, for its use in the prevention and / or treatment of an autoimmune disease, in a subject in need.

[0066] According to a preferred object, the present invention is not limited to the compound of formula I, formula II, or formula III alone, but also to its known derivatives. Advantageously, the mebeverine derivatives are selected from the group consisting of mebeverine hydrochloride, mebeverine sulfate, and polyethylene glycol-modified mebeverine (PEG-mebeverine).

[0067] According to another object, the invention also relates to the salts of the compound according to the invention, said salts may be any known salts of mebeverine.

[0068] Indeed, compounds of formula I, formula II, or formula III are useful as free bases or as acid addition salts. Acid addition salts are preferably non-toxic, pharmaceutically acceptable addition salts with suitable acids, such as inorganic acids, for example hydrochloric, hydrobromic, nitric, sulfuric, and phosphoric acids, or organic acids, such as organic carboxylic acids, for example glycolic, maleic, hydroxymaleic, fumaric, malic, tartaric, citric, salicylic, o-acetoxybenzoic, nicotinic, or isonicotinic acids, or organic sulfonic acids, for example methanesulfonic acid, ethanesulfonic acid, 2- hydroxyethanesulfonic acid, toluene-p-sulfonic acid or naphthalene-2-sulfonic acid.

[0069] Most preferably, the salts of compound of formula I, of formula II are chosen from the group consisting of the hydrochloride of compound of formula I of formula II; sulfate of compound of formula I of formula II; hydrobromide of compound of formula I of formula II; phosphate of compound of formula I of formula II; citrate of compound of formula I of formula II; tartrate of compound of formula I of formula II; maleate of compound of formula I of formula II; fumarate of compound of formula I of formula II; succinate of compound of formula I of formula II; oxalate of compound of formula I of formula II; benzoate of compound of formula I of formula II; acetate of compound of formula I of formula II; lactate of compound of formula I of formula II; gluconate of compound of formula I, of formula II and salicylate of compound of formula I, of formula II.

[0070] When the compound according to the invention is mebeverine, the salts are the salts of mebeverine selected from the group consisting of mebeverine hydrochloride, mebeverine sulfate, mebeverine hydrobromide, mebeverine phosphate, mebeverine citrate, mebeverine tartrate, mebeverine maleate, mebeverine fumarate, mebeverine succinate, mebeverine oxalate, mebeverine benzoate, mebeverine acetate, mebeverine lactate, mebeverine gluconate and mebeverine salicylate.

[0071] These salts can be chosen to improve the solubility, stability, bioavailability, or formulation properties of the compound according to the present invention. The choice of a particular salt falls within the knowledge of a person skilled in the art and depends, in particular, on factors such as the intended route of administration, the desired physicochemical properties, and manufacturing and storage considerations.

[0072] Thus, according to a preferred object of the invention, the compound of formula I, the compound of formula II, or the compound of formula III, namely mebeverine and one of its known derivatives, is in the form of a salt.

[0073] When the compound according to the invention is in the form of a salt, it is very preferentially in the form of a hydrochloride salt.

[0074] According to another object of the present invention, the compound of formula I, the compound of formula II, or the compound of formula III, namely mebeverine and one of its known derivatives, is in the form of a solvate.

[0075] Preferably, the solvates are chosen from the group consisting of the hydrate of compound of formula I or formula II (aqueous solvate), the ethanoate of compound of formula I or formula II, the methanolate of the compound of formula I or formula II, the isopropanolate of the compound of formula I or formula II, the acetonide of the compound of formula I or formula II, the dioxanate of the compound of formula I or formula II, the tetrahydrofuranate of the compound of formula I or formula II, the dimethylformamide (DMF) solvate of the compound of formula I or formula II, the dimethyl sulfoxide (DMSO) solvate of the compound of formula I or formula II, and the acetonitrile solvate of the compound of formula I or formula II.

[0076] When the compound according to the invention is mebeverine, the solvates are the solvates selected from the group consisting of mebeverine hydrate (aqueous solvate), mebeverine ethanoate, mebeverine methanolate, mebeverine isopropanolate, mebeverine acetonide, mebeverine dioxanate, mebeverine tetrahydrofuranate, dimethylformamide (DMF) mebeverine solvate, dimethyl sulfoxide (DMSO) mebeverine solvate and mebeverine acetonitrile solvate.

[0077] These solvates are formed when solvent molecules are incorporated into the crystal structure of the compound of formula I, formula II, or formula III. Solvate formation can affect the compound's physicochemical properties, such as solubility, stability, and bioavailability. Consequently, solvates can offer advantages in terms of pharmaceutical formulation or therapeutic performance, as is well known to those skilled in the art.

[0078] The compound according to the invention and its known derivatives contain at least one asymmetric carbon atom. Thus, the present invention also includes the use of isolated optical isomers and / or mixtures of these isomers.

[0079] Preferably, the preferred therapeutically effective amount of a compound of formula I, or of formula II, advantageously of a compound of formula III, of a known derivative of mebeverine and / or of a salt and / or a solvate thereof, between 0.01 and 100 mg / kg of the subject's body weight, for example, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80, 90 mg / kg of body weight, and values ​​between those listed. In a preferred embodiment, it is used in an amount of approximately 5-25 mg / kg. The dose may vary from 100 to 600 mg / day in divided doses, for example 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 300 mg, 400 mg, 500 mg.

[0080] The exact quantity of a compound of formula I, or of formula II, preferably of formula III, of a known derivative of mebeverine and / or one of its salts, and / or of a The solvates in its composition will of course depend on the route of administration, the nature of the stage of SLE or other complication of SLE disease, the therapeutically effective amount required, and the general nature and state of health of the subject to whom the composition is administered.

