Neprilysin inhibitors

1. A compound of formula I:

where:

R 1 is selected from —OR 7 and —NR 8 R 9 ;

R 2 is H or —P(O)(OH) 2 or R 2 is taken together with R 7 to form —CR 18 R 19 — or is taken together with R 8 to form —C(O)—;

X is a —C 1-9 heteroaryl;

R 3 is absent or is selected from H; halo; —C 0-5 alkylene-OH; —NH 2 ; —C 1-6 alkyl; —CF 3 ; —C 3-7 cycloalkyl; —C 0-2 alkylene-O—C 1-6 alkyl; —C(O)R 20 ; —C 0-1 alkylene-COOR 21 ; —C(O)NR 22 R 23 ; —NHC(O)R 24 ; ═O; —NO 2 ; —C(CH 3 )═N(OH); phenyl optionally substituted with one or two groups independently selected from halo, —OH, —CF 3 , —OCH 3 , —NHC(O)CH 3 , and phenyl; naphthalenyl; pyridinyl; pyrazinyl; pyrazolyl optionally substituted with methyl; thiophenyl optionally substituted with methyl or halo; furanyl; and —CH 2 -morpholinyl; and R 3 , when present, is attached to a carbon atom;

R 4 is absent or is selected from H; —OH; —C 1-6 alkyl; —C 1-2 alkylene-COOR 35 ; —CH 2 OC(O)CH(R 36 )NH 2 ; —OCH 2 OC(O)CH(R 36 )NH 2 ; —OCH 2 OC(O)CH 3 ; —CH 2 OP(O)(OH) 2 ; —CH 2 CH(OH)CH 2 OH; —CH[CH(CH 3 ) 2 ]—NHC(O)O—C 1-6 alkyl; pyridinyl; and phenyl or benzyl optionally substituted with one or more groups selected from halo, —COOR 35 , —OCH 3 , —OCF 3 , and —SCF 3 ; and R 4 , when present, is attached to a carbon or nitrogen atom;

or R 3 and R 4 are taken together to form -phenylene-O—(CH 2 ) 1-3 — or -phenylene-O—CH 2 —CHOH—CH 2 —;

a is 0 or 1; R 5 is selected from halo, —CH 3 , —CF 3 , and —CN;

b is 0 or an integer from 1 to 3; each R 6 is independently selected from halo, —OH, —CH 3 , —OCH 3 , and —CF 3 ;

R 7 is selected from H, —C 1-8 alkyl, —C 1-3 alkylene-C 6-10 aryl, —C 1-3 alkylene-C 1-9 heteroaryl, —C 3-7 cycloalkyl, —[(CH 2 ) 2 O] 1-3 CH 3 , —C 1-6 alkylene-OC(O)R 10 , —C 1-6 alkylene-NR 12 R 13 , —C 1-6 alkylene-C(O)R 31 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl,

R 10 is selected from —C 1-6 alkyl, —O—C 1-6 alkyl, —C 3-7 cycloalkyl, —O—C 3-7 cycloalkyl, phenyl, —O-phenyl, —NR 12 R 13 , —CH[CH(CH 3 ) 2 ]—NH 2 , —CH—NHC(O)O—C 1-6 alkyl, and —CH(NH 2 )CH 2 COOCH 3 ; and R 12 and R 13 are independently selected from H, —C 1-6 alkyl, and benzyl; or R 12 and R 13 are taken together as —(CH 2 ) 3-6 —, —C(O)—(CH 2 ) 3 —, or —(CH 2 ) 2 —O—(CH 2 ) 2 —; R 31 is selected from —O—C 1-6 alkyl, —O-benzyl, and —NR 12 R 13 ; and R 32 is —C 1-6 alkyl or —C 0-6 alkylene-C 6-10 aryl;

R 8 is selected from H, —OH, —OC(O)R 14 , —CH 2 COOH, —O-benzyl, -pyridyl, and —OC(S)NR 15 R 16 ; R 14 is selected from H, —C 1-6 alkyl, —C 6-10 aryl, —OCH 2 —C 6-10 aryl, —CH 2 O—C 6-10 aryl, and —NR 15 R 16 ; and R 15 and R 16 are independently selected from H and —C 1-4 -alkyl;

