Beneficial effects of combination therapy on cholesterol

1. A method of treating a disease in a mammal, wherein the disease is selected from the group consisting of atherosclerosis, myocardial infarction, hypercholesterolemia, hyperlipidemia, ischemic heart disease, congestive heart failure, acute coronary syndrome, plaque instability, coronary artery disease, cerebrovascular disease, peripheral vascular disease and cardiac risk management, comprising administering to a mammal in need thereof a therapeutically effective amount of a Janus Kinase inhibitor and a HMG-CoA reductase inhibitor or a pharmaceutically acceptable salt thereof or a pharmaceutical composition of pharmaceutical composition comprising:

a Janus Kinase inhibitor or a pharmaceutically acceptable salt thereof; and

a HMG-CoA reductase inhibitor or a pharmaceutically acceptable salt thereof; and

a pharmaceutically acceptable carrier.

2. The pharmaceutical combination therapy of claim 1 , wherein the Janus Kinase inhibitor is a compound of the formula

or the pharmaceutically acceptable salt thereof; wherein

R 1 is a group of the formula

wherein y is 0, 1 or 2;

R 4 is selected from the group consisting of hydrogen, (C 1 -C 6 )alkyl, (C r C 6 )alkylsulfonyl, (C 2 -C 6 )alkenyl, (C 2 -C 6 )alkynyl wherein the alkyl, alkenyl and alkynyl groups are optionally substituted by deuterium, hydroxy, amino, trifluoromethyl, (C 1 -C 4 )alkoxy, (C 1 -C 6 )acyloxy, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, cyano, nitro, (C 2 -C 6 )alkenyl, (C 2 -C 6 )alkynyl or (C 1 -C 6 )acylamino; or R 4 is (C 3 -C 10 )cycloalkyl wherein the cycloalkyl group is optionally substituted by deuterium, hydroxy, amino, trifluoromethyl, (C 1 -C 6 )acyloxy, (C 1 -C 6 )acylamino, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, cyano, cyano(C 1 -C 6 )alkyl, trifluoromethyl(C 1 -C 6 )alkyl, nitro, nitro(C 1 -C 6 )alkyl or (C r C 6 )acylamino;

R 5 is (C 2 -C 9 )heterocycloalkyl wherein the heterocycloalkyl groups must be substituted by one to five carboxy, cyano, amino, deuterium, hydroxy, (C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy, halo, (C 1 -C 6 )acyl, (C 1 -C 6 )alkylamino, amino(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy-CO—NH, (C 1 -C 6 )alkylamino-CO—, (C 2 -C 6 )alkenyl, (C 2 -C 6 )alkynyl, (C 1 -C 6 )alkylamino, amino(C 1 -C 6 )alkyl, hydroxy(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy(C 1 -C 6 )alkyl, (C 1 -C 6 )acyloxy(C 1 -C 6 )alkyl, nitro, cyano(C 1 -C 6 )alkyl, halo(C 1 -C 6 )alkyl, nitro(C 1 -C 6 )alkyl, trifluoromethyl, trifluoromethyl(C 1 -C 6 )alkyl, (C 1 -C 6 )acylamino, (C 1 -C 6 )acylamino(C 1 -C 6 )alkyl, (C r C 6 )alkoxy(C 1 -C 6 )acylamino, amino(C 1 -C 6 )acyl, amino(C 1 -C 6 )acyl(C 1 -C 6 )alkyl, (C r C 6 )alkylamino(C 1 -C 6 )acyl, ((C 1 -C 6 )alkyl) 2 amino(C 1 -C 6 )acyl, R 15 R 16 N—CO—O—, R 15 R 16 N—CO—(C 1 -C 6 )alkyl, (C 1 -C 6 )alkyl-S(O) m , R 15 R 16 NS(O) m , R 15 R 16 NS(O) m (C 1 -C 6 )alkyl, R 15 S(O) m R 16 N, R 15 S(O) m R 16 N(C 1 -C 6 )alkyl wherein m is 0, 1 or 2 and R 15 and R 16 are each independently selected from hydrogen or (C 1 -C 6 )alkyl; or a group of the formula

wherein a is 0, 1, 2, 3 or 4;

b, c, e, f and g are each independently 0 or 1;

d is 0, 1, 2, or 3;