[0081] Preferably, the concentration of compound I or II, compound III, a known derivative of mebeverine and / or one of its salts, and / or one of its solvates in the composition will be sufficient (qs) to deliver a therapeutically effective dose to the target cells. This therapy may be directed toward the treatment of the prevention of organ damage or flare-ups, exacerbation or worsening of the disease, or any adverse health consequence of SLE in a subject with SLE.

[0082] Preferably, the therapeutically effective dose is intended for the treatment or prevention of organic damage or flare-ups, exacerbation or worsening of the disease or any adverse health consequence of SLE in a subject with mild, moderate, moderately severe or severe SLE.

[0083] Composition according to the invention

[0084] The present invention also relates to a pharmaceutical composition comprising at least one compound according to the invention of formula I, of formula II as described above and at least one pharmaceutically acceptable excipient, for use in the prevention and / or treatment of an autoimmune disease, preferably SLE.

[0085] Most preferably, the compound of formula I is the compound of formula III and this is included in the pharmaceutical composition according to the present invention.

[0086] The pharmaceutical compositions according to the invention can be formulated, in particular, for topical administration, oral administration, or injection, especially via the oral, topical, parenteral, transdermal, transmucosal, intranasal, rectal, or vaginal routes, said compositions being advantageously intended for human use. The pharmaceutical composition can be administered orally by means of tablets, capsules, liquid doses, gels, or powders.

[0087] For example, when a solid composition is prepared in tablet form, the main active ingredient is mixed with a pharmaceutical vehicle such as gelatin, starch, lactose, magnesium stearate, talc, gum arabic, and others. The tablets may be coated with sucrose or other suitable materials, or they may be treated, according to the knowledge of those skilled in the art, to have prolonged or delayed activity and to continuously release a predetermined amount of active ingredient.

[0088] A gelatin capsule preparation is obtained by mixing the active ingredient with a diluent and pouring the resulting mixture into soft or hard gelatin capsules.

[0089] The pharmaceutical composition administered by injection is preferably injected in liquid form. Thus, for administration by injection, aqueous suspensions, isotonic saline solutions, or sterile injectable solutions containing pharmacologically compatible dispersing and / or wetting agents are used.

[0090] The pharmaceutical compositions according to the invention can also be administered topically by means of a cream, gel, stick or serum.

[0091] The active ingredient can be administered in unit dose forms, mixed with standard pharmaceutical carriers, to humans.

[0092] The invention also proposes a pharmaceutical composition for the treatment of the prevention of organic lesions and flare-ups, exacerbation or aggravation of the disease or any adverse health consequence of SLE in a subject with SLE, the composition comprising a therapeutically effective amount of a compound of formula I, a compound of formula II, a compound of formula III, a known derivative of mebeverine and / or a salt, and / or a solvate thereof and one or more pharmaceutically acceptable additives, excipients, carriers and / or diluents.

[0093] Preferably, the composition according to the invention comprises 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, or 400 mg of a compound of formula I, a compound of formula II, a compound of formula III, a known derivative of mebeverine, and / or one of its salts and / or solvates. In a preferred embodiment, it is used in an amount of approximately 5–25 mg / kg. The dose may vary from 100 to 600 mg / day in divided doses, for example, 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 300 mg, 400 mg, 500 mg.

[0094] The composition of the present invention, comprising a compound of formula I, a compound of formula II, a compound of formula III, a known derivative of mebeverine and / or a salt and / or a solvate thereof, is preferably adapted for administration to A patient who needs it more than once a day, once a day, or less frequently. For example, if the composition is suitable for oral administration, it is preferably administered once a day. However, the composition may be administered more frequently (e.g., two or three times a day) or less frequently (e.g., every two days, every three days, once a week). Furthermore, if the composition, comprising a compound of formula I, a compound of formula II, a compound of formula III, a known derivative of mebeverine and / or one of its salts and / or one of its solvates, is in the form of an injectable formulation, it is preferable that the composition be suitable for administration once a week or once a month.

[0095] The additives, excipients, carriers and diluents to be used in the compositions of the present invention include, but are not limited to: water, saline solution, ethanol, dextrose, glycerol, glycerol and polyhydric alcohols, milk proteins, vitamins, animal and vegetable oils, polyethylene glycols, lactose, dextrose, sucrose, sorbitol, mannitol and other sugars, starches, acacia gum, calcium phosphates, alginate, tragacanth gum, gelatin, calcium silicate, cellulose and its derivatives such as microcrystalline cellulose and methylcellulose, polyvinylpyrrolidone, water syrup, methylhydroxybenzoates and propylhydroxybenzoates, talc, magnesium carbonate, titanium dioxide, magnesium stearate and mineral oil or combinations thereof.

[0096] The composition may also include lubricating agents, dispersing media, pH buffers, wetting agents, emulsifying and suspending agents, solvents, preservatives, sweeteners or flavorings, antifoaming agents, polymers, antioxidants, chelating agents, viscomodulators, tonics, flavorings, colorants, odorants, opacifiers, suspending agents, binders, fillers, plasticizers, lubricants, absorption promoters, and mixtures of these products. Preservatives include antimicrobial, antibacterial, and antifungal agents, antioxidants, chelating agents, and inert gases. The specific selection of components that may be included in the compositions described here generally depends on the type of preparation.

[0097] In preferred embodiments, the composition is formulated to allow the localization and retention of the compound of formula I, of a compound of the Formula II, a compound of formula III, a known derivative of mebeverine and / or one of its salts and / or one of its solvates in the area required to produce the desired therapeutic effect, while not significantly interfering with the efficacy of the compound. It is therefore understood that the therapeutically effective composition may be formulated differently depending on the area to be treated and the manner in which the composition is to be administered.

