YEAR IN REVIEW: KEY CLINICAL UPDATES IN CMDT 2025

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Topic Page Number Key New Advances Aecting Clinical Practice*

Entries presented in the Year in Review are curated by the editors as being extremely impactful to daily clinical practice.

YEAR IN REVIEW: KEY CLINICAL UPDATES IN CMDT 2025

These highlighted entries are only a fraction of all the updates included across this edition of CMDT.

Topic Page Number

Key New Advances Aecting Clinical Practice

CHAPTER 1: DISEASE PREVENTION & HEALTH PROMOTION

• TheUSPSTFrecommendsofferingannuallungcancerscreeningwithlow-dose CTtocurrentsmokersaged50to80yearsandatleasta20-pack-yearsmoking

Cancer Prevention

historyandtosmokerswhoquitwithinthepast15years.UpdatedAmerican CancerSocietyrecommendationsremovetherestrictiononthenumberofyears sincequitting.

Wolf AMD. CA Cancer J Clin. [PMID: 37909877]

CHAPTER 3: PREOPERATIVE EVALUATION & PERIOPERATIVE MANAGEMENT

• TheAABB(formerlyAmericanAssociationofBloodBanks)statesthatatransition

Perioperative Hematologic Evaluation

thresholdof7.5g/dL(75g/L)couldbeconsideredforhospitalizedpatients undergoingcardiacsurgery,and8g/dL(80g/L)couldbeconsideredfor hospitalizedpatientsundergoingorthopedicsurgeryorwhohaveunderlying CVD.

Carson JL et al. JAMA. [PMID: 37824153]

CHAPTER 4: GERIATRIC DISORDERS

• PatientslivingwithAlzheimerdiseasewhoarechosenfortreatmentwith monoclonalantibodies(aducanumaborlecanemab)requireregularmonitoring

Dementia

foramyloid-relatedimagingabnormalities(ARIA)usingMRI.

Cummings J et al. J Prev Alzheimers Dis. [PMID: 37357276] Van Dyck CH et al. N Engl J Med. [PMID: 36449413]

CHAPTER 6: DERMATOLOGIC DISORDERS

• TheIL-36receptorantibodyspesolimabisthefirsttherapyapprovedspecifically

Psoriasis

136

forgeneralizedpustularpsoriasis.

Raharia A et al. Clin Med (Long). [PMID: 34001566] Lee H et al. Int J Mol Sci. [PMID: 37686119]

• Fortreatment-resistantpatients,0.9%spinosadsuspension,appliedonceover agreaterthan6-hourtimeperiod,canbeconsidered,thoughefficacyislower

Scabies

128

thanthatforivermectinorpermethrin.

Richards RN. J Cutan Med Surg. [PMID: 32998532] Widaty S et al. J Infect Dev Ctries. [PMID: 35298417]

CHAPTER 9: PULMONARY DISORDERS

• ForstableCOPDmanagement,ifthepatienthassignificantdyspneaandairflow obstruction,the2023GOLDupdaterecommendsearlyinitiationoftreatment

Chronic Obstructive Pulmonary

259

Disease

*See chapter for further details and references. (continued on following page)

withlong-actingmuscarinicantagonists(LAMA)pluslong-actingbeta-2-agonist (LABA),ratherthanLAMAalone.

• TheGOLD2023guidelinesdonotencourageuseofinhaledcorticosteroid(ICS) inearlystagesofCOPDandcallformorejudicioususeofICSinpatientswith moresevereCOPDwithfrequentexacerbations,thosewithbloodeosinophiliaof 300cellspermcLormore,concomitantasthma,orhistoryofhospitalizationsdue toCOPDexacerbations.

Venkatesan P et al. Lancet Respir Med. [PMID: 36462509]

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Topic Page Number Key New Advances Aecting Clinical Practice*

• Twoclassesofpneumococcalvaccinesforadultsareavailableandapproved foruseintheUnitedStates:onecontainingcapsularpolysaccharideantigens

270

Pneumonia

270

to23commonstrainsofStreptococcus pneumoniae(PPSV23)andseveralother polyconjugatevaccines,including13-valent(PCV13),15-valent(PCV15),and 20-valent(PCV20).

Kobayashi M et al. MMWR Recomm Rep. [PMID: 37669242]

• Vaccinationisrecommendedforalladultsaged65andover,andadultsaged 19-64withcertainmedicalcomorbidities(diabetes,chroniclungdisease, chronicliverdisease);increasedriskofmeningitis(CSFleak,cochlearimplant); orimmunocompromisingcondition,includingasplenia.

Kobayashi M et al. MMWR Recomm Rep. [PMID: 37669242]

Pulmonary Tuberculosis

281

• In2023,aregimenwasapprovedusingalongercourseofpretomanid, bedaquiline,andlinezolidformultidrug-resistanttuberculosis(MDR-TB) resistanttofluoroquinolone.

