RU2683641C2 - Pharmaceutical composition for the treatment of hyperlipidemia - Google Patents

Abstract

FIELD: pharmaceuticals.

SUBSTANCE: invention relates to pharmaceutical composition for treatment of hyperlipidemia. Pharmaceutical composition for treatment of hyperlipidemia comprises a hypolipidemic drug selected from atorvastatin, lovastatin, rosuvastatin, simvastatin, pravastatin, pitavastatin, fluvastatin, and a glycyrrhizin derivative selected from glycyrrhizic acid or a pharmaceutically acceptable salt thereof in a weight ratio of 1:0.5 to 1:200.

EFFECT: pharmaceutical composition for treatment of hyperlipidemia has been proposed.

1 cl, 35 tbl, 2 ex

Description

FIELD OF THE INVENTION

The present invention relates to a pharmaceutical composition for treating hyperlipidimia and a kit.

BACKGROUND

Hypercholesterolemia is one of the most important disorders of lipid metabolism in the development of cardiovascular diseases. In recent decades, most developed countries have adopted national programs for the prevention and treatment of cardiovascular disease (CVD), which have contributed to a reduction in mortality from cardiovascular disease by more than 50%. An important part of these programs is the widespread use of statins in clinical practice.

HMG-CoA reductase inhibitors, commonly known as statins, are a class of drugs used to lower blood lipids (especially cholesterol) by inhibiting the HMG-CoA reductase enzyme. This enzyme plays a key role in the synthesis of cholesterol in the liver, which produces about 70 percent of total cholesterol in the body. The occurrence of cardiovascular disease is directly related to increased cholesterol. Therefore, the ability of statins to lower cholesterol is especially successfully used in the treatment and prevention of cardiovascular diseases.

In particular, simvastatin is one of the most commonly prescribed, effective, relatively safe, and affordable statins. Extensive multicenter clinical studies conducted in strict accordance with modern standards have proven the effectiveness of simvastatin not only in the secondary prevention of cardiovascular disease, but also in patients with diabetes mellitus and patients with dyslipidemia. There is strong evidence of a significant effect of statins on the pathogenesis of certain rheumatic diseases. Although simvastatin is not the first synthesized substance in the class of statins, with its use the most clinically important evidence has been obtained of the high effectiveness of this group of drugs in the outcome of cardiovascular diseases. It is noted that the results of almost all studies of simvastatin radically changed modern cardiological practice and conclusively confirmed the indications for the use of this drug for all new diseases and syndromes (Karpov Yu.A. and Sorokin E.V. Russian Medical Journal: an independent publication for practitioners. 2008 , 16 (21), 1435-1438). Nevertheless, a number of side effects associated with the use of statins are known, in particular when they are taken in high daily doses (20-80 mg / day). Examples of side effects include elevated levels of liver enzymes such as alanine aminotransferases and aspartate aminotransferases, myalgia (muscle pain), myopathy (muscle dystrophy), and rhabdomyolysis (muscle cell destruction). In addition, prolonged use of statins can be expensive for the patient and medical facilities.

In particular, in June 2011, the US Food and Drug Administration (FDA) recommended limiting the use of simvastatin at a dose of 80 mg per day due to the risk of muscle tissue damage. It was noted that patients taking simvastatin at a dose of 80 mg per day are at a higher risk of myopathy than patients who received it or other statins in lower doses. It was also noted that the likelihood of adverse reactions of this type is especially high during the first year of statin therapy and can be associated with both drug interactions and a genetic predisposition to the development of simvastatin-dependent myopathy. Therefore, 40 mg is the maximum safe daily dose of simvastatin. The FDA also proportionally reduces (by 50% or more) the maximum safe dose of simvastatin when used in combination with other drugs that can increase the concentration of statin in the serum (due to drug interactions).

In addition to rhabdomyolysis, statins can contribute to the development of myorenal syndrome (due to blockage of the renal tubules by the aggregates of myoglobulin and uromodulin) and acute renal failure.

Glycyrrhizic acid (also known as glycyrrhizin) is the main substance with a sweet taste in the roots of Glycyrrhiza glabra (licorice). Glycyrrhizic acid has anti-atherosclerotic activity: it is believed that the mechanism of action includes inhibition of the activity of phospholipase A2 and acceleration of the synthesis of bile acids. The ability of glycyrrhizin to inhibit liver cell damage is also known and is approved in Japan for intravenous administration for the treatment of chronic viral hepatitis and cirrhosis (Inoue N., Saito N., Koshihara Y., Murota S. // Chem. Pharm. Bull. 1986. V 34 (2). P. 897-901).

As you know, glycyrrhizins have hypolipidemic and antiatherosclerotic effects. For example, Furman et al. (Nutrition. 2002, 18 (3), 268-273) describe the antiatherosclerotic effect of the alcohol extract of Glycyrrhiza glabra L. When the extract was administered to patients with high cholesterol, a decrease in cholesterol and plasma triglycerides were observed, and also increasing the resistance of low molecular weight lipoproteins to oxidation and lowering systolic blood pressure.

In addition, Vasilenko et al. (Pharmaceutical Chemistry Journal, 1981, No. 5, 50-53) and Skulipe et al. (Biol, sciences. 1952. No. 10. 56-60) describe that glycyram, glycyrrhetic acid and the sodium salt of glycyrrhetic acid (sodium glycyrrhizinate) (10 mg / kg) also shows lipid-lowering and anti-atherosclerotic effects, lower cholesterol, β-lipoproteins and triglycerides in the blood of rabbits with experimental atherosclerosis, reduce cholesterol in the liver tissue, increase blood coagulation.

In another experiment, the animals used showed an increase in the time of recalcification of blood plasma and a decrease in blood tolerance to heparin (Baran JS, Langford DD, Chi-Dean Liang BS, Pitzele BS // J. Med. Chem. 1974. V. 17. P. 184 -191). Powerful hypolipidemic properties were found in acetates of glycyrrhizic acid, glycyrrhetic acid and 3-amino-glycyrrhetic acid when used in animals with experimental atherosclerosis (see Furman et al., Supra; Vasilenko et al. Abs. Sev.-kavk. Learn , (centers higher school of Natural science) 1984. No. 4, 83-87; and Vasilenko et al. Pharmacology and Toxicology. 1952. No. 5, 66-70). When glycyrrhizinate (10 mg / kg) was used, there was a decrease in cholesterol, β-lipoproteins in the aorta, as well as a decrease in the amount of cholesterol in the liver tissues (Vasilenko et al., // Pharmaceutical Chemistry Journal, 1981. No. 5, 50-53 )

The lipid-lowering and anti-atherosclerotic activity of the glycyrrhizic acid derivative and glycyrrhetic acid is higher than that of official drugs such as Polisponin and Miskleron. For example, 18-dehydro-glycyrrhetic acid by its hypolipidemic and anticoagulant properties significantly exceeds the antisclerotic drug Polisponin in the case of experimental atherosclerosis and can be a promising substance as an antiatherosclerotic drug (Abdullaev et al. Analysis, Synthesis and Pharmaceutical Activity of Tashkent State Substances. Medical Institute, 1991. p. 3).

The ammonium salt of glycyrrhetic acid and 18-denidroglycyrrhetic acid reduce the concentration of total cholesterol, triglycerides, lipoproteins in the blood plasma of rabbits in the model of cholesterol atherosclerosis. Due to their powerful hypolipidemic and antioxidant effects, these compounds significantly reduce the area of atherosclerotic changes in the aorta and even significantly exceed the activity of Polisponin in this case (Zakirov et al., Experimental and Clinical Pharmacology. 1996. T. J9 (5)). However, glycyrrhizic acid does not affect the synthesis of cholesterol (Novikov et al. Biochemistry. 1992. V. 57 (6). P. 897-903).

The mechanism of anti-atherosclerotic activity of glycyrrhizic acid is explained by inhibition of the activity of phospholipase A2 (Inoue N., Saito N., Koshihara Y., Murota S. // Chem. Pharm. Bull. 1986. V. 34 (2). P. 897-901; Yano Sh., Harada M., Watanabe K., Nakamura K., Hatakeyama Y., Shibata Sh., Takahashi K, Mori T., Hirabayashi K., TakedaM., Nagata N. // Chem. Pharm. Bull. 1989. V. 37 (9). P. 2500-2504; Farina C, Pinza M., Pifferi G. // IL Farmaco. 1998. V. 53. P. 22-32). In 1964, it was shown that triterpene saponosides have a specific affinity for cholesterol, destroy cholesterol complexes with proteins, as well as other complexes of lipid substances in blood serum (Turova et al., Pharmacology and Toxicology. 1964. T. 27 (2) P. 242 -249). Therefore, saponosides, including glycyrrhizic acid, can serve as drugs for the treatment of atherosclerosis.

In vitro experiments have shown that glycyrrhizic acid inhibits the formation and release of lipoproteins from [14C] glucose and the binding of [14C] cholesterol to low molecular weight lipoproteins at a concentration of 25-50 mmol (Shiraiv et al., Chem. Abs. 1986. V 104.28680). A review of the antisclerotic activity of glycyrrhizic acid and its derivatives was carried out in publications (Kumagai et al., Chiryogaku. 1985. V. 14 (1). P. 127-134 (Chem. Abs. 1985. V. 103. 47653).

Pharmaceutical compositions comprising a pharmaceutically active ingredient and further determining statin as a possible second pharmaceutically active ingredient are known in the art. Some of these publications determine that the composition may contain a sweetener, and include glycyrrhizic acid or its salt in the list of possible sweeteners. Examples of such publications include WO 2005/041962, EP 2295406 A, EP 2172200 A, WO 2012/104654, WO 2004/084865, EP 2359812 A, EP 1304121 A, EP 2597095 A, and US 2007/116829. However, none of the publications listed above disclose specific examples of products that are a combination of statin and glycyrrhizin. Moreover, none of the documents discloses that glycyrrhizic acid (or its salt) can exhibit pharmacological properties when used in combination with statin, since in all documents glycyrrhizic acid is used to improve the taste of the finished dosage form.

RU 2308947 describes a composition representing a molecular complex of simvastatin with β-glycyrrhizic acid in a molar ratio of simvastatin: β-glycyrrhizic acid 1: 1-1: 4, and the preparation of this complex by mixing two components in a solution where water, ethanol are used as solvents or acetone.

Obtaining a complex of simvastatin with glycyrrhizic acid in a ratio of 1: 4 is achieved by dissolving 3.48 g of 95% glycyrrhizic acid in 30 ml of a 70% aqueous solution of ethanol and adding to the resulting solution a solution of 0.41 g of simvastatin in 1 ml of acetone. The mixture is boiled for 2 hours, the solvents are evaporated on a rotary evaporator to obtain a solid residue (3 hours, room temperature, residual pressure 1 mm Hg).

Similarly, RU 2396079 describes a composition comprising a molecular complex of atorvastatin with β-glycyrrhizic acid in a molar ratio of atorvastatin: β-glycyrrhizic acid 1: 1-1: 4, and the preparation of this complex by mixing two components in a solution where water is used as solvents ethanol or acetone. Not wanting to be bound by the correspondence of any particular theory, the authors believe that in both cases the molecular complexes are formed due to non-covalent interactions, such as Van der Waals forces, between the two components of the combination: it is possible that the statin molecule is a guest molecule in the micelle consisting of 4 molecules of glycyrrhizic acid.

The stability of these complexes was determined based on the quantitative content of glycyrrhizic acid (in percentage terms). The interval between the control points was 7 months. The analysis method was taken from the 7th edition of the European Pharmacopoeia. The data obtained showed that glycyrrhizic acid, a complex formed from glycyrrhizic acid and statin in the liquid phase, is unstable in time due to the rapid decrease in the glycyrrhizic acid content. This decrease is associated both with the synthesis conditions (the maximum decrease was observed in the case of liquid-phase synthesis) and with the properties of the active components.

Consequently, the molecular complexes described in both of the above documents are unstable during long-term storage (as was characterized, for example, by a% glycyrrhizic acid content that decreases over time). Such a reduction can be associated either with the synthesis conditions or with the properties of the active substance itself. In addition, the solubility in water of the molecular complex simvastatin / glycyrrhizic acid described in RU 2308947 also decreases with time. The instability of these molecular complexes makes them unsuitable for industrial pharmaceutical production.

SUMMARY OF THE INVENTION

In one aspect of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug;

provided that: the hypolipidemic agent atorvastatin, the combination does not contain a molecular complex of atorvastatin and glycyrrhizic acid; and the lipid-lowering agent simvastatin, the combination does not contain a molecular complex of simvastatin and glycyrrhizic acid.

In one embodiment, the invention provides a combination in which the glycyrrhizin derivative and the lipid-lowering drug are present in a weight ratio (glycyrrhizin derivative: derivative and lipid-lowering drug) from 1: 0.03 to 1: 5.

In another aspect of the invention, a pharmaceutical composition is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug;

provided that: atorvastatin hypolipidemic agent, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; and a lipid-lowering agent simvastatin, the composition does not contain a molecular complex of simvastatin and glycyrrhizic acid.

In another embodiment, the invention provides a pharmaceutical composition in which the glycyrrhizin derivative and lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: derivative and lipid-lowering drug) from 1: 0.03 to 1: 5.

Preferably, the pharmaceutical composition is a solid pharmaceutical composition. Therefore, in one aspect of the invention, a solid pharmaceutical composition is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug.

In another embodiment, the invention provides a solid pharmaceutical composition in which the glycyrrhizin derivative and lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: derivative and lipid-lowering drug) from 1: 0.03 to 1: 5. In a further aspect of the invention, the above-mentioned solid pharmaceutical composition is provided, which is a solid mixture of a glycyrrhizin derivative and a lipid-lowering drug.

More preferably, the solid pharmaceutical composition is a solid pharmaceutical composition for oral administration. Therefore, in one embodiment, a solid pharmaceutical composition for oral administration is provided, comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug.

In another embodiment, the invention provides a solid pharmaceutical composition in which the glycyrrhizin derivative and lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: derivative and lipid-lowering drug) from 1: 0.03 to 1: 5. In a further embodiment of the invention, a kit is provided comprising:

(a) a therapeutically effective amount of a glycyrrhizin derivative, and additionally pharmaceutically acceptable carriers or diluents in a first unit dosage form;

(b) a therapeutically effective amount of a lipid-lowering drug, and further pharmaceutically acceptable carriers or diluents in a second unit dosage form; and

(c) a container for containing said first and second dosage forms.

where the glycyrrhizin derivative and lipid-lowering drug are present in a weight ratio of 0.03: 1 to 5: 1.

