Name: NEJM This Week — January 8, 2026
Uploaded: 2026-01-11T13:52:28.000Z
Duration: 25 min 11 s
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This week we explore new options in cardiovascular fish oil supplementation in dialysis patients, RSV vaccination, and

cutting edge cellular therapy for leukemia.

We discuss advances in lung cancer treatment, approaches to functional dyspepsia, and

a complex case of severe infection after travel.

Perspectives examine access to and cost of weight loss drugs, the promise and risks of AI in clinical care, and

what it means to care for others while carrying personal loss.

A New Clinical Decisions asks which would you choose?

Transcatheter or surgical aortic valve replacement?

This feature about a woman with asymptomatic severe aortic stenosis offers a case vignette accompanied by two essays, one supporting treatment with transcatheter aortic valve replacement and the other supporting surgical aortic valve replacement.

Visit nejm.org to vote and to see how others chose Evolocumab in patients without a previous myocardial infarction or stroke By Erin Bahula from Brigham and Women's Hospital, Boston and co authors the proprotein convertase subtilisinquexin type 9 PCSK9 inhibitor evolocumab reduces the risk of major adverse cardiovascular events among patients with a previous myocardial infarction, stroke, or symptomatic peripheral artery disease.

This study evaluated the effect of evolocumab on the risk of MACE among patients without a previous myocardial infarction or stroke.

More than 12,000 patients with atherosclerosis or diabetes and without a previous myocardial infarction or stroke who had a low density lipoprotein cholesterol level of at least 90 mg per deciliter were randomly assigned to receive evolocumab or placebo.

PCSK9 inhibition with evolocumab led to a lower risk of first cardiovascular events than placebo among these patients with a 25% lower risk of the primary composite of death from coronary heart disease, myocardial infarction or ischemic stroke and a 19% lower risk of the expanded primary composite endpoint 4 point mace, which included ischemia driven revascularization.

Chadi Ndumele and Roger Blumenthal from the Johns Hopkins Chickarone center for the Prevention of Cardiovascular Disease, Baltimore, write in an editorial that these findings from the trial by Bohula and co authors represent an important step forward in clinical knowledge.

Although PCSK9 inhibitors had been shown to reduce the risk of atherosclerotic cardiovascular disease events among patients with previous myocardial infarction or stroke.

This new trial has found that PCSK9 inhibition conferred clinical benefit in patients without previous myocardial infarction or stroke.

It is also important to recognize what the current trial does not tell us because combining generic high intensity statin therapy and ezetimibe leads to an LDL cholesterol level below 70mg DL in the vast majority of patients with a baseline LDL cholesterol level of less than 160mg per deciliter.

It was the recommended initial strategy in the 2018 Multi Society Clinical Practice Guideline.

However, only 20% of the patients in the current trial were receiving ezetimibe.

Whether similar clinical benefits would be observed in a population of patients receiving more aggressive treatment at baseline with less residual atherosclerotic cardiovascular disease risk is unclear.

Nevertheless, the investigators should be applauded for this landmark trial.

Fish oil supplementation and cardiovascular events in patients receiving hemodialysis By Charmaine Locke from the University of Health Network, Toronto and co authors Cardiovascular disease is the leading cause of death in patients receiving hemodialysis, yet effective preventive therapies remain limited.

Supplementation with N3 polyunsaturated fatty acids, especially eicosapentoenoic acid and docosahexaenoic acid, may have cardiovascular benefits in the general population, but

efficacy among patients receiving hemodialysis is uncertain.

In this trial, conducted at 26 sites in Canada and Australia, 1,228 adult patients receiving maintenance hemodialysis were randomly assigned to daily supplementation with fish oil, 4 grams of N3 polyunsaturated fatty acids, or corn oil.

Placebo the rate of serious cardiovascular events among participants receiving maintenance hemodialysis was lower with daily supplementation with N3 fatty acids than with placebo.

In an editorial, Finnian McCausland from Brigham and Women's Hospital, Boston and David Charatin from the New York University Grossman School of Medicine ask should fish oil now be recommended for our patients receiving hemodialysis?

On the one hand, the reported differences in cardiovascular risk are are impressive, with upper boundaries of 95% confidence intervals well below unity.

So it seems unlikely that these findings are due to chance.

Given the lack of efficacious therapies in this population, clinicians may feel compelled to strongly consider recommending the use of N3 polyunsaturated fatty acids in their patients, even in the absence of a significant difference in all cause mortality.

On the other hand, contemporary medicine is replete with examples in which potentially practice.

Changing outsized results of early trials have failed to be replicated.

This situation suggests that we should pause before accepting the remarkable results reported by Locke and co authors as gospel.

Issues related to generalizability and a lack of mechanistic understanding of the findings warrant caution.

A confirmatory trial is certainly indicated.

RSV prefusion F vaccine for prevention of hospitalization in older adults by Mats Hoiberg Lassen from the Copenhagen University Hospital, Heerleb and Genthofte, Denmark and co authors Respiratory syncytial virus can cause serious illness in older adults.

The bivalent RSV prefusion F protein based vaccine has been shown to prevent RSV associated respiratory illness, but

data from randomized trials with regard to its effect on outcomes involving hospitalization are limited.

In this pragmatic phase 4 trial with individual randomization, 131,276 participants 60 years of age or older or were assigned to receive RSV pre F vaccine or no vaccine during the 2024-25 winter season.

The RSV pre F vaccine as compared with no vaccine, reduced the incidence of hospitalization for RSV related respiratory tract disease as well as the incidence of hospitalization for respiratory tract disease from any cause among adults 60 years of age or older.

Universal Base edited Car 7T cells for T cell acute lymphoblastic leukemia by Robert Chiesa from the Great Ormond Street Hospital for Children NHS Trust, London and co authors.