Bateson A et al. N Engl J Med. [PMID: 36053506]

CHAPTER 10: CORONARY ARTERY DISEASE, VALVULAR DISEASE, & OTHER KEY TOPICS IN CARDIOLOGY

Acute MI with ST-Segment

369

• Foratypicalpatient,itisreasonabletouseaDOACandclopidogrelandto discontinueaspirinatthetimeofhospitaldischargeor1–4weeksafterstenting.

Writing Committee Members, Lawton JS et al. J Am Coll Cardiol. [PMID: 34895950]

Elevation

• Treatmentwithbempedoicacid,anATPcitratelyaseinhibitor,resultedin reductioninthecompositeprimaryend-pointofcardiovasculardeath/nonfatal MI/nonfatalstroke/orcoronaryrevascularizationprocedure.

Nissen SE et al. N Engl J Med. [PMID: 36876740]

• TheSELECTRCTshowedastatisticallysignificantdecreaseinthecomposite primaryend-pointofcardiovasculardeath/nonfatalMI/ornonfatalstrokein thegrouptreatedwithsemaglutide.

Lincoff AM et al. N Engl J Med. [PMID: 37952131]

• Colchicine0.5mgdailyresultedina23%reductioninmajoradversecardiac eventsinpatientsafterMIand31%inpatientswithstableCAD.

Nelson K et al. J Am Coll Cardiol. [PMID: 37558377]

• Transcatheteredge-to-edgerepairwassafeandeffectiveatreducingthedegree oftricuspidregurgitationandimprovingqualityoflifeinpatientswithsevere functionaltricuspidregurgitationrandomizedtotreatmentwiththeTriClip deviceversusmedicaltherapy.

Sorajja P et al. N Engl J Med. [PMID: 36876753]

Coronary Heart Disease

Tricuspid Regurgitation

349

350

350–351

344

CHAPTER 11: HEART FAILURE & CARDIOMYOPATHY

• ResynchronizationtherapyisindicatedforpatientswithclassIItoIIIHF,EFof35% orless,sinusrhythm,andleftbundlebranchblockpatternwithQRSdurationof 150msecormore.

Heidenreich PA et al. J Am Coll Cardiol. [PMID: 35379503]

• Bothempagliflozinanddapagliflozinhavebeenshowntodecreasecardiovascular mortalityandHFhospitalizationorworseningofHFinpatientswithHFpEF.

Kosiborod MN et al. N Engl J Med. [PMID: 37622681]

• Tafamidis,theonlyFDA-approvedmedicationavailableforallATTR cardiomyopathy,reducedthecompositeofall-causemortalityandcardiovascular hospitalizationsintrials.

Writing Committee: Kittleson MM et al. J Am Coll Cardiol. [PMID: 36697326]

Heart Failure

Restrictive Cardiomyopathy

*See chapter for further details and references.

397

398

409

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Topic Page Number Key New Advances Aecting Clinical Practice*

CHAPTER 12: DISORDERS OF CARDIAC RHYTHM

• Inpatientswithatrialfibrillationandnoclinicalriskfactors(CHA2DS2-VASc

420

score0),thereisnoindicationforanticoagulantorantithrombotictherapy. Ingeneral,unlessthereisanindicationforantiplatelettherapy(CHD, peripheralvasculardisease),patientswithatrialfibrillationshouldnotbe prescribedaspirinforstrokeprevention.

Atrial Fibrillation

Syncope

422

429

• Inpatientswithatrialfibrillationdurationofgreaterthan48hours(orunknown), aminimumof3weeksofanticoagulationorexclusionofleftatrialthrombus byTEEpre-cardioversionisrequired.Anticoagulationshouldbecontinuedfor atleast4weeksfollowingcardioversiontopreventthromboembolism.

• Inpatientswithpriorleftatrialappendageocclusion,TEEisrecommended toexcludedevice-relatedthrombusorperi-deviceleakwhichmayprompt anticoagulantinitiation.

Joglar J et al. Circulation. [PMID: 38033089]

• Cardioneuroablationinpatientswithvasovagalsyncopewithsignificant cardioinhibitoryresponsesignificantlydecreasedrecurrentsyncope comparedtomedicaltherapyinasmallRCT.

Piotrowski R et al. JACC Clin Electrophysiol. [PMID: 36114133]

CHAPTER 13: SYSTEMIC HYPERTENSION

• “Polypills”combiningmultipledrugsinasinglepillareeffectiveandwell

Drug Therapy: Current Antihypertensive Agents

452

toleratedininitialtreatmentofhypertension.

O’Hagan ET et al. Heart. [PMID: 36810213]

• Cardiovascularandrenaloutcomesintype2diabetesareimprovedwithGLP-1 agonistsdespitemodestreductionsinbloodpressure.