In a further embodiment of the invention, there is provided a method for preparing the solid pharmaceutical composition described above, a method for mixing the solid form of glycyrrhizin and the solid form of a lipid-lowering drug.

In some embodiments, the lipid-lowering drug is a statin. Therefore, in one embodiment of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin;

provided that if atorvastatin is used as the statin, the combination does not contain the molecular complex of atorvastatin and glycyrrhizic acid; and if simvastatin is used as the statin, the combination does not contain a molecular complex of simvastatin and glycyrrhizic acid.

In other embodiments of the invention, the glycyrrhizin derivative and statin are presented in a ratio by weight (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5.

In another embodiment of the invention, there is provided a pharmaceutical composition comprising:

(a) a glycyrrhizin derivative; and

(b) statin;

where atorvastatin is used as a statin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; and where simvastatin is used as a statin, the combination does not contain a molecular complex of simvastatin and glycyrrhizic acid.

In another embodiment of the invention, the glycyrrhizin derivative and statin are presented in a ratio by weight (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5.

Preferably, the pharmaceutical composition containing the glycyrrhizin derivative is a solid pharmaceutical composition. Therefore, in one embodiment of the invention, a solid pharmaceutical composition is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin.

where the glycyrrhizin derivative and statin are present in a weight ratio (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5.

In a further embodiment of the invention, the above-mentioned solid pharmaceutical composition is provided, which is a solid mixture of a glycyrrhizin derivative and statin.

In a further embodiment of the invention, a kit is provided comprising:

(a) a therapeutically effective amount of a glycyrrhizin derivative, and additionally pharmaceutically acceptable carriers or diluents in a first unit dosage form;

(b) a therapeutically effective amount of statin, and additionally pharmaceutically acceptable carriers or diluents in a second unit dosage form; and

(c) a container for containing said first and second dosage forms; where the glycyrrhizin derivative and statin are present in a weight ratio of 1: 0.03 to 1: 5.

In a further embodiment of the invention, a kit is provided comprising:

(1) a pharmaceutical composition for treating hyperlipidimia or a solid dosage form comprising a pharmaceutical composition for treating hyperlipidimia, wherein the pharmaceutical composition comprises a mixture of:

(a) a glycyrrhizin derivative selected from the group consisting of glycyrrhizic acid and a pharmaceutically acceptable salt thereof;

(b) a lipid-lowering drug, wherein the lipid-lowering drug is a statin selected from the group consisting of atorvastatin, lovastatin, rosuvastatin, simvastatin, pravastatin, pitavastatin, fluvastatin, or a pharmaceutical salt thereof, or a mixture thereof, provided that

if the lipid-lowering drug is atorvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is lovastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is rosuvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is simvastatin, then the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is pravastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is pitavastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or

if the lipid-lowering drug is fluvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid;

(c) excipients,

in the container and

(2) instructions for use.

In the kit, the lipid-lowering drug and the glycyrrhizin derivative may be present in a weight ratio of 1: 0.5-1: 200.

In a further embodiment of the invention, there is provided a method for preparing the solid pharmaceutical composition described above, a method for mixing the solid form of glycyrrhizin and the solid form of statin.

In some embodiments, the combination does not include combinations of glycyrrhizic acid and atorvastatin in the ratios disclosed in RU 2396079, or combinations of glycyrrhizic acid and atorvastatin in the ratios disclosed in RU 2308947, in which these documents describe the formed molecular complexes. Therefore, in some embodiments, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug; in which the glycyrrhizin derivative and lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: derivative and lipid-lowering drug) from 1: 0.03 to 1: 5, with the exception of the following combinations :.

(i) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.17 to 1: 0.182;

(ii) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.45 to 1: 0.5;

(iii) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.1 to 1: 0.14; and

(iv) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.45 to 1: 0.5.

In one embodiment, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin;

where the glycyrrhizin derivative and statin are presented in a ratio by weight (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5, with the exception of the following combinations:

(i) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.17 to 1: 0.182;

(ii) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.45 to 1: 0.5;

(iii) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.1 to 1: 0.14; and

(iv) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.45 to 1: 0.5.

In one embodiment, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin;

where the glycyrrhizin derivative and statin are presented in a ratio by weight (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5, with the exception of the following combinations:

(i) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.17 to 1: 0.182;

(ii) glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.45 to 1: 0.5;

(iii) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.1 to 1: 0.14; and

(iv) glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.45 to 1: 0.5.

In one embodiment of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug.

where the glycyrrhizin derivative and the lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: lipid-lowering drug.) from 1: 0.03 to 1: 5.

In another aspect of the invention, a pharmaceutical composition is provided comprising:

(a) a glycyrrhizin derivative; and

(b) a lipid-lowering drug.

where the glycyrrhizin derivative and the lipid-lowering drug are present in a ratio by weight (glycyrrhizin derivative: lipid-lowering drug.) from 1: 0.03 to 1: 5.

In one aspect of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin.

where the glycyrrhizin derivative and statin are present in a weight ratio (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5.

In another aspect of the invention, a pharmaceutical composition is provided comprising:

(a) a glycyrrhizin derivative; and

(b) statin.

where the glycyrrhizin derivative and statin are present in a weight ratio (glycyrrhizin derivative: statin) from 1: 0.03 to 1: 5.

In another embodiment, the invention provides combinations, pharmaceutical compositions, and kits that contain a lipid-lowering drug other than statin. Examples include lipid-lowering drugs of the fibrate class, such as clofibrate, gemfibrozil and fenofibrate, sequestrants of bile acids, such as cholestipol, cholestriamine and cholesevel, and other lipid-lowering drugs, such as nicotinic acid.

Thus, in one embodiment of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) fibrate (preferably selected from the group consisting of clofibrate, gemfibrozil and fenofibrate);

where the glycyrrhizin derivative and fibrate are present in a weight ratio (glycyrrhizin derivative: fibrate) from 1: 0.03 to 1: 5.

In another embodiment of the invention, there is provided a pharmaceutical composition (preferably a solid pharmaceutical composition) comprising:

(a) a glycyrrhizin derivative; and

(b) fibrate (preferably selected from the group consisting of clofibrate, gemfibrozil and fenofibrate); where the glycyrrhizin derivative and fibrate are present in a weight ratio (glycyrrhizin derivative: fibrate) from 1: 0.03 to 1: 5.

Thus, in one embodiment of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) sequestrant of bile acids (preferably selected from the group consisting of cholestipol, cholestriamine and cholesevel);

where the glycyrrhizin derivative and sequestrant of bile acids are present in a ratio by weight (glycyrrhizin derivative: sequestrant of bile acids) from 1: 0.05 to 1: 5.

In another embodiment of the invention, there is provided a pharmaceutical composition (preferably a solid pharmaceutical composition) comprising:

(a) a glycyrrhizin derivative; and

(b) sequestrant of bile acids (preferably selected from the group consisting of cholestipol, cholestriamine and cholesevel);

where the glycyrrhizin derivative and sequestrant of bile acids are present in a ratio by weight (glycyrrhizin derivative: sequestrant of bile acids) from 1: 0.05 to 1: 5.

Thus, in one embodiment of the invention, a combination is provided comprising:

(a) a glycyrrhizin derivative; and

(b) nicotinic acid;

where the glycyrrhizic derivative and nicotinic acid are present in a ratio by weight (glycyrrhizin derivative: nicotinic acid) from 1: 0.05 to 1: 4.

In another embodiment of the invention, there is provided a pharmaceutical composition (preferably a solid pharmaceutical composition) comprising:

(a) a glycyrrhizin derivative; and

(b) nicotinic acid;

where the glycyrrhizic derivative and nicotinic acid are present in a ratio by weight (glycyrrhizin derivative: nicotinic acid) from 1: 0.05 to 1: 4.

In another embodiment of the invention, there is provided a pharmaceutical composition comprising a lipid-lowering drug and a glycyrrhizin derivative in a weight ratio of 1: 0.5-1: 200. The glycyrrhizin derivative is selected from the group consisting of glycyrrhizic acid and a pharmaceutically acceptable salt thereof. The lipid-lowering drug is a statin selected from the group consisting of atorvastatin, lovastatin, rosuvastatin, simvastatin, pravastatin, pitavastatin, fluvastatin, or a pharmaceutical salt thereof, or a mixture thereof.

In yet another embodiment of the present invention, the use of any of the above combinations or pharmaceutical compositions as a medicine is provided.

Another embodiment of the present invention provides for the use of said combination or pharmaceutical composition in the treatment of cardiovascular diseases (including, but not limited to, coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, coronary artery disease, diseases peripheral vessels, peripheral arterial disease, and intermittent claudication).

In another embodiment of the present invention, the use of said combination or pharmaceutical composition in the manufacture of a medicament for the treatment of hyperlipidemia is provided. In one embodiment, hyperlipidemia is selected from hypercholesterolemia (also known as hyperlipoproteinemia), hypertriglyceridemia, or their concomitant diseases.

Another embodiment of the present invention provides for the use of said combination or pharmaceutical composition in the manufacture of a medicament for the treatment of cardiovascular diseases (including, but not limited to, coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, diseases coronary artery, peripheral vascular disease, peripheral arterial disease, and intermittent claudication).

In yet another embodiment of the present invention, there is provided a method for treating hyperlipidemia, the method comprising administering to the patient the aforementioned combination or pharmaceutical composition. In one embodiment, hyperlipidemia is selected from hypercholesterolemia (also known as hyperlipoproteinemia), hypertriglyceridemia, or their concomitant diseases.

In yet another aspect, the present invention provides a method for treating cardiovascular diseases (including, but not limited to, coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, coronary artery disease, peripheral vascular disease, peripheral artery disease , and intermittent claudication) in patients, the method includes the patient taking the aforementioned combination or pharmaceutical composition.

Benefits and unexpected findings

The inventors of the present invention unexpectedly discovered beneficial and synergistic effects of a combination of statins with a glycyrrhizin derivative, which provides potential for improving properties in the treatment of diseases such as hyperlipidemia, hypercholesterolemia, hypertriglyceridemia and cardiovascular diseases. In particular, the use of the combination has the potential to increase the safety profile during long-term statin therapy, since the risk of the side effects described above for statins is significantly reduced.

The issue of side effects of statins was addressed by reducing doses of statins and combining them with glycyrrhizin derivatives while maintaining the hypolipidemic effect characteristic of the maximum dose of statins. The proposed solution eliminates the need for prescribing high doses of statins in long-term therapy. This fact could not be predicted, or expected from the prior art.

In particular, it was unexpectedly found by the present inventors that administration of statins (in particular, but not limited to simvastatin) in combination with a glycyrrhizin derivative (in particular, but not limited to, glycyrrhizic acid or a salt thereof, such as ammonium glycyrrhizinate) contributes to an improved reduction total cholesterol in the blood compared with the same dose of statin when taken in monotherapy, and lower total cholesterol in the blood, similar to the effect of high doses of statins (namely, twice as much) when taken in m noterapii. This favorable hypocholesterolemic efficacy of the combination provides an opportunity to reduce the dose of statin in the composition, along with the ability to reduce or eliminate some side effects associated with the use of statins.

In particular, it has been demonstrated that combinations of statins and glycyrrhizinates in accordance with the present invention (such as combinations of statins with ammonium glycyrrhizinate, glycyrrhizic acid, sodium glycyrrhizinate and glycyrrhetinate) have a synergistic hypocholesterolemic effect.

Moreover, the present inventors have unexpectedly found that the use of statin (in particular, but not limited to simvastatin) in combination with a glycyrrhizin derivative (in particular, but not limited to, glycyrrhizic acid or its salt, such as ammonium glycyrrhizinate) is equally effective as well as the use of higher doses of statin (for example, a twice as large dose) in monotherapy, but the severity of side effects such as hepatotoxicity and myotoxicity is lower. What gives statin compositions an improved safety profile than was known from the prior art.

A solid pharmaceutical composition comprising a statin and a glycyrrhizin derivative is not known in a certain weight ratio from the prior art. In addition, the inventors of the present invention unexpectedly found that mixing a solid form of statin (in particular, but not limited to, simvastatin and atorvastatin) with a solid form of glycyrrhizic derivative (in particular, but not limited to, glycyrrhizic acid) in the absence of solvents avoids the formation of unstable molecular complexes formed by mixing these components in solution. This increased stability allows the use of these mixtures for commercial pharmaceutical products.

DETAILED DESCRIPTION

Definitions

Unless otherwise specified, the following terms used in this description have the following meanings for the purposes of this application.

Definitions of standard chemical terms can be found in reference books, including Keri and Sandberg's Advanced Organic Chemistry Course, 4th ed. Vol. A (2000) and B (2001), Plenum Press, New York. Some specific definitions are given below.

In this description, unless otherwise indicated, the term “combination of the present invention” generally refers to all aspects of the present invention (combination, pharmaceutical composition, preparation method, method of use / treatment, kit).

“Alkyl” means a straight or branched, saturated aliphatic radical having a carbon chain. In the notation (C _X ) alkyl and (C _XY ) alkyl, typically X and Y denote the number of carbon atoms in the chain. For example, (C _1-6 ) alkyl includes alkyls that contain chains having from 1 to 6 carbon atoms. Examples include methyl, ethyl, propyl, isopropyl, butyl, sec-butyl, isobutyl, tert-bitulum, pentyl and hexyl. In one embodiment, the alkyl is (C _1-10 ) alkyl. In one embodiment, the alkyl is (C _1-6 ) alkyl. In one embodiment, the alkyl is (C _1-4 ) alkyl.

"Alkoxy" means "-O-alkyl", where "alkyl" is as defined below. Examples of alkoxy include methoxy, ethoxy, propoxy, isopropoxy, butoxy, sec-butoxy, isobutoxy, tert-butoxy, pentoxy and hexoxy. In one embodiment, alkoxy is (C _1-10 ) alkoxy. In one embodiment, alkoxy is ( _C1-6 ) alkoxy. In one embodiment, alkoxy is (C _1-4 ) alkoxy.

“Aryl” means a monocyclic or polycyclic ring system, where each ring is aromatic (ie has a total number of pi-electrons equal to 4n + 2, where n is an integer, preferably 1 or 2) or is an aromatic ring system, consisting of condensed one or more rings. Examples of aryl include phenyl and naphthyl.