[0098] Pharmaceutically acceptable carriers, adjuvants, and vehicles that may be used in oral, parenteral, sublingual, buccal, rectal, intravaginal, or inhaled compositions may include: ion exchangers; alumina; aluminum stearate; lecithin; self-emulsifying drug delivery systems such as polyethylene glycol 1000 alpha-tocopherol succinate, or other similar polymeric matrices or delivery systems such as nanoparticles; serum proteins such as human serum albumin; buffering substances such as phosphates; glycine; sorbic acid; potassium sorbate; mixtures of partial glycerides of saturated fatty acids of vegetable origin; water; salts or electrolytes, such as protamine sulfate, disodium hydrogen phosphate, potassium hydrogen phosphate, sodium chloride, zinc salts; colloidal silica; magnesium trisilicate;polyvinylpyrrolidone; cellulose-based substances; polyethylene glycol; sodium carboxymethylcellulose; polyacrylates; polyethylene-polyoxypropylene block polymers; and wool grease.

[0099] The composition of the present invention, comprising a compound of formula I, a compound of formula II, or a compound of formula III, or a known derivative of mebeverine, and / or a salt and / or a solvate thereof, may also contain one or more additives, provided that they do not interfere with the therapeutic effect of the compound of formula I, a compound of formula II, the compound of formula III, a known derivative of mebeverine, and / or one of its salts and / or one of its solvates. In one instance, the additive is a colorant. In other embodiments, the additive is a preservative such as a mold inhibitor or an antioxidant, a fragrance, or a stabilizer. Additional additives may also be agents that make the composition an emulsion, a microemulsion, or a nanoemulsion.

[0100] In a preferred embodiment, the compound of formula I, a compound of formula II, the compound of formula III, a known derivative of mebeverine and / or one of its Salts and / or one of its solvates can therefore be administered orally. Mebeverine may thus be presented in the form of a tablet, capsule, gel, or liquid composition. If compound I, compound II, or compound III, a known derivative of mebeverine and / or one of its salts and / or one of its solvates is presented in tablet form, the tablet may further comprise fillers such as: lactose (milk sugar), microcrystalline cellulose, corn starch, sugars (including sucrose, mannitol, sorbitol, fructose, and dextrose), whey, and yeast; and / or binders such as: povidone, xanthan gum, and carbopol.Additional ingredients may include: disintegrants such as crospovidone, croscarmellose sodium and gellan gum; coatings such as shellac; lubricants such as magnesium stearate, stearic acid, sodium stearyl fumarate and hydrogenated vegetable oil; colorants such as titanium dioxide and iron oxides; flavorings (in chewable tablets); and plasticizers.

[0101] Preferably, the compound of formula I, formula II or formula III and / or one of its salts and / or one of its solvates is administered in the form of a tablet comprising mebeverine, magnesium stearate, lactose, maize starch and povidone. Preferably, the tablet, capsule, gel or liquid composition comprises between 0.01 and 100 mg / kg of the subject's body weight, for example, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80, 90 mg / kg of body weight, and values ​​in between.

[0102] The compound of formula I, formula II or formula III and / or one of its salts and / or one of its solvates may also be administered sublingually, buccally, rectally or intravaginally, for example by administration of a tablet, capsule, gel, powder or spray.

[0103] In another embodiment, the compound of formula I, formula II or formula III and / or one of its salts and / or one of its solvates is administered parenterally, preferably by injection, for example subcutaneously or intramuscularly. However, administration can also be via intra-arterial or intraperitoneal routes for the treatment or prevention of lupus flares in a patient. The composition may be presented as a sterile injectable preparation, for example, as a sterile injectable suspension for the treatment or Prevention of lupus flares in a patient. This suspension can be formulated according to techniques known in the art using appropriate dispersing agents, surfactants, and suspending agents (e.g., Tween 80). The sterile injectable preparation may also be a sterile injectable solution or suspension in a non-toxic diluent or solvent acceptable to parents (e.g., 1,2-propanediol). Acceptable vehicles and solvents may include mannitol, water, Ringer's solution, and isotonic saline solution with buffer. In addition, sterile fixed oils may be used as a solvent or suspension medium. For this purpose, any bland fixed oil may be used, including mono- or diglycerides.Fatty acids, such as oleic acid and its glyceride derivatives, and pharmaceutically acceptable natural oils, such as polyoxyethylated olive oil or castor oil, can also be used in the preparation of injectables. Preferably, the injectable composition comprises between 0.01 and 100 mg / kg of the subject's body weight, for example, 0.02, 0.03, 0.04, 0.05, 0.06, 0.07, 0.08, 0.09, 0.10, 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80, 0.90, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, 40, 50, 60, 70, 80, 90 mg / kg of body weight, and values ​​in between.

[0104] The pharmaceutical compositions according to the invention may further comprise at least one other active ingredient selected from the group consisting of an antimalarial agent, a corticosteroid, an immunosuppressant and a non-steroidal anti-inflammatory drug (NSAID).

[0105] The present invention therefore also relates to a pharmaceutical composition comprising: - (i) at least one compound of formula I, or of formula II or of formula III as described above, and - (ii) at least one other active ingredient, selected from the group consisting of an antimalarial agent, a corticosteroid, an immunosuppressant and a non-steroidal anti-inflammatory drug (NSAID) as a combination product for simultaneous, separate or sequential use.

[0106] When the active ingredient is an antimalarial agent, it is chosen from among hydroxychloroquine, chloroquine and their derivatives.

