Indoprofen, a new non-steroidal anti-inflammatory drug, in the treatment of osteoarthrosis: report on a multi-centre study in 1629 patients

One-Pot, Tandem Reductive Amination/Alkylation-Cycloamidation for Lactam Synthesis from Keto or Amino Acids

Monotrifluoroacetoxyborane-amines, prepared by treating borane-amines with trifluoroacetic acid, have been shown to be efficient reagents for a one-pot, tandem reductive amination/alkylation-cycloamidation of keto or amino acids to achieve the synthesis of 5-aryl or 5-methyl pyrrolidin-2-ones and 6-aryl or 6-methyl piperidin-2-ones.

Crystallization kinetics and molecular dynamics of binary coamorphous systems of nimesulide and profen analogs

Coamorphous drug delivery systems have emerged as a promising formulation technique for improving the solubility and oral bioavailability of poorly soluble drugs. The selection of a suitable coformer is the key to obtaining a successful coamorphous formulation. This study aims to investigate the impacts of coformers with similar chemical structures but different physical properties on the crystallization behavior and molecular dynamics of binary amorphous systems. The addition of three profen analogs, ibuprofen (IBU), ketoprofen (KETO) and indoprofen (INDO) leads to significantly different effects on the crystallization kinetics of amorphous nimesulide (NIME). The crystal growth rates for amorphous NIME are substantially accelerated in the presence of IBU, but drastically reduced in the presence of INDO, while the incorporation of KETO results in a negligible effect. Broadband dielectric spectroscopy is employed to characterize the molecular dynamics of neat amorphous NIME and coamorphous systems. The addition of three structural analogs alters the molecular mobility of amorphous NIME in different ways, which is consistent with the trend observed for their impacts on the crystallization kinetics, suggesting that the relative mobility between the components of coamorphous mixtures governs the physical stability. In addition, it is found that the temperature dependence of the α-relaxation times for NIME with and without coformers is superimposed once the temperature is scaled by T_g/T, whereas the crystallization kinetics do not overlap on a T_g/T scale. This deviation can result from a complex interplay of thermodynamic and kinetic factors involved in multicomponent amorphous systems. This study provides insights into the crystallization kinetics and molecular dynamics of coamorphous systems containing drug analogs, which can potentially offer more flexibility for the control of physical stability without sacrificing therapeutic efficacy.

A three-component coupling process based on vicarious nucleophilic substitution (VNS(AR))-alkylation reactions: an approach to indoprofen and derivatives

The intermediate anion derived from the vicarious nucleophilic substitution (VNS) of hydrogen reacts with a series of alkyl halides to generate the corresponding alpha-alkylated conventional VNS product in a one-pot process. This one-pot VNS-alkylation reaction offers a convenient route to a range alpha-substituted nitrobenzyl phosphine oxides, sulfones, and esters via a three-component coupling reaction. Reactions of alpha-chloroethyl phenyl sulfone (14) and ethyl 2-chloropropionate (16) with nitrobenzene followed by subsequent addition of an alkylating agent give a series of sulfones and esters bearing an alpha-aryl quaternary center. The VNS-alkylation protocol has been applied to the synthesis of derivatives of Indoprofen from nitrobenzene using readily available inexpensive starting materials. Indoprofen itself was prepared using the conventional VNS reaction in four steps and 24% overall yield from nitrobenzene.

Outcome measurement in osteoarthritis clinical trials: the case for standardisation

Outcome measures for clinical trials to be valid and reliable should also be responsive to change. There are currently no standardised methods of measuring the outcome in osteoarthritis clinical trials. A review of 63 trials of nonsteroidal anti-inflammatory drugs revealed a large degree of variability in the items, instruments and scales employed. The implications of this variability are discussed and methods proposed for rationalising outcome measurement in this area of clinical research.

