Opening a carotid does not open the mind, and an injection beats a daily pill

The edition in brief

The CREST-2 trials tested whether revascularising a severely narrowed but asymptomatic carotid artery improves thinking. Among 2,165 patients assessed, neither stenting nor endarterectomy added to intensive medical management produced any cognitive advantage over medical management alone at four years — between-group differences in composite z score of 0.03 and 0.02, against a prespecified minimal clinically important difference of 0.50 standard deviations. The LATA trial randomised 476 virologically suppressed adolescents with HIV in Kenya, South Africa, Uganda and Zimbabwe to two-monthly injectable cabotegravir-rilpivirine or daily oral dolutegravir-lamivudine-tenofovir. By week 96, confirmed viral load of 50 copies/mL or higher occurred in 0.9% on injections against 6.4% on tablets — a difference of −5.5% (99% CI −10.3 to −1.5), meeting non-inferiority and then superiority. Serious adverse events were similar. Two phase 3 trials of oveporexton, an oral orexin receptor 2 agonist, in 273 participants with narcolepsy type 1 found mean sleep latency on the Maintenance of Wakefulness Test improved by 14.3 to 19.8 minutes against −0.4 to −0.8 with placebo, with weekly cataplexy falling by 79 to 89%. Adverse events affected 86 to 89% of treated participants, mostly urinary frequency and transient insomnia. In 370 nulliparous women, instilling 10 mL of mepivacaine before intrauterine device placement lowered pain by a mean 14.8 mm on a 100 mm scale. The updated VA/DoD obesity guideline removes the requirement to complete lifestyle intervention before starting drug treatment and advises against stopping a medication that is working.