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New England Journal of Medicine

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https://www.readbyqxmd.com/read/28937928/the-graham-cassidy-plan-the-most-harmful-aca-repeal-bill-yet
#1
Loren Adler, Henry J Aaron, Paul B Ginsburg, Matthew Fiedler
Senate Republicans are making one last attempt to pass legislation repealing major provisions of the Affordable Care Act (ACA) before September 30, when their ability to use the "budget reconciliation" procedure to prevent a Democratic filibuster expires. This effort centers on a new proposal..
September 22, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28910237/effects-of-once-weekly-exenatide-on-cardiovascular-outcomes-in-type-2-diabetes
#2
Rury R Holman, M Angelyn Bethel, Robert J Mentz, Vivian P Thompson, Yuliya Lokhnygina, John B Buse, Juliana C Chan, Jasmine Choi, Stephanie M Gustavson, Nayyar Iqbal, Aldo P Maggioni, Steven P Marso, Peter Öhman, Neha J Pagidipati, Neil Poulter, Ambady Ramachandran, Bernard Zinman, Adrian F Hernandez
Background The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. Methods We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke...
September 14, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902574/dreams-deferred-the-public-health-consequences-of-rescinding-daca
#3
Atheendar S Venkataramani, Alexander C Tsai
After months of conflicting statements, President Donald Trump has announced that the Deferred Action for Childhood Arrivals (DACA) program, a landmark immigration program introduced during the Obama administration, will be rescinded as of March 2018. The announcement was made in the face of..
September 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28902570/tragedy-perseverance-and-chance-the-story-of-car-t-therapy
#4
Lisa Rosenbaum
In 2010, 5-year-old Emily Whitehead was diagnosed with acute lymphoblastic leukemia (ALL). Though her parents were told that if you had to have a kid with cancer, ALL was the best one to have, Emily’s course was hardly typical. After two rounds of chemotherapy, necrotizing fasciitis developed in..
September 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28899222/effects-of-sotagliflozin-added-to-insulin-in-patients-with-type-1-diabetes
#5
Satish K Garg, Robert R Henry, Phillip Banks, John B Buse, Melanie J Davies, Gregory R Fulcher, Paolo Pozzilli, Diane Gesty-Palmer, Pablo Lapuerta, Rafael Simó, Thomas Danne, Darren K McGuire, Jake A Kushner, Anne Peters, Paul Strumph
Background In most patients with type 1 diabetes, adequate glycemic control is not achieved with insulin therapy alone. We evaluated the safety and efficacy of sotagliflozin, an oral inhibitor of sodium-glucose cotransporters 1 and 2, in combination with insulin treatment in patients with type 1 diabetes. Methods In this phase 3, double-blind trial, which was conducted at 133 centers worldwide, we randomly assigned 1402 patients with type 1 diabetes who were receiving treatment with any insulin therapy (pump or injections) to receive sotagliflozin (400 mg per day) or placebo for 24 weeks...
September 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28899219/adjunctive-treatments-for-type-1-diabetes
#6
David M Nathan
The proliferation of new drug treatments for type 2 diabetes in the United States in the past 15 years, with more than 17 drugs approved in six new classes of antidiabetic drugs, has been promoted by several factors. First, the recognition of the importance of intensive glycemic control to reduce..
September 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28893134/mepolizumab-for-eosinophilic-chronic-obstructive-pulmonary-disease
#7
Ian D Pavord, Pascal Chanez, Gerard J Criner, Huib A M Kerstjens, Stephanie Korn, Njira Lugogo, Jean-Benoit Martinot, Hironori Sagara, Frank C Albers, Eric S Bradford, Stephanie S Harris, Bhabita Mayer, David B Rubin, Steven W Yancey, Frank C Sciurba
Background Patients with chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype may benefit from treatment with mepolizumab, a monoclonal antibody directed against interleukin-5. Methods We performed two phase 3, randomized, placebo-controlled, double-blind, parallel-group trials comparing mepolizumab (100 mg in METREX, 100 or 300 mg in METREO) with placebo, given as a subcutaneous injection every 4 weeks for 52 weeks in patients with COPD who had a history of moderate or severe exacerbations while taking inhaled glucocorticoid-based triple maintenance therapy...
September 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28893123/eosinophil-biology-in-copd
#8
Christine F McDonald
No abstract text is available yet for this article.
September 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28892459/romosozumab-promising-or-practice-changing
#9
Clifford J Rosen
No abstract text is available yet for this article.
