Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07K—PEPTIDES
  • C07K16/00—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies
  • C07K16/18—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans
  • C07K16/24—Immunoglobulins [IGs], e.g. monoclonal or polyclonal antibodies against material from animals or humans against cytokines, lymphokines or interferons
  • C07K16/244—Interleukins [IL]
  • C07K16/245—IL-1
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/02—Drugs for dermatological disorders for treating wounds, ulcers, burns, scars, keloids, or the like
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P17/00—Drugs for dermatological disorders
  • A61P17/10—Anti-acne agents
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/22—Anxiolytics
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K39/00—Medicinal preparations containing antigens or antibodies
  • A61K2039/505—Medicinal preparations containing antigens or antibodies comprising antibodies

Definitions

• the invention relates generally to the fields of medicine, dermatology, and immunology. More particularly, the invention relates to the use of antibodies (Abs) which specifically bind interleukin-lot (IL-lot) to treat inflammatory skin diseases as well as psychiatric conditions.
• Abs antibodies which specifically bind interleukin-lot (IL-lot) to treat inflammatory skin diseases as well as psychiatric conditions.
• the invention is based on the discovery that a mAb that specifically binds IL-lot is useful for treating acne vulgaris and various psychiatric conditions (such as anxiety and poor self-image).
• the invention features a method of reducing the number of acne lesions in a human subject, as well as a method of treating a psychiatric condition (e.g., anxiety, depression, or poor self-image) in a human subject.
• a psychiatric condition e.g., anxiety, depression, or poor self-image
• These methods can include the step of administering to the subject a pharmaceutical composition including a pharmaceutically acceptable carrier and an amount of an agent that selectively binds IL-lot effective to reduce to reduce the number of acne lesions or improve a psychiatric condition in the subject.
• the agent can be an anti-IL- 1 a antibody such as a monoclonal antibody (e.g., of the IgGl isotype), a monoclonal antibody that includes a complementarity determining region of MABpl, or MABpl.
• a monoclonal antibody e.g., of the IgGl isotype
• a monoclonal antibody that includes a complementarity determining region of MABpl e.g., of the IgGl isotype
• MABpl e.g., MABpl
• Another aspect of the invention features a method of reducing skin inflammation in a human subject by administering to the subject a pharmaceutical composition including a pharmaceutically acceptable carrier and an amount of an anti-IL- 1 a Ab (or other agent that specifically and/or selectively binds IL-la) effective to reduce a symptom of skin inflammation (e.g., redness, swelling, leukocyte infiltration, lesion development, or lesion number) in the subject by at least about 10% (e.g., at least 8, 9, 10, 15, 17, 20, 30, 40, 50, 60, 70, 80, 90, or 100%) as measured by any standard dermatological test.
• the anti-IL- la Ab can be a mAb such as an IgGl.
• the anti-IL- la Ab can be the mAb designated as MABpl or a mAb that includes one or more complementarity determining regions (CDRs) of MABpl.
• the pharmaceutical composition can be administered to the subject by injection, subcutaneously, intravenously, intramuscularly, or intradermally. In the method, the dose can be at least 0.25 (e.g., at least 0.2, 0.5, 0.75., 1, 2, 3, 4, or 5) mg/ml.
• the invention includes use of an agent that selectively binds IL-la to treat acne and/or a psychiatric condition in the subject, and a pharmaceutical composition for treating acne and/or a psychiatric condition in the subject, the composition comprising an agent that selectively binds IL-la.
• the agent can be an anti-IL- la antibody such as a monoclonal antibody (e.g., of the IgGl isotype), or a monoclonal antibody that includes a CDR of MABpl, or MABpl.
• an “antibody” or “Ab” is an immunoglobulin (Ig), a solution of identical or heterogeneous Igs, or a mixture of Igs.
• An “Ab” can also refer to fragments and engineered versions of Igs such as Fab, Fab', and F(ab') 2 fragments; and scFv's, heteroconjugate Abs, and similar artificial molecules that employ Ig-derived CDRs to impart antigen specificity.
