Clinical Practice Guidelines on Antiviral Therapies for Adults With COVID-19 Infection
https://jamanetwork.com/journals/jama/fullarticle/2855723
To the Editor The JAMA Clinical Guidelines Synopsis by Dr Leung and colleagues offered a useful risk-stratified overview of antiviral therapy for mild to moderate COVID-19 infection. Two descriptions of drug precautions may nonetheless benefit from clarification because both concern prescribing safety.
https://jamanetwork.com/journals/jama/fullarticle/2855723
To the Editor The JAMA Clinical Guidelines Synopsis by Dr Leung and colleagues offered a useful risk-stratified overview of antiviral therapy for mild to moderate COVID-19 infection. Two descriptions of drug precautions may nonetheless benefit from clarification because both concern prescribing safety.
Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855677
This randomized clinical trial examines whether a video decision aid about treatment options for advanced chronic kidney disease, combined with patient-created video declarations, increases advance care planning documentation among older adults with advanced chronic kidney disease.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855677
This randomized clinical trial examines whether a video decision aid about treatment options for advanced chronic kidney disease, combined with patient-created video declarations, increases advance care planning documentation among older adults with advanced chronic kidney disease.
Trastuzumab Rezetecan in EBBR2-Low Metastatic Breast Cancer
https://jamanetwork.com/journals/jama/fullarticle/2855792
Antibody-drug conjugates (ADCs) combine the tumor-targeting specificity of a monoclonal antibody with a cytotoxic payload, using a chemical linker designed to remain stable in the bloodstream and to release the drug selectively within tumor cells. Third-generation ADCs can exert a bystander effect, whereby the payload diffuses into neighboring tumor cells, killing them independently of target expression. The drug to antibody ratio further modulates potency and tolerability. ADCs have transformed the life expectancy of patients with erythroblastic oncogene B (ERBB2; formerly HER2/neu)–overexpressing breast cancer and are rapidly expanding into new tumor types and molecular subgroups.
https://jamanetwork.com/journals/jama/fullarticle/2855792
Antibody-drug conjugates (ADCs) combine the tumor-targeting specificity of a monoclonal antibody with a cytotoxic payload, using a chemical linker designed to remain stable in the bloodstream and to release the drug selectively within tumor cells. Third-generation ADCs can exert a bystander effect, whereby the payload diffuses into neighboring tumor cells, killing them independently of target expression. The drug to antibody ratio further modulates potency and tolerability. ADCs have transformed the life expectancy of patients with erythroblastic oncogene B (ERBB2; formerly HER2/neu)–overexpressing breast cancer and are rapidly expanding into new tumor types and molecular subgroups.
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Trastuzumab Rezetecan in ERBB2-Low Advanced Breast Cancer
https://jamanetwork.com/journals/jama/fullarticle/2855791
This randomized, multicenter, phase 3 trial compares progression-free survival with trastuzumab rezetecan vs physician’s choice of chemotherapy in patients with ERBB2-low metastatic breast cancer.
https://jamanetwork.com/journals/jama/fullarticle/2855791
This randomized, multicenter, phase 3 trial compares progression-free survival with trastuzumab rezetecan vs physician’s choice of chemotherapy in patients with ERBB2-low metastatic breast cancer.
Trastuzumab Rezetecan in ERBB2-Low Advanced Breast Cancer Research Summary
https://jamanetwork.com/journals/jama/fullarticle/2855790
This trial compared trastuzumab rezetecan vs physician’s choice of chemotherapy in patients with erythroblastic oncogene B (ERBB2)–low metastatic breast cancer.
https://jamanetwork.com/journals/jama/fullarticle/2855790
This trial compared trastuzumab rezetecan vs physician’s choice of chemotherapy in patients with erythroblastic oncogene B (ERBB2)–low metastatic breast cancer.
Subclinical Atherosclerosis in Young Individuals and Mortality Risk
https://jamanetwork.com/journals/jamacardiology/fullarticle/2855732
This cohort study investigates the long-term implications of having elevated coronary artery calcium scores in young adults compared with their peers.
https://jamanetwork.com/journals/jamacardiology/fullarticle/2855732
This cohort study investigates the long-term implications of having elevated coronary artery calcium scores in young adults compared with their peers.