"Acyl" means a group R'C (= O) -, where R 'is another substituent, such as an alkyl group (as defined above) or an aryl group (as defined above) or a benzyl group.

"Acyloxy" means an R'C group (= O) -O-, where R 'is another substituent, such as an alkyl group (as defined above) or an aryl group (as defined above) or a benzyl group.

“Carboxyl” means a group —C (═O) —OH.

“Halo” means fluoro, chloro, bromo or iodo.

“Hydroxy” means a —OH group.

“Cyano” means the group —CN.

“Nitro” means the group —NO ₂ .

“Amino” means a group —NR ₂ where each R is independently hydrogen or alkyl (as defined above).

Unless otherwise indicated, the alkyl, alkoxy and aryl groups may be substituted with one or more substituents. The number of substituents is limited only by the number of substitutable positions, but preferably 1, 2, 3, 4 or 5. Examples of substituents include alkyl, alkoxy, carboxy, halo, hydroxy, cyano, nitro, amino (-NR ₂ , where each R is independently hydrogen or alkyl )

“Monosaccharide” means a carbohydrate (sugar) moiety that cannot be hydrolyzed to a simpler sugar. The term "monosaccharide" is intended to encompass both free monosaccharides and monosaccharide residues that form part of a larger molecule (in particular, but not limited to, monosaccharides attached via an oxygen atom, in particular via a glycosidic bond), to the rest of the molecule ( usually in an anomeric position). The monosaccharide may have a D- or L-configuration, and may be aldose or ketose. In one embodiment, the monosaccharide is hexose, examples of which include aldohexoses, such as glucose, galactose, allose, altrose, mannose, gulose, idose and thalose, and ketohexoses, such as fructose, tagatose, psychosis and sorbose. In another embodiment, the monosaccharide is a pentose, examples of which include aldopentoses, such as ribose, arabinose, xylose and lyxose, and ketopentoses, such as ribulose and xyluloses. The term "monosaccharide" is also intended to cover oxidized monosaccharide residues (where one or more primary alcohol groups are oxidized to carboxyl groups, in particular uronic acids, in which the terminal primary alcohol group of a monosaccharide is oxidized to a carboxyl group), reduced monosaccharide residues (where one or several carbonyl groups are reduced to hydroxy groups), deoxy monosaccharide moieties (where one or more hydroxyl groups are replaced by hydrogen), esterified mon osaccharide residues (where one or more free hydroxyl groups are converted to ether groups such as alkoxy or benzyloxy), and esterified monosaccharide residues (where one or more free hydroxyl groups are converted to acyloxy groups).

"Disaccharide" means a residue containing 2 monosaccharide residues, as defined above, linked to each other via a glycosidic bond. The term “disaccharide” is intended to encompass both free disaccharides and disaccharide residues that form part of a larger molecule (in particular, but not limited to, disaccharides attached through an oxygen atom, in particular through a glycosidic bond), to the rest of the molecule ( usually in an anomeric position). When the monosaccharide residues are hexose residues, the glycosidic bonds can be of the following types: 1,4'-glycosidic bonds (which may be 1,4'-α- or 1,4'-β-glycosidic bonds), 1,6'- glycosidic bonds (which may be 1,6'-α- or 1,6'-β-glycosidic bonds), 1,2'-glycosidic bonds (which may be 1,2'-α- or 1,2'-β - glycosidic bonds), or 1,3'-glycosidic bonds (which may be 1,3'-α-or 1,3'-β-glycosidic bonds). Examples of suitable disaccharides include lactose, maltose, cellobiose, sucrose, trehalose, isomaltulose and trehalulose. Each of the monosaccharide residues of the disaccharide residue can be oxidized, reduced, esterified and / or esterified.

"Oligosaccharide" means a residue containing from 3 to 10 monosaccharide residues (as defined above) linked to each other via a glycosidic bond (as defined and examples above) in a branched or unbranched chain or ring (possibly having a saccharide side chain) . In one embodiment, there may be monosaccharide residues (“oligosaccharide chain”) in the chain, examples of which include maltotriose, maltotetraose, maltopentaose, maltohexanose, maltoheptanose, cellobiose, cellotriose, cellotetosaose, cellogeloseose, and short chain fructose residues; mannanoligosaccharides, isomaltooligosaccharides, galactooligosaccharides and xyloooligosaccharides. In another embodiment, monosaccharide residues can form a ring "cyclic oligosaccharides", usually the ring consists of 5-8 monosaccharide residues, preferably from 6 to 8, and even more preferably 6 monosaccharide residues; examples of such cyclic oligosaccharides include cyclodextrins such as α-cyclodextri (6-membered sugar molecule), β-cyclodextrin (7-membered sugar molecule) and γ-cyclodextrin (8-membered sugar molecule).

Statins and other lipid-lowering drugs

One element of the combination of the present invention is a lipid-lowering drug. In the description, the term “antihyperlipidemic drug” is synonymous with “lipid-lowering drug” and refers to any drug that is effective in lowering the level of lipids in the blood of a subject. The term "lipids" typically includes, for example, triglycerides, monoglycerides, diglycerides, free fatty acids, phospholipids, glycerolipids, glycerophospholipids, sphingolipids, lipoproteins (low density lipoproteins, high density lipoproteins), sterol lipids and in particular derivatives such as cholesterol esters), prenol lipids, saccharolipids and polyketides.

The hypolipidemic effect of an antihyperlipidemic drug may include a hypocholesterolemic effect (i.e., lowering the level of cholesterol in the blood of the subject), a hypotriglyceridemic effect (i.e., lowering the level of triglycerides in the blood of the subject), or both. In one embodiment, the antihyperlipidemic drug is a hypocholesterolemic drug (or antihypercholesterolemic). In one embodiment, the hypocholesterolemic effect of the drug is manifested in a decrease in the ratio of LDL cholesterol to HDL cholesterol. In one embodiment, the antihypercholesterolemic effect is to reduce the ratio of total cholesterol to HDL cholesterol.

In one embodiment, one element of the combination of the present invention is a statin. As used herein, the term “statin” is a synonym for “HMG-CoA reductase inhibitor” and means a compound that is capable of inhibiting HMG-CoA reductase. HMG-CoA reductase (also known as 3-hydroxy-3-methyl-glutaryl-CoA reductase) is the speed controlling enzyme of the mevalonate pathway, the metabolic pathway in which cholesterol is formed, which is the first involved HMG-CoA reductase pathway enzyme. Statins take the place of HMG-CoA in the enzyme and reduce the rate of formation of mevalonate, the next molecule in the cascade of cholesterol biosynthesis.

In another embodiment, the combination of the present invention comprises one statin. In another embodiment, the combination of the present invention comprises a mixture of two or more (e.g., two, three, four) statins.

In one embodiment, the statin is selected from the group consisting of atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin and fluvastatin, and a mixture of any of these components.

Statin may be in its free form (i.e., not ionized) or in the form of a pharmaceutically acceptable salt (as defined and described below).

In one embodiment, statin is atorvastatin. Atorvastatin is sold (as calcium salt) by Pfizer under the trade name Lipitor® and a number of generic pharmaceutical manufacturers. It has the systematic name (3R, 5R) -7- [2- (4-fluorophenyl) -3-phenyl-4- (phenylcarbamoyl) -5-propan-2-ylpyrrol-1-yl] -3,5-dihydroxyheptanoic acid and the structure depicted below:

The synthesis of atorvastatin is described in US Pat. No. 4,681,893.

In one embodiment, the statin is lovastatin. Lovastatin is sold by Merck under the trade name Mevacor®. It has a systematic name (1S, 3R, 7S, 8S, 8aR) -8- {2 - [(2R, 4R) -4-hydroxy-6-oxooxan-2-yl] ethyl} -3,7-dimethyl-1, 2,3,7,8,8a-hexahydronaphthalen-1-yl (2S) -2-methylbutanoate and the structure shown below:

Lovastatin is a naturally-occurring compound found in oyster mushrooms and red rice yeast. The synthesis / isolation of lovastatin is described in patents EP 022478 B and US 4231983.

In one embodiment, the statin is pravastatin. Pravastatin is sold by Bristol-Myers Squibb and Daiichi Sankyo under the trade names Pravakol® and Selektin® and a number of generic pharmaceutical manufacturers. It has the systematic name (3R, 5R) -3,5-dihydroxy-7 - ((1R, 2S, 6S, 8R, 8аR) -6-hydroxy-2-methyl-8 - {[(2S) -2-methylbutanoyl ] hydroxy} -1,2,6,7,8,8a-hexahydronaphthalen-1-yl) heptanoic acid and the following structure:

Pravastatin can be obtained by fermentation with the bacterium Nocardia autotrophica. The synthesis / isolation of pravastatin is described in GB 2111052 B.

In one embodiment, the statin is rosuvastatin. Rosuvastatin is sold by AstraZeneca under the trade name Crestor®. It has a systematic name.

(3R, 5S, 6E) -7- [4- (4-fluorophenyl) -2- (N-methylmethanesulfonamido) -6- (propan-2-yl) pyrimidin-5-yl] -3,5-dihydroxyheptan-6 acid and the following structure:

The synthesis of rosuvastatin is described in patent EP 521471 A.

In one embodiment, the statin is simvastatin. Simvastatin is sold by a number of generic pharmaceutical manufacturers under the brand name Zokor®. It has a systematic name (1S, 3R, 7S, 8S, 8aR) -8- {2 - [(2R, 4R) -4-hydroxy-6-oxotetrahydro-2H-pyran-2-yl] ethyl} -3,7- dimethyl-1,2,3,7,8,8a-hexahydronaphthalen-1-yl 2,2-dimethylbutanoate and has the following structure:

Simvastatin is a synthetic derivative of the fermentation product of Aspergillus terreus fungi. The synthesis of simvastatin is described in patent EP 033538 B.

In one embodiment, the statin is fluvastatin. Fluvastatin is marketed by a number of generic manufacturers, as well as under the Leskol® brand name. It has the systematic name (3R, 5S, 6E) -7- [3- (4-fluorophenyl) -1- (propan-2-yl) -1H-indol-2-yl] -3,5-dihydroxyheptan-6- hydrochloric acid and the following structure:

The synthesis of fluvastatin is described in patent EP 0114027 B.

In one embodiment, the statin is pitavastatin. Pitavastatin is marketed under the trade name Livalo®. It has the systematic name (3R, 5S, 6E) -7- [2-cyclopropyl-4- (4-fluorophenyl) quinolin-3-yl] -3,5-dihydroxyheptan-6-oic acid and the following structure:

The synthesis of pitavastatin is described in US 5753675.

In another embodiment, the combination of the present invention may include an antihyperlipidemic drug other than statin. Examples of such drugs include fibrate class drugs such as bezafibrate (Besalip®), ciprofibrate (Modalim®), clofibrate, gemfibrosio (Lopid®) and fenofibrate (TriCor®), bile acid sequestrants such as cholestipol, cholestriamine and cholevelam, and other lipid-lowering drugs, such as nicotinic acid

In one embodiment, the lipid-lowering drug is not a glycyrrhizin derivative (as described and defined in the example below). In one embodiment, the lipid-lowering drug is not glycyrrhizic acid or its salt. In one embodiment, the lipid-lowering drug is not glycyrrhetic acid or its salt.

Glycyrrhizic acid derivative

Another combination element of the present invention is a glycyrrhizin derivative. In one embodiment, the glycyrrhizin derivative is a compound of the following formula:

where R is selected from the groups consisting of:

where R is selected from the group including:

hydrogen;

a monosaccharide, disaccharide or oligosaccharide residue that can be oxidized, reduced, esterified and / or esterified;

hydroxy;

amino;

halo;

C _1-10 alkoxy substituted with one or more substituents selected from halo, hydroxy, C _1-10 alkoxy, carboxy, (C _1-10 alkoxy) carbonyl, a monosaccharide, disaccharide or oligosaccharide residue, which can be oxidized, reduced, esterified and / or esterified;

C _1-10 alkyl substituted with one or more substituents selected from halo, hydroxy, C _1-10 alkoxy, carboxy, (C _1-10 alkoxy) carbonyl, a monosaccharide, disaccharide or oligosaccharide residue, which can be oxidized, reduced, esterified and / or esterified; or its dehydro derivative.

In one embodiment, R is a monosaccharide fragment. Typically, this monosaccharide residue is bound to the rest of the molecule fragments via a glycosidic bond in the anomeric position, for example, the oxygen atom of the monosaccharide residue is bound to the glycyrrhetic acid residue. Examples of suitable monosaccharide residues include aldohexoses, such as glucose, galactose, allose, altrose, mannose, gulose, idose and thalose, and ketohexoses, such as fructose, tagatose, psychosis and sorbose. In another embodiment, the monosaccharide is a pentose, examples of which include aldopentoses, such as ribose, arabinose, xylose and lyxose, and ketopentoses, such as ribulose and xyluloses. A preferred monosaccharide residue is a glucose moiety.

The monosaccharide residue may be unmodified (i.e., having only functional groups inherent in natural monosaccharide residues) or modified. In one embodiment, the monosaccharide residue is not modified. Examples of modifications include oxidation (when one or more primary alcohol groups are oxidized to carboxyl groups, in particular uronic acids, in which the terminal primary alcohol group of a monosaccharide is oxidized to a carboxyl group), reduction (when one or more carbonyl groups are reduced to hydroxy groups) , deoxy (when one or more hydroxyl groups are replaced by hydrogen), esterification (when one or more free hydroxyl groups are converted to ether groups, such as alk B or benzyloxy) and eterifitsikatsiya (wherein one or more free hydroxyl groups are converted into an acyloxy group).

In one embodiment, the monosaccharide residue is oxidized, usually by oxidation of one or more primary alcohol groups to carboxy groups. In one embodiment, the monosaccharide residue is a uronic acid residue in which the terminal primary hydroxy group is oxidized to a carboxy group. Examples of such uronic acid residues include glucuronic acid and galacturonic acid. A glucuronic acid residue is preferred.

