AU3948699A - Use of a cox-2 inhibitor and a nk-1 receptor antagonist for treating inflammation - Google Patents

Use of a cox-2 inhibitor and a nk-1 receptor antagonist for treating inflammation Download PDF

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AU3948699A
AU3948699A AU39486/99A AU3948699A AU3948699A AU 3948699 A AU3948699 A AU 3948699A AU 39486/99 A AU39486/99 A AU 39486/99A AU 3948699 A AU3948699 A AU 3948699A AU 3948699 A AU3948699 A AU 3948699A
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Prior art keywords
phenyl
trifluoromethyl
benzenesulfonamide
methylsulfonyl
fluorophenyl
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AU758983B2 (en
Inventor
Susan Boyce
Raymond George Hill
Nadia Melanie Rupniak
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Organon Pharma UK Ltd
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Merck Sharp and Dohme Ltd
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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
    • A61K31/40—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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • 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
    • A61P19/02—Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • 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
    • A61P19/06—Antigout agents, e.g. antihyperuricemic or uricosuric agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P29/00—Non-central analgesic, antipyretic or antiinflammatory agents, e.g. antirheumatic agents; Non-steroidal antiinflammatory drugs [NSAID]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00

Description

WO 99/59635 PCT/GB99/01632 USE OF A COX-2 INHIBITOR AND A NK-1 RECEPTOR ANTAGONIST FOR TREATING INFLAMMATION The present invention involves a drug combination comprising an 5 inhibitor of cyclooxygenase-2 in combination with a neurokinin-1 (NK-1) receptor antagonist. Inhibitors of cyclooxygenase-2 are a sub-class of the class of drugs known as non-steroidal antiinflammatory drugs (NSAIDs). The NSAIDs are active in reducing the prostaglandin-induced pain and swelling 10 associated with the inflammation process but are also active in affecting other prostaglandin-regulated processes such as maintenance of the gastric lining. Thus, use of high doses of most common NSAIDs can produce severe side effects, including life threatenting ulcers, that limit their therapeutic potential. An alternative to NSAIDs is the use of 15 corticosteroids, which have even more serious side effects, especially when long term therapy is involved. Previous NSAIDs have been found to prevent the production of prostaglandin by inhibiting enzymes in the human arachidonic acid/prostaglandin pathway including the enzyme cyclooxygenase (COX). 20 There are two isoforms of the COX enzyme, the first, COX-1, is constitutively expressed and is involved with physiological functions and the second, COX-2, is induced locally in inflamed tissue. While conventional NSAIDs block both forms of the enzyme, the inducible COX-2 enzyme associated inflammation has provided a more focussed drug target 25 which should enable effective antiinflammatory analgesia with reduced gastrointestinal side effects. Many compounds which have activity as COX-2 inhibitors have been identified, and clinical trials are reported to be in progress. Neurokinin 1 (NK-1; substance P) receptor antagonists are being 30 developed for the treatment of a number of physiological disorders associated with an excess or imbalance of tachykinins, and in particular WO 99/59635 PCT/GB99/01632 -2 substance P. Substance P has been implicated in the pathology of a number of inflammatory conditions (see, for instance, International (PCT) patent specification Nos. WO 95/16679, WO 95/18124 and WO 95/23798). Improved therapies for treating and preventing inflammatory 5 disorders are currently being sought for the large number of individuals who are at risk from these disorders. The present invention addresses this problem by providing a combination therapy comprised of a COX-2 inhibitor with a NK-1 receptor antagonist. When administered as part of a combination therapy, the COX-2 inhibitor together with the NK-1 10 receptor antagonist provide enhanced treatment options as compared with administration of either the COX-2 inhibitor or the NK-1 receptor antagonist alone. The present invention provides a novel drug combination comprised of a COX-2 inhibitor in combination with a NK-1 receptor antagonist, 15 which is useful for treating, preventing, reducing the progression, and/or reducing the risk of developing inflammatory disorders. The present invention accordingly provides the use of a COX-2 inhibitor in combination with a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of 20 inflammatory disorders. The present invention also provides a method for the treatment or prevention of inflammatory disorders, which method comprises administration to a patient in need of such treatment an amount of a COX-2 inhibitor and an amount of a NK-1 receptor antagonist, such that 25 together they give effective relief In a further aspect of the present invention, there is provided a pharmaceutical composition for the treatment or prevention of inflammatory disorders comprising a COX-2 inhibitor and a NK-1 receptor antagonist, together with at least one pharmaceutically acceptable carrier 30 or excipient.
WO 99/59635 PCT/GB99/01632 -3 It will be appreciated that the COX-2 inhibitor and the NK-1 receptor antagonist, may be present as a combined preparation for simultaneous, separate or sequential use for the treatment or prevention of inflammatory disorders. Such combined preparations may be, for 5 example, in the form of a twin pack. In a further or alternative aspect of the present invention, there is therefore provided a product comprising a COX-2 inhibitor and a NK-1 receptor antagonist as a combined preparation for simultaneous, separate or sequential use in the treatment or prevention of inflammatory 10 disorders. It will be appreciated that when using a combination of the present invention, both the COX-2 inhibitor and the NK-1 receptor antagonist will be administered to a patient, within a reasonable period of time. The compounds may be in the same pharmaceutically acceptable carrier and 15 therefore administered simultaneously. They may be in separate pharmaceutical carriers such as conventional oral dosage forms which are taken simultaneously. The term "combination" also refers to the case where the compounds are provided in separate dosage forms and are administered sequentially. Therefore, by way of example, the COX-2 20 inhibitor may be administered as a tablet and then, within a reasonable period of time, the NK-1 receptor antagonist may be administered either as an oral dosage form such as a tablet or a fast-dissolving oral dosage form. By a "fast dissolving oral formulation" is meant, an oral delivery form which when placed on the tongue of a patient, dissolves within about 25 10 seconds. By "reasonable period of time" is meant a time period that is not in excess of about 1 hour. That is, for example, if the COX-2 inhibitor is provided as a tablet, then within one hour, the NK-1 receptor antagonist should be administered, either in the same type of dosage form, or another 30 dosage form which provides effective delivery of the medicament.
WO 99/59635 PCT/GB99/01632 -4 It will be appreciated that the combination of the present invention will be particularly useful in the treatment of a COX-2 mediated disease or disorder. COX-2 mediated diseases and disorders includes inflammatory diseases susceptible to treatment with a non-steroidal anti-inflammatory 5 agent. Such "inflammatory disorders" include rheumatoid arthritis, degenerative joint diseases (osteoarthritis), bursitis, tendinitis, ankylosing spondylitis, gout and synovitis. The terms "inhibitor of cyclooxygenase-2", "cyclooxygenase-2 inhibitor" and "COX-2 inhibitor" as used herein embrace compounds which 10 selectively inhibit cyclooxygenase-2 over cyclooxygenase-1. Employing the human whole blood COX-1 assay and the human whole blood COX-2 assay described in C. Brideau et al, Inflamm. Res. 45: 68-74 (1996), herein incorporated by reference, preferably, the compounds have a cyclooxygenase-2 IC 5 o of less than about 2 [tM in the human whole blood 15 COX-2 assay, yet have a cyclooxygenase-1 IC 5 o of greater than about 5 piM in the human whole blood COX-1 assay. Also preferably, the compounds have a selectivity ratio of cyclooxygenase-2 inhibition over cyclooxygenase-1 inhibition of at least 10, and more preferably of at least 40. The resulting selectivity may indicate an ability to reduce the 20 incidence of common NSAID-induced side effects. As explained in J. Talley, Exp. Opin. Ther. Patents (1997), 7(1), pp. 55-62, three distinct structural classes of selective COX-2 inhibitor compounds have been identified. One class is the methane sulfonanilide class of inhibitors, of which NS-398, flosulide, nimesulide and L-745,337 25 are example members.
WO 99/59635 PCT/GB99/01632 -5
NHSO
2
CH
3
NHSO
2
CH
3
NHSO
2
CH
3 00 xa F F
NO
2 NO 2 0 NS-398 Nimesulide L-745,337, X = S Flosulide, X = 0 A second class is the tricyclic inhibitor class, which can be further divided into the sub-classes of tricyclic inhibitors with a central carbocyclic 5 ring (examples include SC-57666, 1, and 2); those with a central monocyclic heterocyclic ring (examples include DuP 697, SC-58125, SC-58635, and 3, 4 and 5); and those with a central bicyclic heterocyclic ring (examples include 6, 7, 8, 9 and 10). Compounds 3, 4 and 5 are described in U.S. Patent No. 5,474,995. 10 CH3SO 2
NH
2 S0 2
CH
3 SO2 | I |C O F F F 1 2 SC-57666
CH
3
SO
2
CH
3
SO
2 N \N\
CF
3 /-Br S FDuP 697 SC-58125 WO 99/59635 PCTIG B9910 1632 -6
NH
2
SO
2
CH
3
SO
2
~CF
3 0
H
3 C SC-58635 3
CH
3
SO
2 CH 3
SO
2 HAC I ~- OH 3 10 F F F0 0 4 5 CH 3 SO 2 CH 3 SO 2 ~ N s N N N 6 C H 3 S O 2 0N H 2 S O 2 N -N \ - C ~~c 3 -~ 8 CH 3 0' NH 2SO 2 N N\ -C CH 3 0OC 10 WO 99/59635 PCT/GB99/01632 -7 The third identified class can be referred to as those which are structurally modified NSAIDS, and includes L-761,066 and structure 11 as example members.
CO
2 H H
CH
3 O11 NN" N N N 2' Br CH/ -Cl
CH
3 \ / L-761,066 0 11 5 In addition to the structural classes, sub-classes, specific COX-2 inhibitor compound examples, and reference journal and patent publications described in the Talley publication which are all herein incorporated by reference, examples of compounds which selectively inhibit cyclooxygenase-2 have also been described in the following patent 10 publications, all of which are herein incorporated by reference: U.S. Patent No.'s 5,344,991, 5,380,738, 5,393,790, 5,409,944, 5,434,178, 5,436,265, 5,466,823, 5,474,995, 5,510,368, 5,536,752, 5,550,142, 5,552,422, 5,604,253, 5,604,260, 5,639,780; and International Patent Specification Nos. 94/13635, 94/15932, 94/20480, 94/26731, 94/27980, 15 95/00501, 95/15316, 96/03387, 96/03388, 96/06840; and International Publication No.'s WO 94/20480, WO 96/21667, WO 96/31509, WO 96/36623, WO 97/14691, WO 97/16435. Additional COX-2 inhibitor compounds which are included in the scope of this invention include: 0, S cv~ 0 0 N 0 0 N 20 12 13 WO 99/59635 PCT/GB99/01632 -8 O O o F 0 0 0 14 F 15 SS s~. 0 O F 0 /\0 F N 16 17 SD 18 O 0 0 0' O00 o8 0 1 0 21 Na 0 0 10 20 21 WO 99/59635 PCT/GB99/01632 -9 S S O O O 0 0 00 OH OH 22 23 0 / F 0 OH 24 25 O NH, S 0 0 N 26 5 Some of the compounds above can also be identified by the following chemical names: 3: 3-phenyl-4-(4-(methylsulfonyl)phenyl)-2-(5H)-furanone; 4: 3-(3,4-difluorophenyl)-4-(4-(methylsulfonyl)phenyl)-2-(5H)-furanone; 5: 5,5-dimethyl-4-(4-(methylsulfonyl)phenyl)-3-(3 -fluorophenyl)-5H-furan 10 2-one; 12: 5,5-dimethyl-4-(4-(methylsulfonyl)phenyl)-3-(2-propoxy)-5H-furan-2 one; WO 99/59635 PCT/GB99/01632 - 10 13: 5-chloro-3-(4-(methylsulfonyl)phenyl)-2-(2-methyl-5-pyridinyl)pyridine; 14: 2-(3,5-difluorophenyl)-3-(4-(methylsulfonyl)phenyl)-2-cyclopenten- 1 one; 15: 5(S)-5-ethyl-5-methyl-4-(4-(methylsulfonyl)phenyl)-3-(2-propoxy)-5H 5 furan-2-one; 16: 5-ethyl-5-methyl-4-(4-(methylsulfonyl)phenyl)-3-(3,4-difluorophenyl) 5H-furan-2-one; 17: 3-((2-thiazolyl)methoxy)-4-(4-(methylsulfonyl)phenyl)-5,5-dimethyl-5H furan-2-one; 10 18: 3-propyloxy-4-(4-(methylsulfonyl)phenyl)-5,5-dimethyl-5H-furan-2-one; 19: 3-(1-cyclopropylethoxy)-5,5-dimethyl-4-(4-methylsulfonyl)phenyl)-5H furan-2-one; 20: sodium 2-(4-chlorophenyl)-3-(4-(methylsulfonyl)phenyl)-4-oxo-2 pentenoate; 15 21: 3-(cyclopropylmethoxy)-5,5-dimethyl-4-(4-(methylsulfonyl)phenyl)-5H furan-2-one; 22: 3-(cyclopropylmethoxy)-5,5-dimethyl-4-(4-(methylsulfonyl)phenyl)-2,5 dihydrofuran-2-ol; 23: 3-isopropoxy-5,5-dimethyl-4-(4-(methylsulfonyl)phenyl)-2,5 20 dihydrofuran-2-ol; 24: 5,5-dimethyl-3-(3-fluorophenyl)-2-hydroxy-4-(4 (methylsulfonyl)phenyl)-2,5-dihydrofuran; 25: 5-chloro-3-(4-(methylsulfonyl)phenyl)-2-(3-pyridinyl)pyridine; 26: 4-(5-methyl-3-phenyl-4-isoxazolyl)benzenesulfonamide. 25 The following publications describe and/or provide methods for making the compounds as indicated: compounds 12, 15, 17, 18, 19 and 21, WO 97/14691; compounds 22, 23 and 24, WO 97/16435; compound 20, WO 96/36623; compound 14, U.S. Patent No. 5,536,752; compound 16, U.S. Patent No. 5,474,995. See Examples herein for compounds 13 and 25; 30 compound 26, U.S. Patent No. 5,633,272.