[0107] When the active ingredient is a corticosteroid, said corticosteroid is preferably a corticosteroid of ATC Class H02.

[0108] Preferably, the corticosteroid is chosen from the group consisting of prednisone, prednisolone, methylprednisolone, dexamethasone, hydrocortisone, cortisone, triamcinolone, betamethasone, deflazacort, fludrocortisone, budesonide, cloprednol, cortivazol, fluocortolone, and paramethasone.

[0109] These corticosteroids can be used at different stages of the disease and depending on the severity of symptoms. The choice of the specific corticosteroid often depends on factors such as the required potency, the desired duration of action, and the side effect profile; a healthcare professional is therefore able to define the corticosteroid based on the desired effect.

[0110] The corticosteroid is particularly preferred from the group consisting of prednisone, dexamethasone, triamcinolone, betamethasone, beclomethasone, flunisolide and fluticasone.

[0111] Prednisone is notably used to control acute flare-ups and severe manifestations of the disease due to its powerful anti-inflammatory effects.

[0112] When the active ingredient is an immunosuppressant, said immunosuppressant is preferably an immunosuppressant of ATC Class L04.

[0113] According to another preferred object, the immunosuppressant is chosen from the group consisting of cyclophosphamide, methotrexate, azathioprine, mycophenolate mofetil, tacrolimus, ciclosporin, belimumab, rituximab, abatacept, anifrolumab, voclosporin, leflunomide, sirolimus (rapamycin), ustekinumab, tofacitinib, baricitinib, ixekizumab, secukinumab, certolizumab pegol and fingolimod.

[0114] These immunosuppressants can be used alone or in combination with other treatments, depending on the severity of the disease, the organs affected, and the individual patient's response. The choice of treatment is therefore tailored to each case, taking into account the benefit-risk ratio for the patient.

[0115] In a particularly preferred manner, the immunosuppressant is chosen from the group consisting of cyclophosphamide, methotrexate, mycophenolic acid, azathioprine and belimumab.

[0116] Finally, the second active ingredient can also be a biological product, such as Belimumab (Benlysta®), a monoclonal antibody targeting the B-cell stimulator (BLyS), particularly for subjects suffering from active SLE and positive for autoantibodies.

[0117] Each of these agents is thus selected according to the individual profile of the patient. of disease activity and organ involvement, thus reflecting the personalized approach needed to manage the heterogeneous manifestations of SLE.

[0118] Use

[0119] The invention therefore proposes the compound according to the invention, namely the compound of formula I, of formula II or of formula II; or the composition comprising it to prevent and / or treat an autoimmune disease.

[0120] The autoimmune disease may be chosen from the group consisting of rheumatoid arthritis, systemic lupus erythematosus (SLE), type 1 diabetes, Crohn's disease, ulcerative colitis, Hashimoto's thyroiditis, Graves' disease, Sjögren's syndrome, systemic scleroderma, myasthenia gravis, psoriasis, ankylosing spondylitis, celiac disease, antiphospholipid syndrome, vasculitis, vitiligo, pernicious anemia, Graves' disease, polymyositis, dermatomyositis, autoimmune hepatitis, primary biliary cirrhosis, pernicious anemia, Guillain-Barré syndrome, psoriatic arthritis, bullous pemphigoid, Behçet's disease, granulomatosis with polyangiitis (formerly Wegener's granulomatosis), the sarcoidosis, autoimmune uveitis, Addison's disease, alopecia areata, autoimmune thrombocytopenia, Raynaud's disease, juvenile idiopathic arthritis, adult-onset Still's disease,and Goodpasture syndrome.

[0121] Preferably, the autoimmune disease is systemic lupus erythematosus (SLE). Most preferably, the compound according to the invention or the composition comprising it are particularly suitable for preventing organ damage and flare-ups, exacerbation or worsening of the disease or any adverse health consequences of SLE in a subject with SLE, preferably at a mild or mildly severe, moderate, moderately severe or severe stage.

[0122] Thus, very preferentially, LED is a mildly severe, moderate, moderately severe or severe lupus.

[0123] Even more preferably, said compound according to the invention or composition according to the invention are suitable for use in the prevention and / or treatment of LED.

[0124] Indeed, SLE is a complex pathology, defined by a plurality of clinical stages based on clinical symptoms. The clinical stages of systemic lupus erythematosus (SLE) can thus be described as follows.

[0125] Mild lupus has the following characteristics: - Minor skin lesions - Mild arthritis - Moderate fatigue - Little or no damage to internal organs

[0126] Moderate lupus has the following characteristics: - More extensive skin lesions - More pronounced arthritis - Significant fatigue - Onset of damage to internal organs (kidneys, heart, lungs) - Mild to moderate anemia

[0127] Moderately severe lupus has the following characteristics: - Significant skin lesions - Debilitating arthritis - Severe fatigue - Moderate damage to internal organs - More pronounced anemia - Possible thrombocytopenia

[0128] Severe lupus has the following characteristics: - Severe skin damage - Severe arthritis - Extreme fatigue - Severe involvement of one or more internal organs (lupus nephritis, pericarditis, pleurisy) - Severe anemia - Marked thrombocytopenia - Possible neurological manifestations

[0129] Critical or fulminant lupus presents the following characteristics: - Severe multi-organ involvement - Life-threatening situation - Need for intensive care

[0130] Lupus is therefore a fluctuating disease, with periods of flare-ups and remissions. remissions. Severity can vary over time for the same patient. The assessment of lupus severity takes into account not only clinical manifestations, but also the results of laboratory tests and imaging.