In one embodiment, R is a disaccharide residue. As a rule, it includes the first monosaccharide residue (as defined and shown in the example above) connected to the rest of the molecule via a glycosidic bond and has a second monosaccharide residue (as defined and shown in the example above) connected to the first monosaccharide residue through another glycosidic bond . When the monosaccharide residues are hexose residues, the glycosidic bonds can be of the following types: 1,4'-glycosidic bonds (which may be 1,4'-α- or 1,4'-β-glycosidic bonds), 1,6'- glycosidic bonds (which may be 1,6'-α- or 1,6'-β-glycosidic bonds), 1,2'-glycosidic bonds (which may be 1,2'-α- or 1,2'-β - glycosidic bonds), or 1,3'-glycosidic bonds (which may be 1,3'-α- or 1,3'-β-glycosidic bonds). The first and second monosaccharide residues may be the same or different, preferably they should be selected from the monosaccharide residues listed above. In one embodiment, at least one monosaccharide residue of the disaccharide residue is a glucose residue. In one embodiment, both monosaccharide residues of the disaccharide residue are glucose residues. In one embodiment, the disaccharide consists of two monosaccharide residues (preferably glucose residues) linked by a 1,2'-glycosidic bond (preferably a 1,2'-β-glycosidic bond).

In one embodiment, both monosaccharide residues of the disaccharide residue are not modified. In another embodiment, one or both (preferably both) of the two monosaccharide disaccharide residues are modified by any of the above method of modifying monosaccharide groups. In one embodiment, one or both (preferably both) of the two monosaccharide residues of the disaccharide are oxidized, usually by oxidizing one or more primary alcohol groups of the residue to carboxyl groups. In one embodiment, one or both (preferably both) of the two monosaccharide residues of the disaccharide residue are uronic acid residues. In one embodiment, one or both (preferably both) of the two monosaccharide disaccharide residues are glucuronic acid residues. In one embodiment, two uronic acid residues (preferably glucuronic acid residues) are linked by a 1,2'-glycosidic bond (preferably a 1,2'-β-glycosidic bond).

In one embodiment, R is an acyl group R'C (= O) - (where R'-C _{1-30 is an} alkyl group optionally substituted with a carboxyl group, an aryl group, for example a phenyl or naphthyl group, or a benzyl group). In this embodiment, it is preferred that R 'is a C _1-6 alkyl group optionally substituted with a carboxy group, and more preferably methyl, ethyl, propyl or 2-carboxyethyl.

In one embodiment, R is a hydroxy or monosaccharide, disaccharide or oligosaccharide residue, wherein the residue can be oxidized, reduced, deoxy, esterified and / or esterified.

In one embodiment, R is a hydroxy or monosaccharide or disaccharide moiety, wherein said moiety is optionally oxidized, reduced, deoxy, esterified, and / or ester.

In one embodiment, R is a hydroxy or monosaccharide or disaccharide residue, wherein the residue may be oxidized.

In one embodiment, R is a hydroxy or disaccharide residue, wherein the residue may be oxidized.

In one embodiment, R is hydroxy.

In one embodiment, R is a disaccharide residue in which both monosaccharide residues are uronic acid residues.

In one embodiment, R is a disaccharide residue in which both monosaccharide residues are glucuronic acid residues.

In one embodiment, the glycyrrhizic derivative is glycyrrhizic acid (also known as glycyrrhine) or a pharmaceutically acceptable salt, solvate or hydrate thereof. This compound has two glucuronic acid residues linked to each other by a 1,2'-β-glycosidic linkage and linked to part of the glycyrrhetic acid molecule by another glycosidic linkage. Glycyrrhizic acid has the systematic name (3β, 18α) -30-hydroxy-11,30-dioxoleolean-12-en-3-yl 2-O-β-D-glucopyranuronosyl-β-D-glucopyranosiduronic acid and the following structure:

In one embodiment, the glycyrrhizic derivative is glycyrrhizic acid. In another embodiment, the glycyrrhizin derivative is a pharmaceutically acceptable salt of glycyrrhizic acid. Examples of pharmaceutically acceptable salts include, in general, those listed and exemplified below. Particularly preferred examples include alkali metal glycyrrhizic acid salts (such as sodium glycyrrhizinate and potassium glycyrrhizinate) and glycyrrhizin salts with ammonium or organic amines (such as ammonium glycyrrhizinate).

In one embodiment (where R is hydroxy), the glycyrrhizin derivative is glycyrrhetic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof. Glycyrrhic acid (also known as glycyrrhetinic acid or enoxolone) is obtained by hydrolysis of glycyrrhizic acid. It has a systematic name (2S, 4aS, 6aS, 6bR, 8aR, 10S, 12aS, 12bR, 14bR) -l0-hydroxy-2,4a, 6a, 6b, 9,9,12a-heptamethyl-13-oxo-1, 2,3,4,4a, 5,6,6a, 6b, 7,8,8a, 9,10,11,12,12a, 12b, 13,14b-icosahydropicene-2-carboxylic acid and the following structure:

In another embodiment, the glycyrrhizin derivative is a pharmaceutically acceptable salt of glycyrrhetic acid. Examples of pharmaceutically acceptable salts include, in general, those listed and exemplified below. Particularly preferred examples include alkali metal glycyrrhizic acid salts (such as sodium glycyrrhizinate and potassium glycyrrhizinate) and glycyrrhizin salts with ammonium or organic amines (such as ammonium glycyrrhizinate).

In another embodiment, the glycyrrhizin derivative is a pharmaceutically acceptable derivative of glycyrrhetic acid. Various derivatives of glycyrrhetic acid can be obtained by converting the hydroxyl group to another functional group R, as defined above.

Specific examples of glycyrrhetic acid derivatives include acetoxolone (where R-CH ₃ C (= O) -O-) and carbenoxolone (where R-HO ₂ C (CH ₂ ) ₂ C (= O) -O-).

In another embodiment, the glycyrrhizic derivative is a dehydro derivative of glycyrrhetic or glycyrrhizic acid. Such a derivative has a double bond between 18 and 19 carbon atoms and the following general structure:

where R is defined and described above in relation to derivatives of glycyrrhizic acid.

In one embodiment, the glycyrrhizin derivative may be presented in pure form. In another embodiment, the glycyrrhizin derivative may be present in combination in the form of a mixture with other components, typically found in natural raw materials, such as licorice (Glycyrrhiza glabra) from which such compounds are usually derived. Typically, such other components include other terpenoid glycosides. Other components may be pharmaceutically inactive or also have a pharmacological effect comparable to that of the glycyrrhizin derivatives mentioned above. In one embodiment, the glycyrrhizin derivative contains at least 10%, for example at least 15%, for example at least 20%, for example at least 25%, for example at least 30%, for example at least 35 %, for example at least 40%, for example at least 45%, for example at least 50%, for example at least 55%, for example at least 60%, for example at least 65%, for example, at least 70%, for example at least 75%, for example at least 80%, for example at least 85%, for example at least 90%, for example at least it least 95%, such as at least 97%, such as at least 98%, such as at least 99%, such as at least 99.5% by weight of the mixture.

Preferred Combinations

In one embodiment, the statin is simvastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is simvastatin, and the glycyrrhizin derivative is monoammonium glycyrrhizinate.

In one embodiment, the statin is atorvastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is atorvastatin and the glycyrrhizin derivative is glycyrrhizic acid. In one embodiment, the statin is atorvastatin, and the glycyrrhizin derivative is monoammonium glycyrrhizinate.

In one embodiment, the statin is lovastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is lovastatin and the glycyrrhizin derivative is mono-, di- or trisodium glycyrrhizinate.

In one embodiment, the statin is pravastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizin derivative is glycyrrhetic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is pravastatin and the glycyrrhizin derivative is glycyrrhetic acid.

In one embodiment, the statin is rosuvastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is rosuvastatin and the glycyrrhizin derivative is monoammonium glycyrrhizinate.

In one embodiment, the statin is fluvastatin or a pharmaceutically acceptable salt or solvate thereof, and the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof. In one embodiment, the statin is fluvastatin and the glycyrrhizin derivative is glycyrrhizic acid.

In one embodiment, the composition does not contain a molecular complex of statin and glycyrrhizin derivative. As used herein, the term “molecular complex” means a complex in which a statin and a glycyrrhizin derivative are combined. In one embodiment, the term "molecular complex" means a complex in which the statin and glycyrrhizin derivative are linked by a covalent bond. In one embodiment, the term “molecular complex” means a complex in which the statin and glycyrrhizin derivative are linked by a non-covalent bond, for example, through electrostatic interactions such as Van der Waals forces, dipole-dipole interactions, or hydrogen bonds. Where statin is atorvastatin, in one embodiment, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid. Where statin is simvastatin, in one embodiment, the composition does not contain a molecular complex of simvastatin and glycyrrhizic acid.

In some embodiments, the combination obtained by liquid-phase synthesis in accordance with the description of RU 2308947 and RU 2396079 (in particular, Examples 1 and 2 of each document) is excluded from this invention. As described, combinations containing such molecular complexes are unstable in time, due to the rapid decrease in glycyrrhizic acid content. In addition, the solubility of the simvastatin / glycyrrhizic acid complex described in RU 2308947 in water also decreases over time. The instability of these molecular complexes makes them industrially unsuitable for pharmaceutical production.

Therefore, in certain embodiments, the following combinations are excluded:

(i) a combination (especially compositions obtained by liquid-phase synthesis using solvents selected, for example, from ethanol, acetone or any mixture thereof) containing glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.17 to 1: 0.182, for example 1: 0.171-1: 0.18, for example 1: 0.171-1: 0.173 or 1: 0.18-1: 0.182;

(ii) a combination (especially compositions obtained by liquid phase synthesis using solvents selected, for example, from ethanol, acetone or any mixture thereof) containing glycyrrhizic acid and atorvastatin in a weight ratio (glycyrrhizic acid: atorvastatin) from 1: 0.45 to 1: 0.5; for example 1: 0.47-1.0.5, for example 1: 0.47-1: 0.472 or 1: 0.495-1: 0.497;

(iii) a combination (especially compositions obtained by liquid phase synthesis using solvents selected, for example, from ethanol, acetone or any mixture thereof) containing glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.1 to 1: 0.14, for example 1: 0.115-1: 0.125, for example 1: 0.116-1: 0.118 or 1: 0.123-0: 0.125; and

(iv) a combination (especially compositions obtained by liquid phase synthesis using solvents selected, for example, from ethanol, acetone or any mixture thereof) containing glycyrrhizic acid and simvastatin in a weight ratio (glycyrrhizic acid: simvastatin) from 1: 0.45 to 1: 0.5, for example 1: 0.47 to 1: 0.5, for example 1: 0.47 to 1: 0.472 or 1: 0.495 to 1: 0.497.

Preferred ratios of glycyrrhizic acid derivative and statin

In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.03 to 1: 5. Preferred weight ratios of the combinations of the present invention are expressed below. In this description, the mass ratios are calculated by weight of each active ingredient of the component (i.e. excluding the contribution of counterions in case the active ingredient is a salt). In particular, if the active ingredient has free acid groups, the mass is calculated based on the free acid form, excluding any counterions. Similarly, excluding any counterions, the mass is calculated if the active ingredient has three free main groups.

In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.03 to 1: 2. In another embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.05 to 1: 2. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.05 to 1: 1.

In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.03 to 1: 0.5. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.01 to 1: 0.45. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.1 to 1: 0.3. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.15 to 1: 0.45. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.2 to 1: 0.4. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 0.2 to 1: 0.35. In one embodiment, the combinations of the present invention, the glycyrrhizin derivative and the lipid-lowering drug (preferably statin) are presented in a weight ratio (glycyrrhizin derivative: lipid-lowering drug) from 1: 1 to 1: 0.8.

In one embodiment, the statin is simvastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof, wherein glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof and simvastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 0.1 to 1: 0.3, more preferably 1: 0.15-1: 0.25, more preferably 1: 0.17-1: 0.21, even more preferably 1: 0.18 -1: 0.2. even more preferably 1: 0.182-1: 0.2, even more preferably 1: 0.184-1: 0.195, and most preferably 1: 0.185-1: 0.19.

In one embodiment, the statin is simvastatin, the glycyrrhizin derivative is ammonium glycyrrhizinate, and ammonium glycyrrhizinate and simvastatin are presented in a weight ratio of 1: 0.1 to 1: 0.3, preferably 1: 0.15-1: 0.25, more preferably 1: 0.17-1: 0.21, and most preferably 1: 0.18 to 1: 0.2.

In one embodiment, the statin is atorvastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof, wherein glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof and atorvastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 0.01-1: 0.2, preferably 1: 0.05-1: 0.15, more preferably 1: 0.07-1: 0.11, and most preferably 1: 0.09 -1: 0.13.

In one embodiment, the statin calcium salt of atorvastatin, the glycyrrhizic derivative is glycyrrhizic acid, and glycyrrhizic acid and atorvastatin are presented in a weight ratio of from 1: 0.01 to 1: 0.2, preferably 1: 0.05-1: 0.15, more preferably 1: 0.07-1: 0.11, and most preferably 1: 0.09-1: 0.13.

In one embodiment, the statin is lovastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof, wherein glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof and lovastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 0.01 to 1: 0.3, preferably 1: 0.15-1: 0.25, more preferably 1: 0.17-1: 0.21, and most preferably 1: 0.18 -1: 0.2.

In one embodiment, the statin lovastatin, the glycyrrhizin derivative is sodium glycyrrhizinate, and sodium glycyrrhizinate and lovastatin are presented in a weight ratio of 1: 0.1 to 1: 0.3, preferably 1: 0.15-1: 0.25, more preferably 1 : 0.17-1: 0.21, and most preferably 1: 0.18-1: 0.2.

In one embodiment, the statin is pravastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhetic acid or a pharmaceutically acceptable salt or solvate thereof, wherein the glycyrrhetic acid or its pharmaceutically acceptable salt or solvate and pravastatin or a pharmaceutically acceptable salt or solvate thereof are provided a mass ratio of from 1: 0.3 to 1: 0.5, preferably 1: 0.35-1: 0.45, more preferably 1: 0.35-1: 0.4, and most preferably 1: 0.36 -1: 0.38.

In one embodiment, statin pravastatin, glycyrrhizin derivative - glycyrrhetic acid, and glycyrrhetic acid and pravastatin are presented in a weight ratio of 1: 0.3 to 1: 0.5, preferably 1: 0.35-1: 0.45, more preferably 1 : 0.35-1: 0.4, and most preferably 1: 0.36-1: 0.38.

In one embodiment, the statin is rosuvastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof, wherein glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof and rosuvastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 0.01 to 1: 0.2, preferably 1: 0.05-1: 0.15, more preferably 1: 0.07-1: 0.11, and most preferably 1: 0.08 -1: 0.12.

