Alternative complement pathway overactivation contributes to IgA nephropathy. In a placebo-controlled trial, iptacopan, a complement factor B inhibitor, significantly slowed kidney-function decline in patients with IgA nephropathy. Full phase 3 APPLAUSE-IgAN trial results: https://nej.md/41rsXdc

Today’s real-world case on Doctordle is from NEJM! A 63-year-old man presents for evaluation of fever and productive cough. Can you guess the diagnosis in five tries or less? Test yourself at http://doctordle.org.

Platelet-activating antibodies against platelet factor 4 cause highly prothrombotic disorders with reduced platelet counts, including heparin-induced thrombocytopenia and vaccine-induced immune thrombocytopenia and thrombosis. Learn more: https://nej.md/4fskK0r

Our latest video in partnership with @glaucomflecken.bsky.social summarizes the OVERLORD-MS trial that compared rituximab versus ocrelizumab in newly diagnosed relapsing multiple sclerosis. Read the full study for free: https://nej.md/DrG46 #neurology

In a new NEJM Voices blog post, Don Dizon, MD, explains how every breakthrough in cancer treatment brings hope for today’s patients while reminding us of those who didn’t live long enough to benefit. Learn more and sign up for email alerts: https://nej.md/4g9zGAJ

The selective Naᵥ1.8 inhibitor LTG-001 led to significantly greater reductions in pain scores than placebo over the course of 48 hours among patients who had moderate or severe pain after abdominoplasty. Full trial results and Research Summary: https://nej.md/4fHl0HJ

The New England Journal of Medicine invites applications from physicians at any career stage for a one-year, full-time, paid editorial fellowship beginning in July 2027. Applications are due by Saturday, August 15, 2026. Learn more: https://nej.md/3cCQajB

APPLAUSE-IgAN: Interim results of a phase 3 trial in patients with IgA nephropathy indicated that therapy with the complement factor B inhibitor iptacopan reduced proteinuria. Final 24-month data with eGFR are now reported in a new Quick Take video. https://nej.md/4pNYamj

Common causes of nasal crusting (seen in table) include nasal vestibulitis, chronic digital manipulation, previous nasal surgery or trauma, side effects of intranasal medications, and intranasal drug use. Learn more: https://nej.md/3TnJBKg

In relapsed multiple myeloma, teclistamab improved 18-month progression-free survival as compared with standard therapy. Grade 3 or 4 infections were common; antimicrobial prophylaxis and immune globulin support were recommended. Full phase 3 MajesTEC-9 trial results: https://nej.md/3PvpJDr

The value-based care approach developed by the Mental Health Cooperative in Tennessee has been associated with improved HEDIS scores, as well as reduced emergency and inpatient care utilization. Learn more in NEJM Catalyst: https://nej.md/4pkMIP6 Explore the August issue: https://nej.md/44nIX1E

A new study supports enzymatic cross-correction of neurons and oligodendrocytes by atidarsagene autotemcel, a gene therapy that prevents or slows neurodegeneration in children with early-onset metachromatic leukodystrophy. Full study results: https://nej.md/4hEk0Xm

Read the latest Voices blog post from @iwashyna.bsky.social: Choosing Humility in the Face of My Ignorance https://nej.md/4yVP1fO

Figure 2 from a new Review Article summarizes the pathogenesis of heparin-induced thrombocytopenia (HIT). Learn more about HIT and other anti–platelet factor 4 disorders in the full review: https://nej.md/4fskK0r

In patients with metastatic prostate cancer with gene alterations, talazoparib–enzalutamide led to better progression-free survival outcomes than placebo–enzalutamide but with more serious adverse events. Full phase 3 TALAPRO-2 trial results and Research Summary: https://nej.md/4nRSB5n

For patients with postoperative pain, nonopioid analgesics have marginal efficacy and side effects that limit their use. Additional nonopioid options are needed. Research findings are summarized in a new Quick Take video. https://nej.md/3TpdycR

A 51-year-old woman with right heart failure presented with worsening abdominal distention and leg swelling. Examination was notable for ascites, leg edema, a grade 4/6 holosystolic murmur, and a pulsatile liver (shown in a video). Read the full case details: https://nej.md/4pOHX0i

Case Record of the Massachusetts General Hospital: A 37-year-old woman was evaluated for a 17-year history of unilateral nasal scabbing and bleeding. Nasal endoscopy showed marked, multifocal crusting and ulceration. A diagnosis was made. Full case details: https://nej.md/3TnJBKg

Whether teclistamab, a bispecific antibody targeting B-cell maturation antigen and CD3, improves outcomes in relapsed or refractory multiple myeloma is unclear. Research findings from the phase 3 MajesTEC-9 trial are summarized in a new Quick Take video. https://nej.md/4wF2ozl

New in NEJM Voices: A patient in shock forced @iwashyna.bsky.social to consider how to respond to the limits of his own knowledge and those of the medical field at large. Read his latest: https://nej.md/4yVP1fO

A 60-year-old man presented with a 1-month history of postprandial epigastric pain. The physical examination was normal, with no jaundice or abdominal tenderness observed. Read the full case details and submit your answer or see how others responded: https://nej.md/IC07302026

I hate candidemia-caused septic shock. So much. Why do we still not know which patients would benefit from early empiric antifungals? I reflect a bit at @nejm.org on living with uncertainty when the patient is dying in front of you: voices.nejm.org/doi/full/10....

Choosing Humility in the Face of My Ignorance

A patient in shock forced me to consider how to respond to the limits of my own knowledge and those of the medical field at large.

voices.nejm.org

Want to gain a deeper understanding of the analyses and considerations that guide decisions about which articles to publish in NEJM? And insight and knowledge that will impact your career going forward? If so, consider applying for the 2027–28 NEJM editorial fellowship. 👉 https://nej.md/3cCQajB

TALAPRO-3: Talazoparib–enzalutamide has been shown to improve survival in patients with metastatic prostate cancer, particularly those with alterations in homologous recombination repair genes. Research findings in this population are summarized in a new Quick Take video. https://nej.md/4fuadBY

Love watching @glaucomflecken.bsky.social explain research published in NEJM? If so, then good news! He and his fellow anchors have a new weekly news podcast called Medlines, designed to help everyone in health care stay in the know. Listen wherever you get your podcasts: medlinespod.com/follow.

Many disorders that cause optic disk edema can produce retinal fluid and even macular exudates in a stellate pattern. The development of pronounced radial macular exudates, known as a macular star, suggests neuroretinitis. Learn more: https://nej.md/4wsAYMQ

A 45-year-old man presented with a 2-month history of worsening pain and swelling in his right shoulder. A radiograph showed destruction of the humeral head with a free-floating humeral diaphysis. Read the full case details: https://nej.md/4wzHz8s

New in NEJM: PARP Inhibition and ADT in Prostate Cancer (TALAPRO-3) Teclistamab in Previously Treated Multiple Myeloma (MajesTEC-9) Naᵥ1.8 Inhibitor for Acute Pain Iptacopan in IgA Nephropathy (APPLAUSE-IgAN) Explore the issue: https://nej.md/current-issue

In a new NEJM Voices blog post, @paulsaxmd.bsky.social shares what cyclosporiasis outbreaks, past and present, can teach us. Learn more and sign up for email alerts: https://nej.md/4x7zAiL

The Butterfly Promise Practicing medicine not only provides clinicians with intellectual fulfillment — but allows them to bear witness to inspiring life stories. voices.nejm.org/doi/full/10.... @nejm.org

The Butterfly Promise

Practicing medicine not only provides clinicians with intellectual fulfillment — but allows them to bear witness to inspiring life stories.

voices.nejm.org