“approached Stjernschantz in the way that an open-minded medicinal chemist without knowledge of the invention would have done. They would have read the whole thing and focused on all the medicinal chemistry content.”
“94. … fluprostenol is mentioned in some of the Coleman classification documents, as a highly potent FP-receptor agonist but which had very low, indeed essentially nil, agonist activity against the other receptor types with which Coleman was concerned. In other words, it was known to be very selective, and indeed more so than PGF 2a. This profile made it highly relevant for classification, and so, for example, it is specifically mentioned in the TIPS supplement, and in Dr Coleman’s chapter in Hansch, Comprehensive Medicinal Chemistry (1st Ed, 1990) it is described as ‘diagnostic in establishing whether FP receptors exist in any particular tissue’. 95. So I agree that to this extent and for this purpose, fluprostenol was CGK, as part of the picture concerning the Coleman classification. 96. However, in terms of its previous use as a drug, fluprostenol had merely been a luteolytic agent in veterinary practice, which effect had been attributed to its FP receptor agonism. I do not think this would have been CGK to the skilled addressee working on glaucoma, but even if they had noticed it referred to in passing, it would not have been of practical interest.”
“It was not argued by Alcon that the technical contribution lies in whole or in part in addressing the side effect of ocular irritation – that is not demonstrated by the Patent for FIE.”
“A topical ophthalmic composition for use in the treatment of glaucoma and ocular hypertension comprising a therapeutically effective amount of fluprostenol isopropyl ester wherein the dosage range for topical administration of fluprostenol isopropyl ester is between 0.05 and 10 mg per eye … wherein fluprostenol isopropyl ester has the following formula: ”
“125. Counsel for the Defendants accepted that there must come a point where side effects are so bad that a drug is not suitable for use despite having an effect on the disease state in question. In particular, he accepted that lethal side effects would prevent a drug being suitable for use. I think that the boundary must depend on context, the disease state including its severity, and the nature and effect of the side effects. So, for example, even the risk of death from side effects might not prevent a cancer chemotherapy from being suitable for use, whereas the same side effects would rule out a drug for, say, bad breath as suitable. 126. In the current context, glaucoma was regarded as an incurable, long-term condition. Neither ocular irritation nor hyperemia would be considered unbearable in the short term, but in the longer term they would be regarded as very burdensome, and were recognised as having a very material adverse effect on patient compliance. They were not just inconveniences. 127. I therefore consider that PGF 2a was not suitable for use in treating glaucoma, and I am fortified in that view by the fact that those in the field considered it as being a dead-end, necessitating the search for other agonists with a better side effect profile.”
“However, substituting part of the omega chain with a phenyl ring (Scheme 2) has been shown to change the pharmaceutical profile of PGF2α dramatically with respect to the side effects in the eye (26)-(29).”
“The marked miotic effect of these compounds in combination with the total lack of irritative effect strongly suggests that substitution of part of the omega chain with an aromatic ring structure either causes conformational alteration in the molecule or imposes a steric hindrance, which enables a discrimination between different prostaglandin receptor subtypes.”
“As can be seen in Table I, all phenyl substituted PGF2alpha-ie analogues (Scheme 2) induced clearly less hyperemia than PGF2alpha-ie. The analogues exhibiting least conjunctival hyperemia were generally those exhibiting least pharmacologic activity such as the earlier mentioned 15-OH epimers 6, 9 and the 15-keto 7, 10 17-phenyl substituted prostaglandin analogues (Table I).”
“The prostaglandin receptor profile of latanoprost has been worked out in vitro using a receptor classification system previously described (56). … Latanoprost has high affinity and selectivity for PGF2α (FP) receptors as demonstrated in Table III (57). The affinity for EP2, EP3, DP, IP and TP receptors is very low compared with the specific ligands [i.e. PGE 2 etc]. However, the affinity for EP1 receptors is somewhat greater (57). These results indicate that FP receptors most likely are important in the mechanism leading to increased uveoscleral outflow and reduced IOP in primate and human eyes.”
“… all clinical studies performed so far indicate that latanoprost (including PhXA34 [its racemate]) effectively reduces IOP with markedly improved side effect profile compared to PGF2α and its isopropyl ester.”
