Dosing ATG to measured exposure improves transplant outcomes, and golimumab troughs track disease activity

The edition in brief

A randomised phase 3 trial in 204 patients undergoing haploidentical stem cell transplant found that dosing anti-thymocyte globulin to a measured exposure target, rather than a fixed 10 mg/kg, raised one-year GVHD-free, relapse-free survival from 50.0% to 66.7% (HR 0.67, 0.45–0.995), lowered moderate to severe chronic GVHD from 22.5% to 9.8%, and reduced grade 3–5 infections from 70.6% to 44.1%. In 59 patients with ankylosing spondylitis on golimumab, lower trough concentrations were the only predictor of higher disease activity and of antidrug antibodies, found in 13.6%. A US claims analysis found 43 of the 100 drugs most prescribed in sickle cell disease carried interaction risk, mostly through CYP3A4 inhibition, with oxycodone and fentanyl among the most prescribed substrates. A 15-patient pilot found sublingual levothyroxine gave numerically higher exposure than oral, without statistical significance. The FDA recorded a supplement to the tirzepatide (Zepbound) application on 20 October; the record does not say what changed. The pearl covers CYP3A4 inhibitors and opioids.