In one embodiment, the statin is the calcium salt of rosuvastatin, the glycyrrhizin derivative is ammonium glycyrrhizinate, and ammonium glycyrrhizinate and rosuvastatin are presented in a weight ratio of 1: 0.01 to 1: 0.2, preferably 1: 0.05-1: 0.15, more preferably 1: 0.07-1: 0.11, and most preferably 1: 0.08-1: 0.12.

In one embodiment, the statin is fluvastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof, wherein glycyrrhizic acid or a pharmaceutically acceptable salt or solvate thereof and rosuvastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 1 to 1: 0.8, preferably 1: 0.95-1: 0.85, more preferably 1: 0.925-1: 0.875, and most preferably 1: 0.9-1: 0.88 .

In one embodiment, the statin is fluvastatin, the glycyrrhizic derivative is glycyrrhizic acid, and glycyrrhizic acid and fluvastatin are presented in a weight ratio of 1: 1 to 1: 0.8, preferably 1: 0.95-1: 0.85, more preferably 1: 0.925-1: 0.875, and most preferably 1: 0.9-1: 0.88.

In one embodiment, the statin is pitavastatin or a pharmaceutically acceptable salt or solvate thereof, the glycyrrhizic derivative is glycyrrhetic acid or a pharmaceutically acceptable salt or solvate thereof, wherein the glycyrrhetic acid or its pharmaceutically acceptable salt or solvate and pitavastatin or a pharmaceutically acceptable salt or solvate thereof are provided in a mass ratio of from 1: 0.2 to 1: 0.5, preferably 1: 0.35-1: 0.45, more preferably 1: 0.35-1: 0.4, and most preferably 1: 0.36 -1: 0.48.

In one embodiment, the statin is pitavastatin, the glycyrrhizin derivative is glycyrrhetic acid, and glycyrrhetic acid and pitavastatin are presented in a weight ratio of 1: 0.2 to 1: 0.5, preferably 1: 0.25-1: 0.45, more preferably 1: 0.35-1: 0.4, and most preferably 1: 0.36-1: 0.48.

Salts, solvates, hydrates and prodrugs

It should be noted that the compounds used in the combination of the present invention can be present and, if necessary, taken in the form of a salt, solvate, hydrate and prodrug, which are converted in vivo to the compounds used in the combination of the present invention. For example, it is within the scope of the present invention to use the compounds of the present invention in the form of their pharmaceutically acceptable salts, derived from various organic and inorganic acids and bases, in accordance with methods well known in the art. As used herein, the term “pharmaceutically acceptable salt” refers to any compound used in combination with the present invention in salt form.

In the case where the compound of the present invention has a free base form, such compounds can be prepared in the form of a pharmaceutically acceptable acid addition salt with a pharmaceutically acceptable inorganic or organic acid, for example a hydrohalide such as hydrochloride, hydrobromide, hydroiodide; other mineral acids and corresponding salts, such as sulfate, nitrate, phosphate, etc .; as well as alkyl and monoaryl and monoaryl sulfonates, such as ethanesulfonate, toluenesulfonate and benzenesulfonate; as well as other organic acids and corresponding salts, such as acetate, tartrate, maleate, succinate, zither, benzoate, salicylate and ascorbate. Other acid addition salts according to the present invention include, but are not limited to, adipate, alginate, arginate, aspartate, bisulfate, bisulfite, bromide, butyrate, camformate, camphorsulfonate, caprylate, chloride, chlorobenzoate, cyclopentane propionate, digluconate, dihydrogen phosphate, dinodicy fumarate, galacterate (from mucic acid), galacturonate, glucoheptonate, gluconate, glutamate, glycerophosphate, hemisuccinate, hemisulfate, heptanoate, hexanoate, hippurate, hydrochloride, hydrobromide, hydroiodide, 2-hydroxy tansulfonate, iodide, isothionate, isobutyrate, lactate, lactobionate, malate, malonate, mandalate, metaphosphate, methanesulfonate, methyl benzoate, monohydrogen phosphate, 2-naphthalenesulfonate, nicotinate, nitrate, oxalate, oleate, pamphate phenylate, pectenyl phenate, 3 pec phosphate, phosphonate and phthalate. It should be understood that the forms of the free bases usually differ slightly from the corresponding salts in physical properties, such as solubility in polar solvents, but otherwise the salts are equivalent to the corresponding free base forms th for the purposes of the present invention.

In the case where the compounds of the present invention have a free acid form, pharmaceutically acceptable base addition salts can be prepared by reacting the free base compound with a pharmaceutically acceptable inorganic or organic base. Examples of such bases are alkali metal hydroxides, including potassium, sodium and lithium hydroxides; alkaline earth metal hydroxides such as barium and calcium hydroxides; alkali metal alkoxides, for example potassium ethanolate and sodium propanolate; and various organic bases such as ammonium hydroxide, piperidine, diethanolamine and N-methylglutamine. Ammonium salts of the compounds of the present invention are also provided. Other base salts of the present invention include, but are not limited to, copper salts, ferrous and ferrous salts, lithium, magnesium salts, divalent and ferric manganese, potassium, sodium and zinc salts. Salts of organic bases include, but are not limited to, salts of primary, secondary and tertiary amines, substituted amines, including naturally occurring substituted amines, cyclic amines and basic ion exchange resins, for example arginine, betaine, caffeine, chlorprocaine, choline, N, N'-dibenzylethylenediamine (benzathine), dicyclohexylamine, diethanolamine, 2-diethylaminoethanol, 2-dimethylaminoethanol, ethanolamine, ethylenediamine, N-ethylmorpholine, N-ethylpiperidine, glucamine, glucosamine, histidine, hydrabramine, isopropylamine, N-methylluene, lidocaine, lidocaine, g yutamin, morpholine, piperazine, piperidine, polyamine resins, procaine, purines, theobromine, triethanolamine, triethylamine, trimethylamine, tripropylamine and tris- (hydroxymethyl) methylamine (trometanamin). It should be understood that the forms of free acids usually differ slightly from the corresponding salts in physical properties, such as solubility in polar solvents, but otherwise the salts are equivalent to the corresponding free base forms for the purposes of the present invention.

Compounds according to the present invention can also be easily obtained or formed during the implementation of the methods according to the present invention in the form of solvates (for example, hydrates). Hydrates of the compounds of the present invention can be easily obtained by recrystallization from a mixture of aqueous / organic solvents such as dioxin, tetrahydrofuran or methanol. Derivatives of the compounds used in the combination of the present invention in the form of prodrugs can be obtained by the modification of the substituents of the compounds of the present invention, which subsequently in vivo acquire an excellent substituent. For example, appropriate prodrugs can be prepared by reacting a non-derivatized compound with a suitable carbamylating agent (e.g., 1.1 acyloxyalkylcarbonochloridate, perenitrophenyl carbonate and the like) or an acylating agent. Further examples and methods for preparing prodrugs are described in Saulnier et al., Bioorganic and Medicinal Chemistry Letters, 1994, 4, 1985).

Pharmaceutical Compositions

A large number of compositions can be used to deliver the combination of the present invention. Such compositions may include, in addition to the statin and glycyrrhizin derivative used in the combination of the present invention, conventional pharmaceutical excipients and other typical pharmaceutically inactive components. In addition, the compositions may include other active substances, in addition to the statin and glycyrrhizin derivative, used in the combination of the present invention. These other active agents may include additional statin and / or glycyrrhizin derivatives, in accordance with the invention, and / or one or more other pharmaceutically active substances.

Compositions containing the combination of the present invention can be administered separately or jointly orally, parenterally, intraperitoneally, intravenously, intraarterially, transdermally, sublingually, intramuscularly, rectally, buccally, intranasally liposomally, by inhalation, vaginally, intraocularly, by local delivery (e.g. catheter or stent), subcutaneously, into adipose tissue, into the joint, or through the trachea. Preferably, the combination of the present invention can be administered orally. The compounds and / or compositions of the present invention may also be administered in sustained or modified release dosage form.

Oral pharmaceutical dosage forms can be solids, gels, or liquids. Examples of solid dosage forms include, but are not limited to, tablets, capsules, granules, powders. More specific examples of oral tablets include compressed tablets, chewable tablets, and tablets which may be enteric coated, film coated or sugar coated. Examples of capsules include hard or soft gelatin capsules. Granules and powders can be presented in effervescent and non-effervescent forms. Each type of dosage form may be combined with other ingredients known to those skilled in the art.

In addition to the statin and glycyrrhizin derivative used in combination in accordance with the present invention, the composition may include a diluent such as lactose, sucrose, dicalcium phosphate or carboxymethyl cellulose; a lubricant such as magnesium stearate, calcium stearate and talc; and a binder, such as starch, natural gums, gum arabic, gelatin, glucose, molasses, polyvinylpyrrolidone, celluloses and their derivatives, povidone, crospovidones and other similar binders known to those skilled in the art.

Liquid compositions for pharmaceutical use can, for example, be prepared by dissolving, dispersing, or otherwise mixing the active compound defined above and optional pharmaceutical excipients, such as carriers, for example, water, phys. a solution, an aqueous solution of dextrose, glycols, ethanol and the like, with the formation of solutions or suspensions. If desired, the pharmaceutical composition for administration may contain minor amounts of auxiliary substances, such as wetting or solubilizing agents, emulsifying agents, pH buffering agents, such as, for example, acetate, sodium citrate, cyclodextrin derivatives, sorbitan monolaurate, sodium triethanolamine acetate, triethanolamine oleate and other similar agents. Actual methods for preparing such dosage forms are known or will be apparent to those skilled in the art; e.g. Remington's Pharmaceutical Sciences, Mack Publishing Company, Easton, Pa., 15th Edition, 1975.

Dosage

Preferred doses expressed in weight of each component of the combination of the present invention are presented below. In one embodiment, the masses are expressed as the total mass of each ingredient of the component (for example, excluding the contribution to the mass of the counterion when the active component is in the form of a salt). In one embodiment, the masses are expressed as the total mass of each ingredient of the component (for example, excluding the contribution of the counterion when the active component is in salt form). Unless otherwise described, the mass of the ingredient may be expressed by any of these methods.

In one embodiment, the statin is simvastatin and statin is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably from 10 to 30 mg / day , significantly more preferably from 15 to 25 mg / day, most preferably 20 mg / day.

In one embodiment, statin is atorvastatin and atorvastatin in an amount of from 0.5 to 100 mg / day, preferably from 0.5 to 50 mg / day, more preferably from 1 to 40 mg / day, even more preferably from 2 to 20 mg / day, significantly more preferably 5 to 15 mg / day, most preferably 10 mg / day.

In one embodiment, the statin is lovastatin and lovastatin is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably from 10 to 30 mg / day , significantly more preferably from 15 to 25 mg / day, most preferably 20 mg / day.

In one embodiment, statin is pravastatin and pravastatin is used in an amount of from 0.02 to 400 mg / day, preferably from 1 to 200 mg / day, more preferably from 2 to 100 mg / day, even more preferably from 5 to 50 mg / day , significantly more preferably from 20 to 30 mg / day, most preferably 40 mg / day.

In one embodiment, the statin is rosuvastatin and rosuvastatin is used in an amount of from 0.05 to 100 mg / day, preferably from 0.5 to 50 mg / day, more preferably from 1 to 40 mg / day, even more preferably from 2 to 20 mg / day, significantly more preferably 5 to 15 mg / day, most preferably 10 mg / day.

In one embodiment, statin is fluvastatin and fluvastatin is used in an amount of from 0.1 to 800 mg / day, preferably from 1 to 400 mg / day, more preferably from 2 to 200 mg / day, even more preferably from 40 to 120 mg / day significantly more preferably 60 to 100 mg / day, most preferably 80 mg / day

In one embodiment, statin is pitavastatin and pitavastatin is used in an amount of from 0.2 to 800 mg / day, preferably from 0.5 to 200 mg / day, more preferably from 2 to 100 mg / day, even more preferably from 5 to 50 mg / day, much more preferably 10 to 30 mg / day, most preferably 40 mg / day.

In one embodiment, the lipid-lowering drug is fibrate and fibrate is used in an amount of from 9 to 9300 mg / day, preferably from 45 to 600 mg / day.

In one embodiment, the lipid-lowering drug is a bile acid sequestrant and a bile acid sequestrant is used in an amount of from 9 to 9300 mg / day, preferably from 625 to 400 mg / day.

In one embodiment, the lipid-lowering drug is nicotinic acid and nicotinic acid is used in an amount of from 22.5 to 9300 mg / day, preferably from 50 to 1000 mg / day.

In one embodiment, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof in a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 85 to 110 mg / day, most preferably 90 or 108 mg / day.

In one embodiment, the glycyrrhizic derivative is glycyrrhizic acid in a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 85 to 100 mg / day, most preferably 90 mg / day.

In one embodiment, the glycyrrhizin derivative is glycyrrhetic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof in a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day, most preferably 108 mg / day.

In one embodiment, the glycyrrhizic derivative is glycyrrhetic acid in a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day, most preferably 108 mg / day .

In one embodiment, the glycyrrhizin derivative is ammonium glycyrrhizinate, which is used at a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day, most preferably 108 mg / day.

In one embodiment, the glycyrrhizin derivative is sodium glycyrrhizinate, which is used at a dose of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day, most preferably 108 mg / day.

In one embodiment, a statin is simvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, a glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof, simvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably from 10 to 30 mg / day, significantly more preferably from 15 to 25 mg / day, most preferably 20 mg / day and glyc rhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 5 to 1000 mg / day, preferably from 5 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day , significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, and most preferably from 80 to 120 mg / day. In one embodiment, the statin is simvastatin, the glycyrrhizin derivative is ammonium glycyrrhizinate, simvastatin is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably from 10 to 30 mg / day, significantly more preferably 15 to 25 mg / day, most preferably 20 mg / day, and ammonium glycyrrhizinate is used in an amount of 5 to 1000 mg / day, preferably 5 to 500 mg / day, more preferably 5 to 400 mg / day, even more preferably 10 to 300 mg / day, s noticeably more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day, most preferably 108 mg / day .

In one embodiment, where the statin is atorvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof, atorvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.05 to 100 mg / day, preferably 0.5 to 50 mg / day, more preferably 1 to 40 mg / day, even more preferably 2 to 20 mg / day, much more preferably 5 to 15 mg / day, most preferably 10 mg / day glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably from 80 to 120 mg / day. In one embodiment, where the statin is atorvastatin, the glycyrrhizin derivative is glycyrrhizic acid, atorvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.05 to 100 mg / day, preferably from 0.5 to 50 mg / day, more preferably from 1 to 40 mg / day, even more preferably 2 to 20 mg / day, significantly more preferably 5 to 15 mg / day, most preferably 10 mg / day, and glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount 0.5 to 1000 mg / day, preferably from 5 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 85 to 100 mg / day, and most preferably 90 mg / day.

