A randomized, double-blind, placebo-controlled study of escitalopram in patients with social anxiety disorder in Japan

Objective: This randomised, double-blind placebo-controlled study compared the efficacy and tolerability of escitalopram (10 and 20mg/day) in Japanese patients with social anxiety disorder (SAD). Research design and methods: Patients aged 18-64 years with a primary diagnosis of DSM-IV-TR defined SAD, a Liebowitz Social Anxiety Scale Japanese version (LSAS-J) total score ≥60 and a Clinical Global Impression-Severity (CGI-S) score ≥4 at baseline were randomly assigned (1:1:1) to placebo, escitalopram 10mg or 20mg. The primary endpoint was change from baseline to Week 12 in the LSAS-J total score for both escitalopram 10mg and 20mg versus placebo (ANCOVA, FAS, LOCF), using a hierarchical testing procedure. Pre-specified secondary endpoints included LSAS-J sensitivity analyses. Clinical trial registration: This study has the www.japic.or.jp identifier: JapicCTI-121842. Results: For the primary efficacy endpoint, the difference from placebo in the LSAS-J was -3.9 (p=0.089) for escitalopram 10mg. Since the superiority of escitalopram 10mg over placebo was not confirmed, an analysis without multiplicity adjustment was made, which showed a difference for escitalopram 20mg versus placebo of -9.8 (p<0.001). In pre-specified sensitivity analyses, the difference versus placebo was -4.9 (p=0.035) (ANCOVA, FAS, OC) and -5.0 (p=0.028) (MMRM, FAS) (escitalopram 10mg) and -10.1 (p<0.001) (ANCOVA, FAS, OC) and -10.6 (p<0.001) (MMRM, FAS) (escitalopram 20mg). Common adverse events (incidence ≥5% and significantly different from placebo) were somnolence, nausea and ejaculation disorder. Conclusion: Escitalopram was efficacious, safe and well tolerated by patients with SAD in Japan. Study limitations are discussed including patient characteristics

Drug Binding Dynamics of the Dimeric SARS-CoV-2 Main Protease, Determined by Molecular Dynamics Simulation

We performed molecular dynamics simulation of the dimeric SARS-CoV-2 (severe acute respiratory syndrome corona virus 2) main protease (Mpro) to examine the binding dynamics of small molecular ligands. Seven HIV inhibitors, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, and tipranavir, were used as the potential lead drugs to investigate access to the drug binding sites in Mpro. The frequently accessed sites on Mpro were classified based on contacts between the ligands and the protein, and the differences in site distributions of the encounter complex were observed among the ligands. All seven ligands showed binding to the active site at least twice in 28 simulations of 200 ns each. We further investigated the variations in the complex structure of the active site with the ligands, using microsecond order simulations. Results revealed a wide variation in the shapes of the binding sites and binding poses of the ligands. Additionally, the C-terminal region of the other chain often interacted with the ligands and the active site. Collectively, these findings indicate the importance of dynamic sampling of protein- ligand complexes and suggest the possibilities of further drug optimisations. Raw trajectory data analysed in this paper and movie examples are available at the zenodo repository. </div

Secondary CIC-rearranged sarcoma responsive to chemotherapy regimens for Ewing sarcoma: A case report

Capicua transcriptional repressor (CIC)-rearranged sarcoma is an Ewing-like sarcoma with an aggressive clinical course and poor prognosis. No standard treatment has been established. The present study describes a case of CIC-rearranged sarcoma with lung metastases developing in a 24-year-old woman as a therapy-associated malignancy following chemotherapy for anaplastic large cell lymphoma at nine years old. This was treated with palliative regimens used for Ewing sarcoma. The patient achieved disease control for one year. Of note, ifosfamide and etoposide (IE), which were used as a second line treatment lead to a partial response. The case described in the present study indicated that treatment with Ewing regimens is a reasonable option for patients with metastatic CIC-rearranged sarcoma, including those with a second malignant case