JAMA最新文献

{"title":"Medications for Alcohol Use Disorder","authors":"Kristin Walter","doi":"10.1001/jama.2026.18147","DOIUrl":"https://doi.org/10.1001/jama.2026.18147","url":null,"abstract":"This JAMA Patient Page describes 3 medications that are approved by the US Food and Drug Administration for alcohol use disorder and 1 medication that has not received approval yet.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Service Use Following the Introduction of AI-Enabled Prior Authorization in Medicare","authors":"Hannah T. Neprash, Michael L. Barnett","doi":"10.1001/jama.2026.21230","DOIUrl":"https://doi.org/10.1001/jama.2026.21230","url":null,"abstract":"This study uses Epic Cosmos data to assess changes in use of medical services by Medicare recipients after the implementation of artificial intelligence–enabled prior authorization requirements under the Center for Medicare & Medicaid Innovation WISeR (Wasteful and Inappropriate Service Reduction) model.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peptides, FDA’s Pharmacy Compounding Advisory Committee, and the Future of FDA Drug Approval","authors":"Sophia Samantaroy, Isabella Xu, Peter Lurie","doi":"10.1001/jama.2026.19125","DOIUrl":"https://doi.org/10.1001/jama.2026.19125","url":null,"abstract":"This Viewpoint discusses the US Food and Drug Administration’s (FDA) Pharmacy Compounding Advisory Committee’s recommendation to add 7 peptides to the compounding 503A Bulks List and the profound threat that compounding these peptides could represent to the drug-approval process and patients.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single Intranasal Administration of the Psychedelic Mebufotenin for Treatment-Resistant Depression","authors":"David Feifel, Mathieu Seynaeve, Wiesław Jerzy Cubała, Fiona Dunbar, Gerhard Gründer, Rosa María Dueñas Herrero, Chandni Hindocha, Paul Liknaitzky, Sean M. McGuigan, Sejal Mehta, Mimi Pierce, Dimitris Repantis, Claire Roberts, Frank Wiegand, Robert Conley","doi":"10.1001/jama.2026.18380","DOIUrl":"https://doi.org/10.1001/jama.2026.18380","url":null,"abstract":"Importance Psychedelics represent a potential breakthrough for treatment-resistant depression; however, the prolonged in-clinic monitoring required for compounds such as psilocybin and lysergic acid diethylamide is a logistical hurdle to widespread use. Intranasal mebufotenin (5-methoxy- <jats:italic>N</jats:italic> , <jats:italic>N</jats:italic> -dimethyltryptamine), a 5-hydroxytryptamine 1A (5-HT <jats:sub>1A</jats:sub> ) and 5-HT <jats:sub>2A</jats:sub> agonist associated with brief psychedelic experiences, may address this limitation. Objective To evaluate the safety, efficacy, and time to discharge readiness following a single dose of intranasal mebufotenin benzoate in adults with treatment-resistant depression. Design, Setting, and Participants Phase 2b, randomized, double-blind trial with an 8-week blinded follow-up conducted between September 2023 and April 2025 at 38 sites in Australia, Europe, and the US. Participants were aged 18 to 75 years with moderate to severe major depressive disorder nonresponsive to 2 to 5 antidepressant trials in the current episode. The last date of follow-up was April 28, 2025. Interventions After antidepressant washout as needed, participants were randomly assigned to receive a single dose of intranasal mebufotenin benzoate, 8 mg (n = 46), 12 mg (n = 73), or 0.3 mg (a low-dose comparator; n = 74), alongside psychological support. Main Outcomes and Measures The primary end point was total score change on the Montgomery-Åsberg Depression Rating Scale (MADRS; score range, 0-60; higher scores indicate more severe depression) from baseline to day 29 in the 12-mg vs 0.3-mg dose groups. Eighteen secondary end points were assessed for the 12-mg and 8-mg vs 0.3-mg doses. Discharge readiness was assessed starting 90 minutes after dosing. Results Among the 193 included participants, the mean age was 41 (SD, 11.1) years and 59.1% were female. From baseline to day 29, treatment with 12-mg intranasal mebufotenin benzoate vs the 0.3-mg dose (the primary end point) was associated with significantly reduced MADRS scores (mean score change, −11.1 [SD, 11.6] vs −5.5 [SD, 9.9], respectively; mean difference, −5.3 [95% CI, −8.9 to −1.8]; <jats:italic>P</jats:italic> = .003). The 8-mg dose also led to reduced scores from baseline to day 29 (mean score change, −12.5 [SD, 12.7]) vs the 0.3-mg dose (mean difference, −6.2 [95% CI, −10.2 to −2.1]; <jats:italic>P</jats:italic> = .003). MADRS reductions with the 8-mg and 12-mg doses were similar and significantly greater at all other time points from 2 to 57 days post dose vs the 0.3-mg dose. Day 29 response rates were 35%, 34%, and 12% and remission rates were 26%, 18%, and 8% in the 8-mg, 12-mg, and 0.3-mg dose groups, respectively. Treatment-emergent adverse events were reported in 76%, 85%, and 73% of participants in the 8-mg, 12-mg, and 0.3-mg dose groups, respectively; most events (99.7%) were mild or moderate. Overall, most participants were deemed ready for discharge within 2 h","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149248810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis","authors":"Yaqin Yang, Changyuan Yang, Yanmei Wang, Pien Rawee, Aleix Cases, David E. Leaf, Lucia del Vecchio, Taulant Muka, Hiddo J. L. Heerspink, Ron T. Gansevoort, Michele F. Eisenga","doi":"10.1001/jama.2026.19921","DOIUrl":"https://doi.org/10.1001/jama.2026.19921","url":null,"abstract":"Importance In randomized clinical trials, sodium-glucose cotransporter 2 (SGLT2) inhibitor use was associated with increased hemoglobin and hematocrit compared with placebo. However, the magnitude and importance of this association remain unclear. Objective To evaluate the associations between SGLT2 inhibitor use and levels of hemoglobin, hematocrit, and markers of iron metabolism and erythropoiesis compared with placebo or active comparator. Data Sources PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to July 22, 2026. Study Selection Randomized, double-masked clinical trials comparing SGLT2 inhibitor use with placebo or active comparators in patients with 1 or more of the following conditions: cardiovascular disease, diabetes, heart failure, and chronic kidney disease. Data Extraction and Synthesis Three reviewers independently extracted data and results were pooled using random-effects meta-analysis. Main Outcomes and Measures Primary outcomes were changes in hemoglobin and hematocrit. Secondary outcomes were changes in red blood cell concentration, erythropoietin (EPO), and iron measures (serum iron, ferritin, transferrin saturation, and hepcidin). Results A total of 85 randomized clinical trials were analyzed (median [IQR] duration, 24 [12-32] weeks), including 70 543 participants (mean [SD] age, 62.4 [9.4] years; 25 334 female [35.9%]). Mean (SD) baseline hemoglobin was 13.6 (1.5) g/dL; baseline hematocrit was 41.5% (4.9). Seventy-eight clinical trials (67 208 participants) compared SGLT2 inhibitors with placebo, and 7 clinical trials (3335 participants) used active comparators, most commonly sitagliptin (2 trials [1158 participants]). From baseline to follow-up, hemoglobin changed by 0.55 g/dL (95% CI, 0.49 to 0.61 g/dL; <jats:italic toggle=\"yes\">P</jats:italic> < .001) in the SGLT2 inhibitor group, and −0.08 g/dL (95% CI, −0.13 to −0.03 g/dL; <jats:italic toggle=\"yes\">P</jats:italic> = .003) in the control group (difference, 0.60 g/dL; 95% CI, 0.55 to 0.66 g/dL; <jats:italic toggle=\"yes\">P</jats:italic> < .001). From baseline to follow-up, hematocrit changed by 2.17% (95% CI, 1.95% to 2.39%; <jats:italic toggle=\"yes\">P</jats:italic> < .001) in the SGLT2 inhibitor group and −0.13% (95% CI, −0.28% to 0.01%; <jats:italic toggle=\"yes\">P</jats:italic> = .07) in the control group (difference, 2.36%; 95% CI, 2.19% to 2.52%; <jats:italic toggle=\"yes\">P</jats:italic> < .001). Of the 6 secondary outcomes, 4 showed significant associations with SGLT2 inhibitors, including increased EPO (2.35 mIU/mL in SGLT2 inhibitor group vs 0.04 mIU/mL in control group; difference, 2.11 mIU/mL [95% CI, 0.5-3.71 mIU/mL]; <jats:italic toggle=\"yes\">P</jats:italic> = .01) and decreased transferrin saturation (−2.2% in SGLT2 inhibitor group vs −0.10% in control group; difference, −0.84% [95% CI, −1.21% to −0.47%]; <jats:italic toggle=\"yes\">P</jats:italic> &","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149241209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic Liver Disease Is Becoming a Higher Priority Worldwide","authors":"Rita Rubin","doi":"10.1001/jama.2026.18418","DOIUrl":"https://doi.org/10.1001/jama.2026.18418","url":null,"abstract":"This Medical News article discusses international efforts to determine the prevalence and increase awareness and detection of steatotic liver disease, which affects an estimated 1.7 billion people worldwide, including most individuals with obesity or type 2 diabetes.