OBJECTIVES:This study aimed to investigate the efficacy and safety of filgotinib, a JAK1 preferential inhibitor, in patients with axial spondyloarthritis (axSpA). METHODS:The phase 3 OLINGUITO trial comprises 2 international, randomised, double-blind, placebo (PBO)-controlled studies. Patients with an established diagnosis of radiographic (r) or nonradiographic (nr) axSpA and an inadequate response/intolerance to ≥2 nonsteroidal anti-inflammatory drugs were randomised 1:1 to filgotinib 200 mg or PBO once daily through week (W) 16 (double-blind period; stratified by high-sensitivity C-reactive protein [hs-CRP] level and prior biologic disease-modifying antirheumatic drug [bDMARD] use). After W16, patients received open-label filgotinib 200 mg through W52; patients ≥65 years and/or with prespecified risk factors received response-based dosing (100 or 200 mg). The primary (Assessment of SpondyloArthritis international Society ≥40% response [ASAS40 response]) and secondary efficacy endpoints were assessed at W16. Efficacy and safety were assessed through W52. RESULTS:At W16, the primary endpoint was met in both studies (ASAS40 response rates: r = axSpA [n = 258], 39.5% filgotinib vs 20.9% PBO [P = .001]; nr-axSpA [n = 237], 34.5% vs 17.8% [P = .003], respectively). ASAS40 improvements, irrespective of hs-CRP level/prior bDMARD use, were observed as early as W1. For secondary endpoints, significant improvements were seen in Axial Spondyloarthritis Disease Activity Score and Spondyloarthritis Research Consortium of Canada magnetic resonance imaging sacroiliac joint inflammation in both studies, and in Bath Ankylosing Spondylitis Functional Index and Ankylosing Spondylitis Quality of Life Questionnaire in patients with r-axSpA. Improvements with filgotinib were maintained/increased further through W52. Overall, 2 cases of myocardial infarction (PBO: n = 1; PBO-filgotinib: n = 1), 3 of herpes zoster (PBO-filgotinib), and 4 of malignancies (excluding nonmelanoma skin cancer; filgotinib: n = 3; PBO-filgotinib: n = 1) occurred. CONCLUSIONS:Across the whole spectrum of axSpA, filgotinib provided rapid and significant patient-relevant improvements in axSpA signs and symptoms and was well tolerated.
The 16th Acromegaly Consensus Conference in September 2024 updated recommendations on diagnosis and treatment of acromegaly comorbidities. Since the 2020 acromegaly comorbidity management guideline was published, new evidence has emerged on novel and known comorbidities and new treatment approaches. Forty-three experts in the management of acromegaly reviewed the current literature and assessed changes in clinical practice standards and management. Current outcome goals were considered and updated, with a focus on the impact of current and emerging treatments of these comorbidities. Participants assessed factors that determine pharmacological choices, as well as use of specific agents in the management of the most relevant acromegaly comorbidities. We present consensus recommendations highlighting optimization of evidence-based acromegaly comorbidities management.
Despite advances in colorectal cancer (CRC) treatment, outcomes in advanced disease remain poor. Current therapies mainly target the epithelial compartment of the tumor, yet increasing evidence highlights the tumor microenvironment (TME), particularly the tumor stroma, as a prognostic and potentially predictive factor. This narrative review summarizes current evidence on stromal features as biomarkers and therapeutic targets in CRC. These stromal markers, such as fibroblast-associated protein (FAP), are associated with adverse outcomes, underscoring their clinical relevance. However, therapies directly targeting these stromal components have largely failed to improve survival as single agents. Combination strategies, stromal modulation integrated with established treatments, appear more promising. However, to date, stromal targeting remains challenging and has not led to standard-of-care treatment options. This highlights the need for more effective agents, the rational design of combination strategies, and improved patient selection. Combining stroma modulators with standard therapy, guided by stromal biomarkers, may enhance efficacy and help overcome the TME-induced resistance.
Aim: To trace the historical evolution of hospital nursing centrism in China (1835-present) and examine how institutional path dependence has shaped the subordinate status of nursing within a doctor-dominated healthcare system. Background/introduction: Despite major expansions in nursing education and policy advocacy, China's nursing profession remains structurally marginalized. Understanding the roots of this subordination requires a historical and institutional lens. Methods: Drawing on path dependence theory, this study analyzes five critical phases in the development of nursing in China from 1835 to the present. A four-dimensional analytical framework that encompasses professional, organizational, fiscal, and governance institutions was applied to archival records, policy documents, academic studies, and interview data. Results or findings: Findings reveal that nursing has been persistently embedded in a "doctor-led, nurse-subordinate" governance structure. Although educational and legislative reforms expanded nursing's professional scope, entrenched institutional arrangements across the four dimensions have locked nursing into a structurally dependent position. Discussion: The historical institutionalization of nursing as an auxiliary role has limited its professional identity, participation in governance, and access to resources. The analysis highlights the limitations of reforms focused solely on education and policy without restructuring governance mechanisms. Conclusion: The professional development of nursing in China has been constrained by enduring path-dependent forces. To achieve true professionalization, reforms must address deep-seated institutional logics. Implications for nursing and nursing policy: Professional empowerment requires the redesign of nursing roles, decision-making power, and career pathways within hospital governance. Policy reforms should dismantle hierarchical governance structures and institutionalize nurses' participation in leadership, ensuring equitable distribution of authority and resources.
Lynch syndrome is an autosomal dominant cancer predisposition syndrome and the most common cause of hereditary colorectal cancer. In addition to colorectal cancer, it confers substantially increased risks for several extracolonic malignancies. While there is broad consensus regarding the effectiveness of endoscopic colorectal surveillance, recommendations for surveillance of gastric, small bowel, and pancreatic cancers vary considerably among guidelines issued by leading professional societies. These discrepancies largely reflect the limited availability of robust, high-quality evidence. In this narrative review, we summarize the cancer risks for gastric, small bowel, and pancreatic malignancies in Lynch syndrome carriers, discuss recent studies evaluating the outcomes of surveillance strategies, and provide an overview of current guideline recommendations. Furthermore, we highlight emerging approaches that may enhance surveillance strategies in the future. In recent years, increasing research efforts have focused on surveillance for less frequent Lynch syndrome-associated malignancies, however, prospective data from large, well-characterized cohorts remain scarce. Such data are essential to harmonize existing guidelines and to enable the development of personalized surveillance strategies for individuals affected by Lynch syndrome.