• a “monoclonal antibody” or “mAb” is an Ab expressed by one clonal B cell line or a population of Ab molecules that contains only one species of an antigen binding site capable of immunoreacting with a particular epitope of a particular antigen.
• a "polyclonal Ab” is a mixture of heterogeneous Abs.
• a polyclonal Ab will include myriad different Ab molecules which bind a particular antigen with at least some of the different Abs immunoreacting with a different epitope of the antigen.
• a polyclonal Ab can be a mixture of two or more mAbs.
• an "antigen-binding portion" of an Ab is contained within the variable region of the Fab portion of an Ab and is the portion of the Ab that confers antigen specificity to the Ab (i.e., typically the three-dimensional pocket formed by the CDRs of the heavy and light chains of the Ab).
• a "Fab portion” or “Fab region” is the proteolytic fragment of a papain- digested Ig that contains the antigen-binding portion of that Ig.
• a “non-Fab portion” is that portion of an Ab not within the Fab portion, e.g., an "Fc portion” or “Fc region.”
• a "constant region" of an Ab is that portion of the Ab outside of the variable region.
• effector portion of an Ab is the portion of an Ab that is responsible for binding other immune system components that facilitate the immune response.
• the site on an Ab that binds complement components or Fc receptors is an effector portion of that Ab.
• purified means separated from components that naturally accompany such molecules.
• an Ab or protein is purified when it is at least about 10% (e.g. , 9%, 10%, 20%, 30% 40%, 50%, 60%, 70%, 80%, 90%, 95%, 98%, 99%, 99.9%, and 100%), by weight, free from the non-Ab proteins or other naturally-occurring organic molecules with which it is naturally associated. Purity can be measured by any appropriate method, e.g. , column chromatography, polyacrylamide gel electrophoresis, or HPLC analysis. A chemically-synthesized protein or other recombinant protein produced in a cell type other than the cell type in which it naturally occurs is "purified.”
• bind By “bind”, “binds”, or “reacts with” is meant that one molecule recognizes and adheres to a particular second molecule in a sample, but does not substantially recognize or adhere to other molecules in the sample.
• an Ab that "specifically binds" another molecule has a K d greater than about 10 5 , 10 6 , 10 7 , 10 8 , 10 9 , 10 10 , 10 11 , or 10 12 liters/mole for that other molecule.
• An Ab that "selectively binds" a first molecule specifically binds the first molecule at a first epitope but does not specifically bind other molecules that do not have the first epitope.
• an Ab which selectively binds IL-1 alpha specifically binds an epitope on IL-1 alpha but does not specifically bind IL-1 beta (which does not have the epitope).
• a "therapeutically effective amount” is an amount which is capable of producing a medically desirable effect in a treated animal or human (e.g. , amelioration or prevention of a disease or symptom of a disease).
• the invention encompasses compositions and methods for reducing skin inflammation including ameliorating one or more symptoms of a dermatological pathology in a subject.
• the below described preferred embodiments illustrate adaptation of these compositions and methods. Nonetheless, from the description of these embodiments, other aspects of the invention can be made and/or practiced based on the description provided below.
• compositions and methods described herein are useful for treating skin inflammation (e.g., associated with rosacea, eczema, psoriasis, xerosis, dermatitis, acne, pyoderma gangrenosum, urticaria, lichenoid disorders, bullous diseases such as bullous pemphigoid, cutaneous vasculitis, and granulomatous skin diseases) as well as psychiatric conditions (e.g., anxiety, depression, and poor self image) in a mammalian subject by administering to the subject a pharmaceutical composition including an amount of an anti-IL- la Ab effective to improve at least one characteristic of the inflammation (e.g., reduction in the number or size of lesions, reduction of redness, and reduction in itchiness) or psychiatric condition in the subject.
• skin inflammation e.g., associated with rosacea, eczema, psoriasis, xerosis, dermatitis, acne,
• the mammalian subject might be any that suffers from skin inflammation or a psychiatric condition including, human beings, dogs, cats, horses, cattle, sheep, goats, and pigs.