• SGLT-2inhibitorsincreasetheriskofdiabeticketoacidosisintype1diabetes.

Tonelli M et al. Circulation. [PMID: 36409780] Neuen BL et al. Circulation. [PMID: 37952217]

CHAPTER 15: BLOOD DISORDERS

Chronic Lymphocytic Leukemia

519

• CautionshouldbeexercisedwhenaBruton’sTyrosineKinaseinhibitor(BTKi) isusedinconjunctionwithanticoagulants(DOACs)andinthepre-and postoperativesetting.

Chirino A et al. Genes (Basel). [PMID: 38137005]

Cold Agglutinin Disease

Hairy Cell Leukemia

Non-Hodgkin Lymphomas

Primary Myelofibrosis

*See chapter for further details and references. (continued on following page)

504

521

523

512

• ComplementblockadeoftheC1sproteinwithsutimlimab(amonoclonal protein)isnowFDA-approvedforcoldagglutininhemolysis.

Röth A et al. Engl J Med. [PMID: 33826820]

• Vemurafenibincombinationwithananti-CD20antibodycanbeusedasinitial therapyforpatientswhoarefrailorhaveactiveinfections.Thenextgeneration BRAFinhibitor,dabrafenib,incombinationwithtrametinib,canbeusedfor patientsrefractorytoinitialnucleosideanalogue–basedtherapy.

Kreitman R et al. Blood. [PMID: 36108341]

• TheCD20:CD3bispecificantibodiesepcoritamabandglofitamabhaveshown clinicalactivityinpatientswhohaveprogressedaftertwolinesoftherapy.

• ThenewerJAK2inhibitorpacritinibisanoptionforpatientswithaplatelet countlessthan50,000/mcL(50×109/L).

• RAS/CBLmutationspredictresistancetoruxolitinibtherapy.

Tefferi A. Am J Hematol. [PMID: 36680511]

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Sickle Cell Anemia & Related Syndromes

501

• Twogeneticallyengineeredstemcellproductsusedwithautologous transplantation,lovotibeglogeneautotemcelandexagamglogene autotemcel,areapprovedintheUnitedStatesforpatients12yearsorolder withseverediseaseandofferthepotentialforlong-termdiseasecontrol.

Kanter J et al. N Engl J Med. [PMID: 34898139]

CHAPTER 16: DISORDERS OF HEMOSTASIS, THROMBOSIS, & ANTITHROMBOTIC THERAPY

• TheAmericanSocietyofHematologysuggestsconsiderationofthrombophilia

Antithrombotic Therapy

562–563

testinginpatientswithVTEprovokedbyanon-surgicaltransientriskfactor,in patientswhohadVTEassociatedwithpregnancyorthepost-partumperiod,and inpatientswithVTEassociatedwithoralcontraceptives,whennegativeresults mightleadtoconsiderationofstoppingtreatment.

Middeldorp S et al. Blood Adv. [PMID: 37195076]

CHAPTER 17: GASTROINTESTINAL DISORDERS

• TheBavenoVIIinternationalconsensusgroupfavorscarvediloloverother nonselectivebeta-blockersduetoitsanti-alpha-adrenergiceffects,which promotevasodilationandagreaterreductioninportalpressures.Itisinitiated

Benign Esophageal Lesions

Gastroesophageal Reflux Disease

605

599

atadoseof6.25mgorallyoncedailyandincreased,astolerated,toamaximum of12.5mgoncedailyprovidedthesystolicbloodpressureremainsgreaterthan 90mmHg.Carvedilolisnotrecommendedforpatientswithdecompensated cirrhosis.

De Franchis R et al. J Hepatol. [PMID: 35120736] Pierre-Emmanuel R et al. Clin Gastroenterol Hepatol. [PMID: 37121529] Tapper EB et al. JAMA. [PMID: 37159031]

• Vonoprazan(20mgorallyoncedaily)maybeconsideredinpatientswitherosive esophagitisorpersistentnocturnalheartburnthatisunresponsivetoPPItherapy.

Laine L et al. Gastroenterology. [PMID: 36228734]

Inflammatory Bowel Disease

Crohn Disease

*See chapter for further details and references.

638

639

645

• FDAhasissuedablackboxwarningfortofacitinibandupadacitinibaboutan increasedriskofthrombosis,includingMI,stroke,arterialthrombosis,DVT,PE, anddeath.

• In2023,anewsubcutaneousformulationofinfliximabbecameavailable.

Buisson A et al. Clin Gastroenterol Hepatol. [PMID: 35987302]

• Vedolizumabisapprovedforadministrationasbothanintravenousand subcutaneousformulation.