R 9 is selected from H, —C 1-6 alkyl, and —C(O)—R 17 ; and R 17 is selected from H, —C 1-6 alkyl, —C 3-7 cycloalkyl, —C 6-10 aryl, and —C 1-9 heteroaryl;

R 18 and R 19 are independently selected from H, —C 1-6 alkyl, and —O—C 3-7 cycloalkyl, or R 18 and R 19 are taken together to form ═O;

R 20 is selected from H and —C 1-6 alkyl;

R 21 and R 35 are independently selected from

H, —C 1-6 alkyl, —C 1-3 alkylene-C 6-10 aryl, —C 1-3 alkylene-C 1-9 heteroaryl, —C 3-7 cycloalkyl, —[(CH 2 ) 2 O] 1-3 CH 3 , —C 1-6 alkylene-OC(O)R 25 , —C 1-6 alkylene-NR 27 R 28 , —C 1-6 alkylene-C(O)R 33 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl,

R 25 is selected from —C 1-6 alkyl, —O—C 1-6 alkyl, —C 3-7 cycloalkyl, —O—C 3-7 cycloalkyl, phenyl, —O-phenyl, —NR 27 R 28 , —CH[CH(CH 3 ) 2 ]—NH 2 , —CH[CH(CH 3 ) 2 ]—NHC(O)O—C 1-6 alkyl, and —CH(NH 2 )CH 2 COOCH 3 ; R 27 and R 28 are independently selected from H, —C 1-6 alkyl, and benzyl; or R 27 and R 28 are taken together as —(CH 2 ) 3-6 —, —C(O)—(CH 2 ) 3 —, or —(CH 2 ) 2 —O—(CH 2 ) 2 —; R 33 is selected from —O—C 1-6 alkyl, —O-benzyl, and —NR 27 R 28 ; and R 34 is —C 1-6 alkyl or —C 0-6 alkylene-C 6-10 aryl;

R 22 and R 23 are independently selected from H, —C 1-6 alkyl, —CH 2 COOH, —(CH 2 ) 2 OH, —(CH 2 ) 2 OCH 3 , —(CH 2 ) 2 SO 2 NH 2 , —(CH 2 ) 2 N(CH 3 ) 2 , —C 0-1 alkylene-C 3-7 cycloalkyl, and —(CH 2 ) 2 -imidazolyl; or R 22 and R 23 are taken together to form a saturated or partially unsaturated —C 3-5 heterocycle optionally substituted with halo, —OH, —COOH, or —CONH 2 ; and optionally containing an oxygen atom in the ring;

R 24 is selected from —C 1-6 alkyl; —C 0-1 alkylene-O—C 1-6 alkyl; phenyl optionally substituted with halo or —OCH 3 ; and —C 1-9 heteroaryl; and

R 36 is selected from H, —CH(CH 3 ) 2 , phenyl, and benzyl;

where each alkyl group in R 1 , R 3 , and R 4 is optionally substituted with 1 to 8 fluoro atoms; and;

where the methylene linker on the biphenyl is optionally substituted with one or two —C 1-6 alkyl groups or cyclopropyl;

or a pharmaceutically acceptable salt thereof.

2. The compound of claim 1 , where X is selected from pyrazole, imidazole, triazole, benzotriazole, furan, pyrrole, tetrazole, pyrazine, thiophene, oxazole, isoxazole, thiazole, isothiazole, oxadiazole, thiadiazole, pyridazine, pyridine, pyrimidine, pyran, benzimidazole, benzoxazole, benzothiazole, pyridylimidazole, and pyridyltriazole.

3. The compound of claim 2 , where X is selected from pyrazole, triazole, benzotriazole, furan, tetrazole, pyrazine, thiophene, oxazole, isoxazole, thiazole, oxadiazole, pyridazine, pyridine, pyrimidine, benzoxazole, pyridylimidazole, and pyridyltriazole.

