The edition · Top Clinical Updates
A triple agonist takes a quarter off, and the limits of two prevention strategies
Retatrutide cut body weight by up to 25% in phase 3, oral but not transdermal menopausal hormone therapy tracks higher clotting risk, antidepressant QTc effects differ by drug without an events signal, and surveillance colonoscopy at five years holds up against three.
The edition in brief
Five findings for the cross-specialty desk, written for clinicians outside each field. In TRIUMPH-1, the triple hormone-receptor agonist retatrutide reduced body weight by 17.6% to 25.0% across doses over 80 weeks against 3.9% with placebo in adults with obesity without diabetes, and also eased knee osteoarthritis pain and sleep apnoea; it is investigational. A Danish registry study linked current oral menopausal hormone therapy to higher venous thromboembolism (hazard ratio 1.6), ischaemic stroke and myocardial infarction, while transdermal therapy carried no excess thrombotic risk. An individual-participant-data meta-analysis found antidepressant QTc effects differ by drug, largest for escitalopram and amitriptyline, with no association between antidepressant use and early major cardiovascular events across 52,398 patients. A maternal diet rich in eggs and peanuts during pregnancy and lactation did not reduce infant egg or peanut allergy at one year. A pearl covers preventing drug-induced QT prolongation. The practice-changer, from the EPoS II interim analysis of 10,799 patients, is that a first surveillance colonoscopy five years after high-risk adenoma removal was non-inferior to three years for colorectal cancer incidence, supporting longer intervals pending the ten-year result.
Retatrutide: up to a quarter of body weight lost in phase 3
Be ready to counsel patients on retatrutide's trial results and place it against available incretin therapies, recognising it is not yet approved for use.
Menopausal hormone therapy: the route matters for clot risk
Prefer transdermal oestrogen over oral where thrombotic risk matters; the registry links oral but not transdermal therapy to higher venous and arterial events.
Antidepressants and the QT interval: drug choice, not class, is the lever
Choose a lower-QTc antidepressant such as venlafaxine or vortioxetine when a patient has a prolonged baseline QTc or other risk factors, rather than avoiding the class.
Eating more eggs and peanuts in pregnancy did not prevent infant allergy
Do not advise pregnant or breastfeeding women to eat extra eggs and peanuts to prevent infant allergy; the evidence-based lever is timely early introduction to the infant.
Preventing drug-induced QT prolongation
Before and after starting a QT-prolonging drug in an at-risk patient, correct potassium and magnesium and review co-prescribed QT-prolonging agents.
Colonoscopy surveillance: five years holds up against three
After high-risk adenoma removal, a first surveillance colonoscopy at five years appears as safe as at three; interval lengthening is supported while the ten-year result is awaited.
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