“These results indicate that the 17-phenyl-18,19,20-trinor- PGF2alpha-ie is unique in that this compound exhibits a structural conformation with no affinity for PG receptors involved in the sensory irritative response (presumably PG receptors on sensory nerves), while retaining the affinity for FP receptors as demonstrated by the miotic response. In contrast, PGF2alpha-ie analogues with shorter or longer phenyl substituted omega chain did show some affinity for PG receptors mediating nociceptive impulses. However, this affinity was much weaker than that of PGF2alpha-ie. It appears that the steric hindrance of the phenyl ring and the interatomic distances between functional groups in the molecules are important for drug-receptor interaction.”
“The introduction of a trifluoromethyl group into position 4 in the phenyl ring 23, as can be expected, rendered the 17-phenyl-18,19,20-trinor-PGF2alpha-ie analogue practically inactive (Table IV).”
“From what is mentioned above, it is evident that by substituting part of the omega chain of PGF2alpha-ie with a phenyl ring, it is possible to totally eliminate the ocular irritating effect and to markedly reduce the hyperemic effect of PGF2alpha-ie. Although a phenyl ring substitution seems to be particularly beneficial, substitution with other ring structures such as cyclohexyl, thiophene and biphenyl also yields compounds with distinctly better side effect profile than that of PGF2alpha and its prodrugs in the eye (unpublished results). Thus, PGF2alpha possessing a terminal ring moiety on the omega chain exhibits a markedly improved therapeutic index in the eye.”
“It is obvious that similar phenyl substitutions e.g. of PGB 2, PGC 2 or PGD 2 can be anticipated analogously to improve the side effect profile of these prostaglandin analogues in the eye.”
“PGF2alpha and its isopropyl ester have been shown to be potent ocular hypotensive agents in several animal species and in man. However, the frequent and disturbing side effects in the eye make it impossible to utilize PGF2alpha as an ocular hypotensive agent clinically. Whereas the prodrug esters of PGF2alpha do not significantly reduce the adverse effects in the eye, partial substitution of the omega chain with a phenyl ring dramatically reduces the ocular side effects of PGF2alpha-ie. Such substitution totally eliminates the superficial irritating effect of PGF2alpha-ie in the eye. This is probably due to a conformational change of the omega chain in the prostaglandin molecule, or steric hindrance, which enables a discrimination between different prostaglandin receptor subtypes. The most optimal chain length to which the ring structure is attached seems to be 5 carbon atoms (17-phenyl-18,19,20-trinor). The biologic activity of these compounds may further be altered by substitutions in the phenyl ring. One of the most promising analogues 8 latanoprost is presently undergoing phase II clinical testing with encouraging results. This drug has been shown to potently reduce IOP in glaucoma patients with few side effects.”
“The Defendants’ case was that Stjernschantz showed that it was most probably FP receptor binding that was responsible for reduced IOP, while side-effects were mediated by other prostaglandin receptors, and that once that was known, it would be obvious to try FIE for treating glaucoma, because it was known from the CGK to be a potent and selective FP receptor agonist. Thus, they argued, FIE fit the profile of an efficacious, side-effect sparing prostaglandin analogue.”
“181. In my view, the natural way for the skilled team to approach obvious developments from Stjernschantz would be to consider further prostaglandin analogues, altered in ways concretely reasoned out from the structure activity work described. This would be logical and routine and in keeping with the approach of the paper. It is suggested in the penultimate paragraph of the paper. … 183. I must not overlook that more than one approach may be obvious from a piece of prior art. In principle it could be obvious both to make structural changes based on Stjernschantz’s structure activity relationship work and also obvious to work with compounds with significantly different structures but similar patterns of activity. It depends on the facts, but Stjernschantz’s being a paper with such a strong basis in structure activity relationships is a point against trying other compounds based on activity.”
“… In particular, I thought it failed to deal with why the skilled team would think of fluprostenol in the first place, was almost entirely lacking in analysis of the prospects of success to be expected, and did not take account of the nature of the work done, and suggestions by, Stjernschantz.”
“I found her analysis very limited and not a good basis for the proposition that the skilled addressee would just switch to other, quite different compounds. I did not think it properly reflected how a medicinal chemist would approach Stjernschantz; they would read the whole of it carefully and suggest specific, rational, structural changes based on the SAR work done.”
“I think it is particularly important in the present case to read the whole passages. When that is done, I think the answers given were not really supportive of the Defendants’ case, and certainly not enough to undermine the evidence that Alcon’s experts had given in their written reports, which in general they continued to support and which I preferred over that of the Defendants’ experts.”
“Mr Burkill, in his skeleton argument, advanced an argument to the effect that where the skilled addressee was taken to be a team (because more than one skill was involved) then the law requires one member of the team to be the “head” directing the others. Here the suggestion was that the head of the team would be a rock bit engineer who would be directing a computer model designer as some kind of assistant. That position was not pursued during the oral argument. And rightly so. If the addressee of a patent is a notional team of persons with differing skills, then it is a team with no boss. Each member of the team is assumed to play his/her own part.”