4. The compound of claim 3 , having formula III:

5. The compound of claim 1 , where R 1 is selected from —OR 7 and —NR 8 R 9 , R 7 is H, R 8 is H or —OH, and R 9 is H.

6. The compound of claim 1 , where:

R 1 is —OR 7 ; and R 7 is selected from —C 1-8 alkyl, —C 1-3 alkylene-C 6-10 aryl, —C 1-3 alkylene-C 1-9 heteroaryl, —C 3-7 cycloalkyl, —[(CH 2 ) 2 O] 1-3 CH 3 , —C 1-6 alkylene-OC(O)R 10 , —C 1-6 alkylene-NR 12 R 13 , —C 1-6 alkylene-C(O)R 31 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl,

R 1 is —NR 8 R 9 ; R 8 is selected from —OC(O)R 14 , —CH 2 COOH, —O-benzyl, pyridyl, and —OC(S)NR 15 R 16 ; and R 9 is H; or

R 1 is —NR 8 R 9 ; R 8 is selected from —OC(O)R 14 , —CH 2 COOH, —O-benzyl, pyridyl, and —OC(S)NR 15 R 16 ; and R 9 is —C 1-6 alkyl or —C(O)R 17 ;

R 1 is —NR 8 R 9 ; R 8 is selected from H or —OH; and R 9 is selected from —C 1-6 alkyl, and —C(O)R 17 ;

R 1 is —OR 7 and R 2 is taken together with R 7 to form —CR 18 R 19 —; or

R 1 is —NR 8 R 9 and R 2 is taken together with R 8 to form —C(O)—.

7. The compound of claim 1 , where R 1 is —OR 7 , and R 7 is selected from H, —C 1-8 alkyl, —C 1-6 alkylene-OC(O)R 10 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl, and

R 10 is —O—C 3-7 cycloalkyl; and R 32 is —CH 3 .

8. The compound of claim 1 , where R 1 is —NR 8 R 9 , where R 8 is H and R 9 is H.

9. The compound of claim 1 , where R 2 is H.

10. The compound of claim 1 , where R 3 is absent or is selected from H; halo; —C 0-5 alkylene-OH; —NH 2 ; —C 1-6 alkyl; —CF 3 ; —C 3-7 cycloalkyl; —C 0-2 alkylene-O—C 1-6 alkyl; —C(O)R 20 ; —C 0-1 alkylene-COOR 21 ; —C(O)NR 22 R 23 ; —NHC(O)R 24 ; ═O; —NO 2 ; —C(CH 3 )═N(OH); phenyl optionally substituted with one or two groups independently selected from halo, —OH, —CF 3 , —OCH 3 , —NHC(O)CH 3 , and phenyl; naphthalenyl; pyridinyl; pyrazinyl; pyrazolyl optionally substituted with methyl; thiophenyl optionally substituted with methyl or halo; furanyl; and —CH 2 -morpholinyl; and R 21 is H.

11. The compound of claim 1 , where R 3 is —C 0-1 alkylene-COOR 21 ; and R 21 is selected from —C 1-6 alkyl, —C 1-3 alkylene-C 6-10 aryl, —C 1-3 alkylene-C 1-9 heteroaryl, —C 3-7 cycloalkyl, —[(CH 2 ) 2 O] 1-3 CH 3 , —C 1-6 alkylene-OC(O)R 25 , —C 1-6 alkylene-NR 27 R 28 , —C 1-6 alkylene-C(O)R 33 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl,

12. The compound of claim 1 , where R 3 is absent or is selected from H; halo; —C 0-5 alkylene-OH; —NH 2 ; —C 1-6 alkyl; —CF 3 ; —C 3-7 cycloalkyl; —C 0-2 alkylene-O—C 1-6 alkyl; —C(O)R 20 ; —C 0-1 alkylene-COOR 21 ; —C(O)NR 22 R 23 ; —NHC(O)R 24 ; ═O; —C(CH 3 )═N(OH); phenyl optionally substituted with one or two groups independently selected from halo, —OH, —CF 3 , —OCH 3 , —NHC(O)CH 3 , and phenyl; naphthalenyl; pyridinyl; pyrazinyl; pyrazolyl substituted with methyl; thiophenyl substituted with methyl or halo; furanyl; and —CH 2 -morpholinyl; R 20 is —C 1-6 alkyl; R 21 is selected from H and —C 1-6 alkyl; R 22 is selected from H and —C 1-6 alkyl; and R 23 is selected from H, —C 1-6 alkyl, —CH 2 COOH, —(CH 2 ) 2 OH, —(CH 2 ) 2 OCH 3 , —(CH 2 ) 2 N(CH 3 ) 2 , —C 3-7 cycloalkyl, and —(CH 2 ) 2 -imidazolyl; or R 22 and R 23 are taken together to form azetidine, pyrrolidine, piperidine or morpholine, all optionally substituted with —OH or —CONH 2 ; and R 24 is selected from —C 1-6 alkyl; —C 0-1 alkylene-O—C 1-6 alkyl; phenyl substituted with halo or —OCH 3 ; and pyridine.

