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2 Minute Medicine Rewind July 6, 2026
1. Leflunomide (LEF) plus prednisone was well tolerated but did not significantly increase clinical remission of Takayasu arteritis (TAK) compared to placebo plus prednisone.
Evidence Rating Level: 1 (Excellent)
TAK is a large-vessel vasculitis that can cause severe ischemic events, potentially leading to death. While glucocorticoids are first-line therapy, disease recurrence can occur in up to 60% of patients during glucocorticoid tapering, and prolonged use has numerous side effects. Thus, there is a need for additional pharmacotherapy in TAK. While immunosuppressive therapies are used, there are few randomized clinical trials to help guide management. This multicenter, randomized, double-blind, placebo-controlled trial investigated the efficacy of LEF in active TAK. Patients with active TAK were randomized to receive LEF 10 mg twice daily (n = 54; mean [SD] age, 35.7 [11.5] years; 85.2% female) or placebo (n = 57; mean [SD] age, 33.4 [10.9] years; 92.9% female) for 24 weeks. All patients received prednisone 0.6 mg/kg/day with a taper starting at week 4. Patients in the LEF group who did not achieve clinical remission by week 24 discontinued the study; all other patients (both LEF and placebo groups) received LEF from week 25 to week 52. The primary outcome was clinical remission at week 24. At 24 weeks, 44 of 54 (81.5%) patients in the LEF arm and 45 of 57 (78.9%) patients in the placebo arm achieved remission (risk difference: 2.6, 95%CI [-12.5, 17.2]). Disease recurrence was seen in 7 and 5 patients in the LEF and placebo groups, respectively (HR: 1.36 [0.43, 4.31]). Prednisone dosage was lower in the LEF arm, although this did not reach significance (mean difference: -2.1, [-4.3, 0.1] mg/d). There were no significant differences in the incidence of adverse events.
Effect of Vitamin C on bleeding and pain after kidney biopsy: a randomized controlled trial
1. Incorporating procalcitonin-guided decision-making in the management of neonatal late-onset sepsis significantly reduced the duration of antibiotic treatment without increasing mortality.
Evidence Rating Level: 1 (Excellent)
PRB is an essential procedure for diagnosing many kidney diseases. As an invasive procedure, it carries inherent side effects of bleeding and pain. Although PRB is minimally invasive, severe hematomas can cause significant pain or even require transfusion or angioembolization. Thus, there is a need for pharmacological strategies to reduce the incidence of these side effects. Vitamin C has been shown to promote homeostasis and alleviate pain and was associated with decreased bleeding events in gynecological and endoscopic surgeries. This single-center, prospective, open-label, randomized controlled trial included adults with chronic kidney disease scheduled for percutaneous ultrasound-guided kidney biopsy. 710 patients were randomized to receive either intravenous vitamin C (20 mg/kg, diluted in 100 mL of 0.9% sodium chloride) administered at 6 hours before and 18 hours after the biopsy (n = 355; mean [SD] age, 46.15 [14.67] years; 41.1% female), or standard care (n = 355; mean [SD] age, 49.25 [14.25] years; 40.8% female). The primary outcome was the area of perirenal hematoma on renal ultrasound at 24 hours and self-reported pain intensity (Visual Analogue Scale, VAS). There were no significant differences in perirenal hematoma area (adjusted mean difference: 4.44 mm² (95% CI, -52.31 to 61.18 mm2; P = 0.878) or incidence of perirenal hematoma (56.3% in the vitamin C arm versus 50.1% in the control arm (risk ratio, 1.12; 95% CI, 0.98-1.29; P = 0.098). There were no significant differences in median VAS score at 2 hours, 12 hours, or 24 hours post-biopsy (adjusted P = 0.105, 0.192, and 0.534, respectively). Vitamin C was well-tolerated, and rates of adverse events were low and comparable between groups.
1. In the management of adult patients with metastatic urothelial carcinoma (MUC), enfortumab vedotin plus pembrolizumab (EV/P) was well-tolerated and significantly more effective than gemcitabine plus cisplatin (G/C).