WO 99/59635 PCT/G B99/01632 - 11 Also incorporated herein by reference are those compounds described in WO 96/41645 as having structural Formula I, shown below, and the definition and preferred definitions and species described therein: 2 R R-SA A // \ / \3 50 Particularly preferred compounds of formula (I) include: 5-(4-fluorophenyl)-1-[4-(methylsulfonyl)phenyl]-3 (trifluoromethyl)pyrazole; 10 4-(4-fluorophenyl)-5-[4-(methylsulfonyl)phenyl-1-phenyl-3 (trifluoromethyl)pyrazole; 4-(5-(4-chlorophenyl)-3-(4-methoxyphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(3,5-bis(4-methylphenyl)-iH-pyrazol-1-yl)benzenesulfonamide; 15 4-(5-(4-chlorophenyl)-3-phenyl-1H-pyrazol-1-yl)benzenesulfonamide; 4-(3,5-bis(4-methoxyphenyl)-lH-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(4-methylphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(4-nitrophenyl)-1H-pyrazol-1 20 yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(5-chloro-2-thienyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(4-chloro-3,5-diphenyl-iH-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(trifluoromethyl)-1H-pyrazol-1 25 yl)benzenesulfonamide; 4-(5-phenyl)-3-(trifluoromethyl)-lH-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-fluorophenyl)-3-(trifluoromethyl)-1H-pyrazol-1 yl)benzenesulfonamide; WO 99/59635 PCT/GB99/OI 632 - 12 4- (5 -(4 -m ethoxyphenyl)-3 -(trifl uorom ethyl) - 1H-pyrazol- 1 yI)benzenesulfonamide; 4-(5 -(4-chl oro phenyl)-3 -(difl uorom ethyl) - 1H-pyrazol- 1 yl)benzenesulfonamide; 5 4-(5-(4-methylphenyl)-3-(trifluoromethyl)-1IH-pyrazol-1I yl)benzenesulfonamide; 4-(4-chl oro- 5-(4-chlorophenyl)-3 -(tri fluorom ethyl)-I 1H- pyra zol- 1 yl)benzenesulfonamide; 4-(3-(difluoromethyl)-5-(4-methylphenyl)- 1H-pyrazol- 1 10 yl)benzenesulfonamide; 4-(3-(difl uoromethyl)-5-phenyl- 1H-pyrazol- 1-yl)benzenesulfonamide; 4-(3-(difl uoromethyl)-5-(4-methoxyphenyl)- 1H-pyrazol- 1 yl)benzenesulfonamide; 4-(3-cyano-5-(4-fl uorophenyl)- I1H-pyrazol- 1-yl)benzenesulfonamide; 15 4-(3-(di fluorornethyl)-5-(3-fluoro-4-methoxyphenyl)-1IH-pyrazol-1I yl)benzenesulfonamide; 4-(5-(3-fluoro-4-methoxyphenyl)-3-(trifl uoromethyl)- 111-pyrazol- 1 yl)benzenesulfonamide; 4-(4--chloro-5-phenyl- I1H-pyrazol- l-yl )benzenesulfonamide; 20 4-(5-(4-chlorophenyl)-3-(hydroxyphenyl )- 1H-pyrazol- 1 yl)benzenesulfonamide; 4-(5-(4-(N,N-dimethylamino)pheny)-3-(trifluoromethy1)- 1H-pyrazol- 1 yl)benzenesulfonamide; 5-(4-fluorophenyl)-6-(4-(methylsulfonyl)phenyl)spiro [2.4] hept-5-ene;, 25 4-(6-(4-fluorophenyl)spiro [2.41 hept-5-en-5-yl)benzenesulfonamide;, 6-(4-fluorophenyl)-7-(4-(methylsulfonyl)phenyl)spiro [3.4] oct-6-ene; 5-(3-chloro-4-methoxyphenyl)--6-(4-(methylsulfonyl)phenyl)spiro [2.4] hept 5-ene; 4-(6-(3-chloro-4-methoxyphenyl)spiro [2.4] hept-5-en-5 30 yl)benzenesulfonamide;, WO 99/59635 PCT/GB99/OI 632 - 13 5-(3 ,5-dichloro-4-methoxyphenyl )-6-(4 (m ethyl sulfonyl)phe nyl) spi ro [2.4] hept-5-ene; 5-(3 -chloro-4-fluorophenyl )-6-(4-(methylsulfonyl)phenyl )spiro [2.4] hept-5 ene; 5 4(6-(3,4-dichlorophenyl~spiro [2.4] hept-5-en-5-yl)benzenesulfonamide; 2-(3-chloro-4-fluorophenyl)-4-(4-fluorophenyl)-5-(4 methylsulfonylphenyl)thiazole; 2-(2-chlorophenyl)-4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)thiazole; 5-4-fluorophenyl)-4-(4-m ethyl sulfonyl phenyl)-2 -m ethylthi az ole; 10 4-(4-fl uorophenyl)-5-4-m ethyl sulfonyl phenyl)- 2-trifl uorom ethylthi az ole; 4-4-fluorophenyl )-5 -(4-m ethyl sulfonylphenyl)-2 -(2 -thienyl)thi azole; 4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)-2-benzylarninothiazole; 4-441luorophenyl)-5-(4-m ethyl sulfonylphenyl)-2-(l -propylani no)thi azole; 2-((3 ,5-dichlorophenoxy)methyl )-4-(4-fluorophenyl)-5-(4 15 (methylsulfonyl)phenyl)thiazole; 5 -(4-fl uorophenyl )-4-(4 -m ethyls ulIfonyl phe nyl )-2-Aniflu orom ethylthi az ole; I1-m ethyl sulfonyl -4- (1, 1-dirnethyl-4-(4-fluorophenyl)cyclopenta-2,4-dien-3 yl)benzene; 4-4-(4-fluorophenyl )- 1, 1 -dim ethyl cyclopenta-2 ,4-dien-3 20 yl)benzenesulfonamide; 5 -(4-fiuorophenyl)-6-(4-(m ethyl sulfonyl)phenyl)spi ro [2.41 hepta-4 ,6-diene; 4-(6-(4-fiuorophenyl)spiro [2.4] hepta-4,6-dien--5-yl)benzenesulfonamide; 6-(4-fluorophenyl)-2-methoxy-5--(4-(methylsulfonyl)phenyl)-pyridine-3 carbonitrile; 25 2-bromo-6-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)-pyridine-3 carbonitrile; 6-(4-fl uorophe nyl)- 5-(4-(m ethyl sul fonyl) phenyl) -2 -phe nyl -pyri di ne-3 carbonitrile; 442-4-m ethyl pyri di n-2 -yl) -4 -(tri fluoromethyl )- 1H-imidazol- 1 30 yl)benzenesulfonamide;- WO 99/59635 PCT/G B99/O 1632 - 14 4-(2-(5-methylpyridin-3-yl)-4-(trifluoromethyl )- 1H-irnidazol-1I yl )benzenesulfonamide; 4-(2-(2-methylpyridin-3 -yl)-4-(trifluorom ethyl )- 1 H-imidazol- 1 yl )benzenesulfonarnide; 5 3 -( 1-(4-(methylsul fo nyl)phenyl) -4-(trifluorom ethyl)- 1 H-imi dazol-2 yl)benzenesulfonamide; 2-( 1-(4-(methylsulfonylphenyl)-4-(trifluorom ethyl)- 1H-imidazol-2 yl)pyridine; 2-methyl-4-( 1-(4-(methylsulfonyl)phenyl)-4-(trifiuoromethyl)-lil-imidazol 10 2-yl)pyridine; 2-methyl-6-( 1-(4-(rnethylsulfonyl )phenyl)-4-( trifluoromethyl)- 1H-imidazol 2-yl)pyridine; 4-(2-(6-rnethylpyridin-3-yl)-4-(trifluoromethyl)- 1 H-imidazol-1I yl )benzenesulfonarnide; 15 2-(3,4-difluorophenyl)- 1-(4-(methylsulfonyl)phenyl)-4-(trifluorornethyl)- 1H imidazole; 442-(4-m ethyl phe nyl)-4 -(tri fl uorom ethyl) - 1H-imidazol-1I.
yl)benzenesulfonamide; 2-(4-chlorophenyl )- 1-(4-(m ethyl sulfo nyl) phenyl) -4 -methyl - 1H-irnidazole; 20 2-(4-chlorophenyl )- 1-4-(m ethyl sul fonyl) phenyl)-4-phenyl - lIl-imidazole;, 2-(4-chlorophenyl)-4-(4-fluorophenyl)-1-(4-(methylsulfonyl)phenyl)- 1H imidazole; 2-(3-fiuoro-4-methoxyphenyl)- 1-(4-(methylsulfonyl)phenyl)-4 (trifluoromethyl )- 1H-imidazole; 25 1-(4-(methylsulfonyl)phenyl)-2-phenyl-4-trifluoromethyl- 1H-imidazole; 2-(4-methylphenyl)-1-(4-(methylsulfonyl)phenyl)-4-trifluoromethyl- 1H imidazole; 442 -(3 -chl oro-4-m ethyl phenyl) -4-(tri fl uoro methyl) -I i-imi dazol- 1 yl )benzenesulfonamide; 30 2-(3-fluoro-5-methylphenyl)- 1-(4 -(m ethyl sul fonyl)phenyl)-4 (trifluoromethyl)- lIl-imidazole; WO 99/59635 PCTIG B9910 1632 - 15 4- (2-43 -fl uoro- 5-methyl phenyl)-4- (tri fl uorom ethyl)- I11-imidlazol-I 1 yl )benzenesulfonamide;, 2-(3-methylphenyl)- 1-(4-(m ethyl sulfonyl) phe nyl)-4 -(tri fl uorom ethyl )- 1H imidazole; 5 4-(2-(3-methylphenyl)-4-(trifluoromethyl)-1H-imidazol-1 yl)benzenesulfonamide; I- (4-(m ethyl sulfonyl)phenyl)- 2-(3 -chl orophenyl)-4-(tri fluoromethyl )- 1H imidazole; 44(24(3-chl orophe nyl) -4-(trifl uorom ethyl)- I1H-imi da zol-I 1 10 yl)benzenesulfonamide; 4 -(2-ph enyl-4 -(triflu orom ethyl) - iR-imidazol- I1-yl)benzenesulfonamide; 4-(2-(4-methoxy-3-chlorophenyl)-4-(trifluoromethyl)- I1H-imidazol- 1 yl )benzenesulfonamide; I1-allyl-4-(4-fluorophenyl)-3-4-(m ethyls ulfonyl)phenyl)-5 -(trifl uorom ethyl) 15 111-pyrazole; 44( -ethyl-4-(4-fl uorophenyl )-5-(trifluorom ethyl)- 1 H-pyrazol-3 yl)benzenesulfonamide; N-phen-yl-(4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl )-5 (tri flu orom ethyl)- 1H-pyrazol- 1l-yl )acetamide; 20 ethyl (4-(4-fl uorophenyl )-3 -(4-(m ethyl sul fonyl)phenyl) -5-(trifl uoromethyl) 1H1-pyrazol- 1-yl)acetate; 4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl)- 1-(2-phenylethyl)- 1H pyrazole; 4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl)- 1-(2-phenyl ethyl)-5 25 (trifluoromethyl)pyrazole; 1-ethyl-4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl)-5-(trifluoromethyl) 1H-pyrazole; 5 -(4-fl uorophenyl )-4- (4-(methyls ulfo nyl)phenyl)- 2-(trifl uorom ethyl)- I1H imidazole; 30 4-(4-(methylsulfonyl )phenyl)-5 -(2 -thi ophenyl)-2-(trifluorom ethyl )- 1H imidazole; WO 99/59635 PCT/GB99/O 1632 - 16 5-(4-fluorophenyl)-2-methoxy-4-(4-(methylsulfonyl)phenyl)-6 (trifl uorom ethyl) )pyri dine', 2-ethoxy-5-(4-fluorophenyl)-4-(4-(methylsulfonyl)phenyl )-6 (trifluoromethyl)pyridine; 5 5-(4-fluorophenyl)-4-(4-(methylsulfonyl)phenyl)-2-(2-propynyloxy)-6 (trifluoromethyl )pyridine; 2 -brom o-5 -(4 -fluorophenyl)-4-(4- (mnethyl sulfonyl) phenyl)-6 (trifluoromethyl) pyri dine', 4-(2-(3-chloro-4-methoxyphenyl)-4,5-difluorophenyl)benzenesulfonamide; 10 1 -(4-fluorophenyl)-2-(4-(methylsulfonyl)phenyl)benzene; 5-difluoromethyl-4-(4-(rnethylsulfonyl)phenyl )-3-phenylisoxazole; 4-(3-ethyl-5-phenylisoxazol-4-yl)benzenesulfonamide, 4-(5-difluoromethyl-3-phenylisoxazol-4-yl)benzenesulfonamide; 4-(5-hydroxymethyl-3-phenylisoxazol-4-yl )benzenesulfonamide; 15 4-( 5-methyl-3-plhenylisoxazol-4-yl)benzenesulfonamide;, 14(2-(4-fl uorophe nyl)cycl openten- 1 -yl)-4 -(inethyl sulfonyl) benz ene; 1-(2-(4-fluoro-2-methylphenyl)cyclopenten- 1-yl)-4-(methylsulfonyl)benzene; 1-(2-(4-chlorophenyl)cyclopenten- l-yl )-4-(methylsulfonyl )benzene; 1-(2-(2 ,4-dichlorophenyl )cyclopenten- I1-yl)-4-(m ethyl sulfonyl)benzene;, 20 1-(2-4-tri fluoromethylphenyl)cycl openten- 1 -yl) -4- (mnethyl sulfonyl)be nzene; 1-(2-(4-methylthiophenyl)cyclopenten- 1-yl)-4-(methylsulfonyl)benzene; 1-(2-(4-fluorophenyl)-4,4-dimethylcyclopenten- l-yl)-4 (methylsulfonyl)benzene; 4-(2-(4-fluorophenyl)-4 ,4-dimethylcyclopenten- 1-yl)benzenesulfonamide; 25 1-(2-(4-chlorophenyl)-4 ,4 -dim ethyl cyclopenten- Il-yl) -4 (methylsulfonyl)benzene-, 44(2 (4-chloro phenyl) -4,4 -dim ethyl cycl openten- I1-yl)benzenes ulfo nami de; 4-(2-(4-fluorophenyl)cyclopenten- 1-yl)benzenesulfonarnide; 4-(2-(4-chlorophenyl)cyclopenten- I1-yl)benzenesulfonamide;, 30 1-(2-(4-methoxyphenyl )cyclopenten- 1-yl)-4-(methylsulfonyl)benzene; 1-(2-(2,3-difluorophenyl )cyclopenten- 1 -yl)-4-(m ethyl sulfo nyl )be nzene; WO 99/59635 PCT/GB99/01632 - 17 4-(2-(3-fluoro-4-methoxyphenyl)cyclopenten- 1-yl)benzenesulfonamide; 1-(2-(3-chloro-4-methoxyphenyl)cyclopenten- 1-yl)-4 (methylsulfonyl)benzene; 4-(2-(3-chloro-4-fluorophenyl)cyclopenten-1-yl)benzenesulfonamide; 5 4-(2-(2-methylpyridin-5-yl)cyclopenten- 1-yl)benzenesulfonamide; ethyl 2-(4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazol-2-yl)-2 benzyl-acetate; 2-(4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazol-2-yl)acetic acid; 2-(tert-butyl)-4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazole; 10 4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)-2-phenyloxazole; 4-(4-fluorophenyl)-2-methyl-5-(4-(methylsulfonyl)phenyl)oxazole; and 4-(5-(3-fluoro-4-methoxyphenyl)-2-trifluoromethyl-4 oxazolyl)benzenesulfonamide; or a pharmaceutically acceptable salt thereof. 15 NK-1 receptor antagonists of use in the present invention are described in published European Patent Specification Nos. 0 360 390, 0 394 989, 0 429 366, 0 443 132, 0 482 539, 0 512 901, 0 512 902, 0 514 273, 0 514 275, 0 517 589, 0 520 555, 0 522 808, 0 528 495, 0 532 456, 0 533 280, 0 536 817, 0 545 478, 0 577 394, 0 590 152, 20 0 599 538, 0 610 793, 0 634 402, 0 686 629, 0 693 489, 0 694 535, 0 699 655, 0 699 674, 0 707 006, 0 708 101, 0 714 891, 0 723 959, 0 733 632 and 0 776 893; and in International Patent Specification Nos. 90/05525, 90/05729, 91/09844, 91/18899, 92/01688, 92/06079, 92/12151, 92/15585, 92/17449, 92/20661, 92/20676, 92/21677, 93/00330, 93/00331, 25 93/01159, 93/01165, 93/01169, 93/01170, 93/06099, 93/09116, 93/10073, 93/14113, 93/18023, 93/19064, 93/21155, 9321181, 93/23380, 93/24465, 94/01402, 94/02461, 94/03429, 94/03445, 94/04494, 94/04496, 94/05625, 94/07843, 94/10165, 94/10167, 94/10168, 94/10170, 94/11368, 94/13639, 94/13663, 94/14767, 94/15903, 94/19320, 94/19323, 94/20500, 94/26735, 30 94/26740, 94/29309, 95/02595, 95/04040, 95/04042, 95/06645, 95/07886, 95/07908, 95/08549, 95/11880, 95/14017, 95/15311, 95/16679, 95/17382, WO 99/59635 PCT/GB99/01632 - 18 95/18124, 95/18129, 95/19344, 95/20575, 95/21819, 96/22525, 95/23798, 95/26338, 95/28418, 95/30674, 95/30687, 96/05193, 96/05203, 96/06094, 96/07649, 96/10562, 96/16939, 96/18643, 96/20197, 96/21661, 96/29304, 96/29317, 96/29326, 96/29328, 96/31214, 96/32385, 96/37489, 97/01553, 5 97/01554, 97/03066, 97/08144, 97/14671, 97/17362, 97/18206, 97/19084, 97/19942, 97/21702, 97/30055, 97/49710 and 98/01450; and in British Patent Specification Nos. 2 266 529, 2 268 931, 2 269 170, 2 269 590, 2 271 774, 2 292 144, 2 293 168, 2 293 169, 2 302 689 and 2 309 458. Particularly preferred NK-1 receptor antagonists are those 10 described in European Patent Specification No. 0 577 394, especially compounds of formula (I): 3 4 R X R( )
R
2 N R" R or a pharmaceutically acceptable salt thereof, wherein: 15 R 1 is selected from the group consisting of: (1) C1.salkyl, substituted with one or more of the substituents selected from: (a) heterocycle, wherein the heterocycle is selected from the group consisting of: 20 (A) benzimidazolyl, (B) imidazolyl, (C) isoxazolyl, (D) isothiazolyl, (E) oxadiazolyl, 25 (F) pyrazinyl, (G) pyrazolyl, (H) pyridyl, (I) pyrrolyl, WO 99/59635 PCT/GB99/01632 -19 (J) tetrazolyl, (K) thiadiazolyl, (L) triazolyl, and (M) piperidinyl, 5 and wherein the heterocycle is unsubstituted or substituted with one or more substituent(s) selected from: (i) CI 6 alkyl, unsubstituted or substituted with halo, -CF 3 ,
-OCH
3 , or phenyl, (ii) C1.6alkoxy, 10 (iii) oxo, (iv) thioxo, (v) cyano, (vi) -SCH 3 , (vii) phenyl, 15 (viii) hydroxy, (ix) trifluoromethyl, (x) -(CH 2 )m,-NR 9
R
10 , wherein m is 0, 1 or 2, and R 9 and R 10 areindependently selected from: (I) hydrogen, 20 (II) C1.