Increased Hemoglobin With SGLT2 Inhibitors
https://jamanetwork.com/journals/jama/fullarticle/2855789
Inhibitors of the sodium-glucose transporter 2 (SGLT2i) were developed to improve metabolic control of diabetes by inducing urinary glucose excretion. When tested for cardiovascular safety, use of SGLT2i surprisingly showed improvements in cardiovascular and kidney outcomes. SGLT2 inhibitors have now become firmly established as guideline-recommended therapy in patients with diabetes and high cardiovascular risk, in patients with heart failure, and in those with chronic kidney disease (CKD).
https://jamanetwork.com/journals/jama/fullarticle/2855789
Inhibitors of the sodium-glucose transporter 2 (SGLT2i) were developed to improve metabolic control of diabetes by inducing urinary glucose excretion. When tested for cardiovascular safety, use of SGLT2i surprisingly showed improvements in cardiovascular and kidney outcomes. SGLT2 inhibitors have now become firmly established as guideline-recommended therapy in patients with diabetes and high cardiovascular risk, in patients with heart failure, and in those with chronic kidney disease (CKD).
SGLT2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron, and Erythropoiesis
https://jamanetwork.com/journals/jama/fullarticle/2855788
This meta-analysis of clinical trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors examines the association of SGLT2 use with increases in levels of hemoglobin and hematocrit.
https://jamanetwork.com/journals/jama/fullarticle/2855788
This meta-analysis of clinical trials of sodium-glucose cotransporter 2 (SGLT2) inhibitors examines the association of SGLT2 use with increases in levels of hemoglobin and hematocrit.
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🔴 Free book: Medical Mnemonics
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The 654-page PDF brings together 38 chapters across seven parts of medicine, with a clickable index, bookmarks and searchable text.
Download it free from Updates in Medicine, and explore more on the website:
https://updatesinmedicine.com/books
Please share it with colleagues who might find it useful.
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Service Use After Introduction of AI-Enabled Prior Authorization in Medicare
https://jamanetwork.com/journals/jama/fullarticle/2855989
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.
https://jamanetwork.com/journals/jama/fullarticle/2855989
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.
Treatment Approach to Major Depressive Disorder
https://jamanetwork.com/journals/jama/fullarticle/2855799
Randomized clinical trials (RCTs) of psychedelic drugs such as psilocybin and lysergic acid diethylamide (LSD) have shown that these drugs have dramatic antidepressant effects in patients with difficult-to-treat depression. An important limitation of these drugs is that the psychedelic effects are also strong and require careful, time-intensive management by an experienced treatment team. Studies are now examining whether new formulations of psychedelics can have strong antidepressant action without the need for such intensive management. Mebufotenin, a 5-hydroxytryptamine 1A (5-HT1A) and 5-HT2A receptor agonist that is naturally found in toad venom, is one example of such a psychedelic drug.
https://jamanetwork.com/journals/jama/fullarticle/2855799
Randomized clinical trials (RCTs) of psychedelic drugs such as psilocybin and lysergic acid diethylamide (LSD) have shown that these drugs have dramatic antidepressant effects in patients with difficult-to-treat depression. An important limitation of these drugs is that the psychedelic effects are also strong and require careful, time-intensive management by an experienced treatment team. Studies are now examining whether new formulations of psychedelics can have strong antidepressant action without the need for such intensive management. Mebufotenin, a 5-hydroxytryptamine 1A (5-HT1A) and 5-HT2A receptor agonist that is naturally found in toad venom, is one example of such a psychedelic drug.
