New England Journal of Medicine最新文献

{"title":"Obinutuzumab in Active Systemic Lupus Erythematosus.","authors":"Omer N Pamuk","doi":"10.1056/NEJMc2610854","DOIUrl":"https://doi.org/10.1056/NEJMc2610854","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1562"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Acting HIV Therapy in African Adults with Adherence Challenges.","authors":"Fiona V Cresswell, Jonathan Kitonsa, Claire Norcross, Victoria Tumusiime, Loice Achieng Ombajo, Nigel Garrett, Sheetal Kassim, Noela C Owarwo, Eva A Laker Odongpiny, Ibrahim Yawe, Sharana Mahomed, Henry Mugerwa, Paddy L Kafeero, Joseph Nkuranga, Ubaldo Bahemuka, Jane Nabbuto, Violet Ankunda, Phiona Nabaggala, Charles Ogwang, Geofrey Kimbugwe, Ayoub Kakande, Upasna Singh, Dorothie van der Vendt, Arnold Onyango, Eve Koile, David S Lawrence, Awhonukeh Idahosa, Veerle van Eygen, Fafa Addo Boateng, Ingrid Eshun-Wilsonova, Daniel J Grint, Eugene Ruzagira","doi":"10.1056/NEJMoa2518753","DOIUrl":"https://doi.org/10.1056/NEJMoa2518753","url":null,"abstract":"<p><strong>Background: </strong>In eastern and southern Africa, approximately 1 million people living with human immunodeficiency virus (HIV) and receiving oral therapy do not have viral suppression because of adherence challenges.</p><p><strong>Methods: </strong>We conducted a phase 3b, open-label, randomized trial to compare long-acting injectable cabotegravir plus rilpivirine with oral dolutegravir-based therapy among adults with virally suppressed HIV type 1 (viral load, <200 copies per milliliter) and suboptimal adherence or care engagement. The participants were assigned in a 1:1 ratio to receive intramuscular injections of cabotegravir (600 mg) plus rilpivirine (900 mg) every 8 weeks, with the first two injection visits occurring 4 weeks apart, or to continue daily oral dolutegravir-based therapy; baseline drug-resistance testing was not performed. The primary end point was a viral load of less than 50 copies per milliliter at week 48; noninferiority was assessed with a margin of -10 percentage points. Confirmed virologic failure (two consecutive viral loads of ≥200 copies per milliliter) was a key secondary end point.</p><p><strong>Results: </strong>A total of 540 participants were enrolled across seven sites in Kenya, South Africa, and Uganda; 537 were included in the primary analysis. At 48 weeks, 244 of 268 participants (91.0%) in the long-acting-therapy group had a viral load of less than 50 copies per milliliter, as compared with 240 of 269 participants (89.2%) in the oral-therapy group (risk difference, 1.9 percentage points; 95% confidence interval [CI], -3.1 to 6.9), which met the criterion for noninferiority. The results of a per-protocol analysis were consistent with those of the primary analysis. Confirmed virologic failure occurred in 5 participants (1.9%) in the long-acting-therapy group and in no participants in the oral-therapy group (risk difference, 1.9 percentage points; 95% CI, 0.3 to 3.5). Serious adverse events were reported in 11 of 271 participants (4.1%) who received long-acting therapy and in 8 of 269 participants (3.0%) who received oral therapy (risk difference, 1.1 percentage points; 95% CI, -1.1 to 4.2).</p><p><strong>Conclusions: </strong>Among persons with HIV in Africa who have adherence challenges, long-acting cabotegravir plus rilpivirine was noninferior to oral dolutegravir-based therapy for maintaining a viral load of less than 50 copies per milliliter. (Funded by Johnson & Johnson; IMPALA ClinicalTrials.gov number, NCT05546242; Pan African Clinical Trials Registry number, PACT202301600757432TMC278LAHTX3005.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1505-1518"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IARC Perspective on Lung Cancer Screening.","authors":"Luciana Neamtiu, Matthew E J Callister, Philip Crosbie, Stephen Lam, Vivienne Milch, Daniela Mariosa, Xiaoshuang Feng, Roya Dolatkhah, Ali Saeed Al-Zahrani, Zhandos Amankulov, Jean-Luc Bulliard, Wendy A Cooper, Luis Corrales, Paolo Giorgi Rossi, Rayjean J Hung, Ella Kazerooni, Mengmeng Li, Peter Mazzone, Rafael Meza, Arn Migowski, Rachael L Murray, Samantha L Quaife, Robert C Rintoul, Witold Rzyman, Wei Jie Seow, Abhishek Shankar, Mahdi Sheikh, Hilary A Robbins, Mattias Johansson, Harry J de Koning, Béatrice Lauby-Secretan","doi":"10.1056/NEJMsb2608211","DOIUrl":"10.1056/NEJMsb2608211","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":"1545-1552"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended