Stevens-Johnson Syndrome Following Treatment With Carbamazepine for a Mood Disorder

A case of Stevens-Johnson Syndrome (SJS) induced by carbamazepine in a psychiatric patient with schizo-affective disorder is reported. The patient also had diabetes mellitus and was on glyburide which posed an initial dilemma at the onset of SJS as to the causative drug. In view of the expanding use of carbamazepine in psychiatric patients and the potentially lethal consequences of SJS, the authors suggest a risk management approach when initiating Carbamazepine therapy to reduce the incidence and morbidity of the syndrome

Are old-old patients with major depression more likely to relapse than young-old patients during continuation treatment with escitalopram?

<p>Abstract</p> <p>Background</p> <p>Escitalopram has shown efficacy and tolerability in the prevention of relapse in elderly patients with major depressive disorder (MDD). This <it>post-hoc </it>analysis compared time to relapse for <it>young-old </it>patients (n = 197) to that for <it>old-old </it>patients (n = 108).</p> <p>Method</p> <p>Relapse prevention: after 12-weeks open-label treatment, remitters (MADRS ≤12) were randomised to double-blind treatment with escitalopram or placebo and followed over 24-weeks. Patients were outpatients with MDD from 46 European centers aged ≥75 years (<it>old-old</it>) or 65-74 years of age (<it>young-old</it>), treated with escitalopram 10-20mg/day. Efficacy was assessed using the Montgomery Åsberg Depression Rating Scale (MADRS).</p> <p>Results</p> <p>After open-label escitalopram treatment, a similar proportion of <it>young-old </it>patients (78%) and <it>old-old </it>patients (72%) achieved remission. In the analysis of time to relapse based on the Cox model (proportional hazards regression), with treatment and age group as covariates, the hazard ratio was 4.4 for placebo <it>versus </it>escitalopram (χ²-test, df = 1, χ²= 22.5, p < 0.001), whereas the effect of age was not significant, with a hazard ratio of 1.2 for <it>old-old </it>versus <it>young-old </it>(χ²-test, df = 1, χ²= 0.41, p = 0.520). Escitalopram was well tolerated in both age groups with adverse events reported by 53.1% of <it>young-old </it>patients and 58.3% of <it>old-old </it>patients. There was no significant difference in withdrawal rates due to AEs between age groups (χ²-test, χ²= 1.669, df = 1, p = 0.196).</p> <p>Conclusions</p> <p><it>Young-old </it>and <it>old-old </it>patients with MDD had comparable rates of remission after open-label escitalopram, and both age groups had much lower rates of relapse on escitalopram than on placebo.</p

Stressed stability and protective efficacy of lead lyophilized formulations of ID93+GLA-SE tuberculosis vaccine

With the recent exception of coronavirus disease 2019 (COVID-19), tuberculosis (TB) causes more deaths globally than any other infectious disease, and approximately 1/3 of the world's population is infected with Mycobacterium tuberculosis (Mtb). However, encouraging progress in TB vaccine development has been reported, with approximately 50% efficacy achieved in Phase 2b clinical testing of an adjuvanted subunit TB vaccine candidate. Nevertheless, current lead vaccine candidates require cold-chain transportation and storage. In addition to temperature stress, vaccines may be subject to several other stresses during storage and transport, including mechanical, photochemical, and oxidative stresses. Optimal formulations should enable vaccine configurations with enhanced stability and decreased sensitivity to physical and chemical stresses, thus reducing reliance on the cold chain and facilitating easier worldwide distribution. In this report, we describe the physicochemical stability performance of three lead thermostable formulations of the ID93 + GLA-SE TB vaccine candidate under various stress conditions. Moreover, we evaluate the impact of thermal stress on the protective efficacy of the vaccine formulations. We find that formulation composition impacts stressed stability performance, and our comprehensive evaluation enables selection of a lead single-vial lyophilized candidate containing the excipient trehalose and Tris buffer for advanced development