In one embodiment, the statin is lovastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof, lovastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably from 10 to 30 mg / day, significantly more preferably from 15 to 25 mg / day, most preferably 20 mg / day and glycyr isinic acid or a pharmaceutically acceptable salt, solvate or hydrate is used in an amount of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably from 80 to 120 mg / day. In one embodiment, the estatin is lovastatin, the glycyrrhizin derivative is sodium glycyrrhizinate, lovastatin or a pharmaceutically acceptable salt, solvate or hydrate is used in an amount of from 0.1 to 200 mg / day, preferably from 1 to 100 mg / day, more preferably from 5 to 50 mg / day, even more preferably 10 to 30 mg / day, much more preferably 15 to 25 mg / day, most preferably 20 mg / day, and sodium glycyrrhizinate is used in an amount of 0.5 to 1000 mg / day, preferably 1 to 500 mg / day, more preferably 5 to 4 00 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, still more preferably 100 to 110 mg / day; and most preferably 108 mg / day.

In one embodiment, the statin is pravastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizin derivative is glycyrrhetic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof, pravastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.02 to 400 mg / day, preferably from 1 to 200 mg / day, more preferably from 2 to 100 mg / day, even more preferably from 5 to 50 mg / day, significantly more preferably from 20 to 30 mg / day, most preferably 40 mg / day and glycyr retic acid or a pharmaceutically acceptable salt, solvate or hydrate is used in an amount of from 0.5 to 1000 mg / day, preferably from 5 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably 80-120 mg / day. In one embodiment, the statin is pravastatin, the glycyrrhizin derivative is glycyrrhetic acid, and pravastatin is used in an amount of 0.02 to 400 mg / day, preferably 1 to 200 mg / day, more preferably 2 to 100 mg / day, even more preferably 5 to 50 mg / day, much more preferably 20 to 30 mg / day, most preferably 40 mg / day, and glycyrrhetic acid is used in an amount of 0.5 to 1000 mg / day, preferably 5 to 500 mg / day more preferably 5 to 400 mg / day, even more preferably 10 to 300 mg / day b, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day and most preferably 108 mg /day.

In one embodiment, the statin is rosuvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizic derivative is glycyrrhizic acid or its pharmaceutically acceptable salt, solvate or hydrate, rosuvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.05 to 100 mg / day, preferably from 0.5 to 50 mg / day, more preferably from 1 to 40 mg / day, even more preferably from 2 to 20 mg / day, significantly more preferably from 5 to 15 mg / day, most preferably 10 mg / day, and gly irrizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of 0.5-1000 mg / day, preferably 1 to 500 mg / day, more preferably 5 to 400 mg / day, even more preferably 10 to 300 mg / day, much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably from 80 to 120 mg / day. In one embodiment, the statin is rosuvastatin, the glycyrrhizin derivative is ammonium glycyrrhizinate, rosuvastatin is used in an amount of 0.05 to 100 mg / day, preferably from 1 to 50 mg / day, more preferably from 1 to 40 mg / day, even more preferably from 2 to 20 mg / day, significantly more preferably 5 to 15 mg / day, most preferably 10 mg / day, and ammonium glycyrrhizinate is used in an amount of 0.5 to 1000 mg / day, preferably 1 to 500 mg / day, more preferably 5 to 400 mg / day, even more preferably 10 to 300 mg / day, known much more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 100 to 110 mg / day and most preferably 108 mg / day .

In one embodiment, the statin is fluvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizic derivative is glycyrrhizic acid or its pharmaceutically acceptable salt, solvate or hydrate, fluvastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.04 to 800 mg / day, preferably from 1 to 400 mg / day, more preferably from 2 to 200 mg / day, even more preferably from 40 to 120 mg / day, significantly more preferably from 60 to 100 mg / day, most preferably 80 mg / day and hl cirrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 5 to 1000 mg / day, preferably from 5 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day , significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably from 80 to 120 mg / day. In one embodiment, the statin is fluvastatin, the glycyrrhizin derivative is glycyrrhizic acid, fluvastatin is used in an amount of 0.04 to 800 mg / day, preferably 1 to 400 mg / day, more preferably 2 to 200 mg / day, even more preferably from 40 to 120 mg / day, significantly more preferably from 60 to 100 mg / day, most preferably from 80 mg / day, and glycyrrhizic acid is used in an amount of from 0.5 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably 5 to 400 mg / day, even more preferably 10 d 300 mg / day, significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 85 to 100 mg / day and most preferably 90 mg / day.

In one embodiment, the statin is pitavastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof, the glycyrrhizic derivative is glycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof, pitavastatin or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.05 to 800 mg / day, preferably from 1 to 400 mg / day, more preferably from 20 to 200 mg / day, even more preferably from 40 to 120 mg / day, significantly more preferably from 50 to 100 mg / day, most preferably 80 mg / day , and r lycyrrhizic acid or a pharmaceutically acceptable salt, solvate or hydrate thereof is used in an amount of from 0.05 to 1000 mg / day, preferably from 1 to 500 mg / day, more preferably from 5 to 400 mg / day, even more preferably from 10 to 300 mg / day, much more preferably from 15 to 250 mg / day, even more preferably from 50 to 200 mg / day, most preferably from 70 to 120 mg / day. In one embodiment, statin is pitavastatin, a glycyrrhizin derivative is glycyrrhizic acid, pitavastatin is used in an amount of 0.05 to 800 mg / day, preferably 1 to 400 mg / day, more preferably 20 to 200 mg / day, even more preferably 40 to 120 mg / day, much more preferably 60 to 100 mg / day, most preferably 80 mg / day, and glycyrrhizic acid is used in an amount of 0.5 to 1000 mg / day, preferably 1 to 500 mg / day more preferably 5 to 400 mg / day, even more preferably 10 d about 300 mg / day. significantly more preferably from 20 to 250 mg / day, even more preferably from 50 to 200 mg / day, even more preferably from 80 to 120 mg / day, even more preferably from 85 to 100 mg / day and most preferably 90 mg / day .

Production methods

The combination and pharmaceutical composition of the present invention can generally be obtained by mixing the glycyrrhizin derivative and statin together with any necessary adjuvants. Mixing can be performed using a number of methods known to those skilled in the art.

The solid pharmaceutical composition of the present invention can generally be obtained by mixing the solid form of the glycyrrhizin derivative and the solid form of statin, together with any other necessary excipients. Mixing can be performed using a number of methods known to those skilled in the art.

It is preferable to carry out the above method in the absence of solvents. In contrast to the methods described previously (in particular, described in RU 2308947 and RU 2396079), mixing the components of the combination in the absence of solvents avoids the formation of unstable molecular complexes of statin and glycyrrhizic acid disclosed in these documents and makes it possible to obtain a pharmaceutical composition that It is more stable (especially during long-term storage) and retains its solubility in water over time.

Sets

The present invention also relates to kits for using the combination of the present invention, in which the lipid-lowering drug (preferably statin) and the glycyrrhizin component of the combination are supplied as separate preparations in the same or different containers. Not wishing to be bound by theory, it should be understood that these two components of the combination can be introduced simultaneously, separately or sequentially and in any case can achieve the effects described in this document.

Therefore, in another aspect of the invention, a kit is provided comprising:

(a) a therapeutically effective amount of a glycyrrhizin derivative, and additionally pharmaceutically acceptable carriers or diluents in a first unit dosage form;

(b) a therapeutically effective amount of a lipid-lowering drug, and further pharmaceutically acceptable carriers or diluents in a second unit dosage form; and

(c) a container for containing said first and second dosage forms.

The composition of the kit may include a glycyrrhizin derivative and a lipid-lowering drug (preferably statin) or their pharmaceutically acceptable salts or solvates in various pharmaceutical compositions in one container or in various pharmaceutical compositions in different containers. In one embodiment, the kit comprises:

(a) a glycyrrhizin derivative combined with a pharmaceutically acceptable carrier; and

(b) a lipid-lowering drug (preferably statin) combined with a pharmaceutically acceptable carrier,

Where components (a) and (b) are presented in a form that is suitable for sequential, separate and / or simultaneous administration.

In one embodiment, the kit comprises:

(a) a first container containing a glycyrrhizin derivative combined with a pharmaceutically acceptable carrier;

(b) a second container containing a lipid-lowering drug (preferably statin) combined with a pharmaceutically acceptable carrier; and

(c) a container intended to contain the first and second containers.

The kit may also contain instructions, such as instructions for use and dosage. Such instructions may be in the form that is provided for the doctor, for example, a drug label, or they may be those provided by the doctor, such as instructions for the patient.

Medical use and methods of therapy

The combination in the form of a pharmaceutical composition and kit in accordance with the present invention can be used as a medicine for the treatment of diseases. As used herein, the term “treating” means any use of the combination of the present invention and includes:

(1) preventing a disease in a subject that may be predisposed to the disease, but the pathology or symptomatology of the disease is not yet manifested, including to reduce risk factors for the disease; (2) inhibition of the disease in a subject that is experiencing or exhibiting a pathology or symptomatology of the disease (i.e., preventing the further development of pathology and / or symptoms), or (3) alleviation of the disease in a subject that is experiencing or exhibiting a pathology or symptomatology of the disease (t .e., relief of pathology and / or symptoms) and includes all the processes of slowing, interrupting, delaying, controlling or stopping the progression of the described conditions, but does not necessarily mean the complete elimination of all symptoms and is there a cure for the disease.

The combinations of the present invention can be used for humans and non-human subjects. Non-human subjects include animals such as dogs, cats, rabbits and horses and livestock such as cows, sheep, pigs and goats. The preferred subject is a human.

The combinations of the present invention can be used to treat any diseases and conditions for which lipid-lowering drugs (such as statins) are useful, in particular diseases treatable by lowering cholesterol and other blood lipids. Thus, in another aspect of the present invention, there is provided a combination or pharmaceutical composition for use in the treatment of hyperlipidemia. In one embodiment, hyperlipidemia is selected from hypercholesterolemia, (also known as hyperlipoproteinemia), hypertriglyceridemia, or their concomitant diseases.

In one embodiment, hyperlipidemia is primary (or familial) hyperlipidemia. Familial hyperlipidemia is classified according to the Fridrickson classification, which is based on the nature of lipoproteins by electrophoresis or ultracentrifugation. Examples of primary hyperlipidemia include type Ia, type Ib, type Ic, type IIA, type IIb (familial combined hyperlipidemia), type III (familial dysbetalipoproteinemia), type IV (familial hypertriglyceridemia), and type V. Primary hyperlipidemias that respond particularly well to statin treatment include type IIA, type IIb, type III and type IV.

In another embodiment, hyperlipidemia is secondary (acquired) hyperlipidemia. Acquired hyperlipidemia, as a rule, secondary to other diseases, such as diabetes, hypothyroidism, renal failure, nephrotic syndrome; alcohol consumption or the use of drugs such as diuretics, beta-blockers, and estrogens.

It is well known that lowering the level of cholesrine and other lipids in the blood is effective in the preventive treatment of cardiovascular diseases. Therefore, in another embodiment of the invention, the combination or pharmaceutical composition for use in the treatment of cardiovascular diseases is provided. In one embodiment, cardiovascular disease is selected from the group consisting of coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, coronary artery disease, peripheral vascular disease, peripheral artery disease, and intermittent claudication.

It is well known that lowering the level of cholesrin and other lipids in the blood is effective in the preventive treatment of conditions other than cardiovascular diseases. Therefore, in another embodiment of the invention, there is provided a combination or pharmaceutical composition for use in the treatment of diseases or conditions selected from the group consisting of liver disease, fatty liver disease, chronic viral hepatitis, cirrhosis of the liver, apoplexy attack, pathology of cerebral and peripheral vessels, arterial hypertension and sugar diabetes.

In particular, the combination of the present invention can be used to treat or prevent and / or reduce the risk of developing atherosclerosis (regardless of whether patients have hyperlipidemia). Thus, in another aspect of the present invention, there is provided a combination or pharmaceutical composition for use in the treatment of atherosclerosis.

In some embodiments, the combination of the present invention can be used to treat or prevent and / or reduce the risk of developing coronary heart disease and / or coronary heart disease (regardless of whether patients have hyperlipidemia). For example, the combination of the present invention can be used in patients with diabetes, stroke, or other cerebrovascular disease, patients with a history of peripheral vascular disease, or in patients with coronary heart disease or their predecessors. The combination can reduce the risk of general mortality, reducing mortality from coronary heart disease; reduce the risk of serious cardiovascular and coronary cases (including, but not limited to, non-fatal myocardial infarctions, revascularization; and / or apopleptic attacks).

The combination can also reduce the risk of requiring coronary blood flow repair operations (such as coronary artery bypass grafting and coronary angioplasty); reduce the need for surgical interventions to restore peripheral blood flow and other types of non-coronary revascularization; and reduce the risk of hospitalization due to angina pectoris.

In patients with diabetes mellitus, the combination can also reduce the risk of peripheral vascular complications (leading to revascularization, amputation of lower limbs or trophic ulcers).

In patients with coronary heart disease and hypercholesterolemia, the combination can also slow down the development of coronary atherosclerosis, including reducing the incidence of new complications.

In one embodiment, the combination may be used to treat hypercholesterolemia. In one embodiment, treatment for hypercholesterolemia includes lowering total blood cholesterol compared to baseline.

In one embodiment, treatment for hypercholesterolemia includes a decrease in LDL levels compared to baseline. In one embodiment, the treatment of hypercholesterolemia includes a decrease in triglycerides compared to baseline. In one embodiment, therapy for hypercholesterolemia includes a decrease in apolipoprotein B (apo B) compared to baseline.

Normal cholesterol: 3.2-5.6 mmol / L.

Normal LDL level: 1.71-3.5 mmol / L.

Normal HDL> 0.9 mmol / L.

Normal triglycerides: 0.41-1.8 mmol / L.

Normal value of atherogenic factor: <3.5.