These authors previously reported results from a first in human study of an investigational therapy consisting of universal base edited anti semic CD7 car T cells that were infused in order to secure deep molecular remissions of refractory T cell acute lymphoblastic leukemia prior to allogeneic stem cell transplantation.

The investigators now report results of the completed phase one study.

Universal base edited anti CD7 car T cells were administered to nine children as well as to two adults who were treated under compassionate use access arrangements.

The investigators found that the investigational therapy induced anti leukemic responses in all the patients with relapsed or refractory CD7T cell all who received treatment.

Nine patients underwent allogeneic hematopoietic stem cell transplantation while in deep remission.

Two patients with quantifiable minimal residual disease in bone marrow received palliative care.

Limitations of this therapy included CD7 antigen loss and risks of viral related complications.

I'm Darin Taichman, a deputy editor at the New England Journal of Medicine.

I've been a full time medical journal editor for over 15 years, but I've never stopped seeing patients.

Just like the other full time physician editors on our team, I continue to practice medicine for a couple of reasons.

I've known many of my patients for over 20 years and I don't want to lose those connections.

I also think seeing patients makes me a better editor.

When we sit around the table and discuss papers, my colleagues and I can understand why the questions asked by the research studies we're considering are important or not to pract clinicians because we see patients ourselves.

I love this work because I always learn a lot and the goal is simple to help our authors clearly, honestly and concisely communicate their findings to our readers so they in turn can use what they read to help their patients.

It certainly helps me take better care of my patients.

We're published by the Massachusetts Medical Society, a not for profit publisher, and

we rely on subscriptions from individual readers, medical schools, and libraries to fund what we do.

Functional Dyspepsia A review article by Pankaj Pashrika from the Mayo Clinic, Scottsdale, Arizona and Nicholas Talley from the University of Newcastle, New South Wales, Australia.

Functional dyspepsia is a common but serious medical syndrome that can induce weight loss and food aversion and may be associated with increased risks of hospitalization and death.

Functional dyspepsia probably comprises several different and yet incompletely characterized disorders.

Patients with local mucosal microinflammation driven by an aberrant TH2 response may represent an important subgroup.

There is overlap with other gastrointestinal syndromes, particularly irritable bowel syndrome and gastroesophageal reflux disease, and

patients with overlap have more severe symptoms.

There is no approved drug for functional dyspepsia.

Treatment is empirical and directed at symptoms and consists of acid suppressants and low dose tricyclic antidepressants and other neuromodulators along with appropriate nutritional and psychological support.

A 50 year old woman with fever and abdominal pain.

A case record of the Massachusetts General Hospital by Stephen Threlkeld and colleagues.

A 50 year old woman was admitted to the hospital because of fatigue, diarrhea, leg pain, headache and chills after returning from a trip to remote northeastern Brazil.

The patient had acquired schistosomiasis as a child in Brazil.

The infection had been complicated by portal hypertension and and hypersplenism.

On current arrival in the emergency department, the patient was hypotensive, febrile and tachypneic with hepatosplenomegaly and petechiae.

Imaging revealed cirrhotic liver changes, esophageal varices, pulmonary infiltrates and a large uterine fibroid.

She rapidly deteriorated into refractory septic shock with disseminated intravascular coagulation and multiorgan dysfunction.

The bacteria on initial gram staining of her blood appear to be gram positive cocci in clusters.

Organism identification performed with matrix assisted laser desorption ionization, time of flight Malditoff mass spectrometry showed findings consistent with Neisseria meningitidis.

Re examination of the initial gram staining and repeat staining identified N. Meningitidis.

The patient was treated with broad spectrum antibiotics, vasopressors, steroids and supportive measures, but refractory shock developed.

Invasive meningococcal disease is associated with a substantial public health burden worldwide.

In the United States, the incidence of invasive meningococcal disease is highest among infants and young children.

However, a growing proportion of cases are occurring in older age groups.

Because clinical manifestations of invasive meningococcal disease vary, a high index of suspicion is required.

Insurance coverage and pricing of weight loss drugs in the United States A perspective by Stacy Ducetzina from Vanderbilt University Medical Center, Nashville and Rachel Sachs from Washington University in St.

Louis on November 6, the Trump administration announced agreements with Eli Lilly and Novo Nordisk regarding pricing and coverage of their glucagon like peptide 1 GLP1 receptor agonists including Tirzepatide and Semaglutide.

The wide ranging agreements include provisions relating to various segments of the market.

Beginning in January 2026, patients purchasing injectable forms of GLP1 agents without insurance cash pay using direct to patient sales platforms are expected to be able to obtain these drugs for an average of $350 per month rather than the current $500 or so per month depending on the drug and dose.

The lower prices are available only for starting doses.

According to a November 6 fact sheet issued by the White House, the companies have agreed to a Medicare price of $245 per month for all injectable GLP1 agents for currently covered indications including diabetes, chronic kidney disease and sleep apnea, and

for newly expanded use for obesity and related coexisting conditions.

Medicare beneficiaries would have their copayments set at $50 per month for all indications.

The announcement also states that Medicaid programs will be able to opt into this price for all GLP1 agents.

In comments to the press, Eli Lilly's chief executive officer, indicated that the lower CO payments and expanded coverage for obesity indications could take effect in 2026.

The new agreements for GLP1 drugs could reduce prices and improve access for some patients, but

will probably also mean that there will be substantial additional spending on these drugs soon.

Generic Liraglutide Overlooked but not Forgotten A perspective by Suhas Gandhi from Massachusetts General Hospital Boston and CO authors Total US spending on GLP1 drugs increased by more than 500% since 2018, exceeding $71 billion in 2023.