Cyclopropane carboxamide modulators of cystic fibrosis transmembrane conductance regulator

1. A compound that is

or a salt thereof.

2. The compound of claim 1 , that is:

or a salt thereof.

3. The compound of claim 1 , that is:

or a salt thereof.

4. The compound of claim 1 , wherein at least one position represented as D has deuterium enrichment of no less than about 10%.

5. The compound of claim 4 , wherein at least one position represented as D has deuterium enrichment of no less than about 50%.

6. The compound of claim 5 , wherein at least one position represented as D has deuterium enrichment of no less than about 90%.

7. The compound of claim 6 , wherein at least one position represented as D has deuterium enrichment of no less than about 98%.

8. The compound of claim 1 , wherein each position represented as D has deuterium enrichment of no less than about 10%.

9. The compound of claim 8 , wherein each position represented as D has deuterium enrichment of no less than about 50%.

10. The compound of claim 9 , wherein each position represented as D has deuterium enrichment of no less than about 90%.

11. The compound of claim 10 , wherein each position represented as D has deuterium enrichment of no less than about 98%.

12. A pharmaceutical composition comprising the compound, or a salt thereof, of claim 1 and a pharmaceutically acceptable carrier.

13. A method of treating a cystic fibrosis transmembrane conductance regulator-mediated disorder, comprising administering a therapeutically effective amount of a compound, or a salt thereof, of claim 1 to a patient in need thereof.

14. The method of claim 13 , wherein the disorder is fibrosis, sarcoglycanopathies, Brody's disease, cathecolaminergic polymorphic ventricular tachycardia, limb girdle muscular dystrophy, asthma, smoke induced chronic obstructive pulmonary disorder, chronic bronchitis, rhinosinusitis, constipation, pancreatitis, pancreatic insufficiency, male infertility caused by congenital bilateral absence of the vas deferens, mild pulmonary disease, idiopathic pancreatitis, allergic bronchopulmonary aspergillosis, liver disease, hereditary emphysema, hereditary hemochromatosis, coagulation-fibrinolysis deficiencies, such as protein C deficiency, type 1 hereditary angioedema, lipid processing deficiencies, such as familial hypercholesterolemia, type 1 chylomicronemia, abetalipoproteinemia, lysosomal storage diseases, such as I-cell disease/pseudo-Hurler, mucopolysaccharidoses, Sandhof/Tay-Sachs, Crigler-Najjar type II, polyendocrinopathy/hyperinsulinemia, diabetes mellitus, Laron dwarfism, myeloperoxidase deficiency, primary hypoparathyroidism, melanoma, glycanosis CDG type 1, congenital hyperthyroidism, osteogenesis imperfecta, hereditary hypofibrinogenemia, ACT deficiency, diabetes insipidus (DI), neurohypophyseal DI, nephrogenic DI, Charcot-Marie tooth syndrome, Pelizaeus-Merzbacher disease, neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, progressive supranuclear palsy, Pick's disease, polyglutamine neurological disorders such as Huntington's, spinocerebellar ataxia type I, spinal and bulbar muscular atrophy, dentatombral pallidoluysian, and myotonic dystrophy, as well as spongifiorm encephalopathies, such as hereditary Creutzfeldt-Jakob disease, Fabry disease, Gerstrnarm-Straussler-Scheinker syndrome, chronic obstructive pulmonary disorder, dry-eye disease, or Sjogren's disease, osteoporosis, osteopenia, bone healing and bone growth, Gorham's Syndrome, chloride channelopathies such as myotonia congenita, Bartter's syndrome type III, Dent's disease, hyperekplexia, epilepsy, lysosomal storage disease, Angelman syndrome, and primary ciliary dyskinesia (PCD), a term for inherited disorders of the structure and/or function of cilia, including PCD with situs inversus , PCD without situs inversus , or ciliary aplasia.

15. The method of claim 13 , further comprising administering an additional therapeutic agent.

16. The method of claim 15 , wherein the additional therapeutic agent is an antibiotic, bronchodilator, anticholinergic, DNase, mucolytic, nonsteroidal anti-inflammatory drug, mast cell stabilizer, corticosteroid, or enzyme replacement.