In one embodiment, the antihypercholesterolemic effect of the combination of the present invention includes a decrease in the ratio of LDL (low density lipoproteins, “bad” cholesterol to HDL (high density lipoproteins, “good” cholesterol). In one embodiment, the antihypercholesterolemic effect is to reduce the ratio of total cholesterol to HDL cholesterol.

In yet another aspect, the invention provides the use of the aforementioned combination or composition in the manufacture of medicaments for the treatment of hyperlipidemia (in particular hypercholesterolemia and / or hypertriglyceridemia). In other aspects of the invention, there is provided the use of the aforementioned combination or composition in the manufacture of a medicament for the treatment of cardiovascular diseases (diseases selected from the group consisting of coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, diseases coronary artery, peripheral vascular disease, peripheral arterial disease, and intermittent claudication).

In another aspect of the invention, there is provided a method for treating hyperlipidemia (in particular hypercholesterolemia and / or hypertriglyceridemia), the method comprising administering to the patient a combination or pharmaceutical composition. In another aspect of the invention, there is provided a method for treating cardiovascular diseases (diseases selected from the group consisting of coronary heart disease, myocardial infarction, tonsillitis, stroke, atherosclerotic vascular disease, coronary heart disease, coronary artery disease, peripheral vascular disease, peripheral diseases arteries, and intermittent claudication), the method consists in the patient taking a combination or pharmaceutical composition.

EXAMPLES

The present invention is described in more detail with reference to the examples below. However, the present invention is not limited to the examples given.

Example 1 - Preclinical Study

Materials and methods

Animals:

As the studied animals, male Wistar rats were used. The weight of animals before the start of the study ranged from 200-220 g. The proposed model using rats as the studied animals is a reproducible standard model for evaluating the cholesterol-lowering effect. The number of animals used in the study is sufficient for a complete statistically significant assessment of the effects studied and is the minimum rational in terms of ethical principles.

Before the start of the study, laboratory animals were kept in groups in cells for 14 days for adaptation. During this period, the clinical status of animals was assessed daily.

The number of animals in each group was 12 male rats. Animals were randomly divided into groups using body weight as a criterion so that the weight of an individual did not differ by more than 20% from the average weight of animals of the same sex.

Dose calculation:

In accordance with the instructions for medical use for each component in terms of the active substance of the corresponding drug, as well as taking into account the potentiating effect of the second component, presumably effective daily doses of drug combinations were selected.

The aim of the study was to assess the hypocholesterolemic effect of a physical mixture of statins (atorvastatin, lovastatin, pravastatin, rosuvastatin, simvastatin, fluvastatin) and glycyrrhizinates (ammonium glycyrrhizinate, glycyrrhizic acid, sodium glycyrrhizinate, and effective glycyrrhizinate acid and glycyrrhizinate acid), and the glycyrrhizinate acid is known to be effective. The studied doses are shown in Table 1.

In each case, the masses indicated above are the masses of the active substances (with the exception of any counterions when the active substance is in salt form). Doses are calculated in terms of anhydrous substance (in accordance with pharmaceutical standards). These combinations were obtained as physical mixtures of solids in 0.5% (w / v) solution of methylcellulose in water without the use of other excipients.

Weighed components in the required amount were placed in a mortar. A 0.5% methylcellulose solution was added to the components in the mortar and suspended until a stable suspension was obtained. The suspension was transferred into a vial, the mortar and pestle were washed three times, the volume was adjusted to 56 ml and mixed thoroughly until a homogeneous suspension was obtained.

In the studies below, the masses of statin and glycyrrhizin derivative are expressed as an equivalent dose to humans (based on known effective therapeutic doses indicated in Table 1). For each component, an equitherapeutic dose was calculated in accordance with the formula for calculating the dose, taking into account rat body weight of 250 g (X mg / kg * 39) / 7.0

where X is the therapeutic dose for humans; 39 - conversion factor, taking into account the average weight of a person (70 kg) and 7.0 - conversion factor, taking into account the weight of the rat (250 g).

The placebo used as a control was a 0.5% (w / v) solution of methyl cellulose in water without the use of other excipients.

Methodology

Study design

Evaluation of the cholesterol-lowering efficacy and safety of the pharmaceutical combination was carried out in an in vivo experiment using an experimental rat model of hypercholesterolemia.

After the pathology was formed, the studied groups were formed within 30 days.

Actions during the course of the study necessary to evaluate the effectiveness of the tested objects are shown in Table 2.

Animal blood samples were taken from all animals in the group

Induction of hypercholesterolemia

Within 90 days, the studied animals received a hypercholesterol diet to induce pathology.

The diet included cholesterol, cholic acid and overheated fats. The daily diet consisted of ordinary food saturated with superheated (for 5 hours) unrefined sunflower oil and 82.5% butter in a 4: 1 ratio, with cholesterol (3%) and cholic acid (0.5%) added.

For 90 days, the animals received the described ad libitum diet (30 g of animal feed). The development of hypercholesterolemia in animals was evaluated based on the parameter of the lipid spectrum on day 30 of the study.

Introduction of test objects and sample preparation

Drugs were administered intragastrically through a gastric tube on days 31-90 of the study at one time of the day.

Clinical examination of animals

Examination of animals in the cells was carried out daily. Any changes in the appearance and behavior of animals were recorded.

Body weight was recorded before administration, and then once a week during the study in order to calculate the increase in body weight, volume and concentration of the studied drugs.

Animals were deprived of food 14 hours before blood sampling and euthanasia. Access to water in this case was not limited.

Blood chemistry

The following animal blood counts were investigated:

Indicators for evaluating the effectiveness of drugs:

- Biochemical parameters and activity of serum enzymes (total cholesterol (cholesterol), cholesterol cholesterol, cholesterol IDP, triglycerides).

Indicators for assessing the toxicity of drugs:

- Biochemical parameters and activity of serum enzymes (aspartate and alanine aminotransferase, creatine phosphokinase, urea, serum amylase, total bilirubin, direct bilirubin, indirect bilirubin, glucose, K ⁺ , Na ⁺ cations).

Blood samples in an amount of 1.0-1.84 ml for biochemical studies were taken from the tail vein of rats. Blood samples were taken after 14-15 hours without food at one time of the day (9.00-11.00). To study biochemical parameters, the A-25 Biochemical Analyzer (Biosystems, Spain) was used.

We used the standard kinetic spectrophotometric method described in the recommendations ("IFCC methods for the easurement of catalytic concentration of enzymes" Part 7: IFCC method for creatine kinase // JIFCC. 1989. Vol. 1. pp. 130-139.) And publications (Quim Clin. 1987. Vol. 6. pp. 241-244; J. Clin Chem Clin Biochem. 1986. Vol. 24. pp. 481-495; and Gella et al. Clin Chim Acta. 1985. Vol. 153. pp. 241-247; Talke H. and Schubert GE Klinische Wochenschrift. 1965. Vol. 43. pp. 174-175; Tanase H et al Jpn Circ J. 1970. Vol. 34 (12). pp. 1197-1212 ; Gutmann I., Bergmeyer HU Methods of enzymatic Analysis, ed Bergmeyer HU, Academic Press, NY. 1974. Vol. 4. pp. 1794-1798; Pearlman FC and Lee RTY. Clin Chem 1974, 20, 447-453; Zoppi F et al, Peracino A., Fenili D., Marcovina S. and Ramella C. Giorn It Chim Cl. 1976; 1: 343-359; Allain CC et al Clin Chem. 1974. Vol. 20. pp. 470-475 ; and in Mei attini F., et al, Clin Chem. 1978. Vol. 24. pp. 2161-2165; Warnick GR et al. Clin Chem 2001, 47, 1579-96; Bucolo G and David H. Clin Chem. 1973. - Vol. 19. pp. 476-482; and in Fossati P. and, Prencipe L., Clin Chem. 1982. Vol. 28. pp. 2077-2080; Trinder P. Ann Clin Biochem. 1969. Vol. 6. pp. 24-27).

Determination of mass ratios of organs

The pancreas, liver, and kidneys of animals were extracted to calculate mass coefficients. The organs were weighed, mass coefficients were calculated by the formula:

Mass coefficient = (organ mass / animal body weight) × 100%

Data analysis

Records and data from the source maps were transferred to the Statistica 6.0 software package (StatSoft, Russia). For all quantitative data, the arithmetic mean and standard deviation of the mean were calculated. The results were processed on an IBM PC / AT with the Statistica 6.0 software package (StatSoft, Russia). The probability of differences between the M values in the groups was determined using the Student or Mann-Whitney test. The differences were considered significant at a confidence level of p <0.05.

results

Observation of the development of pathology

The animals were on a hypercholesterolemic diet for 30 days before starting therapy. During this period, the researchers observed the development of pathological changes in accordance with the results of analyzes of the lipid spectrum of the blood of the studied animals on days 0 and 30 of the diet.

No statistically significant differences were found in the groups of animals. The results of measurements of the lipid spectrum at the beginning of the study and on the 30th day of the diet as an average for all experimental groups are shown in table 3.

Note - * - differences are statistically significant compared with the lipid spectrum at the beginning of the study, t is a test for independent variables at p <0.05

The values of the parameters of the lipid spectrum in experimental animals in this age group correspond to literature data (Physiological, biochemical and biometric standard data for experimental animals. Edited by Makarov VG, Makarova MN Authors: Abrashova TV, Gushchin Ya .A., Kovaleva M.A., Rybakova A.V., Selezneva A.I., Sokolova A.P., Khodko S.V. - St. Petersburg: Lema Publishing House. 2013.p. 17-33).

On the 30th day of the diet, pronounced changes in all indicators of the lipid spectrum of the studied animals were observed. According to observation, the cholesterol level increased on average 3 times, LDL - 5 times, TG - 1.2 times, while the concentration of HDL decreased 1.5 times in comparison with the initial level.

Despite the fact that pronounced changes in the values of the lipid spectrum in rats are observed significantly rarely, critical values of each parameter were achieved for experimental animals on the 30th day. Thus, the type of blood lipid spectrum of the studied animals on the 30th day of the diet was sufficient to determine the existing pathology and start therapy.

THERAPY RESULTS

Blood lipid profile

On the 30th day of therapy, the development of pathology continued against the background of a diet, which manifested itself in a further increase in total cholesterol (cholesterol), HDL cholesterol and triglycerides and a decrease in LDL cholesterol in animals of the control group (Tables 4-10).

On the 30th day of therapy, a stable hypocholesterolemic effect was shown both in the case of using the test mixture and in the case of using the comparison drug (Tables 4-10).

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Thus, taking 20 mg of simvastatin (CB) as monotherapy (comparison drug), we can note a decrease in the concentration of cholesterol, LDL and TG by 26%, 35% and 18%, respectively. Moreover, the concentration of HDL increases by 86% compared with the control group of animals.

In contrast, the use of a mixture of CB and HA for 30 days led to a decrease in the levels of cholesterol, LDL and TG by 43%, 44% and 25%, respectively, with a concomitant increase in the concentration of HDL by 70%.

Thus, we can conclude that on the 30th day of therapy, the use of GA has a significant contribution to the hypocholesterolemic effect of the CB + HA mixture.

The effectiveness of the CB (20 mg) + HA mixture on the 30th day of therapy with respect to the lipid spectrum was higher in comparison with the simvastatin used as a reference drug, both at a dose of 20 mg and at a dose of 40 mg.

In the HA group, a hypocholesterolemic effect is also noted. However, the effectiveness in combination with CB was higher than the effect of each component separately, which may indicate a possible synergistic effect.

For other combinations of statins and glycyrrhizinates, a similar hypocholesterolemic effect was also noted (Tables 5-9).

This indicates a positive hypocholesterolemic efficacy of pharmaceutical compositions. The results can be considered as an opportunity to reduce the effective dose of the drug in the composition against statin.

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 4, t - test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 4, t - test for independent variables at p <0.05

60-1 day:

On the 60th day of treatment, pronounced changes were observed in the values of the lipid spectrum indicators according to the results of therapy with the mixture and the reference drug (Tables 10-15).

For example, in the group receiving the studied mixture of simvastatin + monoammonium glycyrrhizinate, on the 60th day of therapy, the concentrations of cholesterol, TG and LDL decreased by 49%, 28% and 64%, respectively, while the concentration of HDL increased by 136% compared with the control group .

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

It should be noted that on the 60th day of therapy the effectiveness of the CB + HA mixture is much higher than on the 30th day.

The above results of total cholesterol values showed that the pharmaceutical composition of simvastatin 20 mg + ammonium glycyrrhizinate 108 mg, in accordance with the invention, on the 60th day of therapy helps to reduce total blood cholesterol by 50% compared with the control group. The lipid-lowering effect of the therapy of simvastatin 20 mg + ammonium glycyrrhizinate, in accordance with the invention, is comparable to the effect of simvastatin 40 mg as monotherapy and exceeds the activity of 20 mg of simvastatin as monotherapy.

A similar lipid-lowering effect was observed for other combinations of statin + glycyrrhizinate, in accordance with the invention, which is reflected in the data below (Tables 11-15). In particular, the lipid-lowering effect of the atorvastatin groups (10 mg) + glycyrrhizic acid, lovastatin (20 mg) + glycyrrhizic acid, rosuvastatin (10 mg) + monoammonium glycyrrhizinate exceeded the effect of monotherapy with the corresponding statins in the same doses and was comparable to a double dose of statin for atator (20 mg), lovastatin (40 mg) and rosuvastatin (20 mg) as monotherapy. It should also be noted that the hypolipidemic effect in the groups of pravastatin (40 mg) + glycyrrhetic acid and fluvastatin + glycyrrhizic acid exceeds the effect of statins in the same dose as monotherapy.

Hypocholesterolemic activity of all glycyrrhizin derivatives was also noted, which was lower than in the other study groups. But, to summarize, it can be noted that the effect of two components - statin and glycyrrhizin derivative in each combination, in accordance with the present invention, significantly exceeds the effect of each individual compound in free form.

The evidence of the positive hypocholesterolemic efficacy of the pharmaceutical compositions can be considered as an opportunity to reduce the effective dose of the drug to the composition with respect to statin.

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 4, t - test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05

Note - * - the differences are statistically significant compared with group No. 4, t - test for independent variables at p <0.05

Taking into account the data obtained during the 60-day therapy, it can be concluded that the effectiveness of statins increases when they are used with glycyrrhizin derivatives, in accordance with the present invention, which to some extent may indicate a synergistic effect of the combination.

Blood chemistry

The data of the biochemical analysis at the beginning of the study and on the 30th day of the diet in are shown in table 16.