X is S(O) n wherein n is 0, 1 or 2; oxygen, carbonyl or —C(═N-cyano)-;

Y is S(O) n wherein n is 0, 1 or 2; or carbonyl; and

Z is carbonyl, C(O)O—, C(O)NR— or S(O) n wherein n is 0, 1 or 2;

R 6 , R 7 , R 8 , R 9 , R 10 and R 11 are each independently selected from the group consisting of hydrogen or (C 1 -C 6 )alkyl optionally substituted by deuterium, hydroxy, amino, trifluoromethyl, (C 1 -C 6 )acyloxy, (C 1 -C 6 )acylamino, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, cyano, cyano(C 1 -C 6 )alkyl, trifluoromethyl(C 1 -C 6 )alkyl, nitro, nitro(C 1 -C 6 )alkyl or (C 1 -C 6 )acylamino;

R 12 is carboxy, cyano, amino, oxo, deuterium, hydroxy, trifluoromethyl, (C r C 6 )alkyl, trifluoromethyl(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy, halo, (C 1 -C 6 )acyl, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, amino(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy-CO—NH, (C 1 -C 6 )alkylamino-CO—, (C 2 -C 6 )alkenyl, (C 2 -C 6 )alkynyl, (C 1 -C 6 )alkylamino, hydroxy(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy(C 1 -C 6 )alkyl, (C 1 -C 6 )acyloxy(C 1 -C 6 )alkyl, nitro, cyano(C 1 -C 6 )alkyl, halo(C 1 -C 6 )alkyl, nitro(C 1 -C 6 )alkyl, trifluoromethyl, trifluoromethyl(C 1 -C 6 )alkyl, (C 1 -C 6 )acylamino, (C 1 -C 6 )acylamino(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy(C 1 -C 6 )acylamino, amino(C 1 -C 6 )acyl, amino(C 1 -C 6 )acyl(C 1 -C 6 )alkyl, (C 1 -C 6 )alkylamino(C 1 -C 6 )acyl, ((C 1 -C 6 )alkyl) 2 amino(C 1 -C 6 )acyl, R 15 R 16 N—CO—O—, R 15 R 16 N—CO—(C 1 -C 6 )alkyl, R 15 C(O)NH, R 15 OC(O)NH, R 15 NHC(O)NH, (C 1 -C 6 )alkyl-S(O) m , (C 1 -C 6 )alkyl-S(O) m —(C 1 -C 6 )alkyl, R 15 R 16 NS(O) m , R 15 R 16 NS(O) m (C 1 -C 6 )alkyl, R 15 S(O) m R 16 N, R 15 S(O) m R 16 N(C 1 -C 6 )alkyl wherein m is 0, 1 or 2 and R 15 and R 16 are each independently selected from hydrogen or (C 1 -C 6 )alkyl;