6 alkyl, (III) hydroxyCl6alkyl, and (IV) phenyl, (xi) -NR 9 COR1 0 , wherein R 9 and Rio are as defined above, and 25 (xii) -CONR 9
R'
0 , wherein R 9 and R1 0 are as defined above,
R
2 and R 3 are independently selected from the group consisting of: (1) hydrogen; (2) C1-6alkyl (3) C2.ealkenyl, and 30 (5) phenyl; X is -O-; WO 99/59635 PCT/GB99/01632 - 20 R 4 is
R
6
R
7 z R
R
5 is phenyl, unsubstituted or substituted with halo;
R
6 , R 7 and R 8 are independently selected from the group consisting of: 5 (1) hydrogen, (2) C1_6alkyl, (3) halo, and (4) -CF 3 ; Y is -0-; and 10 Z is hydrogen or CI 4 alkyl; and pharmaceutically acceptable salts thereof. Particularly preferred compounds of formula (I) are: 4-(3-(1,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S) phenyl-morpholine; 15 4-(3-(1,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(R) phenyl-morpholine; 4-(3-(5-oxo-1H,4H-1,2,4-triazolo)methyl)-2(S)-(3,5 bis(trifluoromethyl)benzyloxy)-3(S)-phenyl-morpholine; and 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 20 4-(3-(5-oxo-1H,4H-1,2,4-triazolo)methyl)morpholine; or a pharmaceutically acceptable salt thereof. Further preferred NK-1 receptor antagonists are those described in International (PCT) Patent Specification No. WO 95/18124, especially compounds of formula (II) and pharmaceutically acceptable salts thereof: 25 WO 99/59635 PCT/GB99/01632 - 21 A Y| (0 0 2 A' N R A 3 (II) wherein: A' is fluorine or CF 3 ;
A
2 is fluorine or CF 3 ; 5 A 3 is fluorine or hydrogen;
R
6 is a 5-membered or 6-membered heterocyclic ring containing 2 or 3 nitrogen atoms optionally substituted by =0, =S or a C14alkyl group, and optionally substituted by a group of the formula ZNR 7
R
8 where Z is C1-calkylene or C3_6cycloalkylene; 10 R 7 is hydrogen, C14alkyl, C3.7cycloalkyl or C3-7cycloalkylC1-4alkyl, or C2- 4 alkyl substituted by C1.4alkoxy or hydroxyl;
R
8 is hydrogen, C1 4 alkyl, C3-7cycloalkyl or C3_7cycloalkylC1_ 4 alkyl, or C2_ 4 alkyl substituted by one or two substituents selected from C1 4 alkoxy, hydroxyl or a 4, 5 or 6 membered heteroaliphatic ring containing one or 15 two heteroatoms selected from N, 0 and S; or R 7 , R 8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may optionally contain an oxygen or sulphur ring atom, a group S(O) or S(O)2 20 or a second nitrogen atom which will be part of a NH or NRc moiety where RC is CI- 4 alkyl optionally substituted by hydroxy or C1_ 4 alkoxy; or R 7 , R 8 and the nitrogen atom to which they are attached form a non-aromatic azabicyclic ring system of 6 to 12 ring atoms; WO 99/59635 PCT/GB99/01632 - 22 or Z, R 7 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms which may optionally contain an oxygen ring atom; X is an alkylene chain of 1 to 4 carbon atoms optionally substituted 5 by oxo; and Y is a Cl4alkyl group optionally substituted by a hydroxyl group; with the proviso that if Y is CI4alkyl, R 6 is susbstituted at least by a group of formula ZNR 7
R
8 as defined above. Particularly preferred compounds of formula (II) include: 10 2-(R)-(1 -(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl-1,2,3-triazol-4-yl)methyl-3-(S)-phenylmorpholine; 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl-1,2,3-triazol-4-yl)methyl-3-(S)-(4-fluorophenyl)morpholine; 2-(R)-(1-(S)-(3,5-bis(trifluoromethyl)phenyl)-2-hydroxyethoxy)-3-(S)-(4 15 fluorophenyl)-4-(1,2,4-triazol-3-yl)methylmorpholine; and pharmaceutically acceptable salts thereof. Further preferred NK-1 receptor antagonists are those described in European Patent Specification No. WO 95/23798, especially compounds of formula (III):
R
6 R3 X Y R7 2Z R (III)
R
2 1 ~N 11 8(11 (0)1 R 13
R
12 20 BR or a pharmaceutically acceptable salt thereof, wherein:
R
2 and R 3 are independently selected from the group consisting of: (1) hydrogen, 25 (2) Cl6alkyl, WO 99/59635 PCT/G B99/01632 - 23 (3) C2_salkenyl, and (4) phenyl;
R
6 , R 7 and R 8 are independently selected from the group consisting of: (1) hydrogen, 5 (2) C1_6alkyl, (3) fluoro, (4) chloro, (5) bromo, (6) iodo, and 10 (7) -CF 3 ;
R
11 , R 12 and R 13 are independently selected from the group consisting of: (1) fluoro, (2) chloro, (3) bromo, and 15 (4) iodo; A is unsubstituted 1salkyl; B is selected from the group consisting of: H X H x N-N X H H N-N N-N N-N N o O O S N N 0 N x H H X H X N-N N-N N-N NN IN SN N S x H x N-N N N-N / ~N I N N N x x WO 99/59635 PCT/GB99/01632 - 24 x H x / N N / , N 0 O N 0 N H x H H N H H N 1 S X N N x p is 0 or 1; X is selected from: (a) -PO(OH)O- M', wherein M' is a pharmaceutically 5 acceptable monovalent counterion, (b) -PO(O~) 2 - 2M+, (c) -PO(0- 2 - D 2 +, wherein D 2 + is a pharmaceutically acceptable divalent counterion, (d) -CH(R4)-PO(OH)O- - M+, wherein R 4 is hydrogen or Ci-3alkyl, 10 (e) -CH(R4)-PO(0- 2 * 2M+, ()-CH-(R4)-PO(0-)2 * D2+, (i) -CO-CH 2
CH
2 -CO2- * M+, (j) -CH(CH 3
)-O-CO-R
5 , wherein R 5 is selected from the group consisting of: WO 99/59635 PCT/G B99/01632 -25 (i) NH * M HOHM (iij) O N " OH O CO 2 M
CO
2 M+ (iv) C M+ O CO
NH
3 CO M + (vi) 0 CO 2 M +
CO
9 M*
CO
2 M (vii) ; and Y is -0-; Z is hydrogen or C1.
6 alkyl; and pharmaceutically acceptable salts thereof. 5 Particularly preferred compounds of formula (III) include: (1) 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(5-oxo 1H,4H-1,2,4-triazolo)methyl)morpholine N-oxide; WO 99/59635 PCT/GB99/01632 - 26 (2) 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(4 (ethoxycarbonyloxy- 1-ethyl)-5-oxo- 1H- 1,2,4 triazolo)methyl)morpholine; (3) 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4 5 fluorophenyl)-4-(3-(4-monophosphoryl-5-oxo-1H-1,2,4 triazolo)methyl)morpholine; (4) 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4 fluorophenyl)-4-(3-(1-monophosphoryl-5-oxo-1H-1,2,4 triazolo)methyl)morpholine; 10 (5) 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4 fluorophenyl)-4-(3-(2-monophosphoryl-5-oxo- 111-1,2,4 triazolo)methyl)morpholine; (6) 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4 fluorophenyl)-4-(3-(5-oxyphosphoryl-1H- 1,2,4 15 triazolo)methyl)morpholine; (7) 2-(S)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4 fluorophenyl)-4-(3-(1-monophosphoryl-5-oxo-4H- 1,2,4 triazolo)methyl)morpholine; and pharmaceutically acceptable salts thereof. 20 Further preferred NK-1 receptor antagonists are those described in International Patent Specification No. WO 97/49710, especially compounds of formula (IV): (IV) N 3 H | R4 25 wherein WO 99/59635 PCT/GB99/01632 - 27 R 1 represents hydrogen, hydroxy, C1_6alkyl, C 2 .6alkenyl, C3-7cycloalkyl, C3-7cycloalkylCl_4alkyl, C1.6alkoxy, fluoroC1_6alkoxy, C1-6alkoxyCl_4alkyl, C1.
6 alkoxyC1.4alkoxy, fluoroC1_ 6 alkoxyCl_4alkyl, C2.6alkenyloxy, C3-7cycloalkoxy, C3.7cycloalkylC1_4alkoxy, phenoxy, 5 benzyloxy, cyano, halogen, NRaRb, SRa, SORa, SO 2 Ra, OSO 2 Ra, NRaCOR14, CORa, CO 2 Ra or CONRaRb where Ra and Rb each independently represent hydrogen, C1_ 4 alkyl or fluoroC1.4alkyl;
R
2 represents hydrogen, halogen, C1_6alkyl or Cl6alkoxy; or R 1 and R 2 may be joined together such that there is formed a 5- or 10 6-membered saturated or unsaturated ring containing one or two atoms selected from nitrogen, oxygen and sulphur, which ring is optionally substituted by a group selected from CI 4 alkyl, CF 3 , =O or =S;
R
3 represents hydrogen, halogen, C1_ 6 alkyl, fluoroC1.6alkyl, C1-alkoxy, fluoroC1-Galkoxy, C 3 -7cycloalkyl, C3-7CycloalkylC1-4alkyl, cyano, 15 SRa, SORa, SO 2 Ra, NRaRb, NRaCOR1 4 , CORa, CO 2 Ra, CONRaRb or C1_ 4 alkyl substituted by cyano, CO 2 Ra or CONRaRb where Ra and Rb are as previously defined;
R
4 represents hydrogen, halogen, C1_6alkyl, C1_6alkoxy, CF 3 , OCF 3 ,
NO
2 , CN, SRa, SORa, SO 2 Ra, CO 2 Ra, CONRaRb, C 2 _ealkenyl, C2.6alkynyl or 20 C1.4alkyl substituted by C1_4alkoxy, where Ra and Rb are as previously defined; and the broken line represents an optional double bond; and pharmaceutically acceptable salts thereof. Particularly preferred compounds of formula (IV) include: 25 (3R,5R,6S)-3-(2-methoxy-5-(trifluoromethoxy)phenyl)-6-phenyl-1-oxa-7 aza-spiro [4.5] decane; (3R,5R,6S)-3-(2-methoxy-5-(trifluoromethyl)phenyl)-6-phenyl-1-oxa-7-aza spiro[4.5]decane; (3R,5R,6S)-7-benzyl-3- [2-methoxy-5-(trifluoromethoxy)phenyl] -6-phenyl- 1 30 oxa-7-aza-spiro[4.5]decane; (3R, 5R,6S)-3-(2-methoxy-5-trifluoromethoxyphenyl)-6-phenyl- 1-oxa-7-aza- WO 99/59635 PCT/GB99/01632 - 28 spiro[4.5]decane; (3R, 5R,6S)-3,6-bis(phenyl)- 1-oxa-7-aza-spiro [4.5] decane; (3R,5R,6S)-7-benzyl-3-(2-methoxy-5-trifluoromethoxyphenyl)-6-phenyl- 1 oxa-7-aza-spiro [4.5] decane; 5 (±)-(3R*,5R*,6S*)-3-(2-methoxyphenyl)-6-phenyl-1-oxa-7 (phenylmethoxycarbonyl)aza-spiro [4.5] decane; (3R, 5R,6S)-3-(2-methoxyphenyl)-6-phenyl- 1-oxa-7-aza-spiro [4.5] decane; (3S, 5R,6S)-3-(2-cyclopropoxy-5-(trifluoromethoxy)phenyl)-6-phenyl- 1-oxa 7-aza-spiro [4.5] decane; 10 (3R, 5R,6S)-3- [2-cyclopropoxy-5-(trifluoromethoxy)phenyl] -6-phenyl- 1-oxa 7-aza-spiro [4.51 decane; (3S, 5R,6S)-3- [2-cyclopropoxy-5-(trifluoromethyl)phenyl] -6-phenyl- 1-oxa-7 aza-spiro [4.5] decane; and pharmaceutically acceptable salts thereof 15 Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 436 334, i.e. compounds of formula (V): R' R4 R, N R3
R
2 -V) RR R6 20 or a pharmaceutically acceptable salt thereof, wherein Y is (CH 2 ). wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH 2 )n may optionally be replaced by a carbon-carbon double bond, and wherein any one of the carbon atoms of said (CH 2 )n may optionally be substituted with R 4 , and 25 wherein any one of the carbon atoms of said (CH 2 )n may optionally be substituted with R 7
;
WO 99/59635 PCT/G B99/01632 - 29 Z is (CH 2 )m wherein m is an integer from 0 to 6, and wherein any one of the carbon-carbon single bonds of (CH2)m may optionally be replaced by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH 2 )m may optionally be substituted with 5 R8; R1 is hydrogen or C1_8alkyl optionally substituted with hydroxy, Ci4alkoxy or fluoro;
R
2 is a radical selected from hydrogen, C1.6 straight or branched alkyl, C3-7cycloalkyl wherein one of the CH 2 groups in said cycloalkyl may 10 optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C2-6alkyl, benzhydryl and benzyl, wherein each of said aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl 15 C2_6alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, C 1 - alkyl, C1-6alkoxy, trifluoromethyl, amino, C1_6alkylamino, C1.6alkyl-O-CO, C1_ 6 alkyl-O-CO C1.6alkyl, C_-6alkyl-CO-O, C1-6alkyl-CO-C1.6alkyl-O-, C1_ 6 alkyl-CO, C1.6alkyl-CO-C1-6alkyl-, di-C1-6alkylamino, -CONH-Ci-6alkyl, 20 C1_ 6 alkyl-CO-NH-C1-6alkyl, -NHCOH and -NHCO-Cl6alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl;
R
5 is hydrogen, phenyl or Cil6alkyl; or R 2 and R 5 together with the carbon to which they are attached, 25 form a saturated ring having from 3 to 7 carbon atoms wherein one of the
CH
2 groups in said ring may optionally be replaced by oxygen, NH or sulfur;
R
3 is aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, 30 isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 WO 99/59635 PCT/GB99/01632 - 30 carbon atoms wherein one of the (CH 2 ) groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3.7cycloalkyl may 5 optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, C1_6alkyl, C1.6alkoxy, trifluoromethyl, amino, C1_6alkylamino, -CO-NH- C1.6alkyl,
CI_
6 alkyl-CO-NH-C1-6alkyl, -NHCOH and -NHCO-C1_6alkyl;
R
4 and R 7 are each independently selected from hydroxy, halogen, 10 halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl, CI6alkylamino, di-C1.6alkylamino, C1.6alkoxy, C1.
6 alkyl-O-CO, C1.6alkyl-O-CO-C1.6alkyl, C1.6alkyl-CO-0, C1- 6 alkyl-CO-C1- 6 alkyl-O-, C1.
6 alkyl-CO-, C1.
6 alkyl-CO-CI_alkyl, and the radicals set forth in the definition of R 2 ; 15 R 6 is -NHCOR 9 , -NHCH 2
R
9 , S0 2
R
8 or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ;
R
8 is oximino (=NOH) or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ;
R
9 is Ci.alkyl, hydrogen, phenyl or phenylCl6alkyl; 20 with the proviso that (a) when m is 0, R 8 is absent, (b) when R 4 , R 6 , R 7 or
R
8 is as defined in R 2 , it cannot form together with the carbon to which it is attached ,a ring with R 5 , and (c) when R 4 and R 7 are attached to the same carbon atom, then either each of R 4 and R 7 is independently selected from hydrogen, fluoro and C1-6alkyl, or R 4 and R 7 , together with the carbon 25 to which they are attached, for a C 3
_
6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached. A particularly preferred compound of formula (V) is (2S,3S)-cis-3-(2 methoxybenzylamino)-2-phenylpiperidine; or a pharmaceutically 30 acceptable salt thereof.
WO 99/59635 PCT/GB99/01632 - 31 Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 93/21155, i.e. compounds of formula (VI): R R 0 N CH-(VI) R 12 R 5 R 3
R
4 or a pharmaceutically acceptable salt thereof, wherein radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical;
R
1 is optionally substituted phenyl, cyclohexadienyl, naphthyl, 10 indenyl or optionally substituted heterocycle;
R
2 is H, halogen, OH, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino;
R
3 is optionally 2-substituted phenyl; 15 R 4 is OH or fluorine when R 5 is H; or R 4 and R 5 are OH ; or R 4 and R 5 together form a bond. A particularly preferred compound of formula (VI) is (3aS, 4S, 7aS) 7,7-diphenyl-4-(2-methoxyphenyl)-2-[(2S)-(2-methoxyphenyl)propionyl] 20 perhydroisoindol-4-ol; or a pharmaceutically acceptable salt thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 591 040, i.e. compounds of formula (VII): R Q Ar-T-CO-N-CH 2
-C-CH
2
-CH
2 -Am + A (VII Ar' 25 wherein WO 99/59635 PCT/GB99/01632 - 32 Ar represents an optionally substituted mono-, di- or tricyclic aromatic or heteroaromatic group; T represents a bond, a hydroxymethylene group, a C1.4alkoxymethylene group or a C1.
5 alkylene group; 5 Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or fluorine, trifluoromethyl, C1.4alkoxy, C14alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group; 10 R represents hydrogen, C14alkyl, o-C1 4 alkoxyC1.4alkyl, or o-C2- 4 alkanoyloxyC2- 4 alkyl; Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4 butylene group; 15 Am+ represents the radical X in which X 1 , X 2 and X 3 , together with the nitrogen atom to which they are attached, form an azabicyclic or azatricyclic ring system optionally substituted by a phenyl or benzyl group; and 20 A- represents a pharmaceutically acceptable anion. A particularly preferred compound of formula (VII) is (+) 1-[2-[3 (3,4-dichlorophenyl)-1- [(3-isopropoxyphenyl)acetyl] -3-piperidinyl] ethyl] -4 phenyl-1-azabicyclo[2,2,2]octane; or a pharmaceutically acceptable salt, especially the chloride, thereof. 25 Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 0 532 456, i.e. compounds of formula (VIII): WO 99/59635 PCT/GB99/01632 - 33 Rj 1'-N X --- -X-- R'4VI or a pharmaceutically acceptable salt thereof, wherein R1 represents an optionally substituted aralkyl, aryloxyalkyl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, 5 heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an a-amino acid optionally N-substituted by a lower alkanoyl or carbamoyl-lower alkanoyl group;
R
2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group; 10 R 3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy;
R
4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group;
X
1 represents methylene, ethylene, a bond, an optionally ketalised 15 carbonyl group or an optionally etherified hydroxymethylene group;
X
2 represents alkylene, carbonyl or a bond; and
X
3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an alkyl group optionally substituted by phenyl, hydroxymethyl, optionally esterified or amidated carboxy, or (in other than the a-position) hydroxy. 20 A particularly preferred compound of formula (VIII) is (2R*, 4S*)-2 benzyl-1-(3,5-dimethylbenzoyl)-N-(4-quinolinylmethyl)-4-piperidineamine; or a pharmaceutically acceptable salt thereof. Another class of NK-1 receptor antagonists of use in the present invention is that described in European Patent Specification No. 25 0 443 132, i.e. compounds of formula (IX) WO 99/59635 PCT/GB99/01632 - 34 2 z CH 2 R -Y-A-N CONHCHCON (IX) or a pharmaceutically acceptable salt thereof, wherein RI is aryl, or a group of the formula: 5 z' X is CH or N; and Z is 0 or N-R 5 , in which R 5 is hydrogen or lower alkyl;
R
2 is hydroxy or lower alkoxy;
R
3 is hydrogen or optionally substituted lower alkyl; 10 R 4 is optionally substituted ar(lower)alkyl; A is carbonyl or sulfonyl; and Y is a bond or lower alkenylene. A particularly preferred compound of formula (IX) is the compound of formula (IXa) 15 HO 0 NN (IXa) 0 - H, / 0 N
H
3 C N or a pharmaceutically acceptable salt thereof.
WO 99/59635 PCT/GB99/01632 - 35 Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 92/17449, i.e. compounds of the formula (X) H N N R H (X) 5 or a pharmaceutically acceptable salt thereof, wherein
R
1 is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and 10 heteroaryl groups may optionally be substituted with one or more substituents, and said C3.7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, C1.1oalkyl optionally substituted with from one to three fluoro groups, C1-ioalkoxy optionally substituted 15 with from one to three fluoro groups, amino, C1-ioalkyl-S-, C1-ioalkyl-S(O)-, C1_1oalkyl-SO2-, phenyl, phenoxy, Ci1oalkyl-SO2NH-, Ci-oalkyl-SO 2 NH-Ciuoakyl-, Ci-oalkylamino-diCi-oalkyl-, cyano, hydroxy, cycloalkoxy having 3 to 7 carbon atoms, C1_6alkylamino, C1_6dialkylamino, HC(O)NH- and Ci.ioalkyl-C(O)NH-; and 20 R 2 is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, Ci.oalkyl optionally substituted with from one to three fluoro groups and C1ioalkoxy optionally substituted with from one to three fluoro groups. 25 A particularly preferred compound of formula (X) is (2S,3S)-3-(2 methoxy-5-trifluoromethoxybenzyl)-amino-2-phenylpiperidine; or a pharmaceutically acceptable salt thereof.