DAPT for Multivessel Coronary Artery Disease.","authors":"Sukrit Narula, Michael G Nanna","doi":"10.1056/NEJMc2610855","DOIUrl":"https://doi.org/10.1056/NEJMc2610855","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1560-1561"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alkaptonuria.","authors":"Prasanta Padhan, Pratima Singh","doi":"10.1056/NEJMicm2607077","DOIUrl":"https://doi.org/10.1056/NEJMicm2607077","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1529"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult Attention Deficit-Hyperactivity Disorder.","authors":"Jan K Buitelaar, Jeffrey H Newcorn","doi":"10.1056/NEJMcp2516040","DOIUrl":"https://doi.org/10.1056/NEJMcp2516040","url":null,"abstract":"<p><p>Attention deficit-hyperactivity disorder (ADHD) is a medical condition that is present in approximately 2.5% of adults worldwide and manifests in a variety of different ways across the lifespan. Adults with ADHD often have coexisting psychiatric disorders such as anxiety, mood, sleep, substance use, and personality disorders and are at increased risk for coexisting somatic conditions such as obesity, cardiovascular and cerebrovascular disease, type 1 and type 2 diabetes, and immune and inflammatory conditions. Hence, such adults may be seen by clinicians providing care for a wide range of psychiatric and somatic conditions. Nevertheless, ADHD remains unrecognized and undiagnosed in many persons. Assessment requires interviewing of the patient for core ADHD symptoms, coexisting conditions, and their functional effects, which can be facilitated by using standardized rating scales. Key components of treatment are psychoeducation and psychostimulant or nonstimulant medication, mostly in combination with psychosocial interventions and lifestyle guidance.</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"395 15","pages":"1519-1528"},"PeriodicalIF":84.5,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous or Intermittent Renal-Replacement Therapy - What Is the Question?","authors":"Paul M Palevsky","doi":"10.1056/NEJMe2612910","DOIUrl":"https://doi.org/10.1056/NEJMe2612910","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":84.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intermittent or Continuous Renal-Replacement Therapy in Acute Kidney Injury.","authors":"Stéphane Gaudry, Marouane Boubaya, Guillaume Louis, Khalil Chaïbi, Etienne de Montmollin, Julien Bohé, Maxime Desgrouas, Clément Devautour, Adrien Joseph, Bruno Mégarbane, Christophe Camus, Pierre Bailly, Alexis Lambour, Romain Arrestier, Samir Jaber, Adrien Robine, Nicolas Chudeau, Guillaume Chevrel, Béatrice La Combe, Jonathan Nicolas, Laurent Argaud, Côme Bureau, Antoine Kimmoun, Noémie Zucman, Jean-Damien Ricard, Guillaume Thiery, Stanislas Faguer, Mathieu Jozwiak, Nathan Ferrand, Benjamin Chousterman, Mehdi Marzouk, Julien Cadiet, Alain Combes, Arnaud Mari, Damien Contou, Roland Amathieu, Daniel Da Silva, Charlotte Salmon Gandonnière, Pierre-André Rodie-Talbere, Isabelle Durand-Zaleski, Patrick Rossignol, Jean-Pierre Quenot, Lucie Biard, Coralie Bloch, Didier Dreyfuss","doi":"10.1056/NEJMoa2608397","DOIUrl":"https://doi.org/10.1056/NEJMoa2608397","url":null,"abstract":"<p><strong>Background: </strong>The preferred method of renal-replacement therapy for acute kidney injury in critically ill patients remains uncertain.</p><p><strong>Methods: </strong>In this multicenter, open-label, noninferiority trial, we randomly assigned critically ill adults with acute kidney injury who had indications for renal-replacement therapy to undergo intermittent hemodialysis or continuous renal-replacement therapy as the initial treatment. The primary outcome was a major adverse kidney event - defined as death, dependence on renal-replacement therapy, or a serum creatinine concentration more than 25% above the baseline value - by day 90.