NEJM evidence最新文献

{"title":"Outbreak of Legionnaires' Disease Associated with Cooling Tower Systems in Central Harlem.","authors":"Emily McGibbon, Elizabeth Iuppa Burke, Elizabeth Watts, Bri Beaver-Timmons, Vincent Law, Yin Ling Leung, Anupa George, Lia Qiu, Stefan Silver, Vasudha Reddy, Enoma Omoregie, Ulrike Siemetzki-Kapoor, Diane Fung, Corinne Schiff, Shama Desai Ahuja","doi":"10.1056/EVIDpha2600062","DOIUrl":"10.1056/EVIDpha2600062","url":null,"abstract":"<p><p>AbstractCooling tower systems have been the source of multiple large Legionnaires' disease outbreaks. We report a July-August 2025 outbreak in the Central Harlem area of New York City, with 118 confirmed cases and seven deaths. An investigation was initiated on the day the daily spatiotemporal cluster detection analysis by the New York City Health Department noted eight positive urine antigen test results for <i>Legionella pneumophila</i> serogroup 1. A total of 43 cooling tower systems were sampled by day 3. Whole-genome sequencing analysis suggested that the available clinical isolates were highly related to those from two cooling towers located on the same city block.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDpha2600062"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304269","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":"HTD1801 in Combination with Metformin for Type 2 Diabetes.","authors":"Linong Ji, Zhifeng Cheng, Jianhua Ma, Dexue Liu, Xin Zhang, Xiaolin Dong, Yang Lin, Mingming Yang, Shenglian Gan, Hanqing Cai, Xiaomei Wang, Yan Liu, Xiaoguang Shi, Kui Liu, Leigh MacConell, Meng Yu, Liping Liu","doi":"10.1056/EVIDoa2500317","DOIUrl":"10.1056/EVIDoa2500317","url":null,"abstract":"<p><strong>Background: </strong>HTD1801 is an anti-inflammatory metabolic modulator being developed to treat type 2 diabetes (T2D). The safety and efficacy of HTD1801 as an add-on to metformin among patients with T2D with inadequate glycemic control despite stable metformin use have not been well evaluated.</p><p><strong>Methods: </strong>This phase 3 double-blind trial included patients with T2D, glycated hemoglobin (HbA1c) 7.0% to 10.5%, fasting glucose levels of 250.5 mg/dl or lower, and stable use of metformin for 8 weeks or more. Patients were randomly assigned 2:1 to receive either HTD1801 1000 mg orally twice daily (n=365) or placebo (n=184) in addition to their prior metformin treatment. The primary end point was change in HbA1c from baseline to week 24. Data on adverse events were collected during this 24-week time frame.</p><p><strong>Results: </strong>The mean HbA1c was 8.6% at baseline and 7.4% at 24 weeks in the HTD1801 group (mean change, -1.2 percentage points; 95% confidence interval [CI], -1.3 to -1.1). The mean HbA1c was 8.5% at baseline and 7.8% at 24 weeks in the placebo group (mean change, -0.7 percentage point; 95% CI, -0.8 to -0.6). The adjusted least-squares mean difference between groups for the change in HbA1c from baseline to week 24 was -0.5 (95% CI, -0.7 to -0.4; P<0.0001). Diarrhea was the most common adverse event (HTD1801, 23.8%; placebo, 1.1%), with three cases in the HTD1801 group graded as severe, and all the other cases being mild to moderate in severity. No patients experienced severe hypoglycemia.</p><p><strong>Conclusions: </strong>After 24 weeks, HbA1c reduction was significantly greater among patients with T2D taking metformin and randomly assigned to receive HTD1801 versus placebo. A higher proportion of patients in the HTD1801 group experienced mild to moderate diarrhea compared with the placebo group. (Funded by Shenzhen HighTide Biopharmaceutical; ClinicalTrials.gov number, NCT06353347.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2500317"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201507","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":"Berberine-Ursodeoxycholate - Bringing Traditional Chinese Medicine to Our World.","authors":"Binh Ngo, Marc Rendell","doi":"10.1056/EVIDe2600088","DOIUrl":"https://doi.org/10.1056/EVIDe2600088","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDe2600088"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304170","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":"Measles Outbreak in Cook County, Illinois, September-October 2025.","authors":"Demian Christiansen, Sheila Giovanni, Mabel Frias, Kelley Bemis, Heather Reid, Jodi Morgan, Griselle Torres","doi":"10.1056/EVIDpha2600091","DOIUrl":"10.1056/EVIDpha2600091","url":null,"abstract":"<p><p>AbstractA small community outbreak of measles in suburban Cook County, Illinois occurred in September-October 2025. Cook County Department of Public Health investigators identified four measles cases, including one unvaccinated pediatric index case, two vaccinated adult secondary cases, and an unvaccinated pediatric tertiary case. At least 99 individuals were exposed to measles, including 79 (80%) people exposed in emergency department waiting rooms on two separate dates. Incomplete exposure information was ascertained by public health investigators, which might have contributed to preventable health care exposures.