NEJM evidence最新文献

{"title":"Patient-Centered Evaluation of Anticoagulation in Atrial Fibrillation.","authors":"Satoshi Shoji, Pishoy Gouda, Caroline A Falvey, Huiman Barnhart, Derek D Cyr, Robert J Mentz, Jonathan P Piccini, Manesh R Patel, William Schuyler Jones, Veraprapas Kittipibul, Min Soo Cho, Manasi Tannu, Shuntaro Sato, Andre Nicolau, Michael Palazzolo, Lars Wallentin, John Eikelboom, Hwanhee Hong, Robert P Giugliano, Shelby D Reed, Christopher B Granger","doi":"10.1056/EVIDoa2500323","DOIUrl":"10.1056/EVIDoa2500323","url":null,"abstract":"<p><strong>Background: </strong>Prior analyses of trials comparing direct oral anticoagulants (DOACs) to warfarin in atrial fibrillation (AF) have not routinely incorporated patient preferences, despite substantial variation in how patients value the trade-off between outcomes such as stroke and bleeding. By applying patient-centered approaches, we aimed to provide intuitive metrics to inform shared decision-making, particularly for frail older adults for whom DOAC benefit remains controversial.</p><p><strong>Methods: </strong>Individual-level data from 58,634 participants in four randomized controlled trials (RCTs) comparing DOACs to warfarin (A Collaboration Between Multiple Institutions to Better Investigate Non-Vitamin K Antagonist Oral Anticoagulant Use in Atrial Fibrillation; COMBINE-AF) were analyzed using two patient-centered methods. Seven clinical outcomes (death, disabling stroke, major bleeding, moderate-severity stroke, systemic embolism, clinically relevant non-major bleeding, and minor stroke) were weighted based on a prior 1028-patient preference study with all values scaled relative to death. For the weighted composite endpoint (WCE), a survival-based approach incorporated weights of initial and recurrent events to estimate event-free survival. For win statistics, outcomes were hierarchically ranked for pairwise comparisons. The primary estimand was the 2-year difference in weighted death-equivalent events per 100 patients for the WCE. The win ratio was a secondary estimand. A prespecified subgroup analysis was conducted in frail, older patients.</p><p><strong>Results: </strong>In the overall cohort, compared to warfarin, DOACs were associated with a more favorable outcome (WCE: 11.74 vs. 12.85 events per 100 patients; difference, -1.11 [95% confidence interval (CI): -1.61 to -0.61]; P<0.001; win ratio 1.11 [95% CI: 1.07 to 1.15]). In the prespecified subgroup of 5913 frail participants, the difference in the WCE was +0.50 events [95% CI: -1.39 to 2.40]) with a win ratio of 0.99 [95% CI: 0.90 to 1.08]) in individuals treated with DOAC versus warfarin.</p><p><strong>Conclusions: </strong>In individuals with atrial fibrillation pooled from four RCTs, DOACs were associated with a favorable net clinical benefit compared to warfarin when evaluated using a patient-weighted composite clinical outcome. (Funded by a Fellows Supplemental Funding grant from the Duke Clinical Research Institute's Executive Director Pathway Committee.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDoa2500323"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038486","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":"One and Done - Single-Dose Zoledronic Acid in Early-Stage Breast Cancer.","authors":"Neelima Vidula","doi":"10.1056/EVIDe2600083","DOIUrl":"https://doi.org/10.1056/EVIDe2600083","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDe2600083"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038524","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":"Intramuscular Immunoglobulin for Measles Postexposure Prophylaxis.","authors":"","doi":"10.1056/EVIDx2600161","DOIUrl":"10.1056/EVIDx2600161","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDx2600161"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950428","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":"Every Six-Month versus Single-Dose Adjuvant Zoledronate in Early Breast Cancer.","authors":"Mark Clemons, Carol Stober, Gregory R Pond, Henry Conter, Demetrios Simos, Sukhbinder Dhesy-Thind, Mihaela Mates, Mateya Trinkaus, John Hilton, Marie-France Savard, Dean Fergusson, Lisa Vandermeer, Arif Ali Awan","doi":"10.1056/EVIDoa2500202","DOIUrl":"10.1056/EVIDoa2500202","url":null,"abstract":"<p><strong>Background: </strong>Three-year data from a randomized trial comparing a single zoledronate infusion with infusions every 6 months were previously reported showing that a single infusion was associated with increased patient convenience, less toxicity, and lower rates of treatment discontinuation at 3 years. We now report the trial's final, prespecified 5-year follow-up data.</p><p><strong>Methods: </strong>Patients who were postmenopausal (either naturally or treatment induced) with early breast cancer were randomly assigned to receive a single infusion of zoledronate (4 mg intravenously) or an infusion every 6 months for 3 years. Final 5-year preplanned secondary outcomes included recurrence-free survival, bone metastasis-free survival, overall survival, confirmed osteonecrosis of the jaw, and fragility fracture rates.</p><p><strong>Results: </strong>A total of 211 patients were randomly assigned to receive either a single infusion (n=107) or an infusion every 6 months (n=104). After 5 years of follow-up, there were no clearly apparent differences between the groups for recurrence-free survival (88.7% vs. 84.1%; hazard ratio, 0.71; 95% confidence interval [CI], 0.34-1.51), bone metastasis-free survival (90.6% vs. 86.0%; hazard ratio, 0.68; 95% CI, 0.30-1.52), or overall survival (91.6% vs. 88.0%; hazard ratio, 0.79; 95% CI, 0.34-1.82) in the single-infusion group versus the group receiving infusions every 6 months, respectively. After 5 years of follow-up, there were no significant differences in the incidence of osteonecrosis of the jaw (0% vs. 0%) or fragility fractures (5% vs. 2%) in the single-infusion group versus the 6-monthly infusion group, respectively.