Adverse reactions to indoprofen: a survey based on a total of 6764 patients

Safety data on indoprofen are presented, deriving from three sources: the first was a phase 4 multicentre clinical study based on 4042 patients suffering from osteoarthritis and treated with 400-800 mg daily by mouth for about 4 weeks; the second was a survey based on a heterogeneous series of 2722 subjects belonging to phase 1, 2 and 3 investigations, and treated with 200 to 1200 mg daily by the oral and/or parenteral route for from 1 to more than 180 days; the third was a safety laboratory study conducted in 472 patients, most of whom had participated in the first study, while the remainder were included in the second. Adverse events of any type occurred in 22% of patients in the first study and in 13% in the second, but treatment had to be withdrawn for drug-related reasons in less than 5% in both. Potentially life-threatening events were rare, overall including 16 instances of clinically overt gastro-intestinal bleeding and 2 anaphylactic reactions. Unfavourable laboratory changes, i.e. shifting from normal to abnormal values, were recorded in about 10% of the series studied. The adverse reaction profile of indoprofen was similar to that of most NSAIDs, with gastro-intestinal troubles prevailing over the other events, a distribution which, however, was clear-cut only with oral indoprofen. Tolerability problems appeared to be dose-related up to some point between 400 and 600 mg daily plateauing thereafter, and were less frequent following parenteral than following oral administration.

Indoprofen versus indomethacin in acute painful shoulder and other soft-tissue rheumatic complaints

In a double-blind, parallel-group study indoprofen 800 mg daily was compared with indomethacin 100 mg daily in forty patients suffering from acute painful shoulder and other soft-tissue rheumatic complaints. Both drugs were administered orally for 14 days. Clinical assessments, carried out at baseline and on days 4, 8 and 15, included pain (at rest, upon pressure, on motion under load), quality of sleep, range of active motion and patient's opinion. A significant improvement in all variables was found for both indoprofen and indomethacin at each time of observation, almost reaching its maximum within the first week. Excellent or good results, as judged by the patients, were obtained in 90% of case in both treatment groups. No significant differences were observed between the two drugs. One patient taking indomethacin developed headache and dizziness, requiring discontinuation of treatment; three patients on indoprofen complained of mild or moderate gastric pain.

An analysis of the gastro-intestinal side-effects of non-steroidal anti-inflammatory drugs, with particular reference to comparative studies in man and laboratory species

A critical analysis has been performed of reports published on the incidence of gastro-intestinal (GI) side-effects found in arthritic patients being treated with non-steroid anti-inflammatory (NSAI) drugs. The results show the following: 1. The incidence of GI ulceration (as revealed by gastroscopy) and haemorrhage in arthritic patients taking NSAI drugs may be higher than suspected from clinical trial data. 2. Incidence of all GI side-effects (including ulceration and haemorrhage) may be lower with some of the new NSAI drugs than with traditional drugs (e.g. aspirin, indomethacin and phenylbutazone). 3. Arthritic patients may be more susceptible to the ulcerogenic actions of NSAI drugs. Experiments with animals, together with evidence from clinical studies, indicate that stress factors and the presence of decreased mucosal resistance in the diseased state may contribute to the enhanced susceptibility of the GI tract towards the ulcerogenicity of NSAI drugs. 4. Comparison of data on gastroscopic observations in man with the author's data on the effects of NSAI drugs in stress-sensitized rats shows the latter technique appears to be a useful means of predicting the ulcerogenic potential of NSAI drugs in man. The comparison has also been used to predict the ulcerogenicity of drug - alcohol combinations; alcohol being a common ulcerogen consumed by many patients. Some NSAI drugs with low ulcerogenic activity (i.e. azapropazone, benoxaprofen and fenclofenac) in the stressed-rat assay show little or no interaction with alcohol. These studies using laboratory animals show the importance of employing conditions to mimic environmental factors (e.g. stress and alcohol consumption) which might predispose individuals to ulcerogenic or other side-effects of NSAI drugs. From these studies it appears possible to construct 'predictive profiles' of the relative ulcerogenicity of NSAI drugs which may be applicable to the clinical situation in man.