</p><p><strong>Results: </strong>The trial was stopped early after sequential interim analyses showed a sustained signal of higher mortality with intermittent hemodialysis than with continuous renal-replacement therapy. A total of 554 patients underwent randomization, with 272 patients assigned to undergo intermittent hemodialysis and 282 to undergo continuous renal-replacement therapy; 535 patients (260 in the intermittent group and 275 in the continuous group) were included in the intention-to-treat population. A major adverse kidney event occurred by day 90 in 203 patients (78.1%) in the intermittent group and in 197 patients (71.6%) in the continuous group (adjusted absolute risk difference, 6.28 percentage points; 95% confidence interval [CI], -1.22 to 13.79). Death by day 90 occurred in 164 patients (63.1%) and in 147 patients (53.5%), respectively. Kaplan-Meier mortality estimates at day 90 were 63.3% and 53.6% (hazard ratio, 1.30; 95% CI, 1.04 to 1.63). The most common complication potentially related to acute kidney injury or renal-replacement therapy was hypotension, which occurred in 179 patients (68.8%) in the intermittent group and in 183 patients (66.5%) in the continuous group.</p><p><strong>Conclusions: </strong>Among critically ill patients with acute kidney injury who had indications for renal-replacement therapy, intermittent hemodialysis as the initial treatment approach was not shown to be noninferior to continuous renal-replacement therapy with respect to major adverse kidney events by day 90 and was associated with higher mortality. (Funded by the French Ministry of Health; ICRAKI ClinicalTrials.gov number, NCT06032884.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":84.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes.","authors":"Tamara K Oser, Thomas Martens, Katrina J Ruedy, Simon Bergford, Peter Calhoun, Ku-Lang Chang, Erik S Kramer, Beth A Klug, R Lacy Anderson, Benjamin R Cook, David Pickering, Martin Ortega, Bryce Peterson, Lisa Davidson, Rita Schmid, Nitinchandra D Desai, Edwin Burkett, Jamie L Haynes, Amir Herman, Shehzad M Topiwala, Ryan Bailey, Sean M Oser, Nelly N Cadet, Matthew L Johnson, Karen E Elkind-Hirsch, Stayce E Beck, Jessica R Castle, Roy W Beck","doi":"10.1056/NEJMoa2608571","DOIUrl":"https://doi.org/10.1056/NEJMoa2608571","url":null,"abstract":"<p><strong>Background: </strong>Continuous glucose monitoring (CGM) has been shown to be beneficial in persons with type 1 diabetes and others with insulin-treated type 2 diabetes, but its role in the treatment of persons with type 2 diabetes not being treated with insulin has needed further study.</p><p><strong>Methods: </strong>In a 26-week trial conducted at 22 primary care practices in the United States, we randomly assigned adults with type 2 diabetes who were not using insulin to either CGM or routine care (control). The primary outcome was the glycated hemoglobin level at 26 weeks. Key CGM-measured secondary outcomes were tested hierarchically to control the type I error rate.</p><p><strong>Results: </strong>A total of 145 participants were assigned to the CGM group, and 138 to the routine-care group. Participants ranged in age from 21 to 84 years. The mean (±SD) glycated hemoglobin level decreased from 8.8±1.3% at baseline to 7.2±1.1% at 26 weeks in the CGM group and from 8.7±1.2% to 8.0±1.4% in the routine-care group (adjusted mean difference, -0.9 percentage points; 95% confidence interval [CI], -1.1 to -0.6; P<0.001). The mean percentage of time that the CGM-measured glucose level was in the glucose-level range of 70 to 180 mg per deciliter was 21 percentage points higher (95% CI, 16 to 26) with CGM than with routine care (P<0.001). The between-group difference in the percentage of time that the glucose level was below 54 mg per deciliter was -0.17 percentage points (95% CI, -0.27 to -0.11; P<0.001 for noninferiority); the difference in the percentage of time that the glucose level was below 70 mg per deciliter was -0.20 percentage points (95% CI, -0.43 to -0.09; P<0.001 for noninferiority; P = 0.004 for superiority). No severe hypoglycemia events were reported.</p><p><strong>Conclusions: </strong>Among adults with type 2 diabetes that was not being treated with insulin and was being managed in a primary care setting, the use of CGM led to a greater reduction in the glycated hemoglobin level and to a lower risk of hyperglycemia than routine care. (Funded by Dexcom; CONNECT ClinicalTrials.gov number, NCT06601166.).</p>","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":84.5,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Social Needs among Older Adults — Addressing Mismeasurement","authors":"Mark A. Unruh,Joshua R. Vest","doi":"10.1056/nejmp2608580","DOIUrl":"https://doi.org/10.1056/nejmp2608580","url":null,"abstract":"","PeriodicalId":54725,"journal":{"name":"New England Journal of Medicine","volume":"32 1 1","pages":""},"PeriodicalIF":158.5,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149150406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}