The edition · Top Clinical Updates
Hormone therapy is first line for menopausal hot flushes in an American College of Physicians guideline
An evidence-graded ladder for vasomotor symptoms, from oestrogen to SNRIs to neurokinin antagonists. Also: long-acting injectable HIV therapy outperformed daily pills in African adolescents, fluvoxamine for long COVID fatigue, and what robotic hip replacement does and does not buy.
The edition in brief
The American College of Physicians graded pharmacological treatments for menopausal vasomotor symptoms. It strongly recommends oestrogen with a progestogen for women with a uterus, or oestrogen alone without one, as first line (high-certainty evidence); venlafaxine or desvenlafaxine as second line; and escitalopram, paroxetine, gabapentin, fezolinetant or elinzanetant as third line, with shared decisions throughout. In LATA, 476 virologically suppressed adolescents in four African countries were randomised to cabotegravir-rilpivirine injections every 8 weeks or daily oral dolutegravir-lamivudine-tenofovir; confirmed viral rebound by week 96 was 0.9% versus 6.4%, meeting non-inferiority and superiority. In a Brazilian adaptive trial of 399 adults with long COVID fatigue, fluvoxamine 100 mg twice daily lowered Fatigue Severity Scale scores by about 0.4–0.6 points more than placebo; the metformin arm was inconclusive. A UK registry emulation of 666,283 hip replacements found no difference in five-year implant survival between robotic and conventional surgery, with fewer malposition-related revisions in the robotic group.
Injectable cabotegravir-rilpivirine kept more adolescents virally suppressed than daily oral therapy
For virally suppressed adolescents struggling with daily pills, consider long-acting cabotegravir-rilpivirine where it is available and clinic follow-up is reliable.
Fluvoxamine modestly reduced long COVID fatigue over 90 days; metformin was inconclusive
Consider fluvoxamine as an off-label option for persistent long COVID fatigue after checking interactions, with modest expectations.
Robotic hip replacement matched conventional surgery on implant survival, with fewer malposition revisions
Tell patients that robotic hip replacement has not yet shown better overall implant survival, though it may reduce malposition problems.
Choosing the route of menopausal oestrogen matters for clot risk
When hormone therapy is appropriate and clot risk is raised, choose transdermal oestradiol over oral.
American College of Physicians: hormone therapy first, then SNRIs, then the rest, for menopausal hot flushes
Offer hormone therapy first for menopausal hot flushes when there is no contraindication, and move to non-hormonal options in a graded order.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for top clinical updates, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free