[0131] Preferably, the subject has lupus at a mildly severe, moderate, moderately severe or severe clinical stage.

[0132] Advantageously, the compound according to the invention, in particular of formula I, also prevents damage to several organs and flare-ups, exacerbation or aggravation of the disease or any adverse health consequences of SLE in patients with SLE.

[0133] Preferably, the subject to whom the regimen is administered has lupus at a mild, moderate, moderately severe or severe clinical stage and its treatments.

[0134] Methods

[0135] According to a final aspect, the present invention also relates to a method of prevention / treatment of an autoimmune disease, advantageously systemic lupus erythematosus (SLE) in a subject who needs it, comprising administering to the subject a therapeutically effective amount of a compound of formula I, formula II or formula III according to the invention or of a pharmaceutically acceptable salt and / or solvate thereof.

[0136] Preferably, the method includes the treatment or prevention of morbid manifestations of SLE, even more preferably the prevention or treatment of organic lesions and / or flare-ups, exacerbation or worsening of the disease or any adverse health consequences of SLE associated with lupus erythematosus.

[0137] The present invention therefore also relates to a method of treatment and / or prevention in a subject suffering from SLE, comprising the administration of a dose of 100 mg or 150 mg or 200 mg or 250 mg or 300 mg or 350 mg or 400 mg of a compound of formula I, of a compound of formula II, of a compound of formula III, of a known derivative of mebeverine, and / or of one of its salts and / or of one of its solvates.

[0138] In a preferred embodiment, it is used in an amount of approximately 5-25 mg / kg. The dose can vary from 100 to 600 mg / day in divided doses, for example 100 mg, 125 mg, 150 mg, 175 mg, 200 mg, 300 mg, 400 mg, 500 mg, 600 mg.

[0139] Preferably, the present method aims to prevent serious consequences, y including organic lesions and flare-ups, exacerbation or worsening of the disease or any adverse health consequence of SLE in a subject with systemic lupus erythematosus, including the administration of a dose of 100 mg, 150 mg or 200 mg of a compound of formula I, a compound of formula II, a compound of formula III, a known derivative of mebeverine, and / or one of its salts and / or one of its solvates, once or twice daily.

[0140] Preferably, the treatment method of the present invention results in the treatment or prevention of one or more of the following events: a) organ damage: (i) renal disorders: nephritis, interstitial nephritis, glomerulonephritis, renal failure; (ii) cardiac disorders: myocarditis, pericarditis, endocarditis; (iii) pulmonary disorders: interstitial lung disease, acute pulmonary failure, pleural effusion related to SLE; (iv) hematological disorders: idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, hemorrhagic event on circulating anticoagulants; (v) neurological or psychiatric disorders; (vi) thromboembolic event such as: acute coronary syndrome, myocardial infarction, unstable angina, cardiac arrest; stroke (ischemic or hemorrhagic), transient ischemic attack; pulmonary embolism, deep vein thrombosis, arterial thrombosis, portal vein thrombosis;b) flare-ups or exacerbation of SLE c) worsening of the disease by development of a more severe clinical stage;

[0141] The invention is now illustrated by non-limiting examples of compositions according to the invention and by results. Examples Example 1 - Study of the effectiveness of the compound according to the invention in the prevention and / or treatment of LED

[0142] A comparative efficacy study was conducted to evaluate whether mebeverine or its derivatives (compounds according to the invention) reduce the risk of organ damage or flares or exacerbations of the disease in patients with objectively diagnosed SLE. The name of the study is MELUSINE (MEbeverine and LUPUS INjuriEs).

[0143] 1. Methods

[0144] The SLE cohort study was registered and received ethical approval from CESREES (Committee for the Evaluation of Ethics of Health Research Projects) and CNIL (National Commission for Information Technology and Freedoms) on January 14, 2021.

[0145] The study was conducted within the national cohort of SLE patients registered with the French national health service between January 1, 2010, and December 31, 2020, for at least one year. Within this cohort, patients who received mebeverine treatment were compared to matched SLE patients who did not use mebeverine.

[0146] 1.1 Eligibility

[0147] Patients with chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis) were excluded from the study to minimize confounding factors, as these diseases are associated with both mebeverine use and the occurrence of certain study outcomes. Patients with a history of chronic organ failure (such as chronic renal failure, dialysis, kidney transplantation, lung transplantation, heart transplantation, chronic passive liver congestion, or pulmonary arterial hypertension) at the start of mebeverine exposure were also excluded due to the potential for confusion arising from the treatment of these conditions, which are considered critical states of the disease.

[0148] 1.2 Use of mebeverine

[0149] Patients were considered to be starting active treatment each time they obtained a mebeverine-based product dispensed by their pharmacist. This dispensing is recorded in the computerized registers maintained by the national health insurance system, which covers virtually all patients in the country.

[0150] Patients were able to undergo multiple mebeverine treatment sequences, provided there was an interval of at least 90 days between the end of drug use in one sequence and the start of drug use in the next sequence.

[0151] 1.3 Controls and matching

[0152] Patients treated with mebeverine were matched for sex and age (±1 year at the time of exposure, considered the "index date" in both groups) with non-mebeverine users. To make the groups comparable in terms of co-administered SLE treatments, they were matched for use (or non-use) on the day calendar or within 90 days prior to the index date, of one of the usual treatments for SLE (HCQ, corticosteroids, immunosuppressants), each of these drug categories being matched one by one.

[0153] In addition, a match was made based on the use (or not), also on that date, of at least one NSAID, as well as on the use (or not) of a gastrointestinal drug of the ATC class A03 (with the exception of mebeverine), or of the ATC classes A02 or A06. Finally, to take into account cardiac risk factors, a match was made based on the use (or not) of a cardiovascular or antidiabetic treatment (drugs of the ATC classes C and A10 respectively).