13. The compound of claim 1 , where R 4 is absent or is selected from H; —OH; —C 1-6 alkyl; —C 1-2 alkylene-COOR 35 ; —CH 2 OC(O)CH(R 36 )NH 2 ; —CH 2 CH(OH)CH 2 OH; pyridinyl; and phenyl or benzyl optionally substituted with one or more groups selected from halo, —COOR 35 , —OCH 3 , —OCF 3 , and —SCF 3 ; and R 35 is H.

14. The compound of claim 1 , where R 4 is selected from —OCH 2 OC(O)CH 3 ; —CH 2 OP(O)(OH) 2 ; —C 1-2 alkylene-COOR 35 ; and phenyl or benzyl substituted with at least one —COOR 35 group; where R 35 is selected from —C 1-6 alkyl, —C 1-3 alkylene-C 6-10 aryl, —C 1-3 alkylene-C 1-9 heteroaryl, —C 3-7 cycloalkyl, -[(CH 2 ) 2 O] 1-3 CH 3 , —C 1-6 alkylene-OC(O)R 25 , —C 1-6 alkylene-NR 27 R 28 , —C 1-6 alkylene-C(O)R 33 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl,

15. The compound of claim 1 , where R 4 is absent or is selected from H; —OH; —C 1-6 alkyl; —C 1-2 alkylene-COOR 35 ; —CH 2 OC(O)CH(R 36 )NH 2 ; —CH 2 CH(OH)CH 2 OH; pyridinyl; phenyl optionally substituted with one halo group; and benzyl optionally substituted with one or more groups selected from halo, —COOH, —OCH 3 , —OCF 3 , and —SCF 3 ; R 35 is H; and R 36 is —CH(CH 3 ) 2 ; or R 3 and R 4 are taken together to form -phenylene-O—(CH 2 ) 1-3 — or -phenylene-O—CH 2 —CHOH—CH 2 —.

16. The compound of claim 1 , where a is 0; or a is 1 and R 5 is 3-chloro.

17. The compound of claim 1 , where b is 0; or b is 1 and R 6 is 3′-chloro, 3′-methyl, or 2′-methoxy; or b is 2 and R 6 is 2′-fluoro-5′-chloro, 2′,5′-dichloro, 2′-methyl-5′-chloro, or 3′-chloro-5′-hydroxy.

18. The compound of claim 1 , where the methylene linker on the biphenyl is substituted with 2 methyl groups.

19. The compound of claim 1 , where

R 1 is —OR 7 ; R 7 is selected from H, —C 1-8 alkyl, —C 1-6 alkylene-OC(O)R 10 , —C 0-6 alkylenemorpholinyl, —C 1-6 alkylene-SO 2 —C 1-6 alkyl, and

R 10 is —O—C 3-7 cycloalkyl, R 32 is —CH 3 , R 8 is H; R 9 is H;

R 2 is H;

X is selected from pyrazole, triazole, benzotriazole, furan, tetrazole, pyrazine, thiophene, oxazole, isoxazole, thiazole, oxadiazole, pyridazine, pyridine, pyrimidine, benzoxazole, pyridylimidazole, and pyridyltriazole;

R 3 is absent or is selected from H; halo; —C 0-5 alkylene-OH; —NH 2 ; —C 1-6 alkyl; —CF 3 ; —C 3-7 cycloalkyl; —C 0-2 alkylene-O—C 1-6 alkyl; —C(O)R 20 ; —C 0-1 alkylene-COOR 21 ; —C(O)NR 22 R 23 ; —NHC(O)R 24 ; ═O; —C(CH 3 )═N(OH); phenyl optionally substituted with one or two groups independently selected from halo, —OH, —CF 3 , —OCH 3 , —NHC(O)CH 3 , and phenyl; naphthalenyl; pyridinyl; pyrazinyl; pyrazolyl substituted with methyl; thiophenyl substituted with methyl or halo; furanyl; and —CH 2 -morpholinyl;