R 2 and R 3 are each independently selected from the group consisting of hydrogen, deuterium, amino, halo, hydoxy, nitro, carboxy, (C 2 -C 6 )alkenyl, (C 2 -C 6 )alkynyl, trifluoromethyl, trifluoromethoxy, (C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy, (C 3 -C 10 )cycloalkyl wherein the alkyl, alkoxy or cycloalkyl groups are optionally substituted by one to three groups selected from halo, hydroxy, carboxy, amino(C 1 -C 6 )alkylthio, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, (C 5 -C 9 )heteroaryl, (C 2 -C 9 )heterocycloalkyl, (C 3 -C 9 )cycloalkyl or (C 6 -C 10 )aryl; or R 2 and R 3 are each independently (C 3 -C 10 )cycloalkyl, (C 3 -C 10 )cycloalkoxy, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, (C 6 -C 10 )arylamino, (C 1 -C 6 )alkylthio, (C 6 -C 10 )arylthio, (C 1 -C 6 )alkylsulfinyl, (C 6 -C 10 )arylsulfinyl, (C 1 -C 6 )alkylsulfonyl, (C 6 -C 10 )arylsulfonyl, (C 1 -C 6 )acyl, (C 1 -C 6 )alkoxy-CO—NH—, (C 1 -C 6 )alkyamino-CO—, (C 5 -C 9 )heteroaryl, (C 2 -C 9 )heterocycloalkyl or (C 6 -C 10 )aryl wherein the heteroaryl, heterocycloalkyl and aryl groups are optionally substituted by one to three halo, (C 1 -C 6 )alkyl, (C 1 -C 6 )alkyl-CO—NH—, (C 1 -C 6 )alkoxy-CO—NH—, (C 1 -C 6 )alkyl-CO—NH—(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy-CO—NH—(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy-CO—NH—(C 1 -C 6 )alkoxy, carboxy, carboxy(C 1 -C 6 )alkyl, carboxy(C 1 -C 6 )alkoxy, benzyloxycarbonyl(C 1 -C 6 )alkoxy, (C 1 -C 6 )alkoxycarbonyl(C 1 -C 6 )alkoxy, (C 6 -C 10 )aryl, amino, amino(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxycarbonylamino, (C 6 -C 10 )aryl(C 1 -C 6 )alkoxycarbonylamino, (C 1 -C 6 )alkylamino, ((C 1 -C 6 )alkyl) 2 amino, (C 1 -C 6 )alkylamino(C 1 -C 6 )alkyl, ((C 1 -C 6 )alkyl) 2 amino(C 1 -C 6 )alkyl, hydroxy, (C 1 -C 6 )alkoxy, carboxy, carboxy(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxycarbonyl, (C 1 -C 6 )alkoxycarbonyl(C 1 -C 6 )alkyl, (C 1 -C 6 )alkoxy-CO—NH—, (C 1 -C 6 )alkyl-CO—NH—, cyano, (C 5 -C 9 )heterocycloalkyl, amino-CO—NH—, (C 1 -C 6 )alkylamino-CO—NH—, ((C 1 -C 6 )alkyl) 2 amino-CO—NH—, (C 6 -C 10 )arylamino-CO—NH—, (C 5 -C 9 )heteroarylamino-CO—NH—, (C 1 -C 6 )alkylamino-CO—NH—(C 1 -C 6 )alkyl, ((C 1 -C 6 )alkyl) 2 amino-CO—NH—(C 1 -C 6 )alkyl, (C 6 -C 10 )arylamino-CO—NH—(C 1 -C 6 )alkyl, (C 5 -C 9 )heteroarylamino-CO—NH—(C 1 -C 6 )alkyl, (C 1 -C 6 )alkylsulfonyl, (C 1 -C 6 )alkylsulfonylamino, (C 1 -C 6 )alkylsulfonylamino(C 1 -C 6 )alkyl, (C 6 -C 10 )arylsulfonyl, (C 6 -C 10 )arylsulfonylamino, (C 6 -C 10 )arylsulfonylamino(C 1 -C 6 )alkyl, (C 1 -C 6 )alkylsulfonylamino, (C 1 -C 6 )alkylsulfonylamino(C 1 -C 6 )alkyl, (C 5 -C 9 )heteroaryl or (C 2 -C 9 )heterocycloalkyl.