Lim SH et al. Inflamm Bowel Dis. [PMID: 37603730]

• Ina2023head-to-headcontrolledtrial,patientswithCrohndiseasewhohad notrespondedtoprioranti-TNFtherapieswererandomizedtoinductionand maintenancetherapywitheitherrisankizumab(360mgsubcutaneouslyevery 8weeks)orustekinumab(90mgsubcutaneouslyevery8weeks).After48weeks, clinicalremission(61%versus40%)andendoscopicremission(32%versus16%) weresignificantlyhigherwithrisankizumabthanustekinumab,suggesting risankizumabmaybethepreferredanti-ILagent.

• Ina2023networkmeta-analysisofbiologicandsmallmoleculetherapies, risankizumabrankedfirstinefficacyforpatientswithCrohndiseasewhohad orhadnotreceivedpriorbiologictherapies.

Barberio B et al. Gut. [PMID: 35907636]

• Forpatientswhohavenotrespondedorlostresponsetoanti-TNFagents, vedolizumabappearstobelesseffectivethananti-ILagents(risankizumab orustekinumab).

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• In2023,theoralJAKinhibitorupadacitinibwasapprovedforinductionand maintenancetherapyforCrohndisease.

• Networkmeta-analysessuggestupadacitinibmaybeequivalenttobiologicagents

Crohn Disease (cont.)

645

inthetreatmentofCrohndiseaseandofferstheconvenienceoforaltherapy. However,inlightoftheuncertainrisksofJAKinhibitorsforseriouscomplications (includingthrombosis,cardiovascularevents,andmalignancy),upadacitinib shouldbereservedforpatientswhohavefailedbiologictherapies.

Barberio B et al. Gut. [PMID: 35907636] Loftus EV et al. N Engl J Med. [PMID: 37224198]

651

640

Ulcerative Colitis

651

• Subcutaneousformulationsofvedolizumabandinfliximabareavailablefor maintenancetherapybutarenotapprovedforinductiontherapy.

• Despitetheconvenienceandrapidsymptomresponseoforalsmallmolecules, theinjectableILantagonists(mirikizumabandustekinumab)offerasuperior safetyprofile,especiallyinpatientswhoareolderorhaveanincreasedriskof cardiovascularorthrombosisevents.

D’Haens G et al. N Engl J Med. [PMID: 37611136]

• Mirikizumabwasapprovedin2023forthetreatmentofpatientswithmoderate tosevereulcerativecolitis;it,alongwithanotherILantibody,ustekinumab,is availableasintravenousformulationforinductiontherapyandasasubcutaneous formulationformaintenancetherapy.

D’Haens G et al. N Engl J Med. [PMID: 37611136]

• ThesmallmodelJAKinhibitors(upadacitinibandtofacitinib)offerthe convenienceoforaladministrationandrapidsymptomimprovementwithin 3days.Furthermore,networkmeta-analysessuggesttheseagentsarehighly effectiveinachievingdiseaseremissioninpatientswhohavefailedtherapy withbiologicagents.

• ThesmallmoleculeS1Preceptormodulatorandonce-dailyoralagent etrasimodwasapprovedbytheFDAin2023forthetreatmentofmoderateto severeulcerativecolitis.

Sandborn WJ et al. Lancet. [PMID: 36871574]

CHAPTER 18: LIVER, BILIARY TRACT, & PANCREAS DISORDERS

Acute Pancreatitis

Benign Liver Neoplasms

720

708

• Statinusemayreducetheriskofdiabetes.

Thiruvengadam NR et al. Clin Gastroenterol Hepatol. [PMID: 35750248]

• Focalnodularhyperplasiaisnotcausedbycontraceptives.

Demory A et al. Hepatology. [PMID: 35980227]

Metabolic Dysfunction– Associated Liver

690

• In2024,theFDAgrantedacceleratedapprovaltoresmetirom,athyroidhormone receptor-beta-agonist,forpatientswithMASHandfibrosis.

Harrison SA et al. N Engl J Med. [PMID: 38324483]

Disease

CHAPTER 19: BREAST DISORDERS

• Low-dosetamoxifen(5mgdailyfor3years)isaneffectiverisk-reducingstrategy

730–731

inwomenwithproliferativeatypiaorcarcinomainsitu.

Lazzeroni M et al. J Clin Oncol. [PMID: 36917758]

Carcinoma of the Female Breast

731

*See chapter for further details and references. (continued on following page)

• TheUSPSTFrecommendsscreeningmammographyeveryotheryearbeginning atage40years.

(https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/ breast-cancer-screening-adults#bcei-recommendation-title-area)

YRv

Topic Page Number Key New Advances Aecting Clinical Practice*

• Itmaybeappropriatetotreatmultipletumorsorevenrecurrenttumorsinthe samebreastwithbreast-conservingtherapy.

