BMJ medicine最新文献

{"title":"Progestogens, cervical cerclage, and cervical pessary for preventing preterm birth in asymptomatic singleton pregnancies with a sonographic short cervix and no previous history of spontaneous preterm birth: systematic review and bayesian network meta-analysis.","authors":"Hanglin Wu, Liming Yu, Jindi Zhang, Maria Goya, Katsufumi Otsuki, Sara Cruz-Melguizo, XueWen Fu","doi":"10.1136/bmjmed-2026-003010","DOIUrl":"10.1136/bmjmed-2026-003010","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of different interventions to prevent preterm birth in asymptomatic singleton pregnancies with a sonographic short cervix and no previous history of spontaneous preterm birth.</p><p><strong>Design: </strong>Systematic review and bayesian network meta-analysis.</p><p><strong>Data sources: </strong>Ovid Medline, Cochrane Library, Embase, ClinicalTrials.gov, Google Scholar, and Chinese databases, from inception to 13 March 2025, updated 3 February 2026.</p><p><strong>Eligibility criteria for selecting studies: </strong>Randomised controlled trials comparing two or more active interventions or comparing an active intervention with a control (placebo, expectant management, or usual care) to prevent preterm birth in asymptomatic women with singleton pregnancies and a sonographic short cervix, but no previous history of spontaneous preterm birth.</p><p><strong>Results: </strong>The primary outcomes were preterm birth before 34 and 37 weeks' gestation. 26 randomised controlled trials (8561 women) were identified, with 6004 participants included in the network meta-analysis. In direct pairwise comparisons, vaginal progesterone monotherapy was supported by high certainty evidence as a highly effective intervention for reducing preterm birth before 34 weeks' gestation (risk ratio 0.56, 95% confidence interval (CI) 0.44 to 0.72). In the network meta-analysis for preterm birth before 34 weeks' gestation (24 randomised controlled trials, 5738 women), vaginal progesterone monotherapy maintained a high efficacy ranking (mean rank 3.3, probability of risk ratio <1.00=96.4%), alongside the highest ranking of pessary with vaginal progesterone (mean rank 1.5, probability of risk ratio <1.00=99.1%). For preterm birth before 37 weeks' gestation (16 randomised controlled trials, 4203 women), vaginal progesterone monotherapy similarly showed a strong probability of risk reduction (probability of risk ratio <1.00=92.0%, mean rank 3.4). In terms of safety, direct evidence showed that vaginal progesterone monotherapy was associated with a significantly lower risk of maternal adverse events than combination treatments (risk ratio 0.56, 95% CI 0.42 to 0.76). Efficacy and safety hierarchies of vaginal progesterone remained highly robust across sensitivity analyses. For most secondary outcomes, the certainty of evidence was generally low, with moderate to high between study variability.</p><p><strong>Conclusions: </strong>The results showed that vaginal progesterone monotherapy remains the benchmark standard of care for the prevention of preterm birth, uniquely combining high certainty direct evidence, strong efficacy rankings, and excellent maternal safety. Although combination treatments showed high efficacy rankings, their routine clinical adoption should be restricted to research settings given the safety concerns and lower certainty evidence. A cervical pessary might be an alternative to vaginal progesterone in select","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e003010"},"PeriodicalIF":9.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progestogens, cervical cerclage, and cervical pessary for preventing preterm birth in asymptomatic singleton pregnancies with a sonographic short cervix and no previous history of spontaneous preterm birth: systematic review and bayesian network meta-analysis.","authors":"Hanglin Wu, Liming Yu, Jindi Zhang, Maria Goya, Katsufumi Otsuki, Sara Cruz-Melguizo, XueWen Fu","doi":"10.1136/bmjmed-2026-003010","DOIUrl":"https://doi.org/10.1136/bmjmed-2026-003010","url":null,"abstract":"","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217420","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":"Values, preferences, and treatment burden for initiation of GLP-1 receptor agonists, SGLT-2 inhibitors, tirzepatide, and finerenone in adults with type 2 diabetes: systematic review.","authors":"Daniela C