Evidence Rating Level: 2 (Good)
Recent clinical trials have demonstrated that EV/P offers greater overall survival (OS) and progression-free survival (PFS) compared with platinum-based chemotherapy in MUC. However, clinical trial populations often exclude patients with poor performance status or significant comorbidities. Observational studies are necessary to study whether the benefits of EV/P are observed in broader clinical settings. This retrospective cohort study included adults with MUC who initiated first-line systemic therapy with either EV/P or G/C. The primary outcome was OS. Of 4433 total patients, 1841 received EV/P (mean [SD] age, 70.6 [10.1] years) and 2592 received G/C (mean [SD], 67.2 [10.6] years). Patients in the EV/P were significantly older (P < .001), and racial distribution differed (EV/P vs. G/C; Black patients: 129 [6.7%] vs 139 [5.3%]; P = .04; White patients: 1445 [76.0%] vs 1614 [61.8%]; P < .001); Asian patients: 145 [7.6%] vs 326 [12.5%; P < .001). The EV/P group had a higher comorbidity burden, including more heart failure (275 [14.4%] vs 194 [7.4%]), diabetes (558 [29.2%] vs 560 [21.4%]), and overweight/obesity (548 [28.7%] vs 367 [14.0%]) (all P < .001). Patients receiving EV/P as first-line therapy had significantly lower all-cause mortality (HR, 0.70; 95% CI, 0.63-0.79), longer median OS (20 vs 11 months; P < .001), lower risk of early hospital admission (HR, 0.73; 95% CI, 0.64-0.83), and longer time to next treatment (median, 35 vs 10 months; HR, 0.49; 95% CI, 0.39-0.61). However, these patients also had higher incidences of skin rash (HR, 2.77; 95% CI, 2.24-3.42), diarrhea (HR, 1.42; 95% CI, 1.14-1.77), hyperglycemia (HR, 1.62; 95% CI, 1.21-2.16), and hypothyroidism (HR, 1.78; 95% CI, 1.27-2.48). In contrast, fatigue (HR, 0.76; 95% CI, 0.62-0.92), nausea (HR, 0.63; 95% CI, 0.49-0.80), and anemia (HR, 0.87; 95% CI, 0.78-0.99) were more common in the G/C group.
At-Home Transvaginal Pelvic Ultrasonography and Image Quality in Premenopausal Women
1. At-home transvaginal ultrasonography is clinically accurate compared to in-clinic ultrasonography, preferred by patients, and not associated with an increased incidence of side effects.
Evidence Rating Level: 2 (Good)
Transvaginal ultrasonography is a safe and invaluable diagnostic tool. However, its sensitive and invasive nature poses a barrier to care, particularly for specific populations, such as those with a history of trauma, chronic pelvic pain, or belonging to the LGBTQ+ community. At-home diagnostic testing may provide a more comfortable environment for patients and alleviate the burden of travel. This prospective, interventional, single-group trial included premenopausal women aged 22 to 50 years who were not pregnant. All 263 patients (mean [SD] age, 32.4 [6.7] years) were provided with an ultrasound scanner and guided by verbal communication by a remote sonographer who had real-time access to study images. 5 independent physicians (radiologists and gynecologists) were blinded to the location of ultrasonography and assessed these images in addition to images captured in-clinic from a previous study for image quality. 253 at-home ultrasonographic scans (96.2%) met diagnostic quality. Patients with images that did not meet the quality standard had significantly elevated body mass index compared to those with images that did (mean [SD] BMI, 34.4 [4.2] vs. 26.7 [5.4]; P < .001). Net promoter score was significantly higher in the group that completed at-home ultrasonography (adjusted difference: 33.7 (95% CI, 23.3-44.0; P < .001). Minor pain/discomfort was reported by 20 of 181 participants (11%) 3 days post-procedure. There were no other side effects.
Mortality, Health Care Use, and Spending Patterns During South Korea’s Trainee Physicians’ Walkout
1. The recent South Korean trainee physician strike was associated with significantly higher mortality and reductions in inpatient and outpatient use
Evidence Rating Level: 2 (Good)
From February 2024 to August 2025, South Korean trainee physicians initiated a walkout in protest of proposed reforms. Although previous studies from different countries have shown that physician strikes rarely increase short-term mortality but reduce health care use, the South Korean strike was unique in its prolonged duration and scale, with more than 90% of trainee physicians being ultimately involved. This retrospective cohort study explored the association between the strike and hospital-level mortality, health care use, and spending patterns across 200 teaching hospitals. The analysis included 7 719 828 patients with inpatient admissions (3 520 242 [45.6%] aged ≥ 65 years; 3 883 073 [50.3%] female) and 41 891 392 with outpatient visits (17 552 493 [41.9%] aged ≥ 65 years; 21 992 981 [52.5%] female). 3 727 632 inpatient and 20 400 814 outpatient encounters were from the walkout window, and 3 992 196 inpatient and 21 490 578 outpatient encounters were from a control cohort drawn from the same calendar window 1 year earlier. There were no significant differences in patient composition or demographics. The walkout group was associated with a 0.008 percentage-point increase in weekly mortality among hospital users (95% CI, 0.000 to 0.015 pp) and a 0.39 percentage-point increase in 30-day mortality after hospitalization (95% CI, 0.24 to 0.54 pp). These associations were largest early in the strike and reduced over time. There were significantly fewer hospitalizations (decrease of 19.2 hospitalizations per 10 million people; 95% CI, −24.1 to −14.3 per 10 million people [−17.3%]) and outpatient visits (decrease of 158 outpatient visits per 10 million people; 95% CI, −198 to −118 visits [−8.6%]) in the walkout group compared to the control group.
Image: PD
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