WO 99/59635 PCT/GB99/01632 - 36 Another class of NK-1 receptor antagonists of use in the present invention is that described in International Patent Specification No. WO 95/08549, i.e. compounds of formula (XI) R 2
(CH
2 )x H | N 'I R N H I R4 R 5(XI) 5 or a pharmaceutically acceptable salt thereof, wherein
R
1 is a C1.
4 alkoxy group;
R
2 is 6 N /N
R
3 is a hydrogen or halogen atom; 10 R 4 and R 5 may each independently represent a hydrogen or halogen atom, or a Ci4alkyl, C14alkoxy or trifluoromethyl group;
R
6 is a hydrogen atom, a C14alkyl, (CH2)mcyclopropyl, -S(O)nC1_ 4 alkyl, phenyl, NR7R8, CH 2
C(O)CF
3 or trifluoromethyl group;
R
7 and R 8 may each independently represent a hydrogen atom, or a 15 C14alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and m represents zero or 1. Particularly preferred compounds of formula (XI) are (2-methoxy-5 20 tetrazol-1-yl-benzyl)-([2S,3S]-2-phenyl-piperidin-3-yl)-amine; and [2- WO 99/59635 PCT/GB99/01632 - 37 methoxy-5-(5-trifluoromethyl-tetrazol-1-yl)-benzyl]-([2S,3S] -2-phenyl piperidin-3-yl)-amine; or a pharmaceutically acceptable salt thereof. Another class of tachykinin antagonists of use in the present invention is that described in International Patent Specification No. 5 WO 95/14017, i.e. compounds of formula (XII) R R R-(CH12)n-C--CH2 N-(CH2),)-RS NH R (CO)p (CH 2)m (XII) R or a pharmaceutically acceptable salt thereof, wherein m is zero, 1, 2 or 3; n is zero or 1; 10 o is zero, 1 or 2; p is zero or 1; R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, CI-salkoxy, 15 trifluoromethyl, C14alkyl, phenyl-Ci-salkoxy, or C1-4alkanoyl groups; R1 is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quinolinyl, isoquinolinyl, reduced quinolinyl, reduced isoquinolinyl, 20 phenyl-(C1-4alkyl)-, phenyl-(Cl_4alkoxy)-, quinolinyl-(C1.4alkyl)-, isoquinolinyl-(C1-4alkyl)-, reduced quniolinyl-(C1-4alkyl)-, reduced isoquinolinyl-(C1.4alkyl)-, benzoyl-(Ci-3alkyl)-, C1.4alkyl, or -NH-CH 2
-R
5 ; any one of which R 1 groups may be substituted with halo, C1.
4 alkyl, C1_4alkoxy, trifluoromethyl, amino, C1.4alkylamino, di(C14alkyl)amino, or 25 C2.4alkanoylamino; WO 99/59635 PCT/GB99/01632 - 38 or any one of which R1 groups may be substituted with phenyl, piperazinyl, C3-8cycloalkyl, benzyl, C1.4alkyl, piperidinyl, pyridinyl, pyrimidinyl, C2.6alkanoylamino, pyrrolidinyl, C2-6alkanoyl, or C1-4alkoxycarbonyl; 5 any one of which groups may be substituted with halo, C1.
4 alkyl, C1.4alkoxy, trifluoromethyl, amino, C1-4alkylamino, di(C1-4alkyl)amino, or C2.4alkanoylamino; or RI is amino, a leaving group, hydrogen, C1-4alkylamino, or di(C 1-4alkyl)amino; 10 R 5 is pyridyl, anilino-(Cl3alkyl)-, or anilinocarbonyl;
R
2 is hydrogen, C1-4alkyl, C1-4alkylsulfonyl, carboxy-(C1-3alkyl)-, C1-3alkoxycarbonyl-(Ci-3alkyl)-, or -CO-R 6 ;
R
6 is hydrogen, C1_4alkyl, Ci- 3 haloalkyl, phenyl, C1-3alkoxy, C1-3hydroxyalkyl, amino, C1.4alkylamino, di(C1.4alkyl)amino, or -(CH2)q-R?; 15 q is zero to 3;
R
7 is carboxy, CI.
4 alkoxycarbonyl, C14alkylcarbonyloxy, amino, C1_4alkylamino, di(CI4alkyl)amino, C 1-6alkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(C1-4alkyl)-, 20 quinolinyl-(C1- 4 alkyl)-, isoquinolinyl-(C1.4alkyl)-, reduced quinolinyl (Cl4alkyl)-, reduced isoquinolinyl-(C1-4alkyl)-, benzoyl-Ci-3alkyl; any one of which aryl or heterocyclic R 7 groups may be substituted with halo, trifluoromethyl, C1.4alkoxy, C1.4alkyl, amino, Cl.4alkylamino, di(C1.
4 alkyl)amino, or C2-4alkanoylamino; 25 or any one of which R 7 groups may be substituted with phenyl, piperazinyl, C 3 -8cycloalkyl, benzyl, piperidinyl, pyridinyl, pyrimidinyl, pyrrolidinyl, C2_6alkanoyl, or C1_ 4 alkoxycarbonyl; any of which groups may be substituted with halo, trifluoromethyl, amino, C1_4alkoxy, C1- 4 alkyl, C1-4alkylamino, di(C14alkyl)amino, or 30 C24alkanoylamino;
R
8 is hydrogen or C16alkyl; WO 99/59635 PCT/GB99/01632 - 39 R 3 is phenyl, phenyl-(C1_6alkyl)-, C3_8cycloalkyl, C 5 -8cycloalkenyl, Ci 8 alkyl, naphthyl, C2.
8 alkenyl, or hydrogen; any one or which groups except hydrogen may be substituted with one or two halo, C1-3alkoxy, CI- 3 alkylthio, nitro, trifluoromethyl, or 5 Ci-3alkyl groups; and
R
4 is hydrogen or Ci- 3 alkyl; with the proviso that if RI is hydrogen or halo, R 3 is phenyl, phenyl-(C1-6alkyl)-, C3-8cycloalkyl, C 5 -8cycloalkenyl, or naphthyl. A particularly preferred compound of formula (XII) is [N-(2 10 methoxybenzyl)acetylaminol -3-(1H-indol-3-yl)-2- [N-(2-(4-piperidin- 1 yl)piperidin- 1-yl)acetylamino propane; or a pharmaceutically acceptable salt thereof. The preferred compounds of formulae (I), (II) and (III) will have the 2- and 3-substituents on the morpholine ring in the cis arrangement, the 15 preferred stereochemistry being as shown in the following general formula: o "\\O" 2 0 N )"' 2 20 Where the benzyloxy moiety is a-substituted, the preferred stereochemistry of the a-carbon is either (R) when the substituent is an alkyl (e.g. methyl) group or (S) when the substituent is a hydroxyalkyl (e.g. hydroxymethyl) group. The preferred compounds of formula (IV) will have the 25 stereochemistry of the 5- and 6-positions as shown below (5-(R), 6-(S)). Where the optional double bond shown in formula (IV) is absent, the WO 99/59635 PCT/GB99/01632 - 40 particularly preferred compounds will have the stereochemistry of the 3-position as shown below (3-(R)): 0 - 3 5 H H 5 Unless otherwise defined herein, suitable alkyl groups include straight-chained and branched alkyl groups containing from 1 to 6 carbon atoms. Typical examples include methyl and ethyl groups, and straight chained or branched propyl and butyl groups. Particular alkyl groups are 10 methyl, ethyl, n-propyl, isopropyl, n-butyl, sec-butyl and tert-butyl. Unless otherwise defined herein, suitable alkenyl groups include straight-chained and branched alkenyl groups containing from 2 to 6 carbon atoms. Typical examples include vinyl and allyl groups. Unless otherwise defined herein, suitable alkynyl groups include 15 straight-chained and branched alkynyl groups containing from 2 to 6 carbon atoms. Typical examples include ethynyl and propargyl groups. Unless otherwise defined herein, suitable cycloalkyl groups include groups containing from 3 to 7 carbon atoms. Particular cycloalkyl groups are cyclopropyl and cyclohexyl. 20 Unless otherwise defined herein, suitable aryl groups include phenyl and naphthyl groups. A particular aryl-Cl 1 6 alkyl, e.g. phenyl-Cl6alkyl, group is benzyl. Unless otherwise defined herein, suitable heteroaryl groups include pyridyl, quinolyl, isoquinolyl, pyridazinyl, pyrimidinyl, pyrazinyl, pyranyl, 25 furyl, benzofuryl, thienyl, benzthienyl, imidazolyl, oxadiazolyl and thiadiazolyl groups.
WO 99/59635 PCT/GB99/01632 -41 The term "halogen" as used herein includes fluorine, chlorine, bromine and iodine. Suitable pharmaceutically acceptable salts of the NK-1 receptor antagonists of use in the present invention include acid addition salts 5 which may, for example, be formed by mixing a solution of the compound with a solution of a pharmaceutically acceptable non-toxic acid such as hydrochloric acid, fumaric acid, maleic acid, succinic acid, acetic acid, citric acid, tartaric acid, carbonic acid, phosphoric acid or sulphuric acid. Salts of amine groups may also comprise the quaternary ammonium salts in 10 which the amino nitrogen atom carries an alkyl, alkenyl, alkynyl or aralkyl group. Where the compound carries an acidic group, for example a carboxylic acid group, the present invention also contemplates salts thereof, preferably non-toxic pharmaceutically acceptable salts thereof, such as the sodium, potassium and calcium salts thereof. 15 The compounds of use in this invention may have one or more chiral centers and the present compounds may occur as racemates, racemic mixtures and as individual diasteriomers or enantiomers with all such isomeric forms and mixtures thereof being included within the scope of this invention. Furthermore, some of the crystalline forms for compounds 20 of the present invention may exist as polymorphs and as such are intended to be included in the present invention. In addition, some of the compounds of the instant invention may form solvates with water or common organic solvents. Such solvates and hydrates, as well as anhydrous compositions, are encompassed within the scope of this 25 invention. Some of the compounds described herein may contain olefinic double bonds, and unless specified otherwise, are meant to include both E and Z geometric isomers. The COX-2 inhibitors that may be used with this invention encompass all pharmaceutically acceptable salt forms of the compounds. 30 Examples of such salt forms of COX-2 inhibitors include but are not limited to salts derived from inorganic bases including aluminum, WO 99/59635 PCT/GB99/01632 - 42 ammonium, calcium, copper, ferric, ferrous, lithium, magnesium, manganic salts, manganous, potassium, sodium, zinc, and the like. Particularly preferred are the ammonium, calcium, magnesium, potassium, and sodium salts. Salts derived from pharmaceutically 5 acceptable organic non-toxic bases include salts of primary, secondary, and tertiary amines, substituted amines including naturally occurring substituted amines, cyclic amines, and basic ion exchange resins, such as arginine, betaine, caffeine, choline, N,N-dibenzylethylenediamine, diethylamine, 2-diethylaminoethanol, 2-dimethylaminoethanol, 10 ethanolamine, ethylenediamine, N-ethylmorpholine, N-ethylpiperidine, glucamine, glucosamine, histidine, hydrabamine, isopropylamine, lysine, methylglucamine, morpholine, piperazine, piperidine, polyamine resins, procaine, purines, theobromine, triethylamine, trimethylamine, tripropylamine, tromethamine, and the like. 15 The instant pharmaceutical combination comprising a COX-2 inhibitor in combination with a NK-1 receptor antagonist includes administration of a single pharmaceutical dosage formulation which contains both the COX-2 inhibitor and the NK-1 receptor antagonist, as well as administration of each active agent in its own separate 20 pharmaceutical dosage formulation. Where separate dosage formulations are used, the COX-2 inhibitor and the NK-1 receptor antagonist can be administered at essentially the same time, i.e., concurrently, or at separately staggered times, i.e, sequentially. The instant pharmaceutical combination is understood to include all these regimens. Administration 25 in these various ways are suitable for the present invention as long as the beneficial pharmaceutical effect of the COX-2 inhibitor and the NK-1 receptor antagonist are realized by the patient at substantially the same time. Such beneficial effect is preferably achieved when the target blood level concentrations of each active drug are maintained at substantially 30 the same time. It is preferred that the COX-2 inhibitor and the NK-1 receptor antagonist be co-administered concurrently on a once-a-day WO 99/59635 PCT/GB99/01632 - 43 dosing schedule; however, varying dosing schedules, such as the COX-2 inhibitor once, twice or more times per day and the NK-1 receptor antagonist once per day, is also encompassed herein. A single oral dosage formulation comprised of both the COX-2 inhibitor and the NK-1 receptor 5 antagonist is preferred. A single dosage formulation will provide convenience for the patient, which is an important consideration especially for patients who already have an inflammatory disorder such as rheumatoid arthritis and may be in need of multiple medications. The term "therapeutically effective amount" is intended to mean 10 that amount of a drug or pharmaceutical agent that will elicit the biological or medical response of a tissue, a system, animal or human that is being sought by a researcher, veterinarian, medical doctor or other clinician. The term "prophylactically effective amount" is intended to mean that amount of a pharmaceutical drug that will prevent or reduce 15 the risk of occurrence of the biological or medical event that is sought to be prevented in a tissue, a system, animal or human by a researcher, veterinarian, medical doctor or other clinician. The dosage regimen utilizing a COX-2 inhibitor in combination with a NK-1 receptor antagonist is selected in accordance with a variety of factors including 20 type, species, age, weight, sex and medical condition of the patient; the severity of the condition to be treated; the route of administration; the renal and hepatic function of the patient; and the particular compound or salt or ester thereof employed. Since two different active agents are being used together in a combination therapy, the potency of each of the agents 25 and the interactive effects achieved by combining them together must also be taken into account. A consideration of these factors is well within the purview of the ordinarily skilled clinician for the purpose of determining the therapeutically effective or prophylactically effective dosage amounts needed to prevent, counter, or arrest the progress of the condition. 30 The term "patient" includes mammals, especially humans, who take a COX-2 inhibitor in combination with a NK-1 receptor antagonist for any WO 99/59635 PCT/GB99/01632 - 44 of the uses described herein. Administering of the drug combination to the patient includes both self-administration and administration to the patient by another person. The inhibitor of cyclooxygenase-2 may be administered at a dosage 5 level up to conventional dosage levels for NSAIDs. Suitable dosage levels will depend upon the antiinflammatory effect of the chosen inhibitor of cyclooxygenase-2, but typically suitable levels will be about 0.001 to 50 mg/kg per day, preferably 0.005 to 30mg/kg per day, and especially 0.05 to 10mg/kg per day. The compound may be administered on a regimen of up 10 to 6 times per day, preferably 1 to 4 times per day, and especially once per day. A suitable dosage level for the NK-1 receptor antagonist is about 0.05 to 1500mg per day, preferably about 0.25 to 1500mg per day, and especially about 0.25 to 500mg/kg per day. The compounds may be 15 administered on a regimen of up to 6 times per day, preferably 1 to 4 times per day, especially 1 or 2 times daily. The active agents employed in the instant combination therapy can be administered in such oral forms as tablets, capsules (each of which includes sustained release or timed release formulations), pills, powders, 20 granules, elixirs, tinctures, suspensions, syrups, and emulsions. The instant invention includes the use of both oral rapid-release and time controlled release pharmaceutical formulations. A particular example of an oral time-controlled release pharmaceutical formulation is described in U.S Patent No. 5,366,738. Oral formulations are preferred. Such 25 pharmaceutical compositions are known to those of ordinary skill in the pharmaceutical arts; for example, see Remington's Pharmaceutical Sciences, Mack Publishing Co., Easton, PA. In the methods of the present invention, the active agents are typically administered in admixture with suitable pharmaceutical 30 diluents, excipients or carriers (collectively referred to herein as "carrier" materials) suitably selected with respect to the intended form of WO 99/59635 PCT/GB99/01632 - 45 administration, that is, oral tablets, capsules, elixirs, syrups and the like, and consistent with conventional pharmaceutical practices. For instance, for oral administration in the form of a tablet or capsule, the active drug component can be combined with a non-toxic, 5 pharmaceutically acceptable, inert carrier such as lactose, starch, sucrose, glucose, modified sugars, modified starches, methyl cellulose and its derivatives, dicalcium phosphate, calcium sulfate, mannitol, sorbitol and other reducing and non-reducing sugars, magnesium stearate, steric acid, sodium stearyl fumarate, glyceryl behenate, calcium stearate and the like. 10 For oral administration in liquid form, the drug components can be combined with non-toxic, pharmaceutically acceptable inert carrier such as ethanol, glycerol, water and the like. Moreover, when desired or necessary, suitable binders, lubricants, disintegrating agents and coloring and flavoring agents can also be incorporated into the mixture. 15 Stabilizing agents such as antioxidants (BHA, BHT, propyl gallate, sodium ascorbate, citric acid) can also be added to stabilize the dosage forms. Other suitable components include gelatin, sweeteners, natural and synthetic gums such as acacia, tragacanth or alginates, carboxymethylcellulose, polyethylene glycol, waxes and the like. 20 The active drugs can also be administered in the form of liposome delivery systems, such as small unilamellar vesicles, large unilamellar vesicles and multilamellar vesicles. Liposomes can be formed from a variety of phospholipids, such as cholesterol, stearylamine or phosphatidylcholines. 25 Active drug may also be delivered by the use of monoclonal antibodies as individual carriers to which the compound molecules are coupled. Active drug may also be coupled with soluble polymers as targetable drug carriers. Such polymers can include polyvinyl pyrrolidone, pyran copolymer, polyhydroxy-propyl-methacrylamide-phenol, 30 polyhydroxy-ethyl-aspartamide-phenol, or polyethyleneoxide-polylysine substituted with palmitoyl residues. Furthermore, active drug may be WO 99/59635 PCT/G B99/01632 - 46 coupled to a class of biodegradable polymers useful in achieving controlled release of a drug, for example, polylactic acid, polyglycolic acid, copolymers of polylactic and polyglycolic acid, polyepsilon caprolactone, polyhydroxy butyric acid, polyorthoesters, polyacetals, polydihydropyrans, 5 polycyanoacrylates and cross linked or amphipathic block copolymers of hydrogels. Although the active agents of the present method may be administered in divided doses, for example two or three times daily, a single daily dose of each of the COX-2 inhibitor and the NK-1 receptor 10 antagonist is preferred, with a single daily dose of both agents in a single pharmaceutical composition being most preferred. The instant invention also encompasses a process for preparing a pharmaceutical composition comprising combining the COX-2 inhibitor and the NK-1 receptor antagonist with a pharmaceutically acceptable 15 carrier, as well as the pharmaceutical composition which is made by combining the COX-2 inhibitor and the NK-1 receptor antagonist with a pharmaceutically acceptable carrier. A therapeutically effective amount of a COX-2 inhibitor and a NK-1 receptor antagonist can be used together for the preparation of a 20 medicament useful for preventing or reducing the risk of developing an inflammatory disorder such as rheumatoid arthritis, halting or slowing the progression of an inflammatory disorder such as rheumatoid arthritis, once it has become clinically manifest, and preventing or reducing the risk of a first or subsequent occurrence of an inflammatory disorder such as 25 rheumatoid arthritis. For example, the medicament may be comprised of a COX-2 inhibitor in combination with about 1 mg to 300 mg of a NK-1 receptor antagonist, or more particularly about 3 mg to 100 mg of the NK-1 receptor antagonist. More specific amounts of NK-1 receptor antagonist which may be used in the medicament preparation include 1 30 mg, 3 mg, 5 mg, 10 mg, 20 mg, 30 mg, 50 mg, 100 mg and 300 mg, as well as sub-milligram amounts of NK-1 receptor antagonists which have WO 99/59635 PCT/GB99/01632 - 47 sufficient potency at such levels. As a further example, the medicament may be comprised of a NK-1 receptor antagonist, for example, at the above dosages, in combination with about 0.1 to 20 mg of a COX-2 inhibitor. The instant invention also encompasses the use of a NK-1 receptor 5 antagonist for the manufacture of a medicament for the combined use with a cyclooxygenase-2 inhibitor for preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder; and the use 10 of a cyclooxygenase-2 inhibitor for the preparation of a medicament for the combined use with a NK-1 receptor antagonist for preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder. 15 The compounds of formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) may be prepared by the methods described in EP-A-0 577 394 (or WO 95/16679), WO 95/18124, WO 95/23798, WO 97/49710, EP-A-0 436 334, WO 93/21155, EP-A-0 591 040, EP-A-0 532 456, EP-A-0 443 132, WO 92/17449, WO 95/08549 and 20 WO 95/14017, respectively. Particularly preferred NK-1 receptor antagonists of the formulae (I), (II), (III), (IV), (V), (VI), (VII), (VIII), (IX), (X), (XI) and (XII) for use in the present invention are compounds which are potent NK-1 receptor antagonists, i.e. compounds with an NK-1 receptor affinity (IC 50 ) of less 25 than 1OOnM. Most preferred are compounds of formulae (I), (II), (III) and (IV). Even more preferred NK-1 receptor antagonists of use in the present invention are compounds which are potent NK-1 receptor antagonists with an NK-1 receptor affinity (ICso) of less than 10nM, 30 favourably less than 2nM and preferably less than lnM.