González-Cruz, Mariano Garcia-Campa, Pablo José Moreno-Peña, Andres Avalos-Bishop, Dulce María Manzanares-Gallegos, Fernanda M Garcia-Garcia, Jan Alejandro Montiel Labastida, José Gerardo González-González, Arnav Agarwal, Veena Manja, Per Olav Vandvik, Thomas Agoritsas, Reem A Mustafa, René Rodríguez-Gutiérrez","doi":"10.1136/bmjmed-2026-002780","DOIUrl":"https://doi.org/10.1136/bmjmed-2026-002780","url":null,"abstract":"<p><strong>Objectives: </strong>To summarise existing evidence regarding the values, preferences, and perceived treatment burden of adults with type 2 diabetes when considering initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), finerenone, or tirzepatide.</p><p><strong>Design: </strong>Systematic review.</p><p><strong>Data sources: </strong>Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched from database inception to 7 January 2025 (updating a previous systematic review that captured literature up to 23 May 2020).</p><p><strong>Eligibility criteria: </strong>Quantitative or qualitative studies were included if they reported patient reported values, preferences, or treatment burden among adults with type 2 diabetes and compared initiation of GLP-1 RA, SGLT-2i, tirzepatide, or finerenone with each other or with other glucose-lowering treatments.</p><p><strong>Data extraction and synthesis: </strong>Paired reviewers independently screened studies, extracted data, and assessed risk of bias. Certainty of evidence was evaluated using GRADE. Findings were synthesised narratively.</p><p><strong>Results: </strong>Thirty four studies (15 656 patients) were included, 17 of which were new since the previous 2021 review (8360 patients). Of the newly included studies, 10 evaluated GLP-1 RA, seven evaluated SGLT-2i, and one evaluated tirzepatide; no studies evaluated finerenone (because several studies compared multiple drug classes, these categories are not mutually exclusive). Across comparisons, patients consistently reported glycaemic efficacy, cardiovascular risk reduction, and simplicity of administration as their priorities. Oral once-daily regimens and once-weekly injectable treatments with easy-to-use devices were generally preferred. Weight loss was valued but was typically secondary to glycaemic and cardiovascular benefits. SGLT-2i and GLP-1 RA were often preferred over dipeptidyl peptidase 4-inhibitors (DPP-4i), thiazolidinediones, and insulins, but no consistent preference emerged for SGLT-2i over GLP-1 RA. Tirzepatide was favoured over semaglutide in a single study, largely due to greater haemoglobin A_1c reduction and lower hypoglycaemia risk. Certainty of evidence for all comparisons was low or very low certainty.</p><p><strong>Conclusion: </strong>Adults with type 2 diabetes prioritise treatment effectiveness and convenience among glucose-lowering treatments. Current evidence does not support a clear preference between SGLT-2i and GLP-1 RA, and data for finerenone are absent. These findings underscore the importance of shared decision making informed by individual patient priorities.</p><p><strong>Prospero registration: </strong>CRD42023429170.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002780"},"PeriodicalIF":9.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy complications and risk of cardiometabolic-renal conditions in 1.4 million women in England: longitudinal study.","authors":"Steven Wambua, Megha Singh, Mohamed Rishard, Nadia Sarween, Pushpa Singh, Christopher Yau, Richard D Riley, Nicola J Adderley, Kym I E Snell, Francesca L Crowe, Krishnarajah Nirantharakumar","doi":"10.1136/bmjmed-2026-003035","DOIUrl":"https://doi.org/10.1136/bmjmed-2026-003035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association between pregnancy complications and cardiometabolic-renal conditions (ie, cardiovascular disease, type 2 diabetes mellitus, hypertension, and chronic kidney disease) in the subsequent years after pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Longitudinal study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Clinical Practice Research Datalink (CPRD) Aurum primary care database pregnancy register, UK, 1 January 2000 to 31 December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;1 432 795 women, aged 15-49 years, who had been pregnant, with or without pregnancy complications, and registered with a general practitioner between 1 January 2000 and 31 