R 4 is absent or is selected from H; —OH; —C 1-6 alkyl; —C 1-2 alkylene-COOR 35 ; —CH 2 OC(O)CH(R 36 )NH 2 ; —CH 2 CH(OH)CH 2 OH; pyridinyl; phenyl optionally substituted with one halo group; and benzyl optionally substituted with one or more groups selected from halo, —COOH, —OCH 3 , —OCF 3 , and —SCF 3 ;

or R 3 and R 4 are taken together to form -phenylene-O—(CH 2 ) 1-3 — or -phenylene-O—CH 2 —CHOH—CH 2 —;

a is 0; or a is 1 and R 5 is 3-chloro;

b is 0; or b is 1 and R 6 is 3′-chloro, 3′-methyl, or 2′-methoxy; or b is 2 and R 6 is 2′-fluoro-5′-chloro, 2′,5′-dichloro, 2′-methyl-5′-chloro, or 3′-chloro-5′-hydroxy;

R 20 is —C 1-6 alkyl;

R 21 is selected from H and —C 1-6 alkyl;

R 22 is selected from H and —C 1-6 alkyl; and R 23 is selected from H, —C 1-6 alkyl, —CH 2 COOH, —(CH 2 ) 2 OH, —(CH 2 ) 2 OCH 3 , —(CH 2 ) 2 N(CH 3 ) 2 , —C 3-7 cycloalkyl, and —(CH 2 ) 2 -imidazolyl; or R 22 and R 23 are taken together to form azetidine, pyrrolidine, piperidine or morpholine, all optionally substituted with —OH or —CONH 2 ;

R 24 is selected from —C 1-6 alkyl; —O—C 1-6 alkyl; —CH 2 —O—C 1-6 alkyl; phenyl substituted with halo or —OCH 3 ; and pyridinyl;

R 35 is H;

R 36 is —CH(CH 3 ) 2 ; and

the methylene linker on the biphenyl is optionally substituted with 2 methyl groups.

20. The compound of claim 1 , where

R 1 is —OR 7 ;

R 2 is H;

X is selected from pyrazole, triazole, benzotriazole, isoxazole, pyridazine, pyrimidine, and pyridyltriazole;

R 3 is selected from H; halo; —C 0-5 alkylene-OH; —C 1-6 alkyl; —CF 3 ; —C 3-7 cycloalkyl; —C 0-2 alkylene-O—C 1-6 alkyl; —C(O)R 20 ; —C 0-1 alkylene-COOR 21 ; —C(O)NR 22 R 23 ; —NHC(O)R 24 ; ═O; —C(CH 3 )═N(OH); phenyl optionally substituted with one or two groups independently selected from halo, —OH, and —OCH 3 ; pyridinyl; pyrazinyl; and thiophenyl substituted with methyl or halo;

R 4 is selected from H; —OH; —C 1-6 alkyl; —C 1-2 alkylene-COOR 35 ; —CH 2 CH(OH)CH 2 OH; pyridinyl; and phenyl optionally substituted with one halo group; or R 3 and R 4 are taken together to form -phenylene-O—(CH 2 ) 1-3 —;

a is 0; or a is 1 and R 5 is 3-chloro;

b is 0; or b is 1 and R 6 is 3′-chloro, 3′-methyl, or 2′-methoxy; or b is 2 and R 6 is 2′-fluoro-5′-chloro, 2′,5′-dichloro, 2′-methyl-5′-chloro, or 3′-chloro-5′-hydroxy;

R 20 is —C 1-6 alkyl;

R 21 is H;

R 22 is selected from H and —C 1-6 alkyl; and R 23 is selected from —C 1-6 alkyl, —(CH 2 ) 2 OCH 3 , and —C 3-7 cycloalkyl; or R 22 and R 23 are taken together to form azetidine, pyrrolidine, or piperidine, all optionally substituted with —OH or —CONH 2 ;

R 24 is phenyl substituted with halo or —OCH 3 ;

R 35 is H; and

the methylene linker on the biphenyl is optionally substituted with 2 methyl groups.