“19. … The skilled pharmacologist considering new treatments for glaucoma would be responsible for identifying a potential biological target or pathway which could be pursued … The skilled pharmacologist would then, with the help of the skilled medicinal chemist, develop potential compounds which act on the biological target/pathway. The skilled pharmacologist would then test the activity of these potential compounds … by designing and performing in vitro and in vivo assays. … 20. The skilled medicinal chemist would be led by the skilled pharmacologist and be responsible for synthesising drug candidates for the skilled pharmacologist to test. They would also work with the skilled pharmacologist in assessing how the structure of the potential drug candidate compounds may influence their pharmacological action and therefore in designing potential drug candidates. This would be likely be a trial and error process in which potential drug candidates are made and their activity tested, further structural alterations are made to the … candidates based on the results, and then the modified drugs are, in turn, tested to assess the effect of the modification.”
“The analogues exhibiting least conjunctival hyperemia were generally those exhibiting least pharmacologic activity such as the earlier mentioned 15-OH epimers 6, 9 and the 15-keto 7, 10 17-phenyl substituted prostaglandin analogues (Table I).”
“I agree with Alcon that this gives the impression that hyperemia was in some way correlated to activity. It would reduce any confidence that the skilled addressee could otherwise have that it would be possible to achieve good activity (matching latanoprost, for example), while reducing or eliminating hyperemia.”
“… there is reasonably good correlation between the mioisis and IOP-lowering data at the same dose (1.0 μg). However, based on the lack of correlation between miosis, IOP-lowering and hyperemia, the skilled pharmacologist would conclude that the biological mechanism for the hyperemia is unclear and it cannot be said that those with the lowest efficacy have the lowest hyperemia (see for example compound 11 which ranks highly for cat miosis and IOP-lowering and causes some of the lowest levels of hyperemia).”
“The biologic activity of these compounds may further be altered by substitutions in the phenyl ring.”
“234. While they may discuss the possibility with the skilled medicinal chemist, I also do not believe that the skilled pharmacologist would consider investigating other phenyl-substituted analogues of PGF2a. This is as the skilled pharmacologist would have no reason to believe that it would be possible that structural modifications to compound 5, latanoprost and/or compound 11 would result in a better drug. … 239. I therefore do not believe the skilled pharmacologist would be motivated to investigate other phenyl-substituted analogues and, if they were, it would be a lengthy research program to investigate the potential modifications that could be made.”
“The skilled team would be guided by the skilled pharmacologist as to whether it would be worthwhile to take any further steps after reading Stjernschantz. This is as the skilled team would only consider further work if the skilled pharmacologist thought any of the compounds in Stjernschantz were sufficiently interesting for further development and I would defer to Dr Krauss in this respect. I understand from Bristows that it is Dr Krauss’ evidence that there are a number of potential steps that the skilled pharmacologist may take after reading Stjernschantz, one of which would be to discuss with the skilled medicinal chemist whether it would be possible to modify compounds 5, 8 or 11 to either: (i) improve the efficacy while maintaining (or ideally lowering) any side effects; or (ii) maintaining (or ideally improving) the efficacy while improving the side effects.”
“Instead, the ‘most straightforward approach’ to the … medicinal chemist would be to make routine modifications to the structure of latanoprost to improve its pharmacological effects. However … the … medicinal chemist would have no way of knowing how they would affect the pharmacological properties observed in latanoprost. The … medicinal chemist would also assume that … Stjernschantz had already tested a number of different modifications to latanoprost and alighted upon latanoprost as the best. The … medicinal chemist is therefore left with many different potential modifications to try with no reason to predict that they would improve the pharmacological properties of latanoprost.”
“the specification must disclose some reason for supposing that the implied assertion of efficacy in the claim is true”
“In the event that the claims of the Patent are not obvious because it was understood that the administration of PGF2α isopropyl ester would cause ocular inflammationhyperemia and irritation, the Patent fails to make plausible that the compounds of the invention are suitable for use in treating glaucoma and ocular hypertension. In particular, the data in the specification of the Patent fails to evidence an improvement in these side effects when the compounds of the invention are used over PGF2α isopropyl ester.”
“The point fails on the facts … since, as I have explained above, the Patent does make it plausible that FIE causes reduced hyperemia compared to PGF2α.”