• Human subjects might be male, female, adults, children, seniors (65 and older), and those with other diseases. Particularly preferred subjects are those whose disease has progressed or failed to respond after treatment with other anti-inflammatory or anti-microbial agents such as retinoids, antibiotics, steroids or cytokine inhibitors such as TNFalpha inhibitors.
• Subjects who have developed a human anti-human antibody response due to prior administration of therapeutic antibodies are preferred when the anti-IL-la Ab is a true human Ab (e.g., one that is naturally expressed in a human subject) such as MABpl. Any type of inflammatory skin disease susceptible to treatment with an anti-IL-la Ab might be targeted.
• Anti-IL-la Ab administration is thought to be particularly effective for treating acne vulgaris and psoriasis vulgaris.
• any suitable type of Ab that specifically binds IL-la and reduces a characteristic of a psychiatric condition, skin inflammation and/or an inflammatory skin disease such as acne vulgaris or psoriasis vulgaris in a subject might be used in the invention.
• the anti-IL-la Ab used might be mAb, a polyclonal Ab, a mixture of mAbs, or an Ab fragment or engineered Ab-like molecule such as an scFv.
• the Ka of the Ab is preferably at least 1 xlO 9 M “1 or greater (e.g., greater than 9 xlO 10 M “1 , 8 xlO 10 M “1 , 7 xlO 10 M “1 , 6 xlO 10 M “1 , 5 xlO 10 M “1 , 4 xlO 10 M “1 , 3 xlO 10 M “1 , 2 xlO 10 M “1 , or 1 xlO 10 M “1 ).
• the invention utilizes a fully human mAb that includes (i) an antigen-binding variable region that exhibits very high binding affinity (e.g., at least nano or picomolar) for human IL-la and (ii) a constant region.
• the human Ab is preferably an IgGl, although it might be of a different isotype such as IgM, IgA, or IgE, or subclass such as IgG2, IgG3, or IgG4.
• a particularly useful mAb is MABpl, an IL-la- specific IgGl mAb described in U.S. patent application serial number 12/455,458 filed on June 1, 2009.
• Other useful mAbs are those that include at least one but preferably all the CDRs of MABpl.
• B lymphocytes which express Ig specific for human IL-la occur naturally in human beings
• a presently preferred method for raising mAbs is to first isolate such a B lymphocyte from a subject and then immortalize it so that it can be continuously replicated in culture.
• Subjects lacking large numbers of naturally occurring B lymphocytes which express Ig specific for human IL-la may be immunized with one or more human IL-la antigens to increase the number of such B lymphocytes.
• Human mAbs are prepared by immortalizing a human Ab secreting cell (e.g., a human plasma cell). See, e.g., U.S. patent no. 4,634,664.
• one or more human subjects are screened for the presence of such human IL- la- specific Ab in their blood.
• Those subjects that express the desired Ab can then be used as B lymphocyte donors.
• peripheral blood is obtained from a human donor that possesses B lymphocytes that express human IL- la- specific Ab.
• B lymphocytes are then isolated from the blood sample, e.g., by cells sorting (e.g., fluorescence activated cell sorting, "FACS"; or magnetic bead cell sorting) to select B lymphocytes expressing human IL- la- specific Ig.
• cells sorting e.g., fluorescence activated cell sorting, "FACS"; or magnetic bead cell sorting
• the B lymphocytes within this population that express Ig specific for human IL- la can then be isolated by limiting dilution methods (e.g., cells in wells of a microtiter plate that are positive for Ig specific for human IL-la are selected and subcultured, and the process repeated until a desired clonal line can be isolated). See, e.g., Goding, MAbs: Principles and Practice, pp. 59-103, Academic Press, 1986.
• MAbs secreted by these clonal cell lines can be purified from the culture medium or a bodily fluid (e.g., ascites) by conventional Ig purification procedures such as salt cuts, size exclusion, ion exchange separation, and affinity chromatography.
• heterologous expression systems to produce mAbs. See, e.g., the methods described in U.S. patent application number 11/754,899.