[0154] Up to 10 mebeverine-unexposed controls were selected for each mebeverine treatment; high-density propensity scores were used for prioritization when too many controls were eligible. When a mebeverine user had multiple sequences of product use, an eligible control was matched for each sequence.

[0155] In a sensitivity analysis, patients who had previously used mebeverine were admitted as controls if they had not used it for at least 90 days.

[0156] 1.4 Outcomes

[0157] The primary outcome of the study was a composite outcome of the occurrence of one of the following events: (A) hospitalization for organ involvement such as acute nephritis, interstitial nephritis, glomerulonephritis, acute renal failure; myocarditis, pericarditis, endocarditis, interstitial lung disease, acute pulmonary failure, idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, hemorrhagic event while on circulating anticoagulants, myocardial infarction, unstable angina pectoris, cardiac arrest; stroke, transient ischemic attack, pulmonary embolism, deep vein thrombosis, arterial thrombosis, portal vein thrombosis, or (B) severe flares or exacerbations leading to the administration of a very high dose of CS (> lg) within 10 days of hospitalization with a diagnosis of SLE or a visit to a specialist physician (internal medicine, rheumatology, nephrology).Hospitalizations were documented in the comprehensive records of the national health services database, while medical visits and CS issuances were traced in the records held by the Insurance-. Disease, the two sources being linked. The primary efficacy endpoint is the composite endpoint (A) or (B). The secondary endpoints are the individual components (A) or (B) of the primary endpoint.

[0158] 1.5 Study size and statistical power

[0159] The control group had an expected composite outcome rate of 7 per 100 person-years of cumulative follow-up, assuming constant risk; the sample size required to have power >80% to detect a hazard ratio <0.50 with 95% or greater confidence was at least 345 person-years in the mebeverine group, assuming an average of 4 unexposed controls followed similarly.

[0160] 1.6 Data Analysis

[0161] Descriptive statistics were performed, presenting the mean and standard deviation for continuous variables and proportions for categorical variables, for the characteristics of the treatment groups at the index date or in the previous 90 days).

[0162] In the primary analysis, known as the "intention-to-treat" analysis, a standard 90-day time window was applied after the index date, and the "time-to-event" (times to occurrence of censoring events) were calculated in days by subtracting the index date from: (1) the date of the first outcome in this time window, or (2) the date of development of a chronic disease, or (3) the date of death, or (4) the end of this 90-day time sequence, whichever occurred first in each case.

[0163] Subgroup analyses of this main analysis were performed by matching strata and in particular according to the use of usual treatments for SLE: use of HCQ, use of CS, use of immunosuppressants and use of HCQ, CS or immunosuppressants.

[0164] A secondary "during treatment" analysis was performed to assess the occurrence of outcomes of interest during the duration of mebeverine use in each patient (rather than a fixed 90-day period), applying this timeframe also to matched controls. To estimate this effective exposure period, the amount of mebeverine dispensed in milligrams was divided by the World Health Organization (WHO) defined daily dose (DDD) for this drug, which is 300 mg. A 50% grace period was applied to each prescription, also accounting for overlaps between dispensing episodes. medicine.

[0165] Efficacy was analyzed using a conditional Cox proportional hazards model, including the mebeverine treatment group and the control group for each treatment sequence. A conditional univariate analysis ("crude analysis") and a multivariate analysis were performed for each type of analysis. The multivariate analysis was adjusted, in each case, for the use of gastrointestinal and psychiatric medications during follow-up, as well as for propensity scores for mebeverine use.

[0166] In a secondary analysis, outcome categories (A) and (B) were analyzed separately and each outcome was examined independently.

[0167] 2. Results

[0168] The results of the study are as follows.

[0169] 2.1 Study population:

[0170] Figure 1 [Fig. 1] shows the patient selection for the study (Flowchart). During the study period (between January 1, 2010, and December 31, 2020), 51,674 patients participated in the eligible cohort of patients with SLE from the French National Health Service; among them, 865 [1.7%] had been diagnosed with inflammatory bowel disease and were excluded from the mebeverine study. Of the remaining 50,809 patients, 1,920 used mebeverine at least once, of whom 204 [10.6%] did not meet the inclusion criteria, and 1,716 [89.4%] were eligible for the study. Among these, 1605 found at least one "control" patient in the national cohort of patients with SLE, not using mebeverine on the same day and able to be matched to at least one of its treatment sequences, on all matching criteria.The 1605 mebeverine users accumulated 2016 use sequences during follow-up (1.26 per user on average). Up to 10 controls were matched to each mebeverine use sequence, for a total of 13,244 controls [mean: 6.6 controls per treatment sequence]. All 14,849 patients were followed for at least 90 days (or until a censoring event occurred), and outcome data were obtained for all these patients.

[0171] The basic characteristics according to the treatment groups are presented in Table 1 below. The two groups were very similar with regard to the clinical characteristics considered.

[0172] [Table 1] *Co-morbidities reported during hospitalizations (or CV or antidiabetic treatments, or psychiatric treatments) ** Percentages weighted for the number of controls per exposed patient.

[0173] Table 2 below represents the distribution of usual treatments for SLE (HCQ, CS, IS), NSAIDs and gastrointestinal drugs in the mebeverine and control groups.

[0174] Table 2 shows that over 80% of patients in each group also received at least one standard treatment for SLE: HCQ (61.3%), corticosteroids (54.3%), and / or immunosuppressants (11.6%) within the 90 days prior to or at the index date. Nearly half (49.6%) of patients received an NSAID during this period, and the majority received another gastrointestinal medication in the same class as mebeverine (63.5%) or in a different class (79%). The treatment and control groups were matched for these characteristics.