WO 99/59635 PCT/GB99/01632 - 48 Especially preferred NK-1 receptor antagonists of use in the present invention are orally active, long acting, CNS-penetrant NK-1 receptor antagonists, identified using a combination of the following assays: 5 ASSAY 1: NK-1 Receptor binding NK-1 receptor binding assays are performed in intact Chinese hamster ovary (CHO) cells expressing the human NK-1 receptor using a modification of the assay conditions described by Cascieri et al, J. Pharmacol. Exp. Ther., 1992, 42, 458. Typically, the receptor is expressed 10 at a level of 3x10 5 receptors per cell. Cells are grown in monolayer culture, detached from the plate with enzyme-free dissociation solution (Speciality Media Inc.), and washed prior to use in the assay. 125 1-Tyr 8 substance P (0.1nM, 2000Ci/mmol; New England Nuclear) is incubated in the presence or absence of test compounds (dissolved in 5pl 15 dimethylsulphoxide, DMSO) with 5x10 4 CHO cells. Ligand binding is performed in 0.25ml of 50mM Tris-HCl, pH7.5, containing 5mM MnCl2, 150mM NaCl, 0.02% bovine serum albumin (Sigma), 50jig/ml chymostatin (Peninsula), 0.1nM phenylmethylsulphonyl fluoride, 2 g/ml pepstatin, 2ptg/ml leupeptin and 2.8 tg/ml furoyl saccharine. The incubation proceeds 20 at room temperature until equilibrium is achieved (>40 minutes) and the receptor-ligand complex is harvested by filtration over GF/C filters pre soaked in 0.1% polyethylenimine using a Tomtek 96-well harvester. Non specific binding is determined using excess substance P (1ptM) and represents <10% of total binding. 25 ASSAY 2: Gerbil Foot-Tapping CNS-penetrant NK-1 receptor antagonists for use in the present invention can be identified by their ability to inhibit foot tapping in gerbils induced by central infusion of NK-1 receptor agonists such as GR73632, WO 99/59635 PCT/GB99/01632 - 49 based on the method of Rupniak & Williams, Eur. J. Pharmacol., 1994, 265, 179. Male or female Mongolian gerbils (35-70g) are anaesthetised by inhalation of an isoflurane/oxygen mixture to permit exposure of the 5 jugular vein in order to permit administration of test compounds or vehicle in an injection volume of approximately 5ml/kg i.v. Alternatively, test compounds may be administered orally or by subcutaneous or intraperitoneal routes. A skin incision is then made in the midline of the scalp to expose the skull. The selective NK-1 receptor agonist (e.g. 10 GR73632 (d Ala[L-Pro 9 ,Me-Leu' 0 ] -substance P-(7-11)) is infused directly into the cerebral ventricles (e.g. 3pmol in 5pl i.c.v., depending on test substance) by vertical insertion of a cuffed 27 gauge needle to a depth of 4.5mm below bregma. The scalp incision is closed and the animal allowed to recover from anaesthesia in a clear perspex observation box 15 (approximately 25cm x 20cm x 20cm). The duration and/or intensity of hind foot tapping is then recorded continuously for approximately 5 minutes. ASSAY 3: Ferret Emesis 20 Individually housed male ferrets (1.0 -2.5 kg) are dosed orally by gavage with test compound. Ten minutes later they are fed with approximately 100g of tinned cat food. At 60 minutes following oral dosing, cisplatin (10mg/kg) is given i.v. via a jugular vein catheter inserted under a brief period of halothane anaesthesia. The catheter is 25 then removed, the jugular vein ligated and the skin incision closed. The ferrets recover rapidly from the anaesthetic and are mobile within 10-20 minutes. The animals are observed continuously during recovery from the anaesthetic and for 4 hours following the cisplatin injection, after which time the animals are killed humanely. The numbers of retches and vomits 30 occurring during the 4 hours after cisplatin administration are recorded by trained observers.
WO 99/59635 PCT/GB99/01632 - 50 ASSAY 4: Footpad FCA Guinea Pig Model Male Dunkin Hartly guinea pigs (180g-200g) are housed in groups in a twelve hour dark/light cycle and given vitamin C supplemented food 5 and water ad libitum. Inflammation is induced by injection of 100pl Freunds Complete Adjuvant (FCA) into the right hind footpad. The FCA is composed of 10mg/ml heat killed mycobacterium blended with sterile paraffin. For the purposes of the study 6 animals are included in each treatment group and are dosed with experimental compounds as provided 10 on a daily basis. Inflammation is assessed as follows: 1. The diameter of the hind footpads is measured with vernier calipers 15 at a consistent mid plantar site. 2. Measurement of thermal hyperalgesia is determined by the Hargreaves Method on unrestrained animals. The method determines the withdrawal latency to an infra-red source (Ugo 20 Basile). Hyperalgesia is assessed 4 hours after dosing. 3. Mechanical hyperalgesia is assessed using the Ugo Basile analgesy meter according to the Randall-Selitto test. Force is applied onto the foot pad at a designated site increasing at 4.8g per second. 25 Hyperalgesia is assessed 4 hours after dosing. A suitable selection cascade for NK 1 antagonists of use according to the present invention is as follows: (i) Determine affinity for human NKi receptor in radioligand 30 binding studies (Assay 1); select compounds with IC 50 1OnM, preferably
IC
5 0 5 2nM, especially IC 50 1nM.
WO 99/59635 PCT/GB99/01632 - 51 (ii) Determine ability of compounds to penetrate CNS by their ability to inhibit foot tapping in gerbils induced by central injection of an
NK
1 agonist (Assay 2); select compounds that inhibit foot tapping with
ID
50 3mg/kg i.v., and preferably ID 5 o 1mg/kg i.v. when administered 5 immediately prior to central NK 1 agonist challenge, or 1D 5 o 30mg/kg p.o., and preferably IDo 50 10mg/kg p.o. 1 hour prior to challenge. (iii) Determine central duration of action of compounds in gerbil foot tapping assay following intravenous administration 24 hours prior to central NK 1 agonist challenge; select compounds showing 25-fold loss of 10 potency compared with ID 5 o determined in step (ii) above with the proviso that IDo 50 10mg/kg i.v., and preferably 5mg/kg iv. after 24 hour pre-treatment. (iv) Determine oral bioavailability of compounds by pharmacokinetic analysis, activity in gerbil foot tapping assay following 15 oral administration and/or by ability to inhibit cisplatin-induced emesis in ferrets (Assay 3); select compounds with ID 9 o 3mg/kg p.o., and preferably
ID
9 o 5 1mg/kg p.o. Particularly preferred compounds of use in the present invention are identified using steps (i) to (iv) followed by step (v): 20 (v) Determine activity of compounds in assays for inhibition of pharmacologically evoked foot tapping in gerbils and/or inhibition of adjuvant arthritis in guinea-pigs (Assay 4). Select compounds with ID5o 20mg/kg, and preferably IDo 5 0 10mg/kg. Yet further preferred compounds of use in the present 25 invention may be selected from those compounds which satisfy the NK-1 receptor binding criteria of step (i) which, in addition, have 5-fold shift in affinity when incubated in the presence of human serum albumin (HSA) to show non-specific protein binding. One example of a NK-1 receptor antagonist of use in the present 30 invention is the compound 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)- WO 99/59635 PCT/GB99/01632 - 52 ethoxy)-3-(S)-(4-fluorophenyl)-4-(3-(5-oxo-1H,4H-1,2,4-triazolo)methyl) morpholine, the preparation of which is described in International Patent Specification No. WO 95/16679. In the aforementioned assays, this compound has the following activity: 5 human NK-1 receptor binding: IC 5 o=0.1nM gerbil foot-tapping (5 mins.): ID5o=0.36mg/kg i.v. gerbil foot-tapping (24 hrs.): ID5o=0.33mg/kg i.v. ferret emesis: IDeo<3mg/kg p.o. Another example of a NK-1 receptor antagonist of use in the present invention is the compound 2-(R)-(1-(R)-(3,5 bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(N,N-dimethylamino)methyl- 1,2,3 10 triazol-4-yl)methyl-3-(S)-phenylmorpholine, the preparation of which is described in International Patent Specification No. WO 95/18124. In the aforementioned assays, this compound has the following activity: human NK-1 receptor binding: IC 5 o=0.25nM gerbil foot-tapping (5 mins.): ID5o=0.12mg/kg i.v. gerbil foot-tapping (24 hrs.): ID5o=0.17mg/kg i.v. 15 Especially preferred COX-2 inhibitors of use in the present invention are identified using the following one or more of the following selection criteria: (i) Determine the affinity for human COX-2 in whole cell assay; 20 select compounds with ID 50 4OnM, and preferably ID 5 o 2OnM. (ii) Determine oral bioavailability of compounds by pharmacokinetic analysis or inhibition of carrageenan-induced paw oedema in rats following oral administration. Select compounds with EDo 5mg/kg p.o., and preferably EDWo2.5mg/kg p.o.
WO 99/59635 PCT/GB99/01632 - 53 (iii) Determine the ability of compounds to induce gastric ulceration or increase in faecal 51 Cr excretion. Select compounds that have no adverse gastrointestinal effects at >100mg/kg p.o., when administered up to two times a day. 5 (iv) Determine antinociceptive effects of compounds in carrageenan-induced hyperalgesia in rats; select compounds with ED5o 5mg/kg p.o., and preferably EDWo 2.5mg/kg p.o. (v) Determine the affinity for COX-2 in human whole blood assay which is used as an index for biochemical efficacy in the clinic and select 10 compounds with IC 5 o 1tM for inhibition of PGE 2 . The following examples illustrate pharmaceutical compositions according to the invention. These formulations may be prepared with separate active 15 ingredients or with a combination of active ingredients in one composition. In such combined preparations, the ratio of the COX-2 inhibitor and the NK-1 receptor antagonist will depend upon the choice of active ingredients. EXAMPLE 1 Amount (mg) per tablet NK-1 receptor antagonist 50.0 100.0 300.0 Microcrystalline cellulose 80.0 80.0 80.0 Modified food corn starch 80.0 80.0 80.0 Lactose 189.5 139.5 139.5 Magnesium Stearate 0.5 0.5 0.5 20 The active ingredient, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste. The resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate. The resulting granulation is WO 99/59635 PCT/GB99/01632 - 54 then compressed into tablets containing 50mg, 100mg and 300mg of the NK-1 receptor antagonist per tablet. EXAMPLE 2 Amount (mgz) per tablet NK-1 receptor antagonist 50.0 100.0 300.0 COX-2 inhibitor 20.0 20.0 20.0 Microcrystalline cellulose 80.0 80.0 80.0 Modified food corn starch 80.0 80.0 80.0 Lactose 169.5 119.5 119.5 Magnesium Stearate 0.5 0.5 0.5 5 The active ingredients, cellulose, lactose and a portion of the corn starch are mixed and granulated with 10% corn starch paste. The resulting granulation is sieved, dried and blended with the remainder of the corn starch and the magnesium stearate. The resulting granulation is 10 then compressed into tablets containing 20mg of the COX-2 inhibitor and 50mg, 100mg and 300mg of the NK-1 receptor antagonist per tablet. EXAMPLE 3 Wet granulated tablet composition Amount (mg) per tablet COX-2 Inhibitor 25 12.5 10 5 Microcrystalline cellulose 79.7 86 87.2 89.7 Lactose monohydrate 79.7 86 87.2 89.7 Hydroxypropyl cellulose 6 6 6 6 Croscarmellose sodium 8 8 8 8 Iron oxide 0.6 0.6 0.6 0.6 Magnesium stearate 1 1 1 1 15 WO 99/59635 PCT/GB99/01632 - 55 Tablet dose strengths of between 5 and 25 mg can be accomodated by varying total tablet weight, and the ratio of the first three ingredients. Generally it is preferable to maintain a 1:1 ratio for microcrystalline cellulose:lactose monohydrate. 5 EXAMPLE 4 Directly compressed tablet composition Amount (mg) per tablet COX-2 Inhibitor 25 12.5 10 5 Microcrystalline cellulose 106.9 113.2 42.5 45 Lactose anhydrate 106.9 113.2 42.5 45 Crosmellose sodium 7.5 7.5 4 4 Magnesium stearate 3.7 3.7 1 1 Tablet dose strengths of between 5 and 25 mg can be accomodated 10 by varying total tablet weight, and the ratio of the first three ingredients. Generally it is preferable to maintain a 1:1 ratio for microcrystalline cellulose:lactose monohydrate. EXAMPLE 5 15 Hard gelatin capsule composition Amount (mW) per capsule COX-2 Inhibitor 25 Microcrystalline cellulose 37 Lactose anhydrate 37 Magnesium stearate 1 Hard gelatin capsule 1 capsule Capsule dose strengths of between 1 and 50 mg can be accomodated by varying total fill weight, and the ratio of the first three ingredients.
WO 99/59635 PCT/G B99/01632 - 56 Generally it is preferable to maintain a 1:1 ratio for microcrystalline cellulose : lactose monohydrate. EXAMPLE 6 5 Oral solution Amount per 5 ml dose COX-2 Inhibitor 50 mg Polyethylene oxide 400 to 5 ml Solution dose strengths of between 1 and 50 mg/5ml can be accomodated by varying the ratio of the two ingredients. 10 EXAMPLE 7 Oral suspension Amount per 5 ml dose COX-2 Inhibitor 100 mg Polyvinylpyrrolidone 150 mg Polyoxyethylene sorbitan monolaurate 2.5 mg Benzoic acid 10 mg sorbitol solution (70%) to 5 ml Suspension dose strengths of between 1 and 50 mg/5ml can be accomodated by varying the ratio of the first two ingredients. 15 EXAMPLE 8 Intravenous infusion Amount per 200ml dose COX-2 inhibitor 1 mg Polyethylene oxide 400 0.2 mg Sodium chloride 1.8 mg Purified water to 200ml WO 99/59635 PCT/GB99/01632 - 57 While the invention has been described and illustrated with reference to certain particular embodiments thereof, those skilled in the art will appreciate that various changes, modifications and substitutions 5 can be made therein without departing from the spirit and scope of the invention. For example, effective dosages other than the particular dosages as set forth herein above may be applicable as a consequence of variations in the responsiveness of the mammal being treated for any of the indications for the active agents used in the instant invention as 10 indicated above. Likewise, the specific pharmacological responses observed may vary according to and depending upon the particular active compound selected or whether there are present pharmaceutical carriers, as well as the type of formulation and mode of administration employed, and such expected variations or differences in the results are contemplated 15 in accordance with the objects and practices of the present invention. It is intended, therefore, that the invention be defined by the scope of the claims which follow and that such claims be interpreted as broadly as is reasonable. 20

Claims (9)

1. Use of a COX-2 inhibitor and a NK-1 receptor antagonist for the manufacture of a medicament for the treatment or prevention of 5 inflammatory disorders.