December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;First recorded diagnosis of each of the four conditions: cardiovascular disease (ischaemic heart disease or cerebrovascular disease, including stroke and transient ischaemic attack), type 2 diabetes mellitus, hypertension, and chronic kidney disease (stages 3-5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;1 422 287 participants were included in the cardiovascular disease outcome analysis, 1 389 460 in the hypertension, 1 411 883 in the type 2 diabetes mellitus, and 1 430 965 in the chronic kidney disease cohorts. Median follow-up was 4.1-4.3 years across the four cohorts (interquartile range approximately 1.5-9.8). Of 72 associations examined, 51 were significant after correction for multiple testing. Well established associations were found. Gestational hypertension and pre-eclampsia more than tripled the rate of hypertension and approximately doubled the rate of chronic kidney disease, with smaller increases for cardiovascular disease and type 2 diabetes mellitus. Gestational diabetes mellitus was associated with a sevenfold higher rate of type 2 diabetes mellitus and increased rates for hypertension and cardiovascular disease, but not for chronic kidney disease. Less well established associations were also found. Postnatal depression increased the rate of all four outcomes by 35-56% for the latest pregnancy (hypertension hazard ratio 1.36, 95% confidence interval (CI) 1.33 to 1.40; type 2 diabetes mellitus hazard ratio 1.41, 1.36 to 1.46; cardiovascular disease hazard ratio 1.56, 1.50 to 1.62; and chronic kidney disease hazard ratio 1.35, 1.25 to 1.45). Miscarriage, stillbirth, placental abruption, and preterm birth in the latest or in a previous pregnancy were associated with modestly higher rates of one or more outcomes (eg, stillbirth in the latest pregnancy: type 2 diabetes mellitus hazard ratio 1.67, 95% CI 1.33 to 2.08 and chronic kidney disease hazard ratio 1.79, 1.19-2.70; placental abruption in the latest pregnancy: chronic kidney disease hazard ratio 1.67, 1.06 to 2.62). Small-for-gestational-age birth was associated with higher rates of hypertension and cardiovascular disease, and large-for-gestational-age birth with higher rates for type 2 diabetes mellitus, including without gestational diabetes mellitu","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186521","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 complications and risk of cardiometabolic-renal conditions in 1.4 million women in England: longitudinal study.","authors":"Steven Wambua, Megha Singh, Mohamed Rishard, Nadia Sarween, Pushpa Singh, Christopher Yau, Richard D Riley, Nicola J Adderley, Kym I E Snell, Francesca L Crowe, Krishnarajah Nirantharakumar","doi":"10.1136/bmjmed-2026-003035","DOIUrl":"10.1136/bmjmed-2026-003035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To investigate the association between pregnancy complications and cardiometabolic-renal conditions (ie, cardiovascular disease, type 2 diabetes mellitus, hypertension, and chronic kidney disease) in the subsequent years after pregnancy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Longitudinal study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Clinical Practice Research Datalink (CPRD) Aurum primary care database pregnancy register, UK, 1 January 2000 to 31 December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;1 432 795 women, aged 15-49 years, who had been pregnant, with or without pregnancy complications, and registered with a general practitioner between 1 January 2000 and 31 December 2022.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;First recorded diagnosis of each of the four conditions: cardiovascular disease (ischaemic heart disease or cerebrovascular disease, including stroke and transient ischaemic attack), type 2 diabetes mellitus, hypertension, and chronic kidney disease (stages 3-5).