An oral drug cuts transfusions in thalassaemia, and physiology beats the eye in STEMI

The edition in brief

A phase 3 trial of mitapivat, an oral pyruvate kinase activator, reduced transfusion burden in adults with transfusion-dependent alpha or beta thalassaemia: 30% of patients met the transfusion reduction endpoint against 13% on placebo, an 18 percentage point difference. It is the first oral disease-modifying option in a condition that in India is managed almost entirely by transfusion and chelation. A German randomised trial found liposuction far better than conservative decongestive therapy for leg pain in lipoedema — 68% versus 8% achieving a two-point pain reduction at 12 months — at the cost of serious adverse events in 8% of those operated on. In Uganda, one-fifth and one-half doses of 17DD yellow fever vaccine were non-inferior to a full dose for seroconversion in 1,784 children aged 9 to 23 months, supporting dose-sparing during outbreak supply shortages. An Italian investigation traced 82 cases of severe acquired methaemoglobinaemia in migrants arriving by sea to dermal absorption of N-methylaniline, a petrol additive, from fuel-contaminated water in the vessels; median methaemoglobin was 44.6% and two patients died. A pearl covers the inter-arm blood pressure difference. The edition closes with AIR-STEMI, which randomised 1,823 patients with ST-elevation myocardial infarction and multivessel disease to complete revascularisation guided by coronary physiology or by angiographic appearance: the physiology-guided strategy reduced the composite of death, infarction, stroke and ischaemia-driven revascularisation from 13.7% to 8.9%, with fewer contrast-associated kidney injury and bleeding events as well.