The edition · Top Clinical Updates
Atacicept held kidney function steady in IgA nephropathy, and rituximab did not beat azathioprine in EGPA
Final ORIGIN 3 results show eGFR barely moved over a year on atacicept while placebo lost 5.7 mL/min. In EGPA maintenance, rituximab gave no longer remission than azathioprine and roughly doubled severe infections.
The edition in brief
In the phase 3 ORIGIN 3 trial (428 adults with biopsy-proven IgA nephropathy), weekly atacicept kept eGFR stable over 52 weeks (−0.11 vs −5.69 mL/min/1.73 m² on placebo) and cut composite kidney progression from 17.8% to 5.1% (HR 0.24). In a French double-blind trial of 98 patients with eosinophilic granulomatosis with polyangiitis in remission, rituximab maintenance was not superior to azathioprine for time in remission on low-dose prednisone (91 vs 96 weeks), and severe infections were more common with rituximab (47% vs 24%), mostly COVID-19. In the phase 3 RISE UP trial in sickle cell disease, oral mitapivat produced a haemoglobin response in 41% versus 3% on placebo, but did not significantly reduce pain crises. A Dutch stepped-wedge trial of 2,267 people under Barrett's surveillance found acetic acid chromoendoscopy doubled the number of suspicious areas flagged without finding more neoplasia. The pearl: screen for hepatitis B before any anti-CD20 therapy.
Atacicept kept eGFR stable for a year in IgA nephropathy
Atacicept stabilised kidney function and cut progression in IgA nephropathy; refer persistent haematuria with proteinuria early so patients can be considered for such therapies.
Oral mitapivat raised haemoglobin in sickle cell disease but did not significantly reduce pain crises
Mitapivat improves haemolytic anaemia in sickle cell disease, but its effect on pain crises was not significant; hydroxyurea remains the standard.
Acetic acid spray flagged more Barrett's lesions but found no more neoplasia
In routine Barrett's surveillance, adding acetic acid chromoendoscopy flagged more areas without finding more neoplasia.
Check hepatitis B status before any anti-CD20 therapy
Before any anti-CD20 therapy, test hepatitis B surface antigen and core antibody, and arrange prophylaxis advice for anyone positive.
Rituximab was not better than azathioprine for keeping EGPA in remission, and caused more severe infections
For EGPA maintenance, azathioprine held remission as well as rituximab with fewer severe infections; there is no case here for routine switching.
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