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149235689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone Use Rises Among Women, but Does the Evidence Support It?","authors":"Kate Schweitzer","doi":"10.1001/jama.2026.18998","DOIUrl":"https://doi.org/10.1001/jama.2026.18998","url":null,"abstract":"This Medical News article discusses growing use of testosterone therapy among women, and a US Food and Drug Administration public workshop that explored the current evidence on its use beyond sexual function.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149235691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trastuzumab Rezetecan in ERBB2-Low Advanced Breast Cancer","authors":"Ying Fan, Yunjiang Liu, Yongsheng Wang, Quchang Ouyang, Qingyuan Zhang, Jiuwei Cui, Jingruo Li, Qiang Ding, Xinhong Wu, Xiaojia Wang, Zhongsheng Tong, Yinduo Zeng, Wenhui Wang, Min Yan, Yili Wang, Xiaoyu Liu, Kai Li, Zhengkui Sun, Chunxiu Yuan, Ting Wang, Weimin Xie, Jing Yao, Shoubing Zhou, Jialin Hou, Zhong Ouyang, Yijing Li, Sisi Cui, Xia Zhang, Xiaoyu Zhu, Binghe Xu","doi":"10.1001/jama.2026.21372","DOIUrl":"https://doi.org/10.1001/jama.2026.21372","url":null,"abstract":"Importance Trastuzumab rezetecan (SHR-A1811) has demonstrated encouraging antitumor activity in a global phase 1 trial involving heavily pretreated patients with erythroblastic oncogene B (ERBB2)–low metastatic breast cancer. Objective To compare trastuzumab rezetecan vs physician’s choice of chemotherapy in patients with ERBB2-low metastatic breast cancer. Design, Setting, and Participants This open-label, randomized, multicenter phase 3 trial was conducted at 73 hospitals across China. Eligible patients were females aged 18 to 75 years with centrally confirmed ERBB2-low (immunohistochemistry [IHC] 1+ or IHC 2+/in-situ hybridization [ISH]–negative) unresectable locally recurrent or metastatic breast cancer who had received 1 or fewer prior lines of chemotherapy for metastatic disease, with prior endocrine therapy required for hormone receptor–positive disease. Enrollment began on June 30, 2023, and ended on August 20, 2025. The last day of follow-up for the final analysis for progression-free survival in the current study was March 20, 2026. Interventions Patients were randomly assigned (1:1) to receive trastuzumab rezetecan (6.4 mg/kg intravenously every 3 weeks; n = 277) or physician’s choice of chemotherapy (n = 274). Main Outcomes and Measures The primary end point was progression-free survival assessed by blinded independent central review in chemotherapy-naive patients and the overall population. Results Between June 30, 2023, and August 20, 2025, a total of 551 patients were randomized, with a mean (SD) age of 54.9 (9.9) years. At the data cutoff (March 20, 2026), trastuzumab rezetecan significantly prolonged progression-free survival compared with chemotherapy in the chemotherapy-naive patients (median, 16.6 [95% CI, 14.0-19.4] months vs 6.8 [95% CI, 5.7-7.0] months; hazard ratio, 0.25 [95% CI, 0.19-0.33]; <jats:italic>P</jats:italic> < .001) and the overall population (median, 16.4 [95% CI, 14.0-16.8] months vs 6.8 [95% CI, 5.7-6.9] months; hazard ratio, 0.27 [95% CI, 0.21-0.34]; <jats:italic>P</jats:italic> < .001). The benefit was consistent in hormone receptor–negative disease (median progression-free survival: 16.5 vs 6.8 months; hazard ratio, 0.34, [95% CI, 0.22-0.54]) and hormone receptor–positive disease (median progression-free survival: 16.4 vs 6.7 months; hazard ratio, 0.24 [95% CI, 0.18-0.33]). Grade 3 or greater treatment-related adverse events occurred in 84.1% of patients (232/276) with trastuzumab rezetecan and 67.9% (184/271) with chemotherapy, most commonly decreased neutrophil count (180 [65.2%] vs 147 [54.2%]). Conclusions and Relevance Trastuzumab rezetecan provided significant