Mota BS et al. Cochrane Database Syst Rev. [PMID: 36972145] Youn S et al. Ann Surg Oncol. [PMID: 37620525]

• Onephase3studyshowedthatomissionoflymphnodesamplingisnoninferior tosentinelnodebiopsyinpatientswithT1tumorsandnegativeaxillary ultrasound,thussupportingfurthersurgicalde-escalationinselectcases.

Gentilini OD et al. JAMA Oncol. [PMID: 37733364]

• Recentstudiessuggestthatevenyoungerwomenwithfavorablelesionsmay avoidpost-lumpectomyradiation.

Civil YA et al. Ann Surg Oncol. [PMID: 36869253] Whelan TJ et al. N Engl J Med. [PMID: 37585627]

• AddinganimmunecheckpointinhibitortochemotherapyimprovesthepCR rateinhigh-gradehormone-receptor–positivecancers.

Cardoso F et al. Presented at ESMO Conference 2023. Abstract LBA21. Loi S et al. Presented at ESMO Conference 2023. Abstract LBA20.

• TheoralAKTinhibitorcapivasertibisFDAapprovedforpatientswithHR-positive metastaticbreastcancerandatumorwithaPIK3CA,AKT1orPTENalteration.

Turner NC et al. N Engl J Med. [PMID: 37256976]

Carcinoma of the Female Breast (cont.)

739

740

741

746

CHAPTER 20: GYNECOLOGIC DISORDERS

Carcinoma of the Endometrium

Pelvic Inflammatory Disease

780

775

• Molecularsubtypingmayinformtreatmentdecisions.

Karpel HC et al. Curr Opin Obstet Gynecol. [PMID: 36943683]

• Proceduralinterventionisreservedforcasesoflargetubo-ovarianabscess(TOA) (>8cm),TOArupture,orcaseswithapoorresponsetoantibiotics.Interventional radiologydrainagemaybeconsideredafterTOAantibioticfailureorforlarge (>8cm)TOA.

Frock-Welnak DN et al. Obstet Gynecol Clin North Am. [PMID: 36122985]

CHAPTER 25: UROLOGIC DISORDERS

• A5-yearmulti-centerclinicaltrialofaquablationshowssignificantandsustained

956

Benign Prostatic Hyperplasia

957

improvementsinurinaryflowrate,postvoidresidualvolume,andqualityoflife.

Zorn KC et al. BJUI Compass. [PMID: 35474721]

• Adouble-blind,randomized,sham-controlledstudyoftheOptilumeBPHcatheter systemshowedimprovementinflowrate,post-voidresidual,andpatientsatisfactionscoresthatweresustainedat1year.Treatmentwaslimitedtoprostatesranging insizefrom20mLto80mLandlong-termbenefithasyettobeproven.

Kaplan SA et al. J Urol. [PMID: 37555604]

CHAPTER 26: NERVOUS SYSTEM DISORDERS

• Lecanemab(10mg/kgintravenouslyevery2weeks)modestlyslowedcognitive

Dementia

*See chapter for further details and references.

1004

declineinpatientswithearlyAlzheimerdiseaseandreducedbrainamyloidburden measuredbyamyloidPETcomparedwithplacebo.

Van Dyck CH et al. N Engl J Med. [PMID: 36449413]

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• Patientswithoutatypicalclinicalattackmaybediagnosedwithradiologically isolated syndrome ifabrainMRIincidentallydemonstratesfindingsconsistent

Multiple Sclerosis

Myopathic Disorders

Parkinson Disease

1012

1033

996

withmultiplesclerosis.Teriflunomideanddimethylfumaratewereshownto delaytimetofirstclinicalattackcomparedtoplaceboinsuchpatients.

Lebrun-Frénay C et al. JAMA Neurol. [PMID: 37603328] Okuda DT et al. Ann Neurol. [PMID: 36401339]

• Patientswhoweigh≥40kgandarenotimprovingoninitialenzymereplacement therapy[foracidmaltasedeficiencyorPompedisease]areeligiblefortreatment withthecombinationofcipaglucosidasealfa-atgaandmiglustat, whichdemonstratedsimilarefficacytoalglucosidasealfainarandomizedtrial.

Schoser B et al. J Neurol. [PMID: 38418563]

• Acontinuoussubcutaneousinfusionoffoslevodopa-foscarbidopaalso reduces“off”timeandimprovestheamountof“on”timewithouttroublesome dyskinesias.

Jankovic J et al. J Neurol Neurosurg Psychiatry. [PMID: 32576618]

Polyneuropathies & Mononeuritis Multiplex

Stupor & Coma

1019

1008

• Animplanted10kHzspinalcordstimulatorcombinedwithmedicalmanagement reducedpainbyanaverageof80%inaRCTinpatientswithpainfuldiabetic neuropathy,aresultthatwassustainedfor24monthsandwasalsoassociated withneurologicimprovementinmostpatients.