There was no statistically significant difference as a result of measuring the biochemical parameters of blood at the beginning of the study and on the 30th day of the diet in all groups of animals.

On the 30th day of the diet, a change in biochemical parameters was observed relative to the zero point for all the studied groups. This change reflects the process of violation of all types of metabolism while maintaining a diet rich in fats. The concentration of ACT decreased compared to the initial values (table 16). The presence of the initial substrate for the synthesis of cholesterol (acetyl-CoA) increases as a result of eating food containing carbohydrates and fats, since acetyl-CoA is formed as a result of the oxidation of glucose and fatty acids.

In patients with atherosclerosis, in some cases there is a latent form of a violation of carbohydrate metabolism, which manifests itself in the retention of glucose in tissues and organs. This fact often goes unnoticed, but at the same time is a rather serious risk factor.

Tables 17-22 and 23-28 show the data of biochemical blood parameters on the 30th and 60th days of therapy, respectively (60th and 90th day of the study).

Note - * - the differences are statistically significant compared with biochemical blood parameters at the beginning of the study, t is a test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2, t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2, t - test for independent variables at p <0.05

In the control group, on the 60th day of the study, an increase in ACT and its activity was noted. The de Ritis coefficient (AST / ALT) was 2.2, which suggests the development of pathological processes in the myocardium during the diet. The concentration of glucose in the blood of animal groups taking statins was high. The reason for the increase in blood glucose in animals on the 60th day of the diet could be a violation of glucose tolerance as a result of dyslipoproteinemia.

During a 30-day therapy with a CB + HA mixture, a statistically significant decrease in ACT and ALT activity was noted along with a decrease in glucose concentration. The study shows the contribution of GA to a decrease in transaminase activity and stabilization of glucose levels. A similar effect was noted for other combinations of statin + glycyrrhizinate, in accordance with the present invention. It can be assumed that a decrease in the glucose concentration in the control group of statins can be caused by dysfunction of the liver enzyme system involved in carbohydrate metabolism, while the use of the test mixture statin + glycyrrhizin derivative can prevent a sharp decrease in the glucose concentration in the blood of animals. On the 60th day of therapy, the pronounced hepatoprotective effect of the statin + glycyrrhizin derivative mixture was observed in a significant decrease in transaminase activity. In addition, a decrease in myotoxicity was observed, which manifested itself in a decrease in CPK activity in the group of animals treated with the statin + glycyrrhizin derivative mixture. The values of the parameters ACT, ALT, and CPK for these groups of animals were significantly lower than in groups of animals that received the corresponding statin in the same dose as monotherapy. In the groups treated with glycyrrhizin derivatives, the values of ACT, ALT and CPK were comparable with the parameters of the control group. It should also be noted that the use of the test mixture statin + glycyrrhizin derivative, in addition to affecting the activity of enzymes, affects carbohydrate metabolism, for example: the glucose concentration in the group receiving the test mixture only slightly deviated from the values obtained in the control group, while as with statin monotherapy, the differences were critical. The results of the analyzes of the biochemical profile on the 60th day of therapy (90th day of the study) are shown in Tables 23-28.

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

Note - * - differences are statistically significant compared to group No. 4, ¹ - differences are statistically significant compared to group No. 2. t - test for independent variables at p <0.05

As can be seen from table 23, on the 60th day of therapy, in the case of using the CB + HA mixture, a marked decrease in ACT activity by 33% and CPK by 51% was observed compared with the control group.

The use of the test mixture was also effective against bilirubinemia: thus, the concentration of total bilirubin decreased by 45%, and the concentration of direct bilirubin decreased by 41%, compared with the control group. The effectiveness of the test mixture in relation to bilirubinemia exceeded the effectiveness of the drug by comparison. A similar profile of biochemical dynamics may indicate the hepatoprotective effect of the test mixture and the anti-myotoxic effect, which manifests itself mainly in the contribution of GA efficiency.

On the 60th day of therapy, a pronounced hepatoprotective effect of the statin + glycyrrhizin derivative mixture was observed, which manifests itself in a significant decrease in the activity of transaminases. It is also important to note a decrease in CPK activity in all groups of animals treated with statin + glycyrrhizin derivative, in accordance with the present invention, compared with groups treated with statin as monotherapy.

The values of the parameters ACT and ALT were significantly lower than in the case of using the comparison drug in the same dose. In the groups treated with glycyrrhizin derivatives, the values of ACT, ALT, and CPK were comparable with the initial values.

In addition, the studied statin + glycyrrhizin derivative mixtures, in accordance with the present invention, had a significant effect on glucose concentration: there was a tendency to a decrease in glucose concentration compared to statins used as monotherapy.

Summarizing the results, it was shown that the myotoxicity and hepatotoxicity of the studied combinations in accordance with the present invention was reduced compared with the statin used as monotherapy, due to the presence of the glycyrrhizin derivative in combination. Similar protective properties were observed for other combinations of statin + glycyrrhizin derivative.

Organ mass ratios

Due to the presence of shifts in the biochemical profile of animals with respect to transaminases and CPK, after the killing of animals, their organs were weighed, and mass coefficients for the pancreas, liver, and kidneys were determined (Tables 29-34).

Notes:

¹ - differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05;

² - differences are statistically significant compared with group No. 3, t is a test for independent variables at p <0.05.

¹ - differences are statistically significant compared with group No. 5, t - test for independent variables at p <0.05;

² - differences are statistically significant compared with group No. 3, t is a test for independent variables at p <0.05.

¹ - differences are statistically significant compared with group No. 5, t - test for independent variables at p <0.05;

² - differences are statistically significant compared with group No. 3, t is a test for independent variables at p <0.05.

¹ - differences are statistically significant compared with group No. 4, t is a test for independent variables at p <0.05;

² - differences are statistically significant compared with group No. 2, t is a test for independent variables at p <0.05.

¹ - differences are statistically significant compared with group No. 5, t is a test for independent variables at p <0.05; 2

² - differences are statistically significant compared with group No. 3, t is a test for independent variables at p <0.05.

¹ - differences are statistically significant compared with group No. 4, t is a test for independent variables at p <0.05;

² - differences are statistically significant compared with group No. 2, t is a test for independent variables at p <0.05.

Based on the results presented in tables 29-33, we can conclude that in the case of using comparison drugs as monotherapy, the mass coefficients of the pancreas were increased. Such changes can be justified by the adverse reactions described for statins, among which one of the most significant is the exacerbation of inflammatory changes in the pancreas. In addition, it should be noted that in some cases of the use of simvastatin and atorvastatin as monotherapy, the risk of developing diabetes increases.

Statins have been shown to have an inhibitory effect on the processes of transduction of intercellular signals in the case of insulin, which leads to a decrease in GLUT4 expression and deregulation of GLUT1 adipose tissues (Takaguri et al J Pharmacol Sci. 2008 Vol. 107, No. 1. P. 80- 89). This helps to reduce insulin-dependent transport of glucose into cells and insulin sensitivity, which can provoke the development of glucose intolerance. Insulin resistance associated with the use of statins can also inhibit the biosynthesis of isoprenoid, an intermediate in cholesterol formation. In addition, statins can directly affect insulin secretion by affecting the β-cells of the pancreas due to the inhibition of glucose-stimulated increase in free cytoplasmic calcium and L channels for this ion. The properties of statins to intensify the inflammatory and oxidative processes of pancreatic islets can lead to the development of diabetes in patients with carbohydrate metabolism disorders or at risk of this disease (Otocka-Kmiecik et al Postepy Biochem. 2012. Vol. 58, No. 2. pp. 195-203 )

The use of the studied combinations of the present invention, in particular CB + HA and AB + HA, leads to a statistically significant decrease in the mass coefficients of the pancreas, compared with those for the groups treated with statins as monotherapy. The use of the test mixture, as well as the comparison drug, does not affect the mass coefficients of the liver and kidneys.

findings

The use of physical mixtures of statin and glycyrrhizin derivative, in accordance with the present invention, affects the parameters of the lipid spectrum in the hypocholesterolemic model in rats. The use of a physical mixture leads to a decrease in the level of cholesterol, triglycerides and LDL during therapy.

The effectiveness of the combinations in relation to the lipid spectrum was higher than in the case of the use of reference statins as monotherapy in the same and doubled doses.

The lipid-lowering effect in the groups of atorvastatin (10 mg) + glycyrrhizic acid, lovastatin (20 mg) + glycyrrhizic acid, rosuvastatin (10 mg) + monoammonium glycyrrhizinate exceeded the effects in the case of statin monotherapy at the same doses and was comparable to the effect achieved with twice the dose of the corresponding statins. The hypolipidemic effects in the groups of pravastatin (40 mg) + glycyrrhetic acid and fluvastatin + glycyrrhizic acid exceeded the effects in cases of statin monotherapy at the same doses. Thus, the effectiveness of the combinations described in this invention in relation to the lipid spectrum was higher than the effectiveness of the comparison drugs at the same dose and was comparable to the effect in a double therapeutic dose of the corresponding statin.

Hypocholesterolemic activity of all glycyrrhizin derivatives was found, which was lower than in the rest of the studied groups. However, the effectiveness of the two components of the statin + glycyrrhizin derivative in combination was higher than the effect of each component separately.

Evidence has been demonstrated of the favorable hypocholesterolemic efficacy of the pharmaceutical compositions and the possibility of reducing the effective dose of the drug in the composition against statin.

The data obtained allow us to conclude that combinations of statins and glycyrrhizinates (such as ammonium glycyrrhizinate, glycyrrhizic acid, sodium glycyrrhizinate, glycyrrhetic acid) have synergistic hypocholesterolemic activity.

Thus, when applying the test mixture for 30 and 60 days, a significant contribution of the glycyrrhizin derivative to the hypocholesterolemic effect was noted, which consisted of a more pronounced decrease in the concentration of LDL, cholesterol, TG and an increase in HDL than in the group of animals treated with statin.

Statins did not prevent the toxic effects of diet on liver tissue in experimental animals. The activities of alanine aminotransferase and aspartate aminotransferase were slightly lower in comparison with the control group, but exceeded normal values. Therapy of animals with a combination of statins and glycyrrhizinates affected the activity of transaminases, especially alanine aminotransferase, reducing it. Similar effects were noted in other study groups using statin + glycyrrhizin derivative combinations. These effects confirm the hepatoprotective properties of the studied pharmaceutical compositions of the present invention in comparison with the components when used separately.

A marked decrease in the activity of creatine phosphokinase was observed when using pharmaceutical compositions, compared with the group receiving the reference drug in a therapeutic dose. The data obtained allow us to conclude that the role of glycyrrhizinates is undoubted in reducing myotoxicity, which is a side effect of the use of statins.

The use of the investigated mixtures of statin + glycyrrhizin derivative, in accordance with the present invention leads to a decrease in the mass coefficients of the pancreas in comparison with the group treated with the corresponding reference statin as monotherapy.

The tested statin + glycyrrhizin derivative mixtures in accordance with the present invention have a significant effect on glucose concentration. There was a tendency towards a decrease in glucose concentration, in comparison with statin monotherapy.

The data obtained allow us to conclude that combinations of statins and glycyrrhizinates (such as ammonium glycyrrhizinate, glycyrrhizic acid, sodium glycyrrhizinate and glycyrrhetic acid), in accordance with the present invention, have a synergistic effect that is not characteristic of each individual component.

Thus, the use of a combination of two components leads to less pronounced manifestations of hypercholesterolemia and the protection of target organs in the simulated pathology.

Pharmaceutical compositions containing combinations of glycyrrhizinates with statins, in accordance with this invention, in the indicated daily dose showed a lipid-lowering effect, comparable to that for a double dose of statin as monotherapy. An increased safety profile has been associated with a reduction in side effects such as hepatotoxicity and mitotoxicity. Similar effects were observed for all tested combinations of statin and glycyrrhizinates, in accordance with the present invention.

Example 2 - Chromatographic analysis

The solid pharmaceutical compositions of atorvastatin and ammonium glycyrrhizinate (CB + HA), atorvastatin and glycyrrhizic acid (AB + HA) and rosuvastatin and ammonium glycyrrhizinate (PB + HA) were studied chromatographically to identify molecular complexes of the two ingredients. In all cases, the doses were the same as in Table 1 of Example 1.

The following reagents were used:

CB + HA: acetonitrile for chromatography and analytical use, phosphoric acid, acetic acid, sodium dihydrogen phosphate, sodium hydroxide.

AB + HA: acetonitrile for chromatography and analytical use, phosphoric acid, ammonium citrate, tetrahydrofuran, sodium hydroxide.

PB + HA: acetonitrile for chromatography and analytical use, phosphoric acid, trifluoroacetic acid.

These materials were purchased from Merck, Darmstadt, Germany. Water was prepared using a Millipore Milli.Q Plus water treatment system, Bedford, MA, USA.

The following chromatographic conditions and equipment were used:

The determination was carried out using a UV detector, the signal was monitored and processed using software.

Chromatographic conditions are shown below in Table 34.

The results are shown below in table 35. In all cases, the analysis did not reveal the presence of molecular complexes of statins and glycyrrhizin derivatives.

All publications mentioned in the above description are incorporated by reference. Various modifications and variations of the described methods of the present invention will be apparent to those skilled in the art within the scope and spirit of the present invention. Although the present invention has been described in connection with specific preferred embodiments, it should be understood that the invention should not be unduly limited to such specific embodiments. In fact, various modifications of the described methods of carrying out the invention that are obvious to experts in the field of chemistry, biology, medicine or related fields are intended to be within the scope of the following claims.

Claims (12)

A pharmaceutical composition for treating hyperlipidimia, comprising a mixture of: (a) a glycyrrhizin derivative selected from the group consisting of glycyrrhizic acid and a pharmaceutically acceptable salt thereof; (b) a lipid-lowering drug, wherein the lipid-lowering drug is a statin selected from the group consisting of atorvastatin, lovastatin, rosuvastatin, simvastatin, pravastatin, pitavastatin, fluvastatin, or a pharmaceutical salt thereof, or a mixture thereof, provided that if the lipid-lowering drug is atorvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is lovastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is rosuvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is simvastatin, then the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is pravastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is pitavastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; or if the lipid-lowering drug is fluvastatin, the composition does not contain a molecular complex of atorvastatin and glycyrrhizic acid; (c) excipients, where the lipid-lowering drug and the glycyrrhizin derivative are present in a mass ratio of 1: 0.5 to 1: 200.