• the genes encoding an mAb specific for human IL-la might be cloned and introduced into an expression vector (e.g., a plasmid-based expression vector) for expression in a heterologous host cell (e.g., CHO cells, COS cells, myeloma cells, and E. coli cells).
• a heterologous host cell e.g., CHO cells, COS cells, myeloma cells, and E. coli cells.
• Igs include heavy (H) and light (L) chains in an H 2 L 2 configuration
• the genes encoding each may be separately isolated and expressed in different vectors.
• chimeric mAbs e.g., "humanized” mAbs
• Such chimeric Abs can be prepared by methods known in the art. See, e.g., Morrison et al., Proc. Nat'l. Acad. Sci. USA, 81 :6851, 1984; Neuberger et al., Nature, 312:604, 1984; Takeda et al., Nature, 314:452, 1984.
• Abs can be humanized by methods known in the art.
• mAbs with a desired binding specificity can be humanized by various vendors or as described in U.S. Pat. Nos. 5,693,762; 5,530,101 ; or 5,585,089.
• the mAbs described herein might be affinity matured to enhance or otherwise alter their binding specificity by known methods such as VH and VL domain shuffling (Marks et al. Bio/Technology 10:779-783, 1992), random mutagenesis of the hypervariable regions (HVRs) and/or framework residues (Barbas et al. Proc Nat. Acad. Sci. USA 91 :3809-3813, 1994; Schier et al. Gene 169: 147-155, 1995; Yelton et al. J. Immunol. 155: 1994-2004, 1995; Jackson et al., J. Immunol. 154(7):3310-9, 1995; and Hawkins et al, J. Mol.
• Amino acid sequence variants of an Ab may be prepared by introducing appropriate changes into the nucleotide sequence encoding the Ab.
• modifications to nucleic acid sequences encoding mAbs might be altered (e.g., without changing the amino acid sequence of the mAb) for enhancing production of the mAb in certain expression systems (e.g., intron elimination and/or codon optimization for a given expression system).
• the mAbs described herein can also be modified by conjugation to another protein (e.g., another mAb) or non-protein molecule.
• a mAb might be conjugated to a water soluble polymer such as polyethylene glycol or a carbon nanotube (See, e.g., Kam et al., Proc. Natl. Acad. Sci. USA 102: 11600-11605, 2005). See, U.S. patent application number 11/754,899.
• a water soluble polymer such as polyethylene glycol or a carbon nanotube
• the mAb compositions of the invention are at least 0.5, 1 , 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 20, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 95, 96, 97, 98, 99, 99.9 or more percent by weight pure (excluding any excipients).
• the mAb compositions of the invention might include only a single type of mAb (i.e., one produced from a single clonal B lymphocyte line) or might include a mixture of two or more (e.g., 2, 3, 4, 5, 6, 7, 8, 9, 10 or more) different types of mAbs.
• the human IL-l ot mAbs might be conjugated with another molecule such as a cytotoxin.
• a human IL-l ot specific mAb might be conjugated with one or more cytotoxins to more effectively kill cells expressing IL-l ot.
• Cytotoxins for use in the invention can be any cytotoxic agent (e.g., molecule that can kill a cell after contacting the cell) that can be conjugated to a human IL-lot specific mAb.
• cytotoxins include, without limitation, radionuclides (e.g., S, C, P, I, 131 I, 90 Y, 89 Zr, 201 T1, 186 Re, 188 Re, 57 Cu, 213 Bi, and 211 At), conjugated radionuclides, and chemotherapeutic agents.
• radionuclides e.g., S, C, P, I, 131 I, 90 Y, 89 Zr, 201 T1, 186 Re, 188 Re, 57 Cu, 213 Bi, and 211 At
• conjugated radionuclides e.g., chemotherapeutic agents.