Petersen E et al. Diabetes Res Clin Prac. [PMID: 37536514]

• Anelectroencephalogram,evenwhencombinedwithbrainstemauditoryand somatosensoryevokedpotentials,doesnotfullyevaluatebrainstemfunction andshouldnotbeusedtomakeaformaldeterminationofbraindeath.

Greer DM et al. Neurology. [PMID: 37821233]

CHAPTER 27: PSYCHIATRIC DISORDERS

Alcohol Use Disorder

Anxiety

1075

1040

• Phenobarbitaland,mostrecently,ketamine,havenotdemonstratedsuperiority tobenzodiazepinesinthetreatmentofalcoholwithdrawal.

Kelson M et al. Cureus. [PMID: 37273364] Malone D et al. Neuropsychopharmacol Rep. [PMID: 37368937]

• Virtualrealitytherapyhassimilarefficacytootherestablishedtherapies.

Schröder D et al. J Behav Ther Exp Psychiatry. [PMID: 37453405]

CHAPTER 28: ENDOCRINE DISORDERS

Hyperthyroidism (Thyrotoxicosis)

Osteoporosis

1111–1112

1133

1135

• Digoxinisasecond-lineagentforventricularratecontrolin thyrotoxicosis-inducedatrialfibrillation.Itisreducedashyperthyroidismis corrected.Serumdigoxinlevelsshouldbekeptbelow1.2ng/mL,sincehigher levelsareassociatedwithincreasedmortality.

• Patientswithsevereosteoporosis(DXAT-scorebelow–2.5withafragility fracture)shouldbeconsideredforanabolictherapywithPTH,PTHrP,or romosozumab.

Händel MN et al. BMJ. [PMID: 37130601]

• In2024,theFDAissuedablackboxwarningabouttheriskofsevere hypocalcemiawithdenosumabinpatientswithadvancedCKD,especiallythose withrelatedmineralbonedisorder.

Bird ST et al. JAMA. [PMID: 38241060]

*See chapter for further details and references. (continued on following page)

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Topic Page Number Key New Advances Aecting Clinical Practice*

• Levothyroxineisnolongerprescribedforeuthyroidpatientswithlow-risk

1119

Thyroid Cancer

1119

differentiatedthyroidcancer(DTC)whohavehadaunilateralthyroidlobectomy.

Gigliotti BJ et al. Endocrine. [PMID: 37824045]

• Forpatientswithlow-riskdifferentiatedthyroidcarcinoma(DTC),radioiodine isnolongerrecommendedeitherforthyroidremnantablationorasadjuvant therapyfollowingtotalornear-totalthyroidectomy.

Ullmann TM et al. J Clin Endocrinol Metab. [PMID: 36327392]

Thyroid Nodules & Multinodular

1115

• Whencytopathologyisindeterminateformalignancy,moleculartestingreduces theneedforsurgerybyabout50%.

Alzahrani AS. J Clin Endocrinol Metab. [PMID: 37200449]

Goiter

CHAPTER 29: DIABETES MELLITUS & HYPOGLYCEMIA

• Insulindeliverysystems(eg,MiniMed7870G,TandemControl-IQ,Omnipod5) shouldbeconsideredforallpatientswithtype1diabeteswhoarenolongerin

1199

Diabetes Mellitus

1199

partialclinicalremission.Patientswithothertypesofdiabeteswhohavelabile glucoselevelsandareonintensiveinsulintherapyarealsocandidates(eg,after totalpancreatectomy).

• V-go(MannKind)isamechanicalpatchpumpdesignedspecificallyforpatients withtype2diabeteswhouseabasal/bolusinsulinregimen.CeQurSimplicity (CeQur)isa3-daymechanicalpatchdevicethatholds200unitsofrapid-acting insulinanddeliverstwounitsperpressofabuttontocovermealsandtolower high-glucoseexcursions.

CHAPTER 30: LIPID DISORDERS

• ThestrikingresultsoftheREPRIEVEcardiovascularoutcomestrial,inwhich

Screening & Treatment in Patients with HIV

1228

baselineLDLwasjust108mg/dL,arguesforroutinestatintherapyfornearlyall patientswithHIVwhohavenocontraindications.Treatmentswithpitavastatin mayhavelessdrug-druginteractionsthancertainotherstatins(ie,simvastatin).

Grinspoon SK et al. N Engl J Med. [PMID: 37486775] Kalra DK et al. J Am Coll Cardiol. [PMID: 37407116]

CHAPTER 31: NUTRITION, NUTRITIONAL DISORDERS, & OBESITY

• Inthe2023SELECTcardiovascularoutcomestrial,semaglutide2.4mgreduced theriskofmajoradversecardiovascularevents(MACE)by20%inadultsaged 45andolderwithpreexistingcardiovasculardiseasewhowereoverweight(BMI

1238

Obesity

1238, 1242

greaterthan27)butwhodidnothavetype2diabetes.ThisisthefirstAOMto demonstratereducedincidenceofMACEinpatientswithoutdiabetes.