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;1 422 287 participants were included in the cardiovascular disease outcome analysis, 1 389 460 in the hypertension, 1 411 883 in the type 2 diabetes mellitus, and 1 430 965 in the chronic kidney disease cohorts. Median follow-up was 4.1-4.3 years across the four cohorts (interquartile range approximately 1.5-9.8). Of 72 associations examined, 51 were significant after correction for multiple testing. Well established associations were found. Gestational hypertension and pre-eclampsia more than tripled the rate of hypertension and approximately doubled the rate of chronic kidney disease, with smaller increases for cardiovascular disease and type 2 diabetes mellitus. Gestational diabetes mellitus was associated with a sevenfold higher rate of type 2 diabetes mellitus and increased rates for hypertension and cardiovascular disease, but not for chronic kidney disease. Less well established associations were also found. Postnatal depression increased the rate of all four outcomes by 35-56% for the latest pregnancy (hypertension hazard ratio 1.36, 95% confidence interval (CI) 1.33 to 1.40; type 2 diabetes mellitus hazard ratio 1.41, 1.36 to 1.46; cardiovascular disease hazard ratio 1.56, 1.50 to 1.62; and chronic kidney disease hazard ratio 1.35, 1.25 to 1.45). Miscarriage, stillbirth, placental abruption, and preterm birth in the latest or in a previous pregnancy were associated with modestly higher rates of one or more outcomes (eg, stillbirth in the latest pregnancy: type 2 diabetes mellitus hazard ratio 1.67, 95% CI 1.33 to 2.08 and chronic kidney disease hazard ratio 1.79, 1.19-2.70; placental abruption in the latest pregnancy: chronic kidney disease hazard ratio 1.67, 1.06 to 2.62). Small-for-gestational-age birth was associated with higher rates of hypertension and cardiovascular disease, and large-for-gestational-age birth with higher rates for type 2 diabetes mellitus, including without gestational diabetes mellitu","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e003035"},"PeriodicalIF":9.3,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug treatments for fibromyalgia: systematic review and network meta-analysis of randomised trials.","authors":"Dena Zeraatkar, João Pedro Lima, Sarah Kirsh, Michael Ling, Hamed Movahed, Haotao Li, Alex Huynh, Tanvir Jassal, Alicia Walch, Mahsa Raji Lahiji, Tyler Pitre, Rachel J Couban, Behnam Sadeghirad, Thomas Agoritsas, Jason W Busse","doi":"10.1136/bmjmed-2026-002902","DOIUrl":"10.1136/bmjmed-2026-002902","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of drug treatments for the management of fibromyalgia.</p><p><strong>Design: </strong>Systematic review and network meta-analysis of randomised trials.</p><p><strong>Data sources: </strong>Medline, Embase, AMED (Allied and Complementary Medicine Database), PsycInfo, CINAHL, and Cochrane CENTRAL (Cochrane Central Register of Controlled Trials), from inception to 13 January 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Parallel, crossover, and cluster randomised trials that enrolled adults (aged ≥18 years) with fibromyalgia, according to any published diagnostic criteria or as diagnosed by a physician. Trials compared commercially available, investigational, or discontinued drug treatments with another drug, the same drug at a different dose or regimen, placebo, or standard care. Treatments also included select vitamins and supplements, such as melatonin, vitamin D, vitamin B6, and omega 3 fatty acids.</p><p><strong>Results: </strong>151 eligible trials (32 592 participants) were included in this systematic review. Compared with placebo or usual care, low certainty evidence suggested that sodium oxybate, selective noradrenaline (norepinephrine) reuptake inhibitors (NRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), and gabapentinoids may increase the likelihood of patient reported meaningful improvement or recovery (risk difference 105 to 283 more per 1000 patients). Based on scores from the fibromyalgia impact questionnaire, low certainty evidence further suggested that sodium oxybate (mean difference -8.81, 95% confidence interval (CI) -11.78 to -5.84) and selective serotonin reuptake inhibitors (SSRIs) (mean difference -8.02, 95% CI -13.40 to -2.64) may reduce fibromyalgia symptoms, whereas tricyclic antidepressants, sodium oxybate, and gabapentinoids may improve sleep quality. No drug showed pooled effects on pain, physical health or mental health that met or exceeded a threshold for clinical importance. For sodium oxybate, selective NRIs, SNRIs, and cyclobenzaprine, responder analyses indicated that a potentially important proportion of patients achieved a reduction in pain of at least 30% (risk difference 111 to 202 more per 1000 patients). In addition, no drug increased the risk of discontinuing treatment or serious adverse events.