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDpha2600091"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304254","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":"Immunotherapy for Fertility in Autoimmune Premature Ovarian Insufficiency.","authors":"Angelica Lindén Hirschberg, Sigridur Björnsdottir, Iva Gunnarsson, Fotios Sergouniotis, Kjell Wånggren, Carolina Sousa Silva, Elinor Vogt, Marianne Øksnes, Eystein S Husebye, Sophie Bensing, Olle Kämpe","doi":"10.1056/EVIDoa2500303","DOIUrl":"10.1056/EVIDoa2500303","url":null,"abstract":"<p><strong>Background: </strong>Women with autoimmune diseases have an increased risk of premature ovarian insufficiency (POI), leading to early menopause and infertility. We hypothesized that B-cell depletion with rituximab could reverse autoimmune activity, enhance ovarian responsiveness to gonadotropins, and transiently restore fertility in autoimmune POI.</p><p><strong>Methods: </strong>In this proof-of-concept study, we enrolled women between the ages of 18 and 35 years with autoimmune POI. Each participant underwent controlled ovarian hyperstimulation before and 4 to 6 months after treatment with rituximab (two 1-g infusions, administered 2 weeks apart). Participants were followed for 12 months after rituximab infusion. The primary outcomes of interest were the number of antral follicles and the size of the largest follicle in response to ovarian stimulation. In the case of successful oocyte retrieval, oocytes were cryopreserved or fertilized. For safety, embryo transfer was deferred until at least 12 months after rituximab administration.</p><p><strong>Results: </strong>We enrolled 12 women, with a mean (standard deviation) age of 30.8 (2.8) years. Two women withdrew consent prior to initiating the study. Prior to rituximab, none of the participants responded to ovarian hyperstimulation with follicular development. Following rituximab, after undergoing another ovarian hyperstimulation, follicular development occurred in six women that led to oocyte retrieval (responders). In three of these cases, oocytes were fertilized and embryos preserved; all three women subsequently delivered healthy children. One serious adverse event occurred during the trial, related to ovarian hyperstimulation.</p><p><strong>Conclusions: </strong>In this small proof-of-concept study with no control group, of 10 women with premature ovarian insufficiency who received rituximab followed by ovarian stimulation, six underwent oocyte retrieval. A randomized controlled trial is needed to further evaluate this treatment strategy. (Funded by the Swedish Research Council and others; EudraCT number, 2017-004532-10; ClinicalTrials.gov number, NCT05586737.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDoa2500303"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304152","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":"Disorders of Telomere Length.","authors":"Kristen E Schratz, Mary Armanios","doi":"10.1056/EVIDra2600012","DOIUrl":"https://doi.org/10.1056/EVIDra2600012","url":null,"abstract":"<p><p>AbstractRecent discoveries have uncovered roles for telomere length, at both short and long extremes, as a driver of inherited disease risk in children and adults. For short telomere length the predominant phenotype is degenerative, with immunodeficiency, bone marrow failure, and pulmonary disease being most common. Short telomere syndrome genetics inform clinical decisions and have transformed understanding of the etiology, natural history, and treatment of common diseases such as idiopathic pulmonary fibrosis. At the other extreme, ultra-long telomere length predisposes to neoplasia including lympho- and myeloproliferative disease. Individuals with mutations that lengthen telomeres may show features of youthfulness such as delayed hair graying but paradoxically are at risk for benign and malignant neoplasia, which are associated with aging. Their earliest events are traceable in the blood as premature onset of clonal hematopoiesis which shows complete penetrance with aging. Here, we review the genetic basis, pathophysiology, and contrasting phenotypes of Mendelian short and long telomere syndromes, emphasizing how they inform clinical decisions as well as our understanding of the fundamentals of aging and cancer.