Lincoff AM et al. N Engl J Med. [PMID: 37952131] Wilding JPH et al. N Engl J Med. [PMID: 33567185]

• IntheSURMOUNT-1trial,tirzepatide15mgweeklyproduceda20.9%totalbody weightlosscomparedto3.1%withplacebo.Tirzepatideisassociatedwiththe samecontraindications,adverseevents,andboxedwarningsasliraglutideand semaglutidebutistypicallybettertolerated.

Aronne LJ et al. JAMA. [PMID: 38078870] Jastreboff AM et al. N Engl J Med. [PMID: 35658024]

CHAPTER 33: HIV INFECTION & AIDS

Choosing an Antiretroviral Treatment Regimen

*See chapter for further details and references.

1335

• Demonstrationprojectsareexamininglong-actingcabotegravirandrilpivirine

Gandhi M et al. Ann Intern Med. [PMID: 37399555]

asinjectablesinpeoplechallengedbyadherenceorviremi,withhighvirologic suppressionachievedinonedemonstrationprojectinSanFrancisco,with97.5% virologicsuppressionprojected.

YRviii

Topic Page Number Key New Advances Aecting Clinical Practice*

• Studiesdemonstratingtheefficacyofdoxycyclinepost-exposureprophylaxis (DoxyPEP)amongMSMandtransgenderwomenwithandwithoutHIV(single 200mgdoseaftersexupto72hours)haveshowniteffectiveinprevent-

Prevention

1320

ingchlamydiaandsyphilis,andinonestudy,gonorrhea.Thestudyamong HIV-negativecisgenderwomendidnotshowefficacy,althoughadherencewas lowinthisstudy.

Luetkemeyer AF. N Engl J Med. [PMID: 37018493]

CHAPTER 34: VIRAL & RICKETTSIAL DISEASES

• TAK-003hasefficacyagainstallfourdengueserotypesinchildren4-16years

Dengue

Herpes Zoster

1382

1346–1347

oldlivinginendemiccountrieswhoareseropositiveatbaselineandagainst serotypes1and2inchildrenwhoareseronegativeatbaseline.

Patel SS et al. Clin Infect Dis. [PMID: 35639602]

• Availableevidencesuggeststhatvaccinationwiththerecombinantzostervaccine significantlyreducesthedurationofherpeszoster-relatedpain.

Wang Y et al. Eur J Dermatol. [PMID: 37823492]

Human T-Cell Lymphotropic Virus (HTLV)

Kawasaki Disease

Measles

Mumps

Q Fever

Respiratory Syncytial Virus (RSV) & Other Paramyxoviruses

1375

1376

1427

1428

1356

1358

1425

1398

• Combinationtherapywithzidovudineandinterferon-alphamaybehelpful.

Shafiee A et al. Virol J. [PMID 37287047]

• AJapanesetrialshowedthatI-argininemayimprovemotorfunction.

Nozuma S et al. Ann Clin Transl Neurol. [PMID: 36547017]

• InaCochranereviewIVIGwasmosteffectiveincontrollingfeverbutalsoin reducingcoronaryarteryaneurysmincidenceat30days.

Broderick C et al. Cochrane Database Syst Rev. [PMID: 36695415]

• Exercisestressechocardiogramsareespeciallysensitiveinassessingmyocardial dysfunction.

Tedla BA et al. Pediatr Cardiol. [PMID: 36383234]

• Dataonfebrileconvulsionsaftervaccinationshowaslightlyincreasedriskassociated withMMRVoverMMRvaccinationseparatefromvacciniavaccinationbutwiththe statisticalweaknessoftheassociation,expertsrecommendthatthetwobeseparatedonlywhenthereisanindicationsuchasafamilyhistoryofconvulsions.

Casabona G et al. Expert Rev Vaccines. [PMID: 37642012]

• AnewliveattenuatedmumpsvaccineisreportedfromChina,anditappearsto besafeandeffective.

Hu W et al. PLoS One. [PMID: 37733724]

• Forchildrenunderage8years,ciprofloxacin-basedtherapyispreferred, combinedwithrifampinortrimethoprim/sulfamethoxazole.

• Becauseofadversereactionsamongrecipientswithapriorexposureto C burnetii,theQfevervaccineshouldneverbeusedasabooster.

Peng M et al. Microbes Infect. [PMID: 37499790] Redden P et al. Future Microbiol. [PMID: 37850346]

• In2023,majoradvancesincombattingRSVoccurred,withtwoRSVvaccines beingapprovedforindividuals60yearsandolder(Arexvy)andforpregnant womenbetween32-and36-weeks’gestation(Abrysvo)toprotecttheneonate.