17. The method of claim 16 , wherein:

(i) the antibiotic is amikacin, amoxicillin, ampicillin, arsphenamine, azithromycin, aztreonam, azlocillin, bacitracin, carbenicillin, cefaclor, cefadroxil, cefamandole, cefazolin, cephalexin, cefdinir, cefditorin, cefepime, cefixime, cefoperazone, cefotaxime, cefoxitin, cefpodoxime, cefprozil, ceftazidime, ceftibuten, ceftizoxime, ceftriaxone, cefuroxime, chloramphenicol, cilastin, ciprofloxacin, clarithromycin, clindamycin, cloxacillin, colistin, dalfopristan, demeclocycline, dicloxacillin, dirithromycin, doxycycline, erythromycin, enafloxacin, ertepenem, ethambutol, flucloxacillin, fosfomycin, furazolidone, gatifloxacin, geldanamycin, gentamicin, herbimicin, imipenem, isoniazide, kanamicin, levofloxacin, linezolid, lomefloxacin, loracarbef, mafenide, moxifloxacin, meropenem, metronidazole, mezlocillin, minocycline, mupirozin, nafcillin, neomycin, netilmicin, nitrofurantoin, norfloxacin, ofloxacin, oxytetracycline, penicillin, piperacillin, platensimycin, polymixin B, prontocil, pyrazinamide, quinupristine, retapamulin, rifampin, roxithromycin, spectinomycin, streptomycin, sulfacetamide, sulfamethizole, sulfamethoxazole, teicoplanin, telithromycin, tetracycline, ticarcillin, tobramycin, trimethoprim, troleandomycin, trovafloxacin, or vancomycin;

(ii) the bronchodilator is salbutamol, levosalbutamol, terbutaline, pirbuterol, procaterol, metaproterenol, fenoterol, bitolterol mesylate, reproterol, salmeterol, formoterol, bambuterol, clenbuterol, or indacaterol;

(iii) the anticholinergic is oxyphencyclimine, camylofin, mebeverine, trimebutine, rociverine, dicycloverine, dihexyverine, difemerine, piperidolate, benzilone, glycopyrronium, oxyphenonium, penthienate, propantheline, otilonium bromide, methantheline, tridihexethyl, isopropamide, hexocyclium, poldine, mepenzolate, bevonium, pipenzolate, biphemanil, (2-benzhydryloxyethyl)diethyl-methylammonium iodide, tiemonium iodide, prifinium bromide, timepidium bromide, tiotropium bromide, ipratropium bromide, or fenpiverinium;

(iv) the DNase is DNase I enzyme, pulmozyme, or dornase alfa;

(v) the mucolytic is acetylcysteine, ambroxol, carbocisteine, erdosteine, or mecysteine;

(vi) the nonsteroidal anti-inflammatory drug is lumiracoxib, aceclofenac, acemetacin, amoxiprin, aspirin, azapropazone, benorilate, bromfenac, carprofen, celecoxib, choline magnesium salicylate, diclofenac, diflunisal, etodolac, etoracoxib, faislamine, fenbuten, fenoprofen, flurbiprofen, ibuprofen, indometacin, ketoprofen, ketorolac, lornoxicam, loxoprofen, meloxicam, meclofenamic acid, mefenamic acid, meloxicam, metamizole, methyl salicylate, magnesium salicylate, nabumetone, naproxen, nimesulide, oxyphenbutazone, parecoxib, phenylbutazone, piroxicam, salicyl salicylate, sulindac, sulfinprazone, suprofen, tenoxicam, tiaprofenic acid, or tolmetin;

(vii) the mast cell stabilizer is cromolyn sodium or nedocromil sodium;

(viii) the corticosteroid is prednisone, prednisolone, hydrocortisone, beclometasone, ciclesonide, budesonide, flunisolide, betamethasone, fluticasone, triamcinolone, or mometasone; or

(ix) the enzyme replacement is pancrelipase, lipase, protease, or amylase.

18. The method of claim 13 , further resulting in at least one or two effects that are:

a. decreased inter-individual variation in plasma levels of the compound or a metabolite thereof as compared to the non-isotopically enriched compound;

b. increased average plasma levels of the compound per dosage unit thereof as compared to the non-isotopically enriched compound;

c. decreased average plasma levels of at least one metabolite of the compound per dosage unit thereof as compared to the non-isotopically enriched compound;

d. increased average plasma levels of at least one metabolite of the compound per dosage unit thereof as compared to the non-isotopically enriched compound; or

e. an improved clinical effect during the treatment in the subject per dosage unit thereof as compared to the non-isotopically enriched compound.

19. The method of claim 13 , wherein the method (a) effects a decreased metabolism of the compound per dosage unit thereof by at least one polymorphically-expressed cytochrome P 450 isoform in the subject, as compared to the corresponding non-isotopically enriched compound; or (b) reduces a deleterious change in a diagnostic hepatobiliary function endpoint, as compared to the corresponding non-isotopically enriched compound.

20. The method of claim 13 , wherein the compound is characterized by decreased inhibition of at least one cytochrome P 450 or monoamine oxidase isoform in the subject per dosage unit thereof as compared to the non-isotopically enriched compound.