Azathioprine held its ground against rituximab in EGPA

The edition in brief

The edition closes on a French double-blind trial in 98 people with eosinophilic granulomatosis with polyangiitis (EGPA) in remission: rituximab every six months was not superior to daily azathioprine for time in remission on low-dose prednisone (91 vs 96 weeks), and severe infections were about twice as common with rituximab (47% vs 25%), mostly COVID-19. For most patients, azathioprine remains a sound maintenance choice. The phase 3 RISE UP trial found mitapivat, an oral pyruvate kinase activator, gave a haemoglobin response in 41% of adults with sickle cell disease versus 3% on placebo, but did not significantly reduce pain crises. Two phase 3 trials of retatrutide, an investigational triple hormone agonist, reduced the apnoea-hypopnoea index by 14 to 24 events an hour more than placebo at 80 weeks in adults with obesity and moderate to severe sleep apnoea. A Swedish case-control study of 624,713 births found quadrivalent HPV vaccination before pregnancy was associated with slightly lower odds of preterm birth, which is reassuring on safety more than proof of benefit. The pearl covers screening for sleep apnoea in a routine consultation.