2. A pharmaceutical composition for the treatment or prevention of inflammatory disorders comprising a COX-2 inhibitor and a NK-1 receptor antagonist, together with at least one pharmaceutically 10 acceptable carrier or excipient.
3. A product comprising a COX-2 inhibitor and a NK-1 receptor antagonist as a combined preparation for simultaneous, separate or sequential use in the treatment or prevention of inflammatory disorders. 15
4. A method for the treatment or prevention of inflammatory disorders, which method comprises administration to a patient in need of such treatment of an amount of a COX-2 inhibitor and an amount of a NK-1 receptor antagonist, such that together they give effective relief. 20
5. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the COX-2 inhibitor is selected from the classes of compounds described in U.S. Patent No.'s 5,344,991, 5,380,738, 5,393,790, 5,409,944, 5,434,178, 25 5,436,265, 5,466,823, 5,474,995, 5,510,368, 5,536,752, 5,550,142, 5,552,422, 5,604,253, 5,604,260, and 5,639,780; and International Patent Publication Nos. WO 94/13635, WO 94/15932, WO 94/20480, WO 94/26731, WO 94/27980, WO 95/00501, WO 95/15316, WO 96/03387, WO 96/03388, WO 96/06840, WO 96/21667, WO 96/31509, WO 96/36623, 30 WO 97/14691, and WO 97/16435. WO 99/59635 PCT/GB99/01632 - 59 6. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the COX-2 inhibitor is selected from: NHSO 2 CH 3 NHSO 2 CH 3 NHSO 2 CH 3 F F NO 2 NO 2 0 NS-398 Nimesulide L-745,337, X = S 5 Flosulide, X = 0 CH 3 SO 2 NH 2 SO 2 CH 3 SO 2 0 F F F 1 2 SC-57666 CH 3 SO 2 CH 3 SO 2 F Br\FCF 3 -S DuP 697 SC-58125 NH 2 SO 2 CH 3 SO 2 CF 3 O H 3 C SC-58635 3 WO 99/59635 PCT/GB99/O 1632 - 60 CH 3 S0 2 CH 3 S0 2 HAC OH 3 0 F F 0 0 4 5 CH 3 S0 2 CH 3 S 2 ~ - N 0 NJ N N Fo 7N 6 CH 3 SO 2 0NH 2 SO 2 N -N\ - F I- 8 CH 3 0O NH 2 SO 2 CH 3 0 10 CH 3 O ~C0 2 H H N -" Br-, - - cI CH 3 \/ L-761,066 0 i WO 99/59635 PCT/GB99/01632 - 61 0 SS O C0 12 13 os7 O O F o0 0 0 14 F 15 O 0 F 0 0 F N 16 17 S S S. 10 18 u 19 WO 99/59635 PCT/GB99/01632 - 62 O -ss 0 21 ' 0 o O O 0 20 21 QI O O 0 OH OH 22 23 S / C ~ ~ 0 F 0 NN OH 24 25 0\\ NH 2 S \\0 0 Na 26 5
7. A use, composition, product or method according to claim 6 wherein the COX-2 inhibitor is selected from: WO 99/59635 PCTIGB99O 1632 - 63 3: 3-phenyl-4-(4-(methylsulfonyl)phenyl)-2-(5H)-furanone; 4: 3-(3 ,4-difluorophenyl)-4-(4-(methylsulfonyl)phenyl)-2-( 51)-furanone; 5: 5 ,5 -dim ethyl -4 -(4- (mnethyl sulfo nyl)phenyl) -3 -(3 -fl uoro phenyl )- 5H-furan 2-one; 5 12: 5,5 -dimethyl -4-4-(mnethyl sulfonyl)phenyl)-3 -(2 -propoxy)- 5H-furan-2 one; 13: 5 -chloro-3 -(4-(m ethyl sulfonyl) phenyl)-2 -(2 -methyl -5 pyri dinyl)pyri dine; 14: 2-(3 ,5-difluorophenyl)-3-(4-(methylsulfonyl)phenyl)-2-cyclopenten- 1 10 one; 15: 5(S)-5-ethyl-5-methyl-4-.(4-(methylsulfonyl)phenyl)-3-(2-propoxy)-5H furan-2-one; 16: 5-ethyl-5-methyl-4-(4-(methylsulfonyl)phenyl )-3-(3 .4-difluorophenyl ) 5H-furan-2-one; 15 17: 3 -((2 -thi azolyl)m ethoxy)-4 -(4 -(methyl sulfonyl)phenyl) -5,5 -dim ethyl 511-furan-2-one; 18: 3 -propyloxy-4-(4-(methylsulfonyl )phenyl)-5 ,5-dimethyl-5H-furan-2 one; 19: 3-( 1-cyclopropylethoxy)-5 ,5-dimethyl-4-(4-methylsulfonyl)phenyl)-5H 20 furan-2-one; 20: sodium 2-(4-chlorophenyl)-3-(4-(methylsulfonyl)phenyl)-4-oxo-2 pentenoate; 21: 3-(cyclopropylmethoxy)-5 ,5 -dimethyl-4-(4-(methylsulfonyl)phenyl)-5H furan-2-one; 25 22: 3 -(cyclopropylm ethoxy)- 5,5 -dim ethyl -4-(4-(m ethylsulfonyl) phenyl)-2,5 dihydrofuran-2-ol; 23: 3 -isoprop oxy-5 ,5 -dim ethyl -4 -(4-(m ethyl sulfonyl)phenyl)- 2,5 dihydrofuran-2-ol; 24: 5, 5-dimethyl-3-(3-fluorophenyl)-2-hydroxy-4-(4 30 (methylsulfonyl)phenyl)-2 ,5-dihydrofuran; 25: 5-chloro-3-(4-(methylsulfonyl)phenyl)-2-(3-pyridinyl)pyridine;, WO 99/59635 PCT/GB99/01632 - 64 26: 4-(5-methyl-3-phenyl-4-isoxazolyl)benzenesulfonamide; or a pharmaceutically acceptable salt thereof.
8. A use according to claim 1, a composition according to claim 5 2, a product according to claim 3 or a method according to claim 4 wherein the COX-2 inhibitor is selected from: 5-(4-fluorophenyl)-1-[4-(methylsulfonyl)phenyl]-3 (trifluoromethyl)pyrazole; 4-(4-fluorophenyl)-5-[4-(methylsulfonyl)phenyl]-1-phenyl-3 10 (trifluoromethyl)pyrazole; 4-(5-(4-chlorophenyl)-3-(4-methoxyphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(3,5-bis(4-methylphenyl)-iH-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-phenyl-1H-pyrazol-1-yl)benzenesulfonamide; 15 4-(3,5-bis(4-methoxyphenyl)-1H-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(4-methylphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(4-nitrophenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 20 4-(5-(4-chlorophenyl)-3-(5-chloro-2-thienyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(4-chloro-3,5-diphenyl-1H-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(trifluoromethyl)- 1H-pyrazol-1 yl)benzenesulfonamide; 25 4-(5-phenyl)-3-(trifluoromethyl)-1H-pyrazol-1-yl)benzenesulfonamide; 4-(5-(4-fluorophenyl)-3-(trifluoromethyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(5-(4-methoxyphenyl)-3-(trifluoromethyl)- 1H-pyrazol- 1 yl)benzenesulfonamide; 30 4-(5-(4-chlorophenyl)-3-(difluoromethyl)-1 H-pyrazol- 1 yl)benzenesulfonamide; WO 99/59635 PCT/GB99/01632 -65 4-(5-(4-methylphenyl)-3-(trifluoromethyl)-1H-pyrazol- 1 yl)benzenesulfonamide; 4-(4-chloro-5-(4-chlorophenyl)-3-(trifluoromethyl)- 1H-pyrazol- 1 yl)benzenesulfonamide; 5 4-(3-(difluoromethyl)-5-(4-methylphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(3-(difluoromethyl)-5-phenyl-1H-pyrazol-1-yl)benzenesulfonamide; 4-(3-(difluoromethyl)-5-(4-methoxyphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 10 4-(3-cyano-5-(4-fluorophenyl)-1H-pyrazol-1-yl)benzenesulfonamide; 4-(3-(difluoromethyl)-5-(3-fluoro-4-methoxyphenyl)-1H-pyrazol-1 yl)benzenesulfonamide; 4-(5-(3-fluoro-4-methoxyphenyl)-3-(trifluoromethyl)- 1H-pyrazol- 1 yl)benzenesulfonamide; 15 4-(4-chloro-5-phenyl- 1H-pyrazol- 1-yl)benzenesulfonamide; 4-(5-(4-chlorophenyl)-3-(hydroxyphenyl)- 1H-pyrazol- 1 yl)benzenesulfonamide; 4-(5-(4-(N,N-dimethylamino)phenyl)-3-(trifluoromethyl)-1H-pyrazol-1 yl)benzenesulfonamide; 20 5-(4-fluorophenyl)-6-(4-(methylsulfonyl)phenyl)spiro[2.4]hept-5-ene; 4-(6-(4-fluorophenyl)spiro [2.4] hept-5-en-5-yl)benzenesulfonamide; 6-(4-fluorophenyl)-7-(4-(methylsulfonyl)phenyl)spiro [3.4] oct-6-ene; 5-(3-chloro-4-methoxyphenyl)-6-(4-(methylsulfonyl)phenyl)spiro [2.4] hept 5-ene; 25 4-(6-(3-chloro-4-methoxyphenyl)spiro[2.4]hept-5-en-5 yl)benzenesulfonamide; 5-(3,5-dichloro-4-methoxyphenyl)-6-(4 (methylsulfonyl)phenyl)spiro [2.4] hept-5-ene; 5-(3-chloro-4-fluorophenyl)-6-(4-(methylsulfonyl)phenyl)spiro [2.4] hept-5 30 ene; 4-(6-(3,4-dichlorophenyl)spiro [2.4] hept-5-en-5-yl)benzenesulfonamide; WO 99/59635 PCT/GB99/O 1632 - 66 2-(3-chloro-4-fluorophenyl)-4-(4-fluorophenyl)-5-(4 mnethyl sulfonylphenyl)thi azole; 2-( 2-chlorophenyl)-4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)thiazole; 5-(4-fluorophenyl)-4-(4-methylsulfonylphenyl)-2.-methylthiazole; 5 4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)-2-trifluoromethylthiazole; 4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)-2-(2-thienyl)thiazole; 4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)-2-benzylaminothiazole; 4-(4-fluorophenyl)-5-(4-methylsulfonylphenyl)-2-( 1-propylamino)thiazole; 2-((3 ,5-dichlorophenoxy)methyl)-4-(4-fluorophenyl)-5-(4 10 (methylsulfonyl)phenyl)thiazole; 5 -(441luorophenyl)-4 -(4-m ethyl sul fonylphenyl)-2 -trifluorom ethylthi azol e; 1-methylsulfonyl-4-( 1, 1-dimethyl-4-(4-fluorophenyl)cyclopenta-2 ,4-dien-3 yl)benzene; 4-(4-(4-fluorophenyl )- 1, 1-dimethylcyclopenta-2,4-dien-3 15 yl)benzenesulfonamide; 5-(4-fluorophenyl)-6-(4-(methylsulfonyl)phenyl)spiro [2.4] hepta-4,6-diene; 4-(6-(4-fluorophenyl )spiro [2.4] hepta-4,6-dien-5-yl)benzenesulfonamide;,
64-fl uorophenyl)-2 -mnethoxy- 5-(4 -(methyls ulfonyl) phenyl)- pyri din e-3 carbonitrile; 20 2-brom o-6 -(4-fl uorophenyl) -5 -(4 -(m ethyl sulfonyl)phenyl)-pyri dine-3 carbonitrile; 6-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)-2-phenyl-pyridine-3 carbonitrile; 4-(2-(4-methylpyridin-2-yl)-4-(trifluoromethyl)- 1H-imidazol- 1 25 yl)benzenesulfonamide; 4-(2-(5-methylpyridin-3-yl)-4-(trifluoromethyl)-1H-imidazol- 1 yl)benzenesulfonamide; 4-(2-(2-methylpyridin-3-yl)-4--(trifluoromethyl)- 1H-imidazol- 1 yl)benzenesulfonamide; 30 3 -( 1-(4-(methyl sulfonyl)phenyl)-4-(trifl uorom ethyl)- 1 H-imidazol-2 yl)benzenesulfonamide;, WO 99/59635 PCT/G B99/O 1632 - 67 2-( 1-(4- (m ethyls ulfo nyl) phenyl)-4- (trifluorom ethyl) - 1H-imidazol-2 yl)pyridine;, 2 -m ethyl-4- (1-(4 -(methyl sulfonyl) phenyl) -4 -(tri fl uorom ethyl)- 1 H-1imidazol 2-yl)pyridine; 5 2-methyl-6-( 1-(4-(methylsulfonyl)phenyl)-4-(trifluoromethyl)- 1H-imidazol 2-yl)pyridine; 4-(2-(6-methylpyridin-3-yl)-4-(trifluoromethyl)- 1H-imidazol-1 yl)benzenesulfonamide; 2-(3 ,4-difluorophenyl)- 1-(4-(methylsulfonyl)phenyl)-4-(trifluoromethyl)-l11 10 imidazole; 4-(2-(4-methylphenyl)-4-(trifluoromethyl)- 1H-.imidazol- 1 yl)benzenesulfonarnide; 2-(4.-chlorophenyl)- 1-(4-(methylsulfonyl )phenyl)-4-methyl- 1H-imidazole; 2-(4-chlorophenyl )- 1-(4 -(m ethyl sulfo nyl)phenyl)-4-phenyl - 1H-imidazole; 15 2-(4-chlorophenyl)-4--(4-fluorophenyl )- 1-(4-(methylsulfonyl )phenyl )- 111 imidazole; 2-(3-fluoro-4-methoxyphenyl)- 1-(4-(methylsulfonyl)phenyl )-4 (triflu orom ethyl) - Il-imidazole; 1-(4-(m ethyls ulfonyl) phenyl)- 2- phenyl -4 -trifl uorom ethyl - 1 H-imida zol e; 20 2 -(4-m ethyl phenyl)- 1-4-(methylsulfonyl) phenyl)-4-tri fluorom ethyl - I1H imidazole; 4-(2-(3 -chloro-4-methylphenyl)-4-(trifluoromethyl)- 1H-imidazol- 1 yl)benzenesulfonamide; 2-(3-fluoro-5-methylphenyl)-1-(4-.(methylsulfonyl)phenyl)-4 25 (trifluoromethyl)-1H-imidazole; 4-(2-(3-fluoro-5-methylphenyl)-4-(trifluoromethyl)-1H-imidazol- 1 yl)benzenesulfonamide; 2-(3-methylphenyl)- 1-(4-(m ethyl sulfonyl)phenyl)-4 -(trifluoromethyl) - 1H imidazole;, 30 4-(2-(3-methylphenyl)-4-(trifluoromethyl)- 1H-imidazol- 1 yl)benzenesulfonamide; WO 99/59635 PCT/GB99/O1 632 - 68 1- (4 -(mnethyls ulfonyl) phenyl)-2-(3 -chlorophenyl)-4-(trifl uorom ethyl)-I 1H imidazole;, 4 -(2-43 -chloro phenyl)-4-(trifl uorom ethyl)- IH -imi dazol-I 1 yl)benzenesulfonamide; 5 4 -(2 -phenyl -4-(tri fluorom ethyl)- 1H-imidazol- 1-yl)benzenesulfonamide; 4-(2-(4-methoxy-3-chlorophenyl)-4-(trifluoromethyl)-1H-imidazol-1 yl)benzenesulfonamide; 1 -allyl-4-(4-fluorophenyl)-3 -(4-(m ethyls ulfonyl)phenyl)-5 -(trifluorom ethyl) lIl-pyrazole; 10 4-( 1-ethyl-4-(4-fluorophenyl)-5-(trifluoromethyl)- 1H-pyrazol-3 yl)benzenesulfonamide; N-phenyl-(4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl )-5 (trifiuoromethyl)- 1H-pyrazol- 1 -yl)acetamide;, ethyl (4-(4-fl uorophenyl )- 3-(4 -(methyl sulfonyl)phenyl) -5-(tri fl uorom ethyl) 15 1U-pyrazol-1--yl)acetate;, 4-(4-fluorophenyl)-3-(4-(methylsulfonyl)phenyl)-1-(2-phenylethyl)-1ll pyrazole; 4-4-fl uorophe nyl)-3 -(4- (mnethyls ulfo nyl) phenyl) - 1- (2 -phenyl ethyl )-5 (triflu orom ethyl) pyraz ole; 20 1 -ethyl -4-(4-fl uorophenyl)- 3- (4-(m ethylsulfonyl) phenyl )- 5-(tri fluorom ethyl) iR-pyrazole; 5-(4-fluorophenyl)-4-(4-(methylsulfonyl)phenyl)-2-(trifluoromethyl)-1H imidazole; 4-(4-(methylsulfonyl)phenyl)-5 -(2-thiophenyl)-2 -(trifluorom ethyl) - 1H 25 imidazole; 5-(4-fluorophenyl)-2-methoxy-4-(4-(methylsulfonyl)phenyl)-6 (tri fl uoromethyl)pyri dine; 2-ethoxy-5-(4-fluorophenyl)-4-(4-(methylsulfonyl)phenyl)-6 (trifl uorom ethyl) pyri dine; 30 5 -(4-fl uorophenyl)-4-(4-(methyl sul fonyl) phenyl)- 2-(2 -pro pynyl oxy)-6 (tri flu orom ethyl)pyri dine; WO 99/59635 PCT/GB99/OI 632 - 69 2-bromo-5-(4-fluorophenyl)--4-(4-(methylsulfonyl)phenyl)-6 (trifl uorom ethyl)pyri dine; 4-(2-(3-chloro-4-methoxyphenyl)-4,5-difluorophenyl)benzenesulfonamide; 1-(4-fluorophenyl)--2-(4-(methylsulfonyl)phenyl)benzene; 5 5-difluoromethyl-4-(4-(methylsulforiyl)phenyl)-3-phenylsoxazole; 4-(3-ethyl-5-phenylisoxazol-4-yl)benzenesulfonamide;