</p><p><strong>Conclusions: </strong>This systematic review and network meta-analysis provides low certainty evidence that sodium oxybate, selective NRIs, SNRIs, gabapentinoids, tricyclic antidepressants, and SSRIs may provide typically small benefits in select outcomes for people with fibromyalgia.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42012003291.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002902"},"PeriodicalIF":9.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug treatments for fibromyalgia: systematic review and network meta-analysis of randomised trials.","authors":"Dena Zeraatkar, João Pedro Lima, Sarah Kirsh, Michael Ling, Hamed Movahed, Haotao Li, Alex Huynh, Tanvir Jassal, Alicia Walch, Mahsa Raji Lahiji, Tyler Pitre, Rachel J Couban, Behnam Sadeghirad, Thomas Agoritsas, Jason W Busse","doi":"10.1136/bmjmed-2026-002902","DOIUrl":"https://doi.org/10.1136/bmjmed-2026-002902","url":null,"abstract":"<p><strong>Objective: </strong>To compare the effectiveness of drug treatments for the management of fibromyalgia.</p><p><strong>Design: </strong>Systematic review and network meta-analysis of randomised trials.</p><p><strong>Data sources: </strong>Medline, Embase, AMED (Allied and Complementary Medicine Database), PsycInfo, CINAHL, and Cochrane CENTRAL (Cochrane Central Register of Controlled Trials), from inception to 13 January 2025.</p><p><strong>Eligibility criteria for selecting studies: </strong>Parallel, crossover, and cluster randomised trials that enrolled adults (aged ≥18 years) with fibromyalgia, according to any published diagnostic criteria or as diagnosed by a physician. Trials compared commercially available, investigational, or discontinued drug treatments with another drug, the same drug at a different dose or regimen, placebo, or standard care. Treatments also included select vitamins and supplements, such as melatonin, vitamin D, vitamin B6, and omega 3 fatty acids.</p><p><strong>Results: </strong>151 eligible trials (32 592 participants) were included in this systematic review. Compared with placebo or usual care, low certainty evidence suggested that sodium oxybate, selective noradrenaline (norepinephrine) reuptake inhibitors (NRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs), and gabapentinoids may increase the likelihood of patient reported meaningful improvement or recovery (risk difference 105 to 283 more per 1000 patients). Based on scores from the fibromyalgia impact questionnaire, low certainty evidence further suggested that sodium oxybate (mean difference -8.81, 95% confidence interval (CI) -11.78 to -5.84) and selective serotonin reuptake inhibitors (SSRIs) (mean difference -8.02, 95% CI -13.40 to -2.64) may reduce fibromyalgia symptoms, whereas tricyclic antidepressants, sodium oxybate, and gabapentinoids may improve sleep quality. No drug showed pooled effects on pain, physical health or mental health that met or exceeded a threshold for clinical importance. For sodium oxybate, selective NRIs, SNRIs, and cyclobenzaprine, responder analyses indicated that a potentially important proportion of patients achieved a reduction in pain of at least 30% (risk difference 111 to 202 more per 1000 patients). In addition, no drug increased the risk of discontinuing treatment or serious adverse events.</p><p><strong>Conclusions: </strong>This systematic review and network meta-analysis provides low certainty evidence that sodium oxybate, selective NRIs, SNRIs, gabapentinoids, tricyclic antidepressants, and SSRIs may provide typically small benefits in select outcomes for people with fibromyalgia.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD42012003291.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186455","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":"Pathogenesis, screening, and diagnosis of hypertrophic cardiomyopathy.","authors":"Kendra M Gilreath, Darrell B Newman, Steve R Ommen, Jeffrey B Geske","doi":"10.1136/bmjmed-2025-002433","DOIUrl":"10.1136/bmjmed-2025-002433","url":null,"abstract":"<p><p>Hypertrophic cardiomyopathy is a common heritable heart disease. The disease is genetically, anatomically, and clinically heterogeneous. Hypertrophic cardiomyopathy is inherited in an autosomal dominant pattern but has allelic heterogeneity, incomplete penetrance, and variable expressivity. Beyond family screening, clinical evaluation for hypertrophic cardiomyopathy is often prompted by identification of symptoms or