Substituted spirocyclohexanes as muscarinic M

1. A compound of formula (1a):

or a pharmaceutically acceptable salt thereof,

wherein:

p is 0, 1 or 2;

R 1 is H, (CH 2 ) 0-2 C(O)OR 7 , (CH 2 ) 0-2 C(O)NR 7 R 8 , (CH 2 ) 0-2 S(O) 2 R 7 , or a C 1-6 non-aromatic hydrocarbon group, wherein 1 or 2 carbon atoms of the C 1-6 non-aromatic hydrocarbon group may optionally be replaced by a heteroatom selected from the group consisting of O, N and S;

R 2 is H, halogen, CN, OH, NH 2 , or a C 1-4 non-aromatic hydrocarbon group, wherein the C 1-4 non-aromatic hydrocarbon group is optionally substituted with 1, 2, 3, 4, 5 or 6 F and 1 or 2 carbon atoms of the C 1-4 non-aromatic hydrocarbon group may optionally be replaced by a heteroatom selected from the group consisting of O, N and S;

R 2 is H, halogen, CN, OH, NH 2 , or a C 1-4 non-aromatic hydrocarbon group, wherein the C 1-4 non-aromatic hydrocarbon group is optionally substituted with 1, 2, 3, 4, 5 or 6 F and 1 or 2 carbon atoms of the C 1-4 non-aromatic hydrocarbon group may optionally be replaced by a heteroatom selected from the group consisting of O, N and S;

R 3 is H or oxo;

each R 5 is independently F or a C 1-4 hydrocarbon group;

R 7 is H or a C 1-4 hydrocarbon group;

R 8 is H or a C 1-4 hydrocarbon group;

V is a bond, —NH—, —N(C 1-3 alkyl)-, —NHCH 2 —, or —N(C 1-3 alkyl)CH 2 —;

is a monocyclic or bicyclic ring;

Q 1 is —CH— or —N—;

Q 2 is —CH— or —N—;

X 1 is a saturated hydrocarbon group, optionally substituted with 1, 2 or 3 substituents independently selected from the group consisting of F, Cl, Br, I, CN, OH, NH 2 , and a C 1-6 alkyl, wherein the C 1-6 alkyl is optionally substituted with 1, 2, 3, 4, 5 or 6 F;

X 2 is a saturated hydrocarbon group, optionally substituted with 1, 2 or 3 substituents independently selected from the group consisting of F, Cl, Br, I, CN, OH, NH 2 , and a C 1-6 alkyl, wherein the C 1-6 alkyl is optionally substituted with 1, 2, 3, 4, 5 or 6 F;

W is a 5- or 6-membered heterocyclic aromatic ring containing 1, 2 or 3 heteroatoms selected from the group consisting of O, N and S, optionally substituted with 1 or more substituents independently selected from the group consisting of F, Cl, Br, I, CN, OH, NH 2 , and a C 1-10 non-aromatic hydrocarbon group, wherein the C 1-10 non-aromatic hydrocarbon group is optionally substituted with 1, 2, 3, 4, 5 or 6 F and 1, 2 or 3 carbon atoms of the C 1-10 non-aromatic hydrocarbon group may optionally be replaced by a heteroatom selected from the group consisting of O, N and S; or

W is -Q 3 C(O)YCH 2 R 4 ;

Q 3 is a bond or -(Alk) q -NR 6 , wherein Alk is C 1-4 alkyl;

q is 0 or 1;

Y is —CH 2 — or —O—;

R 4 is H or a C 1-6 non-aromatic hydrocarbon group, wherein the C 1-6 non-aromatic hydrocarbon group is optionally substituted with 1, 2, 3, 4, 5 or 6 F and 1 or 2 carbon atoms of the C 1-6 non-aromatic hydrocarbon group may optionally be replaced by a heteroatom selected from the group consisting of O, N and S; and

R 6 is H or a saturated C 1-4 hydrocarbon group;

with the provisos that:

(1) at least one of Q 1 or V has a nitrogen atom;

(2) when W is an optionally substituted 5- or 6-membered heterocyclic aromatic ring, Q 2 is —CH—;

(3) when Q 2 is —N— and Q 3 is -(Alk) q -NR 6 , there are at least 2 carbons between Q 2 and NR 6 ;

(4) when Q 3 is a bond, Q 2 is —N—; and

(5) X 1 and X 2 together contain a total of 1, 2, 3, 4, 5, 6, 7, 8 or 9 carbons.

2. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein:

3. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein:

(a) p is 0; or

(b) p is 1; and

R 5 is F or CH 3 .

4. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein R 1 is H, C(O)OCH 2 CH 3 , CH 2 C(O)NH 2 , S(O) 2 CH 3 , or CH 3 .

5. The compound according to claim 4 , or a pharmaceutically acceptable salt thereof, wherein R 1 is H.

6. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein:

R 2 is H, F, Cl, CN, CH 3 , or OCH 3 ; and

R 2 is H, F, Cl, CN, CH 3 , or OCH 3 .

7. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein R 3 is oxo.

8. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein:

V is a bond; and

Q 1 is —N—.

9. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein

is A, F, L, M, Q, S, T, CC, or DD:

where “a” indicates the point of attachment to the cyclohexane ring and “b” indicates the point of attachment to the W group.

10. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein W is optionally substituted 1,2,4-oxadiazolyl.

11. The compound according to claim 1 , or a pharmaceutically acceptable salt thereof, wherein:

W is -Q 3 C(O)YCH 2 R 4 ;

Q 3 is a bond, —NH—, or —NCH 3 —;

Y is —O—; and

R 4 is H, CH 3 , or CH 2 CH 3 .

12. The compound according to claim 1 , wherein the compound is selected from the group consisting of:

or a pharmaceutically acceptable salt thereof.

13. The compound according to claim 12 , wherein the compound is:

or a pharmaceutically acceptable salt thereof.

14. The compound according to claim 12 , wherein the compound is:

or a pharmaceutically acceptable salt thereof.

15. The compound according to claim 12 , wherein the compound is:

or a pharmaceutically acceptable salt thereof.

16. The compound according to claim 12 , wherein the compound is:

or a pharmaceutically acceptable salt thereof.

17. The compound according to claim 12 , wherein the compound is:

or a pharmaceutically acceptable salt thereof.

18. A pharmaceutical composition comprising a compound according to claim 1 , or a pharmaceutically acceptable salt thereof, and a pharmaceutically acceptable excipient.