Otolaryngology (ENT)

AD109 (aroxybutynin+atomoxetine) modestly lowers AHI and improves oxygenation versus placebo in PAP-intolerant OSA

In a 26-week randomized trial of 646 PAP-intolerant adults with mild-to-severe OSA, AD109 reduced AHI versus placebo by a mean of -4.0 events/hour (95% CI -6.4 to -1.6; P = .001). Model estimates showed a 44.1% versus 17.6% decrease from baseline in AHI favoring AD109 (P < .0001). AD109 also improved ODI and hypoxic burden but did not significantly improve PROMIS-Fatigue scores. Adverse-event–related discontinuation was substantially higher with AD109 (21.2% vs 3.1%), with common effects including dry mouth, nausea, insomnia, and urinary hesitation. 1

Trials labeled 'personalized/precision' are heterogeneous, often non-genomic, and frequently at high risk of bias

This survey of 262 RCTs (2020–2022) found most trials used 'personalized' labels for behavioral, digital, or medication interventions rather than genomic approaches. Of 221 comparative trials, 156 (70.6%) reported favorable conclusions for personalized interventions, but transparency was poor. Most trials had high overall risk of bias (162/262, 68.6%) and data sharing was rare (13 trials, 5.0%). The term 'personalized' was applied inconsistently, limiting direct clinical applicability without scrutiny of methods. 2

Rapid respiratory multiplex POCT did not change same-day antibiotic prescribing in primary care

In 552 primary-care patients with acute respiratory infections randomized to RM-POCT versus usual care, same-day antibiotic prescriptions occurred in 124 patients in each group (45%; OR 1.00, 95% CI 0.71–1.41). RM-POCT identified 19 viruses and 4 atypical bacteria in ~45 minutes and did not worsen patient-reported symptom severity. Prespecified subgroups showed reduced antibiotic prescribing when a virus was detected (OR 0.35, 95% CI 0.20–0.63). No prescribing reduction was seen in children <16 years, so clinical impact may be setting- and subgroup-dependent. 3