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Orforglipron for Type 2 Diabetes and Pancreatic Risk Assessment
https://jamanetwork.com/journals/jama/fullarticle/2855798
To the Editor The recent ACHIEVE-5 trial reported that the oral, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist orforglipron, when added to titrated insulin glargine, lowered hemoglobin A1c by 1.03 to 1.08 (95% CI, 0.77-1.33) percentage points vs placebo at 40 weeks for both primary dosages (P < .001 for each). We would like to highlight the pancreatic enzyme data presented in eTable 7 in the article’s Supplement 1, which we believe were underrepresented in the discussion.
https://jamanetwork.com/journals/jama/fullarticle/2855798
To the Editor The recent ACHIEVE-5 trial reported that the oral, nonpeptide glucagon-like peptide-1 (GLP-1) receptor agonist orforglipron, when added to titrated insulin glargine, lowered hemoglobin A1c by 1.03 to 1.08 (95% CI, 0.77-1.33) percentage points vs placebo at 40 weeks for both primary dosages (P < .001 for each). We would like to highlight the pancreatic enzyme data presented in eTable 7 in the article’s Supplement 1, which we believe were underrepresented in the discussion.
Preventing Acute Stress in the Operating Room—Is Oxytocin Ready?
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855604
Acute stress symptoms are common after traumatic injury and emergency surgery, are associated with later posttraumatic stress disorder, and have no established pharmacological prevention. In this issue of JAMA Internal Medicine, Huang and colleagues report a single-center, double-blind, randomized clinical trial in which 328 adults undergoing emergency surgery for incidental fracture received a single 40-IU dose of intranasal oxytocin or saline 10 minutes before induction of anesthesia. The primary outcome, a first positive screening result for probable acute stress disorder on the Stanford Acute Stress Reaction Questionnaire (SAS-RQ; score ≥40) within 3 postoperative days, occurred in 15.9% of the oxytocin group and 30.5% of the saline group (risk difference, −14.6 percentage points; 95% CI, −23.5 to −5.5; adjusted hazard ratio, 0.45; 95% CI, 0.27-0.75). Oxytocin was also associated with lower salivary levels of cortisol and malondialdehyde and a smaller decrease in superoxide dismutase levels, whereas anesthetic exposure, analgesic consumption, pain, and cognitive scores did not differ between groups, and no serious adverse events occurred. The authors concluded that preoperative intranasal oxytocin may be a feasible perioperative strategy for preventing acute stress symptoms but acknowledged that the outcome was a screening measure rather than a clinical diagnosis, no preoperative psychological baseline was obtained, follow-up ended at 72 hours, and the biomarker findings were correlates rather than evidence of a mechanism.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855604
Acute stress symptoms are common after traumatic injury and emergency surgery, are associated with later posttraumatic stress disorder, and have no established pharmacological prevention. In this issue of JAMA Internal Medicine, Huang and colleagues report a single-center, double-blind, randomized clinical trial in which 328 adults undergoing emergency surgery for incidental fracture received a single 40-IU dose of intranasal oxytocin or saline 10 minutes before induction of anesthesia. The primary outcome, a first positive screening result for probable acute stress disorder on the Stanford Acute Stress Reaction Questionnaire (SAS-RQ; score ≥40) within 3 postoperative days, occurred in 15.9% of the oxytocin group and 30.5% of the saline group (risk difference, −14.6 percentage points; 95% CI, −23.5 to −5.5; adjusted hazard ratio, 0.45; 95% CI, 0.27-0.75). Oxytocin was also associated with lower salivary levels of cortisol and malondialdehyde and a smaller decrease in superoxide dismutase levels, whereas anesthetic exposure, analgesic consumption, pain, and cognitive scores did not differ between groups, and no serious adverse events occurred. The authors concluded that preoperative intranasal oxytocin may be a feasible perioperative strategy for preventing acute stress symptoms but acknowledged that the outcome was a screening measure rather than a clinical diagnosis, no preoperative psychological baseline was obtained, follow-up ended at 72 hours, and the biomarker findings were correlates rather than evidence of a mechanism.
Medication for Alcohol Use Disorder Awareness and Attitudes
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855603
This survey study evaluates whether US adults are aware of and agree with the use of medication for alcohol use disorder in a national probability-based survey.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855603
This survey study evaluates whether US adults are aware of and agree with the use of medication for alcohol use disorder in a national probability-based survey.