445-di fluorom ethyl -3-phenylis oxazol-4-yl)benzenesulfonamide; 4-(5 -hydroxym ethyl -3 -phenylisoxazol -4 -yl)benzenesulfonamide; 4-(5 -mnethyl- 3-phenylisoxazol-4-yl)benzenes ulfonami de; 10 1-(2-(4-fluorophenyl)cyclopenten- 1-yl)-4-(methylsulfonyl)benzene; 1-(2-(4-fluoro-2-methylphenyl)cyclopenten- l-yl )-4-(methylsulfonyl)benzene; 1- (2 -(4-chl oro phenyl) cycl openten-I byl )-4- methyll sulfo nyl)b enzene; 1-(2-(2 ,4-dichlorophenyl)cyclopenten- I1-yl)-4-(methylsulfonyl)benzene; 1-(2-(4-trifluoromethylphenyl)cyclopenten- l-yl )-4-(methylsulfonyl)benzene; 15 1-(2 -(4 -methyl thi ophenyl)cycl op enten- l -yl )-4-(methylsulfonyl )benzene; 14(2-(4 41luorophe nyl )-4 ,4-dim ethyl cycl opente n- Il-yl)-4 (methylsulfonyl)benzene; 4 -(2 -(441luorophenyl)-4,4 -dim ethyl cycl op ente n- 1 -yl)b e nzenes ulfonarn1ide; 1-(2-(4-chlorophenyl )-4,4-dimethylcyclopenten- Il-yl)-4 20 (mnethyl sulfonyl)benz ene; 4-(2-(4-chlorophenyl)-4,4-dimethylcyclopenten- 1-.yl)benzenesulfonamide; 4-( 2-(4-fluorophenyl)cyclopenten- 1-yl)benzenesulfonamide; 4-(2-(4-chlorophenyl)cyclopenten- 1-yl)benzenesulfonamide; 1-(2-(4-methoxyphenyl)cyclopenten-1-yl)-4-(methylsulfonyl)benzene; 25 1-(2-(2 ,3-difluorophenyl)cyclopenten- 1-yl)-4-(methylsulfonyl)benzene; 4-(2-(3-fluoro-4-methoxyphenyl)cyclopenten- 1-yl)benzenesulfonamide; 1-(2-(3-chloro-4-methoxyphenyl)cyclopenten- Il-yl)-4 (methylsulfonyl)benzene; 4-(2-(3-chloro-4-fluorophenyl)cyclopenten- 1-yl)benzenesulfonamide;, 30 4-(2-(2-methylpyridin-5-yl)cyclopenten- 1-yl)benzenesulfonamide; WO 99/59635 PCT/GB99/01632 - 70 ethyl 2-(4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazol-2-yl)-2 benzyl-acetate; 2-(4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazol-2-yl)acetic acid; 2-(tert-butyl)-4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)oxazole; 5 4-(4-fluorophenyl)-5-(4-(methylsulfonyl)phenyl)-2-phenyloxazole; 4-(4-fluorophenyl)-2-methyl-5-(4-(methylsulfonyl)phenyl)oxazole; and 4-(5-(3-fluoro-4-methoxyphenyl)-2-trifluoromethyl-4 oxazolyl)benzenesulfonamide; or a pharmaceutically acceptable salt thereof. 10 9. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula I: 3 4 RX R R 2 N R5 R 15 wherein: R 1 is selected from the group consisting of: (1) C1.6alkyl, substituted with one or more of the substituents selected from: (a) heterocycle, wherein the heterocycle is selected from 20 the group consisting of: (A) benzimidazolyl, (B) imidazolyl, (C) isoxazolyl, (D) isothiazolyl, 25 (E) oxadiazolyl, (F) pyrazinyl, (G) pyrazolyl, (H) pyridyl, WO 99/59635 PCT/GB99/01632 -71 (I) pyrrolyl, (J) tetrazolyl, (K) thiadiazolyl, (L) triazolyl, and 5 (M) piperidinyl, and wherein the heterocycle is unsubstituted or substituted with one or more substituent(s) selected from: (i) C1_6alkyl, unsubstituted or substituted with halo, -CF 3 , -OCH 3 , or phenyl, 10 (ii) C1-6alkoxy, (iii) oxo, (iv) thioxo, (v) cyano, (vi) -SCH 3 , 15 (vii) phenyl, (viii) hydroxy, (ix) trifluoromethyl, (x) -(CH2)m-NR 9 Rio, wherein m is 0, 1 or 2, and R 9 and R 10 are independently selected from: 20 (I) hydrogen, (II) C1.6alkyl, (III) hydroxyC1.6alkyl, and (IV) phenyl, (xi) -NR 9 COR 10 , wherein R 9 and R 10 are as defined above, 25 and (xii) -CONR 9 R' 0 , wherein R 9 and RIO are as defined above, R 2 and R 3 are independently selected from the group consisting of: (1) hydrogen; (2) C1.6alkyl 30 (3) C 2 _6alkenyl, and (5) phenyl; WO 99/59635 PCT/G B99/01632 -72 X is -O-; R 4 is R 6 R 7 Y8 z R R 5 is phenyl, unsubstituted or substituted with halo; 5 R 6 , R 7 and R 8 are independently selected from the group consisting of: (1) hydrogen, (2) C1.6alkyl, (3) halo, and (4) -CF3; 10 Y is -0-; and Z is hydrogen or C1_4alkyl; or a pharmaceutically acceptable salt thereof. 10. A use according to claim 1, a composition according to claim 15 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula II: A YI A2 6 -X 3 R A (II) wherein: 20 Al is fluorine or CF 3 ; A 2 is fluorine or CF 3 ; WO 99/59635 PCT/GB99/01632 - 73 A 3 is fluorine or hydrogen; R 6 is a 5-membered or 6-membered heterocyclic ring containing 2 or 3 nitrogen atoms optionally substituted by =0, =S or a Ci4alkyl group, and optionally substituted by a group of the formula ZNR 7 R8 where 5 Z is C1_6alkylene or C3_6cycloalkylene; R 7 is hydrogen, Ci- 4 alkyl, C3-7cycloalkyl or C3_7cycloalkylCi4alkyl, or C24alkyl substituted by CiAalkoxy or hydroxyl; R 8 is hydrogen, Ci 4 alkyl, C3-7cycloalkyl or C3_7cycloalkylCl4alkyl, or C24alkyl substituted by one or two substituents selected from Ci4alkoxy, 10 hydroxyl or a 4, 5 or 6 membered heteroaliphatic ring containing one or two heteroatoms selected from N, 0 and S; or R 7 , R 8 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms, optionally substituted by a hydroxy group, and optionally containing a double bond, which ring may 15 optionally contain an oxygen or sulphur ring atom, a group S(O) or S(O)2 or a second nitrogen atom which will be part of a NH or NR moiety where Re is Ci4alkyl optionally substituted by hydroxy or Ci4alkoxy; or R 7 , R 8 and the nitrogen atom to which they are attached form a non-aromatic azabicyclic ring system of 6 to 12 ring atoms; 20 or Z, R 7 and the nitrogen atom to which they are attached form a heteroaliphatic ring of 4 to 7 ring atoms which may optionally contain an oxygen ring atom; X is an alkylene chain of 1 to 4 carbon atoms optionally substituted by oxo; and 25 Y is a Ci 4 alkyl group optionally substituted by a hydroxyl group; with the proviso that if Y is Ci4alkyl, R 6 is susbstituted at least by a group of formula ZNR 7 R 8 as defined above; or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/GB99/01632 - 74 11. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula III: R 6 R3 X R 2 z R 8I R 2N -11R (0) 1 (P A 5 B R13 R wherein: R 2 and R 3 are independently selected from the group consisting of: (1) hydrogen, 10 (2) C1-alkyl, (3) Cz-6alkenyl, and (4) phenyl; R 6 , R 7 and R 8 are independently selected from the group consisting of: (1) hydrogen, 15 (2) C1.6alkyl, (3) fluoro, (4) chloro, (5) bromo, (6) iodo, and 20 (7) -CF 3 ; R11, R1 2 and R 13 are independently selected from the group consisting of: (1) fluoro, (2) chloro, (3) bromo, and 25 (4) iodo; A is unsubstituted 1-6alkyl; WO 99/59635 PCT/GB99/01632 - 75 B is selected from the group consisting of: N- X X\ x\ N-N H H N-N N-N N-N N 0 O O S N N 0 N X H H X H X N-NH /N-N N-N N-N' N S, / 07 X / SN N X H X N-N N N-N' N N N N N x x X H X N / N N 0 N 0 N H X H H N H H N N N ___ / / IN 0 xN S x p is 0 or 1; 5 X is selected from: (a) -PO(OH)0 * M+, wherein M+ is a pharmaceutically acceptable monovalent counterion, (b) -PO(0-) 2 - 2M+, (c) -PO(0-) 2 * D 2 +, wherein D 2 + is a pharmaceutically acceptable 10 divalent counterion, (d) -CH(R 4 )-PO(OH)0- * M+, wherein R 4 is hydrogen or CI-3alkyl, (e) -CH(R4)-P0(0-) 2 - 2M+, (f CHR)POO) XD, WO 99/59635 PCT/GB99/01632 - 76 (i) -CO-CH 2 CH 2 -CO2- * M+, (j) -CH(CH 3 )-O-CO-R 5 , wherein R 5 is selected from the group consisting of: (i) O, NH 3 * M H 2 *M (ii) N OH (iii) 0 CO 2 M CO 2 M + (iv) C 9 O CO, M+ 0 0 (v) O C NH 3 CO M+ (vi) 0 CO 2 M CO 2 M* CO 2 M (vii) ; and 5 Y is -O-; and Z is hydrogen or C1.6alkyl; or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/GB99/01632 - 77 12. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula IV: 5 \ / (IV) N R 3 H | R4 wherein R 1 represents hydrogen, hydroxy, C1. 6 alkyl, C2.6alkenyl, 10 C3.7cycloalkyl, C3-7cycloalkylCi- 4 alkyl, C1.6alkoxy, fluoroCl.6alkoxy, C1-6alkoxyCl_4alkyl, C-6alkoxyC1.4alkoxy, fluoroC1_6alkoxyC1_ 4 alkyl, C2.6alkenyloxy, C3-7cycloalkoxy, C 3 . 7 cycloalkylC1.4alkoxy, phenoxy, benzyloxy, cyano, halogen, NRaRb, SRa, SORa, SO 2 Ra, OSO 2 Ra, NRaCOR1 4 , CORa, CO 2 Ra or CONRaRb where Ra and Rb each independently represent 15 hydrogen, C1_4alkyl or fluoroC1.4alkyl; R 2 represents hydrogen, halogen, C1.6alkyl or C1-6alkoxy; or R 1 and R 2 may be joined together such that there is formed a 5- or 6-membered saturated or unsaturated ring containing one or two atoms selected from nitrogen, oxygen and sulphur, which ring is optionally 20 substituted by a group selected from C14alkyl, CF 3 , =O or =S; R 3 represents hydrogen, halogen, C1_6alkyl, fluoroC1-6alkyl, C1-6alkoxy, fluoroC1.alkoxy, C3-7cycloalkyl, C3-7cycloalkylC1.4alkyl, cyano, SRa, SORa, SO 2 Ra, NRaRb, NRaCOR1 4 , CORa, CO 2 Ra, CONRaRb or C1. 4 alkyl substituted by cyano, CO 2 Ra or CONRaRb where Ra and Rb are as 25 previously defined; R 4 represents hydrogen, halogen, C1.ealkyl, C1_ 6 alkoxy, CF 3 , OCF 3 , NO 2 , CN, SRa, SORa, SO 2 Ra, CO 2 Ra, CONRaRb, C2.6alkenyl, C2_6alkynyl or WO 99/59635 PCT/GB99/01632 - 78 CI 4 alkyl substituted by C14alkoxy, where Ra and Rb are as previously defined; and the broken line represents an optional double bond; or a pharmaceutically acceptable salt thereof. 5 13. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula V: RT 10I P N ' R R 10R or a pharmaceutically acceptable salt thereof, wherein Y is (CH 2 ) wherein n is an integer from 1 to 4, and wherein any one of the carbon-carbon single bonds in said (CH 2 )n may optionally be replaced by a carbon-carbon double bond, and wherein any one of the 15 carbon atoms of said (CH 2 )n may optionally be substituted with R 4 , and wherein any one of the carbon atoms of said (CH 2 )n may optionally be substituted with R 7 ; Z is (CH2)m wherein m is an integer from 0 to 6, and wherein any one of the carbon-carbon single bonds of (CH2)m may optionally be replaced 20 by a carbon-carbon double bond or a carbon-carbon triple bond, and any one of the carbon atoms of said (CH 2 )m may optionally be substituted with R8; R 1 is hydrogen or Cisalkyl optionally substituted with hydroxy, C14alkoxy or fluoro; 25 R 2 is a radical selected from hydrogen, C 1 . 6 straight or branched alkyl, C 3 -7cycloalkyl wherein one of the CH2 groups in said cycloalkyl may WO 99/59635 PCT/GB99/01632 - 79 optionally be replaced by NH, oxygen or sulphur; aryl selected from phenyl and naphthyl; heteroaryl selected from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; phenyl-C2.6alkyl, benzhydryl and benzyl, wherein each of said 5 aryl and heteroaryl groups and the phenyl moieties of said benzyl, phenyl C 2 - 6 alkyl and benzhydryl may optionally be substituted with one or more substituents independently selected from halo, nitro, C1.6 alkyl, C1 6 alkoxy, trifluoromethyl, amino, C-6alkylamino, C-6alkyl-O-CO, C1. 6 alkyl-O-CO C1.6alkyl, C1_6alkyl-CO-0, C1. 6 alkyl-CO-C1-6alkyl-O-, CI 6 alkyl-CO, 10 C1. 6 alkyl-CO-Cl-6alkyl-, di-C1-6alkylamino, -CONH-C1-6alkyl, C1- 6 alkyl-CO-NH-C1.6alkyl, -NHCOH and -NHCO-C1.6alkyl; and wherein one of the phenyl moieties of said benzhydryl may optionally be replaced by naphthyl, thienyl, furyl or pyridyl; R 5 is hydrogen, phenyl or C1_6alkyl; 15 or R 2 and R 5 together with the carbon to which they are attached, form a saturated ring having from 3 to 7 carbon atoms wherein one of the CH 2 groups in said ring may optionally be replaced by oxygen, NH or sulfur; R 3 is aryl selected from phenyl and naphthyl; heteroaryl selected 20 from indanyl, thienyl, furyl, pyridyl, thiazolyl, isothiazolyl, oxazolyl, isoxazolyl, triazolyl, tetrazolyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms wherein one of the (CH 2 ) groups in said cycloalkyl may optionally be replaced by NH, oxygen or sulphur; wherein each of said aryl and heteroaryl groups may optionally be 25 substituted with one or more substituents, and said C 3 - 7 cycloalkyl may optionally be substituted with one or two substituents, each of said substituents being independently selected from halo, nitro, C1-6alkyl, C1-6alkoxy, trifluoromethyl, amino, C1_6alkylamino, -CO-NH- C1.6alkyl, C1- 6 alkyl-CO-NH-C1-6alkyl, -NHCOH and -NHCO-C-6alkyl; 30 R 4 and R 7 are each independently selected from hydroxy, halogen, halo, amino, oxo, cyano, methylene, hydroxymethyl, halomethyl, WO 99/59635 PCT/GB99/01632 - 80 C1-6alkylamino, di-C1-6alkylamino, C1_6alkoxy, C-6alkyl-O-CO, Cl-6alkyl-O-CO-C1-6alkyl, C1_ 6 alkyl-CO-0, C1. 6 alkyl-CO-C1_6alkyl-O-, CI 6 alkyl-CO-, C1_ 6 alkyl-CO-C1. 6 alkyl, and the radicals set forth in the definition of R 2 ; 5 R 6 is -NHCOR 9 , -NHCH 2 R 9 , S0 2 R 8 or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ; R 8 is oximino (=NOH) or one of the radicals set forth in any of the definitions of R 2 , R 4 and R 7 ; R 9 is C1_ 6 alkyl, hydrogen, phenyl or phenylCl6alkyl; 10 with the proviso that (a) when m is 0, R 8 is absent, (b) when R4, R 6 , R 7 or R 8 is as defined in R 2 , it cannot form together with the carbon to which it is attached ,a ring with R 5 , and (c) when R 4 and R 7 are attached to the same carbon atom, then either each of R 4 and R 7 is independently selected from hydrogen, fluoro and C1.6alkyl, or R 4 and R 7 , together with the carbon 15 to which they are attached, for a C 3 - 6 saturated carbocyclic ring that forms a spiro compound with the nitrogen-containing ring to which they are attached; or a pharmaceutically acceptable salt thereof. 20 13. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula VI: R R 0 N CH-R 1 (VI) R R3 R4 25 wherein: radicals R are phenyl radicals optionally 2- or 3-substituted by a halogen atom or a methyl radical; WO 99/59635 PCT/G B99/01632 - 81 R 1 is optionally substituted phenyl, cyclohexadienyl, naphthyl, indenyl or optionally substituted heterocycle; R 2 is H, halogen, OH, alkyl, aminoalkyl, alkylaminoalkyl, dialkylaminoalkyl, alkyloxy, alkylthio, acyloxy, carboxy, optionally 5 substituted alkyloxycarbonyl, benzyloxycarbonyl, amino or acylamino; R 3 is optionally 2-substituted phenyl; R 4 is OH or fluorine when R 5 is H; or R 4 and R 5 are OH ; or R4 and R 5 together form a bond; 10 or a pharmaceutically acceptable salt thereof. 14. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula VII: 15 R Q Ar-T-CO-N-CH 2 -C-CH 2 -CH 2 -Am +, A (VII) Ar' wherein: Ar represents an optionally substituted mono-, di- or tricyclic 20 aromatic or heteroaromatic group; T represents a bond, a hydroxymethylene group, a C1.4alkoxymethylene group or a C1.5alkylene group; Ar' represents a phenyl group which is unsubstituted or substituted by one or more substituents selected from halogen, preferably chlorine or 25 fluorine, trifluoromethyl, C1_4alkoxy, C1.4alkyl where the said substituents may be the same or different; a thienyl group; a benzothienyl group; a naphthyl group; or an indolyl group; R represents hydrogen, C1_4alkyl, o-Cl 4 alkoxyC1.4alkyl, or o-C2_ 4 alkanoyloxyC2.4alkyl; WO 99/59635 PCT/GB99/01632 - 82 Q represents hydrogen; or Q and R together form a 1,2-ethylene, 1,3-propylene or 1,4 butylene group; Am+ represents the radical 5 in which X 1 , X 2 and X 3 , together with the nitrogen atom to which they are attached, form an azabicyclic or azatricyclic ring system optionally substituted by a phenyl or benzyl group; and A- represents a pharmaceutically acceptable anion. 