[0175] [Table 2]

[0176] Among mebeverine users, there were on average 1.26 drug treatment sequences (separated by more than 90 days without use) in the total follow-up of the national cohort.

[0177] Table 3 below presents the event rates by exposure group. A primary outcome (composite endpoint) occurred in 236 cases, including 17 during mebeverine exposure (with a rate of 3.4 outcomes per 100 person-years of mebeverine use) and 219 in the control group (with a rate of 6.7 outcomes per 100 person-years). It is noteworthy that mebeverine use was associated with a rate of serious events half (or less) lower than that observed in the absence of mebeverine and regardless of the stratum of usual SLE treatments administered concurrently with mebeverine.

[0178] [Table 3]

[0179] 2.2 Main Analysis

[0180] The results of the primary analysis are presented in Table 4 below for both the overall model and the stratified analyses. The crude hazard ratio (HR) for mebeverine use or non-use and the composite outcome endpoint was 0.42 [95% CI 0.24–0.73]; p < 0.01. The adjusted HR was very similar: 0.41 [95% CI 0.23–0.73]; p < 0.01.

[0181] [Table 4]

[0182] Table 4 also presents the results of the subgroup analysis based on usual treatments for systemic lupus erythematosus co-administered on the index date or in the preceding 90 days, in the form of a Forest Plot. The effect of mebeverine on the prevention of acute events was maintained regardless of the use of these treatments. In patients not receiving HCQ, the hazard ratio was 0.40, 95% CI 0.17–0.92 (p=0.03), and 0.43, 95% CI 0.20–0.92 (p=0.04) in patients using HCQ. In patients not receiving CS, the hazard ratio was 0.33, 95% CI; 0.11 - 0.97 (p=0.04) and 0.46, 95% CI; 0.24 - 0.88 (p=0.02) in patients using CS. In patients without IS, the risk ratio was 0.42, 95% CI; 0.23 - 0.79 (p<0.01) and it was 0.40, 95% CI; 0.11 - 1.46 (p=0.16) in patients using IS (small sample size group).It is interesting to note that only one subject who consumed mebeverine developed an outcome of interest in patients not using HCQ, CS, or IS.

[0183] Figure 2 [Fig. 2] presents the raw results from Table 4 in the form of a "Forest Plot" (Forest Diagram)

[0184] Table 5 presents the secondary and sensitivity results.

[0185] The results of the analysis examining the outcomes that occurred during the actual treatments are consistent with those of the analysis (which used a 90-day "ITT" window), perhaps even better [HR: 0.32 95% CI, 0.16 - 0.65; adjusted HR: 0.35, 95% CI, Q, 7 - 0.71].

[0186] Analysis using only the first treatment sequence in mebeverine users gave results very comparable to analysis using all sequences [HR: 0.39 95% CI, 0.20 - 0.74; adjusted HR: 0.37, 95% CI, 0.19 - 0.71.

[0187] The sensitivity analysis, which allowed controls to have previously used mebeverine, identified 775 such patients out of a total of 13,882 controls, which were matched with 1,613 patients (2,029 sequences) who had used mebeverine. The results of this sensitivity analysis were very similar to those of the primary analysis [HR: 0.44, 95% CI; 0.25–0.72; adjusted HR: 0.45, 95% CI; 0.26–0.79].

[0188] When only organic lesions were considered, the hazard ratio was 0.43 [95% CI; 0.23 - 0.79] and the adjusted HR was 0.41 [95% CI: 0.22 - 0.77]; and when severe flares without specific organic lesions were considered, the HR was 0.40 [95% CI; 0.15 - 1.05] and the adjusted HR was 0.47 [95% CI: 0.17 - 1.28], with central estimates similar to those of the overall analysis, the small sample sizes explaining the width of the confidence intervals.

[0189] [Table 5]

[0190] 3. Conclusion

[0191] The MELUSINE study demonstrates that the use of mebeverine significantly reduces the risk of organ damage or flares / exacerbations in patients with SLE, which can represent signs of disease progression. The benefits of mebeverine were observed in the context of widespread use of standard, effective SLE treatments, such as hydroxychloroquine (HCQ), corticosteroids (CS), or immunosuppressants (IS). It is noteworthy that mebeverine had the same effect whether or not patients were using these medications; therefore, mebeverine has a beneficial effect on SLE outcomes independently of the effect of any known SLE treatments. These surprising results have never been described in the prior art.

[0192] Example 2 - Study of the effectiveness of the compound according to the invention in the prevention and / or treatment of autoimmune diseases

[0193] This study aims in particular to demonstrate the effect of compound formula III, mebeverine, on several inflammatory markers linked to autoimmune diseases.

[0194] RAW 264.7 cells, derived from a tumor-derived macrophage line in a male mouse, were seeded at a density of 5x10 5Cells were cultured in 24-well plates. The cells were initially cultured for 24 hours in DMEM HG medium supplemented with 1% penicillin-streptomycin. Concurrently, mebeverine hydrochloride was incubated in mouse plasma at 37°C for 1 hour to promote its hydrolysis. After 24 hours of culture, the cells were stimulated for 12 hours with a bacterial or viral inflammation inducer (1 pg / mL lipopolysaccharides (LPS) or 10 pg / mL Poly(I:C)), either alone or in combination with different concentrations of mebeverine hydrochloride (10, 30, or 90 pM), with or without prior incubation in plasma.