September 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28892457/romosozumab-or-alendronate-for-fracture-prevention-in-women-with-osteoporosis
#10
Kenneth G Saag, Jeffrey Petersen, Maria Luisa Brandi, Andrew C Karaplis, Mattias Lorentzon, Thierry Thomas, Judy Maddox, Michelle Fan, Paul D Meisner, Andreas Grauer
Background Romosozumab is a monoclonal antibody that binds to and inhibits sclerostin, increases bone formation, and decreases bone resorption. Methods We enrolled 4093 postmenopausal women with osteoporosis and a fragility fracture and randomly assigned them in a 1:1 ratio to receive monthly subcutaneous romosozumab (210 mg) or weekly oral alendronate (70 mg) in a blinded fashion for 12 months, followed by open-label alendronate in both groups. The primary end points were the cumulative incidence of new vertebral fracture at 24 months and the cumulative incidence of clinical fracture (nonvertebral and symptomatic vertebral fracture) at the time of the primary analysis (after clinical fractures had been confirmed in ≥330 patients)...
September 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28889792/overall-survival-with-combined-nivolumab-and-ipilimumab-in-advanced-melanoma
#11
Jedd D Wolchok, Vanna Chiarion-Sileni, Rene Gonzalez, Piotr Rutkowski, Jean-Jacques Grob, C Lance Cowey, Christopher D Lao, John Wagstaff, Dirk Schadendorf, Pier F Ferrucci, Michael Smylie, Reinhard Dummer, Andrew Hill, David Hogg, John Haanen, Matteo S Carlino, Oliver Bechter, Michele Maio, Ivan Marquez-Rodas, Massimo Guidoboni, Grant McArthur, Celeste Lebbé, Paolo A Ascierto, Georgina V Long, Jonathan Cebon, Jeffrey Sosman, Michael A Postow, Margaret K Callahan, Dana Walker, Linda Rollin, Rafia Bhore, F Stephen Hodi, James Larkin
Background Nivolumab combined with ipilimumab resulted in longer progression-free survival and a higher objective response rate than ipilimumab alone in a phase 3 trial involving patients with advanced melanoma. We now report 3-year overall survival outcomes in this trial. Methods We randomly assigned, in a 1:1:1 ratio, patients with previously untreated advanced melanoma to receive nivolumab at a dose of 1 mg per kilogram of body weight plus ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses, followed by nivolumab at a dose of 3 mg per kilogram every 2 weeks; nivolumab at a dose of 3 mg per kilogram every 2 weeks plus placebo; or ipilimumab at a dose of 3 mg per kilogram every 3 weeks for four doses plus placebo, until progression, the occurrence of unacceptable toxic effects, or withdrawal of consent...
September 11, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28891423/adjuvant-nivolumab-versus-ipilimumab-in-resected-stage-iii-or-iv-melanoma
#12
Jeffrey Weber, Mario Mandala, Michele Del Vecchio, Helen J Gogas, Ana M Arance, C Lance Cowey, Stéphane Dalle, Michael Schenker, Vanna Chiarion-Sileni, Ivan Marquez-Rodas, Jean-Jacques Grob, Marcus O Butler, Mark R Middleton, Michele Maio, Victoria Atkinson, Paola Queirolo, Rene Gonzalez, Ragini R Kudchadkar, Michael Smylie, Nicolas Meyer, Laurent Mortier, Michael B Atkins, Georgina V Long, Shailender Bhatia, Celeste Lebbé, Piotr Rutkowski, Kenji Yokota, Naoya Yamazaki, Tae M Kim, Veerle de Pril, Javier Sabater, Anila Qureshi, James Larkin, Paolo A Ascierto
Background Nivolumab and ipilimumab are immune checkpoint inhibitors that have been approved for the treatment of advanced melanoma. In the United States, ipilimumab has also been approved as adjuvant therapy for melanoma on the basis of recurrence-free and overall survival rates that were higher than those with placebo in a phase 3 trial. We wanted to determine the efficacy of nivolumab versus ipilimumab for adjuvant therapy in patients with resected advanced melanoma. Methods In this randomized, double-blind, phase 3 trial, we randomly assigned 906 patients (≥15 years of age) who were undergoing complete resection of stage IIIB, IIIC, or IV melanoma to receive an intravenous infusion of either nivolumab at a dose of 3 mg per kilogram of body weight every 2 weeks (453 patients) or ipilimumab at a dose of 10 mg per kilogram every 3 weeks for four doses and then every 12 weeks (453 patients)...
September 10, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28891408/adjuvant-dabrafenib-plus-trametinib-in-stage-iii-braf-mutated-melanoma
#13
Georgina V Long, Axel Hauschild, Mario Santinami, Victoria Atkinson, Mario Mandalà, Vanna Chiarion-Sileni, James Larkin, Marta Nyakas, Caroline Dutriaux, Andrew Haydon, Caroline Robert, Laurent Mortier, Jacob Schachter, Dirk Schadendorf, Thierry Lesimple, Ruth Plummer, Ran Ji, Pingkuan Zhang, Bijoyesh Mookerjee, Jeff Legos, Richard Kefford, Reinhard Dummer, John M Kirkwood
Background Combination therapy with the BRAF inhibitor dabrafenib plus the MEK inhibitor trametinib improved survival in patients with advanced melanoma with BRAF V600 mutations. We sought to determine whether adjuvant dabrafenib plus trametinib would improve outcomes in patients with resected, stage III melanoma with BRAF V600 mutations. Methods In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned 870 patients with completely resected, stage III melanoma with BRAF V600E or V600K mutations to receive oral dabrafenib at a dose of 150 mg twice daily plus trametinib at a dose of 2 mg once daily (combination therapy, 438 patients) or two matched placebo tablets (432 patients) for 12 months...