• AmonoclonalantibodyforRSV(nirsevimab)wasalsoapprovedforinfantsandyoung childrenforseveredisease.NirsevimabiscurrentlyavailableintheUnitedStates, Europe,andtheUnitedKingdomforpreventionofRSVinneonatesduringtheirfirst seasonatrisk(andextendedintheUnitedStatesthroughtheirsecondat-riskseason). PhysicianshavetheoptionofprovidingAbrysvotothemotherandrelyingonpassivelytransmittedantibodytoprotectinfants,orusingnirsevimabforinfants.

Centers for Disease Control: Update on RSV and new vaccine recommendations. 2023 Sept 23. Keam SJ. Drugs. [PMID: 36577878] Papi A et al. N Engl J Med. [PMID: 36791160] Walsh EE et al. N Engl J Med. [PMID: 37018468]

*See chapter for further details and references. (continued on following page)

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Topic Page Number Key New Advances Aecting Clinical Practice*

Rubella

Scrub Typhus

Seasonal Influenza

Severe Acute Respiratory Syndrome— Coronavirus 2019 (SARS-CoV-2)

1359

1419

1401

1393

1394

• Vaccinationoutsidetherecommendedagerange(greaterthanage7)iseffective.

Pawaskar M et al. Hum Vaccin Immunother. [PMID: 34128759]

• ARCTcomparingdoxycycline,azithromycinandbothforseverescrubtyphus showednodifferencebetweendoxycyclineandazithromycinbutnotedlower incidenceofprimaryoutcome(composite28-daymortality,complicationsatday 7andpersistentfeveratday5)withcombinationtherapy.

Varghese GM et al. N Engl J Med. [PMID: 36856615]

• Thenewrecommendationforthosewitheggallergyisthatonlythosewith urticarialreactionsshouldbeobservedclosely,butallvaccinatedpatientsshould befollowedforpossiblereactionsregardlessofeggallergyhistory.

Grohskopf LA et al. MMWR Recomm Rep. [PMID: 36006864]

• Treatmentwithnirmatrelvir/ritonavirdoesnotreducetheincidenceof long-COVIDinasmallstudy,althoughtheRECOVER-VITALtrialisstudying whetheralongercourseofthemedicationwillreducelong-COVIDsymptoms.

Durstenfeld MS et al. J Med Virol. [PMID: 38175151]

• Nirmatrelvir/ritonavirhadnobenefitintwotrials(EPIC-SRandEPIC-PEP). InonestudyofelderlypatientsfromMassachusettsandNewHampshire,however,themedicationreducedhospitalizationanddeathamong outpatientsbyone-half.

• Alowrateofrecurrentviremiaisreportedafternirmatrelvir/ritonavirisstopped, mostlikelyfromtheimmuneresponse.Delayingthemedicationfor2daysafter symptomonsetwilllikelyreducetheriskofrebound.

Dryden-Peterson S et al. Ann Intern Med. [PMID: 36508742] Edelstein GE et al. medRxiv [Preprint]. Update in Ann Intern Med. [PMID: 37425934]

• InoneVAstudymolnupiravirshowedabenefitformortalityatboth30and 30-180daysbutnotforhospitalization(unlikenirmatrelvir/ritonavirwhichdid showa30-daybenefitforhospitalization).

Bajema KL et al. Ann Intern Med. [PMID: 37276589]

• OnMarch1,2024,theCDCupdatedtheirisolationguidanceagaintorecommend peoplewithCOVIDstayhomewhensickoruntilsymptomshaveresolvedfor 24hours.

1394–1395

Viruses & Gastroenteritis

*See chapter for further details and references.

1395

1396

1411

• Population-levelmaskingprobablymadelittleornodifferencetothe outcomeoflaboratory‐confirmedinfluenzaorSARS‐CoV‐2comparedtonot wearingmasks(RR1.01,95%CI0.72to1.42;6trials,13,919participants; moderate‐certaintyevidence).However,compliancetomaskwearingvaried acrossrandomizedtrialsandanindividual-levelbenefitoffacemaskscould certainlystillbepresent.

Jefferson T et al. Cochrane Database Syst Rev. [PMID: 36715243]

• TheWHOandmostcountriesrecommendongoingboostersforolderand immunosuppressedgroupsgiventheircontinuedvulnerabilitytoseveredisease anddeathifinfected.

• Ingeneral,theneurologicsafetyprofileofCOVID-19vaccinationsishigh.

Guo M et al. Autoimmun Rev. [PMID: 37075917]

• Ameta-analysisof15randomizedcontrolledstudiesshowsnostatistically significantincreaseinintussusceptionwithrotavirusvaccination.

Wang G et al. Front Pediatr. [PMID: 37583623]

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