[0195] Within one week of extraction, the RNA was quantified, reverse-transcribed into complementary DNA (cDNA), and gene expression was analyzed by quantitative PCR (qPCR) using the SYBR Green PCR Master Mix. The target genes were those encoding interferon beta (Ifnbl) and interleukin-6 (116). Gene expression levels were normalized to the expression of the reference gene Rpll3a.

[0196] The results are shown in Figure 3. Exposure to LPS for 12 hours resulted in a significant increase in the expression of target genes in RAW 264.7 cells: a 5.67-fold increase in Ifnbl expression and a 5,092.21-fold increase in 116 expression (Figure 3A). The presence of plasma in the culture medium potentiated this effect, as LPS exposure then led to a 61.41-fold increase in Ifnbl expression and a 7,444.84-fold increase in 116 expression.

[0197] Treatment with mebeverine (pre-incubated in plasma or not) significantly reduced LPS-induced overexpression of both genes. Indeed, Ifnbl expression was reduced by 4.73-fold, 5.18-fold, and 6.41-fold in response to treatment with 10, 30, and 90 pM mebeverine, respectively, and by 45.17-fold, 40.20-fold, and 33.98-fold in response to treatment with 10, 30, and 90 pM pre-incubated mebeverine. Similarly, the expression of 116 was reduced 1.36 times, 1.76 times, and 2.17 times respectively in response to treatment with 10, 30, and 90 pM mebeverine, and 1.37 times, 2.57 times, and 1.42 times in response to treatment with 10, 30, and 90 pM pre-incubated mebeverine.

[0198] On the other hand, exposure to Poly(I:C) for 12 hours also resulted An increase in the expression of target genes was observed: an 11.15-fold increase in Ifnbl expression and a 9.69-fold increase in 116 expression (Figure 3B). Conversely, the presence of plasma in the culture medium inhibited this effect, as exposure to Poly(I:C) then led to a 3.26-fold increase in Ifnbl expression and a 2.91-fold increase in 116 expression. Treatment with mebeverine significantly reduced Ifnbl gene overexpression: by 4.62-fold, 11.85-fold, and 12.01-fold in response to treatment with 10, 30, and 90 pM mebeverine, respectively, and by 1.32-fold, 2.60-fold, and 3.51-fold in response to treatment with pre-incubated 10, 30, and 90 pM mebeverine. Expression of 116 was reduced by 5.85 times, 5.06 times, and 5.41 times respectively in response to treatment with 10, 30, and 90 pM mebeverine, and to a lesser extent treatments with different concentrations of pre-incubated mebeverine also reduced overexpression of 116.

[0199] Thus, compound III, mebeverine, significantly inhibits LPS-induced inflammation (Figure 3A) and Poly(I:C)-induced inflammation (Figure 3B) in RAW 264.7 cells, as evidenced by the reduction in the expression of the inflammatory markers I116 and IFNBL. These results demonstrate an anti-inflammatory role for mebeverine and therefore a role in the prevention and / or treatment of autoimmune diseases.

Claims

Demands

1. Compound of the following general formula (I): or a pharmaceutically acceptable salt and / or solvate of such a compound, in which: RI is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3, or 4 carbons. R2 is chosen from the group consisting of a hydrogen, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons. R3 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, R4 is chosen from the group consisting of a hydrogen atom, a linear alkyl chain, and an alkyl chain branched at 1, 2, 3 or 4 carbons, X is an oxygen (O) or nitrogen (NH) atom, n is equal to 1, 2 or 3, m is between 0 and 6, p is equal to 0, 1, or 2, q is equal to 1, 2 or 3. for its use in the prevention and / or treatment of an autoimmune disease, in a subject in need.

2. Compound for its use according to claim 1, wherein group RI, group R2 and group R3 is a methyl group.

3. Compound for use according to any one of claims 1 or 2, wherein group X is an oxygen atom (O).

4. A compound for use according to any one of claims 1 to 3, wherein the OR1 group is, on the aromatic ring corresponding, in position chosen from the group consisting of position 3, 4, 5 and their combination.

5. Compound for use according to any one of claims 1 to 4, wherein n is equal to 2 and group OR1 is in positions 3 and 4.

6. Compound for its use according to claim 1, characterized in that the compound is mebeverine of the following formula:

7. Compound for its use according to claim 6, characterized in that the compound is mebeverine hydrate or mebeverine ethanoate.

8. Compound for use according to any one of claims 1 to 6, characterized in that the compound is in the form of a hydrochloride salt.

9. Compound for use according to any one of claims 1 to 8, characterized in that the autoimmune disease is systemic lupus erythematosus (SLE).

10. Compound for use according to any one of claims 1 to 9, to prevent and / or treat organic lesions and / or flare-ups and / or exacerbation and / or aggravation or adverse consequences of SLE.

11. Compound for use according to any one of claims 9 or 10, characterized in that the subject has SLE disease at a mildly severe, moderate, moderately severe or severe stage.

12. Pharmaceutical composition comprising at least one compound according to any one of claims 1 to 11 and at least one pharmaceutically acceptable excipient, for use in the prevention and / or treatment of an autoimmune disease.

13. Pharmaceutical composition according to claim 12, for its use in the prevention and / or treatment of systemic lupus erythematosus (SLE).

14. Pharmaceutical composition for its use according to claim 12, further comprising another active ingredient selected from the group consisting of an antimalarial agent, a corticosteroid, an immunosuppressant, and a non-steroidal anti-inflammatory drug (NSAID).

15. Pharmaceutical composition for use according to any one of claims 12 to 14, characterized in that it is in the form of a tablet, a capsule, a liquid dose, a gel or a powder.

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