• cytotoxins include, but are not limited to, antimetabolites (e.g., 5-fluorouricil (5-FU), methotrexate (MTX), fludarabine, etc.), anti- microtubule agents (e.g., vincristine, vinblastine, colchicine, taxanes (such as paclitaxel and docetaxel), etc.), alkylating agents (e.g., cyclophasphamide, melphalan, bischloroethylnitrosurea (BCNU), etc.), platinum agents (e.g., cisplatin (also termed cDDP), carboplatin, oxaliplatin, JM-216, CI-973, etc.), anthracyclines (e.g., doxorubicin, daunorubicin, etc.), antibiotic agents (e.g., mitomycin-C), topoisomerase inhibitors (e.g., etoposide, tenoposide, and
• IL-la specific Abs described above are preferred for use in the invention
• other agents that specifically target IL-la might be used so long as their administration leads to improvement of a characteristic of an inflammatory skin disease and/or a psychiatric condition.
• agents that specifically target IL-la might include vaccines that cause the production of anti- IL-la Abs, proteins or peptides that bind IL-la, and small organic molecules which specifically target IL-la. Those that do not specifically bind other agents that specifically target IL- ⁇ are preferred.
• the anti-IL-la Ab compositions may be administered to animals or humans in pharmaceutically acceptable carriers (e.g., sterile saline), that are selected on the basis of mode and route of administration and standard pharmaceutical practice.
• pharmaceutically acceptable carriers e.g., sterile saline
• a list of pharmaceutically acceptable carriers, as well as pharmaceutical formulations, can be found in Remington's Pharmaceutical Sciences, a standard text in this field, and in USP/NF.
• Other substances may be added to the compositions and other steps taken to stabilize and/or preserve the compositions, and/or to facilitate their administration to a subject.
• the Ab compositions might be lyophilized (see Draber et al., J. Immunol. Methods. 181:37, 1995; and PCT/US90/01383); dissolved in a solution including sodium and chloride ions; dissolved in a solution including one or more stabilizing agents such as albumin, glucose, maltose, sucrose, sorbitol, polyethylene glycol, and glycine; filtered (e.g., using a 0.45 and/or 0.2 micron filter); contacted with beta-propiolactone; and/or dissolved in a solution including a microbicide (e.g., a detergent, an organic solvent, and a mixture of a detergent and organic solvent.
• a microbicide e.g., a detergent, an organic solvent, and a mixture of a detergent and organic solvent.
• the Ab compositions may be administered to animals or humans by any suitable technique. Typically, such administration will be parenteral (e.g. , intravenous, subcutaneous, intramuscular, or intraperitoneal introduction).
• the compositions may also be administered directly to the target site (e.g., the skin) by, for example, topical application.
• Other methods of delivery e.g., liposomal delivery or diffusion from a device impregnated with the composition, are known in the art.
• the composition may be administered in a single bolus, multiple injections, or by continuous infusion (e.g., intravenously or by peritoneal dialysis).
• a therapeutically effective amount is an amount which is capable of producing a medically desirable result in a treated animal or human.
• An effective amount of anti-IL-l ot Ab compositions is an amount which shows clinical efficacy in patients as measured by the improvement in one or more symptoms of skin inflammation.
• dosage for any one animal or human depends on many factors, including the subject' s size, body surface area, age, the particular composition to be administered, sex, time and route of administration, general health, and other drugs being administered concurrently.
• Preferred doses range from about 0.1 to 5 (e.g., 0.05, 0.1 , 0.15, 0.2, 0.3, 0.4, 0.5, 1 , 2, 3, 4, 5, or 6) mg/kg body weight.
• a single dose is effective at resolving an episode of skin inflammation.
• doses may be given repeatedly, e.g., semi-weekly, weekly, bi-weekly, tri-weekly, semi-monthly, once every three weeks, monthly, bi-monthly, or as needed (if skin inflammation recurs).
• XilonixTM is a sterile injectable liquid formulation of 15 mg/mL MABpl in a stabilizing isotonic buffer (pH 6.4).
• a stabilizing isotonic buffer pH 6.4.
• Each 10-mL Type I borosilicate glass serum vial contains 5 mL of the formulation, and is sealed with a 20-mm Daikyo Flurotec butyl rubber stopper and flip-off aluminum seal.