21. A process for preparing the compound of claim 1 , comprising the step of coupling a compound of formula 1 with a compound of formula 2:

to produce a compound of formula I; where P 1 is H or an amino-protecting group selected from t-butoxycarbonyl, trityl, benzyloxycarbonyl, 9-fluorenylmethoxycarbonyl, formyl, trimethylsilyl, and t-butyldimethylsilyl; and where the process further comprises deprotecting the compound of formula 1 when P 1 is an amino protecting group.

22. A process for preparing the compound of claim 1 , comprising the step of deprotecting a compound selected from:

or a salt thereof; where R 1P is selected from —O—P 3 , —NHP 2 , and —NH(O—P 4 ); R 3P is selected from —C 0-5 alkylene-O—P 4 , —C 0-1 alkylene-COO—P 3 , and phenyl substituted with —O—P 4 ; R 4P is selected from —O—P 4 ; —C 1-2 alkylene-COO—P 3 ; and phenyl or benzyl substituted with —COO—P 3 ; P 2 is an amino-protecting group selected from t-butoxycarbonyl, trityl, benzyloxycarbonyl, 9-fluorenylmethoxycarbonyl, formyl, trimethylsilyl, and t-butyldimethylsilyl; P 3 is a carboxy-protecting group selected from methyl, ethyl, t-butyl, benzyl, p-methoxybenzyl, 9-fluorenylmethyl, trimethylsilyl, t-butyldimethylsilyl, and diphenylmethyl; and P 4 is a hydroxyl-protecting group selected from —C 1-6 alkyl, triC 1-6 alkylsilyl, —C 1-6 alkanoyl, benzoyl, benzyl, p-methoxybenzyl, 9-fluorenylmethyl, and diphenylmethyl.

23. A pharmaceutical composition comprising the compound of claim 1 and a pharmaceutically acceptable carrier.

24. The pharmaceutical composition of claim 23 , further comprising a therapeutic agent selected from adenosine receptor antagonists, α-adrenergic receptor antagonists, β 1 -adrenergic receptor antagonists, β 2 -adrenergic receptor agonists, dual-acting β-adrenergic receptor antagonist/α 1 -receptor antagonists, advanced glycation end product breakers, aldosterone antagonists, aldosterone synthase inhibitors, aminopeptidase N inhibitors, androgens, angiotensin-converting enzyme inhibitors and dual-acting angiotensin-converting enzyme/neprilysin inhibitors, angiotensin-converting enzyme 2 activators and stimulators, angiotensin-II vaccines, anticoagulants, anti-diabetic agents, antidiarrheal agents, anti-glaucoma agents, anti-lipid agents, antinociceptive agents, anti-thrombotic agents, AT 1 receptor antagonists and dual-acting AT 1 receptor antagonist/neprilysin inhibitors and multifunctional angiotensin receptor blockers, bradykinin receptor antagonists, calcium channel blockers, chymase inhibitors, digoxin, diuretics, dopamine agonists, endothelin converting enzyme inhibitors, endothelin receptor antagonists, HMG-CoA reductase inhibitors, estrogens, estrogen receptor agonists and/or antagonists, monoamine reuptake inhibitors, muscle relaxants, natriuretic peptides and their analogs, natriuretic peptide clearance receptor antagonists, neprilysin inhibitors, nitric oxide donors, non-steroidal anti-inflammatory agents, N-methyl d-aspartate receptor antagonists, opioid receptor agonists, phosphodiesterase inhibitors, prostaglandin analogs, prostaglandin receptor agonists, renin inhibitors, selective serotonin reuptake inhibitors, sodium channel blocker, soluble guanylate cyclase stimulators and activators, tricyclic antidepressants, vasopressin receptor antagonists, and combinations thereof.

25. The pharmaceutical composition of claim 24 , wherein the therapeutic agent is an AT 1 receptor antagonist.

26. A method for treating hypertension, heart failure, or renal disease, comprising administering to a patient a therapeutically effective amount of the compound of claim 1 .