detection of a heart murmur, additionally, abnormal electrocardiogram or imaging results performed for another reason can provide evidence. Evaluation should include obtaining a patient's history, a physical examination, cardiac imaging, and, often, genetic testing. Prognosis is variable; major causes of morbidity and mortality are caused by sudden cardiac death, heart failure, and atrial fibrillation with associated stroke risk. An understanding of the pathogenesis at the genetic, cellular, and individual levels helps clinicians to implement appropriate screening, recognise clinical manifestations, and improve the treatment of patients with hypertrophic cardiomyopathy. The understanding of this condition is evolving, with recent advances and insights into its pathogenesis, refinement of risk stratification, and use of artificial intelligence in screening, diagnosis, and prognostication.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":""},"PeriodicalIF":9.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Millennium Cohort Study: cohort profile and data resource update.","authors":"Aase Villadsen, Emla Fitzsimons","doi":"10.1136/bmjmed-2025-002429","DOIUrl":"10.1136/bmjmed-2025-002429","url":null,"abstract":"<p><p>This cohort profile gives a comprehensive overview of the Millennium Cohort Study (MCS), a nationally representative study of children born in the UK during 2000-02. The study is for researchers in public health and other disciplines who seek a comprehensive overview of the MCS and its data resources. This profile describes the study design, sampling strategy, population characteristics, breadth of measures collected, the availability of biological samples and linked administrative data, approaches to missing data and attrition, and key resources for navigating and accessing the datasets. Earlier cohort profiles are also updated here, and the full range of data resources currently available (through to the most recent survey of participant at age 23 years) is documented.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002429"},"PeriodicalIF":9.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mexico City Prospective Study: cohort profile update.","authors":"Jonathan Emberson, Jesus Alegre-Diaz, Jaime Berumen, Pablo Kuri-Morales, Roberto Tapia-Conyer","doi":"10.1136/bmjmed-2025-002223","DOIUrl":"10.1136/bmjmed-2025-002223","url":null,"abstract":"<p><p>To fully understand the causes of human disease worldwide, large blood based prospective studies are needed in a range of populations with different healthcare settings and exposures to environmental and genetic risk factors. The Mexico City Prospective Study, updated in this cohort profile, was established in the late 1990s to investigate the sociodemographic, lifestyle, physical, and biological (including genetic) determinants of disease among around 150 000 adults in Mexico City. The study has over 20 years of mortality follow-up, cohort-wide biochemical and genetic data, repeat survey data from a subset of surviving participants, and ongoing ascertainment of non-fatal diseases. All Mexico City Prospective Study data are available for open access academic research within a trusted research environment, with preferential access for researchers based in Mexico and no data access fees for researchers in low income or middle income countries. Beyond representing a genetically diverse Latin American population, a key distinguishing feature of the study is the high baseline prevalence of obesity and diabetes. Earlier findings showed that diabetes had a substantially greater impact on mortality than suggested by evidence from high income countries, with a third of all deaths at ages 35-74 years attributed to diabetes. These results contributed to rapid changes in national disease prevention policies. By combining a genetically admixed (ie, individuals with ancestry from multiple ancestral populations) Latin American population, family based recruitment, a high burden of metabolic disease, availability of biochemical and genetic data, long term follow-up, and open access data availability, the Mexico City Prospective Study offers unique opportunities for health related discoveries within Mexico and internationally.</p>","PeriodicalId":72433,"journal":{"name":"BMJ medicine","volume":"5 1","pages":"e002223"},"PeriodicalIF":9.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}