Interpretation of Between-Group Differences in Regard to Minimal Clinically Important Differences
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855602
To the Editor We were interested to read the randomized clinical trial by Bronfort et al that evaluated clinician-supported biopsychosocial self-management (SSM) for preventing chronic low back pain (LBP). The study addresses an important gap in secondary prevention and provides valuable long-term comparative data.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2855602
To the Editor We were interested to read the randomized clinical trial by Bronfort et al that evaluated clinician-supported biopsychosocial self-management (SSM) for preventing chronic low back pain (LBP). The study addresses an important gap in secondary prevention and provides valuable long-term comparative data.
Error in Nonauthor Collaborators
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855741
The Original Investigation titled “Comparative Effectiveness of Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy,” published online February 9, 2026, and the April issue was corrected to fix the surname of a nonauthor collaborator from Damavandi to Tabaee Damavandi. This article was corrected online.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855741
The Original Investigation titled “Comparative Effectiveness of Brivaracetam, Cenobamate, Lacosamide, and Perampanel in Focal Epilepsy,” published online February 9, 2026, and the April issue was corrected to fix the surname of a nonauthor collaborator from Damavandi to Tabaee Damavandi. This article was corrected online.
Errors in Text, Table 1, Figures 1 to 3, and Supplements
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855740
In the Original Investigation titled “Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial,” published online first on May 26, 2026, and in the July 2026 issue, there were errors in the article text, Table 1, Figures 1 and 3, and the caption of Figure 2; the protocol in Supplement 1; and eTables 2, 4, 7, 12, and 14, footnote d of eTable 5, and the captions for eFigures 1 and 2 in the original Supplement 2 (now Supplement 3). The author has provided a letter of explanation. This article was corrected online.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855740
In the Original Investigation titled “Effect of Electroacupuncture on Postherpetic Neuralgia: A Randomized Clinical Trial,” published online first on May 26, 2026, and in the July 2026 issue, there were errors in the article text, Table 1, Figures 1 and 3, and the caption of Figure 2; the protocol in Supplement 1; and eTables 2, 4, 7, 12, and 14, footnote d of eTable 5, and the captions for eFigures 1 and 2 in the original Supplement 2 (now Supplement 3). The author has provided a letter of explanation. This article was corrected online.
Error in Byline
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855739
The Original Investigation titled “Efficacy and Safety of Gefurulimab in Generalized Myasthenia Gravis: The PREVAIL Phase 3 Randomized Clinical Trial,” published online July 27, 2026, and in the September issue, was corrected to add the study group to the byline and a supplement listing the nonauthor collaborators. This article was corrected online.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855739
The Original Investigation titled “Efficacy and Safety of Gefurulimab in Generalized Myasthenia Gravis: The PREVAIL Phase 3 Randomized Clinical Trial,” published online July 27, 2026, and in the September issue, was corrected to add the study group to the byline and a supplement listing the nonauthor collaborators. This article was corrected online.
Toward Coordinated Systems of Care for TIA—The Role and Scope of EDs
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855738
In this issue of JAMA Neurology, Mamer and colleagues present national trends in the emergency department (ED)–based care of transient ischemic attack (TIA) from 2013 to 2021. The authors demonstrate remarkable increases in the rate of advanced imaging in the ED and decreases in the hospitalizations of this population. The marked increase in use of vascular imaging is reassuring to see, as the timely identification of significant atherosclerotic disease—especially carotid stenosis requiring revascularization—is a key step in lowering the risk of early recurrent stroke.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2855738
In this issue of JAMA Neurology, Mamer and colleagues present national trends in the emergency department (ED)–based care of transient ischemic attack (TIA) from 2013 to 2021. The authors demonstrate remarkable increases in the rate of advanced imaging in the ED and decreases in the hospitalizations of this population. The marked increase in use of vascular imaging is reassuring to see, as the timely identification of significant atherosclerotic disease—especially carotid stenosis requiring revascularization—is a key step in lowering the risk of early recurrent stroke.