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDra2600012"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304149","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":"Future Therapies for Autoimmune Premature Ovarian Insufficiency.","authors":"Claire L Wood, Simon H Pearce","doi":"10.1056/EVIDe2600164","DOIUrl":"https://doi.org/10.1056/EVIDe2600164","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDe2600164"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304199","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":"Secukinumab for Giant Cell Arteritis.","authors":"John H Stone, Nils Venhoff, Frank Buttgereit, Christian Dejaco, Wolfgang A Schmidt, Robert Spiera, Ricardo Blanco, Andrea Rubbert-Roth, Christian Von Frenckell, Daniel Blockmans, Benjamin Terrier, Gerald Tracey, Ellen Margrethe Hauge, Monica Pastoral Keyport, Jennifer Ng, Renuka Hiremath, Rong Fu, GaEun Cho, Gerald Bacher, Jens Thiel, Meryl H Mendelson","doi":"10.1056/EVIDoa2600112","DOIUrl":"10.1056/EVIDoa2600112","url":null,"abstract":"<p><strong>Background: </strong>Glucocorticoids (GCs) are standard treatment for giant cell arteritis (GCA). Many patients experience relapses or GC-related toxicity. Secukinumab, a fully human monoclonal antibody that selectively inhibits interleukin-17A, is being studied as additional therapy for GCA.</p><p><strong>Methods: </strong>GCAptAIN was a randomized, parallel-group, double-blind, placebo-controlled, multicenter phase 3 trial. Patients with new-onset or relapsing GCA were initially randomly assigned (2:1) to either 300 mg of secukinumab (SEC-300) or placebo for 52 weeks. After a protocol amendment, patients were randomly assigned (1:1:1) to either SEC-300, 150 mg of secukinumab (SEC-150), or placebo. Patients in the SEC-300 and SEC-150 groups received a 26-week GC taper. Patients in the placebo group received a 52-week GC taper. The primary outcome was the proportion of patients experiencing sustained remission in the SEC-300 versus placebo groups at week 52. Sustained remission in patients in the SEC-150 group versus patients in the placebo group enrolled after the protocol amendment was a secondary outcome. Adverse events (AEs) and serious AEs (SAEs) were assessed.</p><p><strong>Results: </strong>A total of 140 patients in the SEC-300 group, 98 in the SEC-150 group, and 115 in the placebo group (19 patients were enrolled in the placebo group before and 96 after the protocol amendment) were analyzed for efficacy and safety. The proportion of patients achieving sustained remission at week 52 was 25.6% for SEC-300 versus 16.9% for placebo (marginal difference: 8.7 percentage points; 95% confidence interval [CI], -1.3 to 18.8; P=0.09) and 19.4% for SEC-150 versus 17.7% for placebo (marginal difference, 1.6 percentage points; 95% CI, -9.2 to 12.4). AEs occurred in 92.9%, 95.9%, and 97.4% of patients in the SEC-300, SEC-150, and placebo groups, respectively. SAEs occurred in 20.0%, 27.6%, and 32.2% of patients in the SEC-300, SEC-150, and placebo groups, respectively. Serious infections occurred in 5.0%, 9.2%, and 6.1% of patients in the SEC-300, SEC-150, and placebo groups, respectively.</p><p><strong>Conclusions: </strong>Sustained remission at week 52 did not differ significantly between patients with GCA randomly assigned to receive SEC-300 with a 26-week GC taper versus placebo with a 52-week GC taper. (Funded by Novartis Pharma; EudraCT number, 2020-004809-31; ClinicalTrials.gov number, NCT04930094.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDoa2600112"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148152465","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":"Evidence for Evidence-Based Medicine - A Call for Some Theory and a New Problem.","authors":"Thomas A Trikalinos","doi":"10.1056/EVIDe2500311","DOIUrl":"https://doi.org/10.1056/EVIDe2500311","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDe2500311"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304129","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":"Interval Likelihood Ratios - Shades of Gray Wherever I Go.","authors":"Zaven Sargsyan","doi":"10.1056/EVIDe2600145","DOIUrl":"https://doi.org/10.1056/EVIDe2600145","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 7","pages":"EVIDe2600145"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304216","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}