</p><p><strong>Conclusions: </strong>At 3 years of follow-up, a single infusion of zoledronate had previously been shown to be associated with increased patient convenience, less toxicity, and lower rates of treatment discontinuation compared with treatment every 6 months. In the current analysis, extended to 5 years of follow-up, there was no clear evidence of a difference in survival outcomes between the treatment approaches. (Funded by the CURE Foundation, REthinking Clinical Trials Program at the Ottawa Hospital Research Institute, and the Ottawa Hospital Foundation and its generous donors. Participating sites also received accrual support from the Canadian Cancer Clinical Trials Network [3CTN].).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDoa2500202"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038521","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":"Intramuscular Immunoglobulin for Measles Postexposure Prophylaxis.","authors":"Angela Weil, Anna Jones, Kelly Mansfield, Andrew T Pavia, Angie White, Leisha D Nolen","doi":"10.1056/EVIDpha2600093","DOIUrl":"10.1056/EVIDpha2600093","url":null,"abstract":"<p><p>AbstractIntramuscular immunoglobulin (IMIG) administered at a dose of 0.5 ml/kg is an option for prophylaxis in infants after exposure to measles. The weight-based dosing volumes require multiple or large-volume injections; however, no clear administration guidelines exist. In 2025, the Utah Department of Health and Human Services (DHHS) assisted with coordination of IMIG administration after an exposure event at a pediatric clinic. Utah DHHS worked with the local health department and health care facility to develop a plan for administration that has been used in subsequent exposure events in Utah.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600093"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13496007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935913","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":"Clonal Hematopoiesis after Immune Suppression - Adaptive Remodeling without Evolution? Early Lessons from the RACE Trial.","authors":"Simona Pagliuca, Carmelo Gurnari","doi":"10.1056/EVIDe2500310","DOIUrl":"https://doi.org/10.1056/EVIDe2500310","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 5","pages":"EVIDe2500310"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791499","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":"Clonal Hematopoiesis Diversity in Aplastic Anemia - When Does It Matter Clinically?","authors":"Rodrigo T Calado, Mayko J S Vasconcelos","doi":"10.1056/EVIDe2500304","DOIUrl":"https://doi.org/10.1056/EVIDe2500304","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 5","pages":"EVIDe2500304"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791508","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":"Exertional Heat Illness in Active Populations.","authors":"Caroline E Murphy, David W DeGroot, Francis G O'Connor","doi":"10.1056/EVIDra2500270","DOIUrl":"10.1056/EVIDra2500270","url":null,"abstract":"<p><p>AbstractExertional heat illness (EHI) is a leading yet preventable cause of morbidity and mortality in active populations. EHI develops when the body's integrated thermoregulatory responses, including cardiovascular adjustments and evaporative cooling, are unable to dissipate the combined burden of metabolic heat production, environmental heat stress, clothing or protective equipment, and other contributing factors. This review examines the physiological mechanisms that underlie EHI and the effects of heat stress on the exercising heart. We also summarize best practices for the prevention, recognition, and management of exertional heat illness.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 5","pages":"EVIDra2500270"},"PeriodicalIF":11.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791479","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":"A 65-Year-Old Woman with Fatigue and Leg Pain.","authors":"Niloufar Ebrahimi, Amir Abdipour, Pravir Baxi","doi":"10.1056/EVIDmr2500335","DOIUrl":"10.1056/EVIDmr2500335","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the story of a 65-year-old woman who presented to the emergency department with fatigue and progressively worsening leg pain. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 5","pages":"EVIDmr2500335"},"PeriodicalIF":11.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147791487","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":"Emergence of Medetomidine in New York's Illicit Drug Supply.","authors":"John S Angles, Lucila M Zamboni, Jeffery Sauer, Matthew Fallico, Leonardo Dominguez-Gomez, Anne Delvecchio, Hannah Helmy, Sophia Reinicke, Izza Zaidi, Brittany Okon, Ellenie Tuazon, Gail Cooper, Rebecca Linn-Walton, David R Holtgrave","doi":"10.1056/EVIDpha2600045","DOIUrl":"10.1056/EVIDpha2600045","url":null,"abstract":"<p><p>AbstractNew York State and New York City health departments have closely monitored the emergence of medetomidine, a sedative that can cause prolonged sedation and a complex withdrawal syndrome, in the illicit drug supply. Drug checking and toxicology data first detected medetomidine in New York in mid-2024, and through 2025 it was identified in 25.1% of opioid samples analyzed. This Public Health Alerts report highlights state and local collaboration to detect emerging substances of concern in the illicit drug supply and to implement data-guided programmatic responses, including enhanced surveillance, public alerts, and medetomidine test strip distribution.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600045"},"PeriodicalIF":11.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147655503","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}