NEJM This Week NEJM This Week — May 15, 2025
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May 14, 2025 Dive into breakthrough treatments for multiple sclerosis and narcolepsy type 1. Explore the evolving landscape of pediatric HIV therapies. Reflect on the power of physicians in challenging times and the crucial role community health centers play. Discover the impact of AI on clinical documentation in healthcare. Uncover innovative approaches to treating acute lymphoblastic leukemia, and hear a compelling case report of a unique medical situation. This engaging discussion offers insights into contemporary medical challenges and advancements.
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Tolibrutinib Targets MS Progression
- Tolibrutinib, a brain-penetrant BTK inhibitor, may slow disability progression in secondary progressive multiple sclerosis without affecting acute relapse activity.
- It likely targets chronic CNS inflammation, representing a novel mechanism for treating MS progression.
Oviporexin Treats Narcolepsy
- Oviporexin, an oral orexin receptor 2 agonist, improves wakefulness, sleepiness, and cataplexy in narcolepsy type 1.
- Developing small-molecule orexin agonists overcomes the challenge of the blood-brain barrier to orexin peptides.
Effective Second-Line ART for Children
- Second-line ART regimens including tenofovir alafenamide/emtricitabine and dolutegravir are effective and safe for African children with HIV after first-line failure.
- Ritonavir-boosted darunavir also shows efficacy in this population, expanding treatment options.