3. The method of claim 1 , wherein the Janus Kinase inhibitor is selected from the group consisting of:

Methyl-[4-methyl-1-(propane-1-sulfonyl)-piperidin-3-yl]-(7H-pyrrolo[2,3-d]-pyrimidin-4-yl)-amine;

4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxylic acid methyl ester;

3,3,3-Trifluoro-1-{4-methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-propan-1-one;

4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxylic acid dimethylamide;

({4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carbonyl}-amino)-acetic acid ethyl ester;

3-{4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-3-oxopropionitrile;

3,3,3-Trifluoro-1-{4-methyl-3-[methyl-(5-methyl-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-propan-1-one;

1-{4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-but-3-yn-1-one;

1-{3-[(5-Chloro-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-methyl-amino]-4-methyl-piperidin-1-yl}-propan-1-one;

1-{3-[(5-Fluoro-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-methyl-amino]-4-methyl-piperidin-1-yl}-propan-1-one;

N-cyano-4-methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-N′-propylpiperidine-1-carboxamidine;

N-cyano-4,N′,N′-Trimethyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxamidine;

Methyl-[(3R,4R)-4-methyl-1-(propane-1-sulfonyl)-piperidin-3-yl]-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amine;

(3R,4R)+4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxylic acid methyl ester;

3,3,3-Trifluoro-1-{(3R|4R)-4-methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-propan-1-one;

(3R,4R)-4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxylic acid dimethylamide;

{(3R,4R)-4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carbonyl}-amino)-acetic acid ethyl ester;

3-{(3R,4R)-4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-3-oxo-propionitrile;

3,3,3-Trifluoro-1-{(3R,4R)-4-methyl-3-[methyl-(5-methyl-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-propan-1-one;

1-{(3R,4R)-4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidin-1-yl}-but-3-yn-1-one;

1-{(3R,4R)-3-[(5-Chloro-7H-pyrrolo[2,3-d]pyrimidin-4-yl)-methyl-amino]-4-methylpiperidin-1-yl}-propan-1-one;

1-{(3R,4R)-3-[(5-Fluoro-7H-pyrrolo[2|3-d]pyrimidin-4-yl)-methyl-amino]-4-methyl-piperidin-1-yl}-propan-1-one;

(3R,4R)—N—Cyano-4-methyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-N′-propylpiperidine-1-carboxamidine; and

(3R,4R)—N-Cyano-4,N′,N′-Trimethyl-3-[methyl-(7H-pyrrolo[2,3-d]pyrimidin-4-yl)-amino]-piperidine-1-carboxamidine,

or a pharmaceutically acceptable salt thereof.

4. The method of claim 1 , wherein the Janus Kinase inhibitor is 3-{(3R,4R)-4-Methyl-3-[methyl-(7H-pyrrolo[2,3-d]-pyrimidin-4-yl)-amino]-piperidin-1-yl}-3-oxopropionitrile or a pharmaceutically acceptable salt thereof.

5. The method of claim 1 , wherein the HMG-CoA reductase inhibitor is a statin.

6. The method of claim 5 , wherein the statin is selected from the group consisting of atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, cerivastatin, rivastatin, mevastatin, velostatin, compactin, dalvastatin, fluindostatin, rosuvastatin, pitivastatin, and dihydrocompactin.

7. The method of claim 5 , wherein the statin is atorvastatin.

8. The method of claim 5 , wherein the statin is atorvastatin calcium salt.

9. The method of claim 1 , wherein the mammal is a human.

10. The method of claim 1 , wherein the Janus Kinase inhibitor or a pharmaceutically acceptable salt thereof and the HMG-CoA reductase inhibitor or a pharmaceutically acceptable salt thereof are administered simultaneously, sequentially or separately.

11. The method of claim 1 , wherein the ratio of Janus Kinase inhibitor or a pharmaceutically acceptable salt thereof to the HMG-CoA reductase inhibitor or a pharmaceutically acceptable salt thereof is about 2:1 to about 1:40 w/w.

12. The method of claim 1 , wherein the dosage form is selected from the group consisting of a solution, a suspension, a tablet, a pill, a sachet, a capsule, multiparticulates and a powder.