• the product is stored at 5+3 °C, with excursions to room temperature permitted.
• the exact composition of the drug product is shown below:
• the calculated volume is withdrawn from the drug (mAb)-containing vial(s) using a suitable syringe.
• the drug is then injected into a subject subcutaneously.
• Example 3 Formulation of MABpl for subcutaneous injection.
• T2-18C3 is a sterile liquid formulation of 100+5 mg/mL MABpl in a stabilizing isotonic formulation buffer (pH 6.4+0.1). 1.4+0.1 mL of this formulation was contained within two mL Type I borosilicate glass serum vials sealed with a 20-mm Daikyo Flurotec butyl rubber stopper and flip-off aluminum seal. The product with stored upright at 5+3°C, with excursions to room temperature permitted. The exact composition of the Drug Product is shown below in Table 2:
• the patient has a positive family history of psoriasis vulgaris, with his sibling, father, and grandmother being affected as well. He was previously treated with topical retinoids and vitamin D3 preparations with minimal improvement. Previous treatment with topical steroids and UV treatment showed benefit. Prior to administration of T2-18C3, the patient had no history of treatment with biologic agents.
• the patient was administered 2 subcutaneous injections of MABpl in the lower abdomen (a total of 160 mg MABpl) on day 0.
• the patient tolerated the injections well, and there were no complications.
• the patient's back was evaluated at 17 hours, 41 hours, 5 days, 6 days and 10 days post-administration.
• a modest improvement in the redness associated with the lesions was observed.
• 41 hours continued improvement was noted with a clearly observable decrease in the size and redness of the lesions.
• significant resolution of the lesions was observed. This improvement continued through day 6.
• the lesions were almost completely resolved by day 10.
• Example 6 Interim Results of A Phase II Open Label Study of the Safety, Pharmacokinetics, and Efficacy of a True HumanTM Anti-Inflammatory Therapeutic Antibody (RA-18C3) in Subjects with Moderate to Severe Acne Vulgaris.
• RA-18C3 True HumanTM Anti-Inflammatory Therapeutic Antibody
• RA-18C3 is a sterile injectable liquid formulation of MABpl in a stabilizing isotonic buffer.
• the research population consists of subjects >18 years of age, with moderate to severe acne vulgaris. Subjects had an Investigator's Global Assessment of >3, >15 inflammatory facial lesions, and were candidates for systemic therapy. 11 patients were enrolled. Seven of the 11 enrolled subjects who had lesion count data available for day 56 are included in the analysis. Most patients (86%) were Caucasian, median age was 23 (19-30) years, 5 (71 ) were female. The total facial inflammatory lesion count showed an average improvement of 35+8% (median 34%, range 25-48%) on day 42; and 44+23% (median 42%, range 19-71 %) on day 56.
• the Body Image Disturbance Questionnaire (BIDQ) is a self-administered, clinically validated questionnaire used to assess "negative body image”.
• BIDQ Body Image Disturbance Questionnaire
• the internal consistency, reliability and validity of the 7-item Body Image Disturbance Questionnaire has been established by several prior studies, as well as its potential utility in clinical contexts for qualitative analysis. Recently a modified version of the BIDQ was validated specifically for use in patients with acne vulgaris.
• Self-reported measures of Modified Body Image Disturbance Questionnaire collected on Day 0 (DO) and Day 21 (D21), were analyzed. This 7-item survey tool assessed different facets of the body image construct, including appearance related concerns, mental preoccupation with those concerns, and resulting impairment of social and occupational functioning.
• DO and D21 scores were available for all the 7 subjects.
• the mean anxiety score on DO and D21 were 6.1+3.1 (median 6.0) and 3.3+3.9 (median 3), respectively ( ⁇ 2.9) (figure 3).
• Much level of baseline anxiety was prevalent in the study population (median 6).
• the subjects showing >3 point improvement in anxiety score had a substantial (21% to 34%) reduction in "facial inflammatory lesion count" on D21.
• Mean depression score was 2.6+3.1 (median 1) and 2.1+3.1 (1) on DO and D21, respectively.

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