September 10, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28885881/durvalumab-after-chemoradiotherapy-in-stage-iii-non-small-cell-lung-cancer
#14
Scott J Antonia, Augusto Villegas, Davey Daniel, David Vicente, Shuji Murakami, Rina Hui, Takashi Yokoi, Alberto Chiappori, Ki H Lee, Maike de Wit, Byoung C Cho, Maryam Bourhaba, Xavier Quantin, Takaaki Tokito, Tarek Mekhail, David Planchard, Young-Chul Kim, Christos S Karapetis, Sandrine Hiret, Gyula Ostoros, Kaoru Kubota, Jhanelle E Gray, Luis Paz-Ares, Javier de Castro Carpeño, Catherine Wadsworth, Giovanni Melillo, Haiyi Jiang, Yifan Huang, Phillip A Dennis, Mustafa Özgüroğlu
Background Most patients with locally advanced, unresectable, non-small-cell lung cancer (NSCLC) have disease progression despite definitive chemoradiotherapy (chemotherapy plus concurrent radiation therapy). This phase 3 study compared the anti-programmed death ligand 1 antibody durvalumab as consolidation therapy with placebo in patients with stage III NSCLC who did not have disease progression after two or more cycles of platinum-based chemoradiotherapy. Methods We randomly assigned patients, in a 2:1 ratio, to receive durvalumab (at a dose of 10 mg per kilogram of body weight intravenously) or placebo every 2 weeks for up to 12 months...
September 8, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28874074/game-of-tor-the-target-of-rapamycin-rules-four-kingdoms
#15
Brendan D Manning
No abstract text is available yet for this article.
September 5, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28847206/effects-of-anacetrapib-in-patients-with-atherosclerotic-vascular-disease
#16
(no author information available yet)
Background Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. Methods We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1...
August 28, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28844200/oxygen-therapy-in-suspected-acute-myocardial-infarction
#17
Robin Hofmann, Stefan K James, Tomas Jernberg, Bertil Lindahl, David Erlinge, Nils Witt, Gabriel Arefalk, Mats Frick, Joakim Alfredsson, Lennart Nilsson, Annica Ravn-Fischer, Elmir Omerovic, Thomas Kellerth, David Sparv, Ulf Ekelund, Rickard Linder, Mattias Ekström, Jörg Lauermann, Urban Haaga, John Pernow, Ollie Östlund, Johan Herlitz, Leif Svensson
Background The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. Methods In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air...
August 28, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28844195/is-oxygen-therapy-beneficial-in-acute-myocardial-infarction-simple-question-complicated-mechanism-simple-answer
#18
Joseph Loscalzo
No abstract text is available yet for this article.
August 28, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28844193/dual-antithrombotic-therapy-with-dabigatran-after-pci-in-atrial-fibrillation
#19
Christopher P Cannon, Deepak L Bhatt, Jonas Oldgren, Gregory Y H Lip, Stephen G Ellis, Takeshi Kimura, Michael Maeng, Bela Merkely, Uwe Zeymer, Savion Gropper, Matias Nordaby, Eva Kleine, Ruth Harper, Jenny Manassie, James L Januzzi, Jurrien M Ten Berg, P Gabriel Steg, Stefan H Hohnloser
Background Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. Methods In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups)...
August 27, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28844192/rivaroxaban-with-or-without-aspirin-in-stable-cardiovascular-disease
#20
John W Eikelboom, Stuart J Connolly, Jackie Bosch, Gilles R Dagenais, Robert G Hart, Olga Shestakovska, Rafael Diaz, Marco Alings, Eva M Lonn, Sonia S Anand, Petr Widimsky, Masatsugu Hori, Alvaro Avezum, Leopoldo S Piegas, Kelley R H Branch, Jeffrey Probstfield, Deepak L Bhatt, Jun Zhu, Yan Liang, Aldo P Maggioni, Patricio Lopez-Jaramillo, Martin O'Donnell, Ajay Kakkar, Keith A A Fox, Alexander N Parkhomenko, Georg Ertl, Stefan Störk, Matyas Keltai, Lars Ryden, Nana Pogosova, Antonio L Dans, Fernando Lanas, Patrick J Commerford, Christian Torp-Pedersen, Tomek J Guzik, Peter B Verhamme, Dragos Vinereanu, Jae-Hyung Kim, Andrew M Tonkin, Basil S Lewis, Camilo Felix, Khalid Yusoff, P Gabriel Steg, Kaj P Metsarinne, Nancy Cook Bruns, Frank Misselwitz, Edmond Chen, Darryl Leong, Salim Yusuf
Background We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. Methods In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction...
August 27, 2017: New England Journal of Medicine
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