progression-free survival benefit over physician’s choice of chemotherapy in patients with ERBB2-low advanced breast cancer, with benefit observed across all key subgroups. It exhibited the potential as a new treatment option with a distinct safety profile in this setting. Trial Registration ClinicalTrials.gov Identifier:","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149235693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy Outcomes After Living Kidney Donation","authors":"Carol Wang, Kyla L. Naylor, Eric McArthur, James A. King, Jessica M. Sontrop, Joseph Beyene, Dervla Connaughton, Elizabeth Hendren, Michelle Hladunewich, Ngan N. Lam, Krista L. Lentine, Rhiannon Lyons, Sarah D. McDonald, Pavel S. Roshanov, Erik Youngson, Amit X. Garg","doi":"10.1001/jama.2026.21737","DOIUrl":"https://doi.org/10.1001/jama.2026.21737","url":null,"abstract":"Importance People who become pregnant after living kidney donation may be at increased risk of pregnancy-related adverse outcomes, although the evidence is unclear. Objective To determine whether pregnancies after living kidney donation are associated with a higher risk of adverse pregnancy outcomes than matched pregnancies among nondonors. Design, Setting, and Participants This matched cohort study used provincial administrative health care databases from Ontario, British Columbia, and Alberta, Canada, and included living female kidney donors aged 18 to 42 years who donated a kidney between July 1992 and August 2021 and subsequently had singleton pregnancies of at least 20 weeks’ gestation. These pregnancies were matched 1:4 with singleton pregnancies of at least 20 weeks’ gestation among female nondonors. Pregnancies in donors and nondonors were matched on delivery date, age at delivery, years between cohort entry and delivery, number of prior pregnancies, and income. Final follow-up occurred until March 2023. Outcome analysis occurred from August 2024 to September 2026. Main Outcomes and Measures The primary outcome was a composite of hospitalization with a diagnosis of gestational hypertension, preeclampsia, or eclampsia. Secondary outcomes included 12 maternal, fetal and neonatal adverse outcomes, including the individual components of the primary outcome, the composite of low birth weight or preterm birth, and small for gestational age at birth. Results The sample included 385 pregnancies in 252 living kidney donors (mean [SD] age, 27.8 [5.0] years) matched to 1540 pregnancies in 1535 nondonors (mean [SD] age, 27.0 [4.8] years). The primary composite outcome of gestational hypertension, preeclampsia, or eclampsia occurred in 46 donor pregnancies (11.9%) and 128 nondonor pregnancies (8.3%; risk ratio, 1.51; 95% CI, 1.10-2.08). Among the 12 secondary outcomes, the 95% CI for the risk ratio excluded 1.00 for the outcome of small for gestational age, which occurred in 53 donor pregnancies (13.8%) and 121 nondonor pregnancies (7.9%) (risk ratio, 1.86; 95% CI, 1.37-2.52). CONCLUSIONS AND RELEVANCE In this study, pregnancy after living kidney donation was associated with a higher risk of the composite outcome of hospitalization with a diagnosis of gestational hypertension, preeclampsia, or eclampsia, when compared with matched pregnancies in nondonors. Most postdonation pregnancies were uncomplicated. These findings support counseling donor candidates who may become pregnant about this risk and informing the prenatal care of donors who become pregnant.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149235688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer’s Transformation From Terminal to Manageable","authors":"Derek C. Angus, Matthew B. O’Connor, Lauren J. Young","doi":"10.1001/jama.2026.21078","DOIUrl":"https://doi.org/10.1001/jama.2026.21078","url":null,"abstract":"The history and future of breast cancer research and treatment are discussed by <jats:italic toggle=\"yes\">JAMA</jats:italic> Senior Editor Derek C. Angus, MD, MPH, and Nancy E. Davidson, MD, chief academic officer and executive vice president of the Fred Hutchinson Cancer Center, for this episode of the <jats:italic toggle=\"yes\">Healthy Dialogue</jats:italic> podcast.","PeriodicalId":518009,"journal":{"name":"JAMA","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}