10 15. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula VIII R -N X 2 --- X R 2 ---X 15 wherein: R1 represents an optionally substituted aralkyl, aryloxyalkyl, heteroaralkyl, aroyl, heteroaroyl, cycloalkylcarbonyl, aralkanoyl, heteroarylalkanoyl, aralkoxycarbonyl or arylcarbamoyl group or the acyl group of an a-amino acid optionally N-substituted by a lower alkanoyl or 20 carbamoyl-lower alkanoyl group; R 2 represents cycloalkyl or an optionally substituted aryl or heteroaryl group; R 3 represents hydrogen, alkyl, carbamoyl or an alkanoyl or alkenoyl group optionally substituted by carboxy or esterified or amidated carboxy; 25 R 4 represents an optionally substituted aryl group or an optionally partially saturated heteroaryl group; WO 99/59635 PCT/GB99/01632 - 83 Xi represents methylene, ethylene, a bond, an optionally ketalised carbonyl group or an optionally etherified hydroxymethylene group; X 2 represents alkylene, carbonyl or a bond; and X3 represents carbonyl, oxo-lower alkyl, oxo(aza)-lower alkyl, or an 5 alkyl group optionally substituted by phenyl, hydroxymethyl, optionally esterified or amidated carboxy, or (in other than the a-position) hydroxy; or a pharmaceutically acceptable salt thereof. 16. A use according to claim 1, a composition according to claim 10 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula IX: CHR R -Y-A-N CONHCHCON (IX) 15 wherein: R' is aryl, or a group of the formula: z X is CH or N; and Z is 0 or N-R 5 , in which R 5 is hydrogen or lower alkyl; 20 R 2 is hydroxy or lower alkoxy; R 3 is hydrogen or optionally substituted lower alkyl; R 4 is optionally substituted ar(lower)alkyl; A is carbonyl or sulfonyl; and Y is a bond or lower alkenylene; 25 or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/G B99/01632 - 84 17. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula X: H N R H 5 (X) wherein: R1 is aryl selected from indanyl, phenyl and naphthyl; heteroaryl selected from thienyl, furyl, pyridyl and quinolyl; and cycloalkyl having 3 to 7 carbon atoms, wherein one of said carbon atoms may optionally be 10 replaced by nitrogen, oxygen or sulfur; wherein each of said aryl and heteroaryl groups may optionally be substituted with one or more substituents, and said C3-7cycloalkyl may optionally be substituted with one or two substituents, said substituents being independently selected from chloro, fluoro, bromo, iodo, nitro, C1ioalkyl optionally substituted 15 with from one to three fluoro groups, C1_1oalkoxy optionally substituted with from one to three fluoro groups, amino, C1-ioalkyl-S-, C1ioalkyl-S(O)-, C1-loalkyl-S02-, phenyl, phenoxy, C1iloalkyl-SO2NH-, C1.1oalkyl-SO 2 NH-C1-oakyl-, Ci-oalkylamino-diCi.oalkyl-, cyano, hydroxy, cycloalkoxy having 3 to 7 carbon atoms, C1.6alkylamino, CI6dialkylamino, 20 HC(O)NH- and C 1 .1oalkyl-C(O)NH-; and R 2 is thienyl, benzhydryl, naphthyl or phenyl optionally substituted with from one to three substituents independently selected from chloro, bromo, fluoro, iodo, cycloalkoxy having 3 to 7 carbon atoms, Ci-ioalkyl optionally substituted with from one to three fluoro groups and C1ioalkoxy 25 optionally substituted with from one to three fluoro groups; or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/GB99/01632 - 85 18. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula XI: R 2 (CH 2 ). H N 3 R N__ H R 4 5 R 5 (XI) wherein: R 1 is a C1. 4 alkoxy group; R 2 is 6 _ NN -N 10 R 3 is a hydrogen or halogen atom; R4 and R 5 may each independently represent a hydrogen or halogen atom, or a C1.4alkyl, C1_4alkoxy or trifluoromethyl group; R 6 is a hydrogen atom, a C1-4alkyl, (CH2)mcyclopropyl, -S(O)nCI 4 alkyl, phenyl, NR 7 R 8 , CH 2 C(O)CF 3 or trifluoromethyl group; 15 R 7 and R 8 may each independently represent a hydrogen atom, or a C1_4alkyl or acyl group; x represents zero or 1; n represents zero, 1 or 2; and m represents zero or 1; 20 or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/GB99/01632 - 86 19. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is a compound of formula XI: I 3 R-(CH 2)n-~C-CH 2 N-(CHz2)- -R NH 1 (CO), (CH 2 ) (XII) 5 R wherein: m is zero, 1, 2 or 3; n is zero or 1; o is zero, 1 or 2; 10 p is zero or 1; R is phenyl, 2- or 3-indolyl, 2- or 3-indolinyl, benzothienyl, benzofuranyl, or naphthyl; which R groups may be substituted with one or two halo, Ci-3alkoxy, trifluoromethyl, C1.4alkyl, phenyl-C1_3alkoxy, or C1-4alkanoyl groups; 15 R 1 is trityl, phenyl, diphenylmethyl, phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, hexamethyleneiminyl, benzofuranyl, tetrahydropyridinyl, quinolinyl, isoquinolinyl, reduced quinolinyl, reduced isoquinolinyl, phenyl-(Cl.4alkyl)-, phenyl-(C1.4alkoxy)-, quinolinyl-(Cl.4alkyl)-, 20 isoquinolinyl-(Cl4alkyl)-, reduced quniolinyl-(Cl4alkyl)-, reduced isoquinolinyl-(Cl_4alkyl)-, benzoyl-(C-3alkyl)-, C1_4alkyl, or -NH-CH 2 -R 5 ; any one of which R1 groups may be substituted with halo, C1.4alkyl, Ci-4alkoxy, trifluoromethyl, amino, C14alkylamino, di(Ci-4alkyl)amino, or C2_4alkanoylamino; WO 99/59635 PCT/GB99/01632 - 87 or any one of which R 1 groups may be substituted with phenyl, piperazinyl, C3-8cycloalkyl, benzyl, Ci4alkyl, piperidinyl, pyridinyl, pyrimidinyl, C2-6alkanoylamino, pyrrolidinyl, C2-6alkanoyl, or Ci- 4 alkoxycarbonyl; 5 any one of which groups may be substituted with halo, Ci 4 alkyl, Ci 4 alkoxy, trifluoromethyl, amino, Ci 4 alkylamino, di(Ci4alkyl)amino, or C2-alkanoylamino; or R 1 is amino, a leaving group, hydrogen, Ci 4 alkylamino, or di(Ci-alkyl)amino; 10 R 5 is pyridyl, anilino-(C1-3alkyl)-, or anilinocarbonyl; R 2 is hydrogen, Ci-4alkyl, Cl4alkylsulfonyl, carboxy-(C1-3alkyl)-, Cl- 3 alkoxycarbonyl-(C1-3alkyl)-, or -CO-R 6 ; R 6 is hydrogen, Ci4alkyl, Ci.haloalkyl, phenyl, C1-3alkoxy, C1-3hydroxyalkyl, amino, Ci4alkylamino, di(Cl4alkyl)amino, or -(CH2)q-R 7 ; 15 q is zero to 3; R 7 is carboxy, Ci4alkoxycarbonyl, CI 4 alkylcarbonyloxy, amino, C1alkylamino, di(Ci-4alkyl)amino, CI.6alkoxycarbonylamino, or phenoxy, phenylthio, piperazinyl, piperidinyl, pyrrolidinyl, morpholinyl, indolinyl, indolyl, benzothienyl, benzofuranyl, quinolinyl, phenyl-(Ci14alkyl)-, 20 quinolinyl-(Ci-4alkyl)-, isoquinolinyl-(Ci 4 alkyl)-, reduced quinolinyl (Ci-4alkyl)-, reduced isoquinolinyl-(Cl4alkyl)-, benzoyl-Ci-3alkyl; any one of which aryl or heterocyclic R 7 groups may be substituted with halo, trifluoromethyl, Ci-4alkoxy, C1-4alkyl, amino, Ci4alkylamino, di(Ci- 4 alkyl)amino, or C24alkanoylamino; 25 or any one of which R 7 groups may be substituted with phenyl, piperazinyl, C3-8cycloalkyl, benzyl, piperidinyl, pyridinyl, pyrimidinyl, pyrrolidinyl, C2-6alkanoyl, or Cl4alkoxycarbonyl; any of which groups may be substituted with halo, trifluoromethyl, amino, Ci4alkoxy, Cil4alkyl, C-4alkylamino, di(Ci-4alkyl)amino, or 30 C24alkanoylamino; R 8 is hydrogen or CI-6alkyl; WO 99/59635 PCT/GB99/01632 - 88 R 3 is phenyl, phenyl-(C1.6alkyl)-, C 3 - 8 cycloalkyl, C5sscycloalkenyl, C1-8alkyl, naphthyl, C2-8alkenyl, or hydrogen; any one or which groups except hydrogen may be substituted with one or two halo, C1_3alkoxy, C1.3alkylthio, nitro, trifluoromethyl, or 5 C1-3alkyl groups; and R 4 is hydrogen or Ci-3alkyl; with the proviso that if R 1 is hydrogen or halo, R 3 is phenyl, phenyl-(Cl-6alkyl)-, C3-8cycloalkyl, C5s-cycloalkenyl, or naphthyl; or a pharmaceutically acceptable salt thereof. 10 20. A use, composition, product or method according to any one of the preceding claims wherein the NK-1 receptor antagonist is orally active, long acting and CNS-penetrant. 15 21. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is selected from the classes of compounds described in EP-A-0577394, WO-A-9508549, WO-A-9518124, WO-A-9523798 or WO-A-9605181. 20 22. A use according to claim 1, a composition according to claim 2, a product according to claim 3 or a method according to claim 4 wherein the NK-1 receptor antagonist is selected from 4-(3-(1,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(S) 25 phenyl-morpholine; 4-(3-(1,2,4-triazolo)methyl)-2(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3(R) phenyl-morpholine; 4-(3-(5-oxo-1H,4H-1,2,4-triazolo)methyl)-2(S)-(3,5 bis(trifluoromethyl)benzyloxy)-3(S)-phenyl-morpholine; 30 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 4-(3-(5-oxo-1H,4H-1,2,4-triazolo)methyl)morpholine; WO 99/59635 PCT/GB99/01632 - 89 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl-1,2,3-triazol-4-yl)methyl-3-(S)-phenylmorpholine; 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-4-(5-(dimethylamino) methyl- 1,2,3-triazol-4-yl)methyl-3-(S)-(4-fluorophenyl)morpholine; 5 2-(R)-(1-(S)-(3,5-bis(trifluoromethyl)phenyl)-2-hydroxyethoxy)-3-(S)-(4 fluorophenyl)-4-(1,2,4-triazol-3-yl)methylmorpholine; 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(5-oxo- 1H,4H 1,2,4-triazolo)methyl)morpholine N-oxide; 2-(S)-(3,5-bis(trifluoromethyl)benzyloxy)-3-(S)-phenyl-4-(3-(4 10 (ethoxycarbonyloxy-1-ethyl)-5-oxo-1H-1,2,4-triazolo)methyl)morpholine; 2-(R)-( 1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 4-(3-(4-monophosphoryl-5-oxo-1H-1,2,4-triazolo)methyl)morpholine; 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 4-(3-(1-monophosphoryl-5-oxo-1H-1,2,4-triazolo)methyl)morpholine; 15 2-(R)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 4-(3-(2-monophosphoryl-5-oxo-1H-1,2,4-triazolo)methyl)morpholine; 2-(R)-( 1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 4-(3-(5-oxyphosphoryl-1H-1,2,4-triazolo)methyl)morpholine; 2-(S)-(1-(R)-(3,5-bis(trifluoromethyl)phenyl)ethoxy)-3-(S)-(4-fluorophenyl) 20 4-(3-(1-monophosphoryl-5-oxo-4H-1,2,4-triazolo)methyl)morpholine; (3R,5R,6S)-3-(2-methoxy-5-(trifluoromethoxy)phenyl)-6-phenyl-1-oxa-7 aza-spiro [4.51 decane; (3R,5R,6S)-3-(2-methoxy-5-(trifluoromethyl)phenyl)-6-phenyl-1-oxa-7-aza spiro [4.51 decane; 25 (3R,5R,6S)-7-benzyl-3- [2-methoxy-5-(trifluoromethoxy)phenyl] -6-phenyl- 1 oxa-7-aza-spiro [4.5] decane; (3R, 5R,6S)-3-(2-methoxy-5-trifluoromethoxyphenyl)-6-phenyl-1-oxa-7-aza spiro[4.5]decane; (3R, 5R,6S)-3,6-bis(phenyl)-1-oxa-7-aza-spiro [4.5] decane; 30 (3R,5R,6S)-7-benzyl-3-(2-methoxy-5-trifluoromethoxyphenyl)-6-phenyl-1 oxa-7-aza-spiro [4.5] decane; WO 99/59635 PCT/GB99/01632 - 90 (±)-(3R*,5R*,6S*)-3-(2-methoxyphenyl)-6-phenyl-1-oxa-7 (phenylmethoxycarbonyl)aza-spiro [4.5] decane; (3R,5R,6S)-3-(2-methoxyphenyl)-6-phenyl- 1-oxa-7-aza-spiro [4.5] decane; (3S, 5R,6S)-3-(2-cyclopropoxy-5-(trifluoromethoxy)phenyl)-6-phenyl- 1-oxa 5 7-aza-spiro[4.5]decane; (3R, 5R,6S)-3- [2-cyclopropoxy-5-(trifluoromethoxy)phenyl] -6-phenyl- 1-oxa 7-aza-spiro [4.5] decane; (3S, 5R,6S)-3- [2-cyclopropoxy-5-(trifluoromethyl)phenyl] -6-phenyl-1-oxa-7 aza-spiro [4.5] decane; 10 (2S,3S)-cis-3-(2-methoxybenzylamino)-2-phenylpiperidine; (3aS, 4S, 7aS)-7,7-diphenyl-4-(2-methoxyphenyl)-2-[(2S)-(2 methoxyphenyl)propionyl]perhydroisoindol-4-ol; (+) 1-[2-[3-(3,4-dichlorophenyl)-1-[(3-isopropoxyphenyl)acetyl]-3 piperidinyl] ethyl] -4-phenyl- 1-azabicyclo [2,2,2] octane; 15 (2R*, 4S*)-2-benzyl-1-(3,5-dimethylbenzoyl)-N-(4-quinolinylmethyl)-4 piperidineamine; HO / 0 (2S,3S)-3-(2-methoxy-5-trifluoromethoxybenzyl)-amino-2 phenylpiperidine; 20 (2-methoxy-5-tetrazol-1-yl-benzyl)-([2S,3S]-2-phenyl-piperidin-3-yl)-amine; [2-methoxy-5-(5-trifluoromethyl-tetrazol-1-yl)-benzyl]-([2S,3S]-2-phenyl piperidin-3-yl)-amine; and [N-(2-methoxybenzyl)acetylamino]-3-(1H-indol-3-yl)-2-[N-(2-(4-piperidin-1 yl)piperidin- 1-yl)acetylamino] propane; 25 or a pharmaceutically acceptable salt thereof. WO 99/59635 PCT/G B99/01632 - 91 23. A process for preparing a pharmaceutical composition comprising combining a COX-2 inhibitor and a NK-1 receptor antagonist with a pharmaceutically acceptable carrier. 5 24. The use of a NK-1 receptor antagonist for the manufacture of a medicament for the combined use with a cyclooxygenase-2 inhibitor for preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for 10 preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder. 25. The use of a cyclooxygenase-2 inhibitor for the preparation of a medicament for the combined use with a NK-1 receptor antagonist for 15 preventing or reducing the risk of developing an inflammatory disorder, for halting or slowing the progression of an inflammatory disorder, or for preventing or reducing the risk of occurrence or recurrence of an inflammatory disorder. 20 26. A use, composition, product or method according to any one of the preceding claims wherein the inflammatory disorder is selected from rheumatoid arthritis, degenerative joint diseases, osteoarthritis, bursitis, tendinitis, ankylosing spondylitis, gout and synovitis.
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GB9810920D0 (en) 1998-07-22
JP2002515461A (en) 2002-05-28
AU758983B2 (en) 2003-04-03

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