Tag: Medication

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Biomarkers Could Help in Antidepressant Choice

Antidepression treatment based on a person’s individual biomarkers could help determine which of the world’s most popular medications to use, a clinical trial suggests.

The SMART Trial to Predict Anhedonia Response to Antidepressant Treatment results suggest that behavioral, brain, and clinical data could together determine the optimal antidepressant to choose before a person starts treatment.

There were no significant primary endpoint differences in depression outcomes between participants who received bupropion or sertraline based on biomarkers identified in the prior Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) study.

But people negative for biomarkers with both drugs had significantly worse depression symptom trajectories than those who had at least one positive biomarker, regardless of the drug they received.

Response rates among participants with both biomarkers were almost double that of those without any biomarkers, with those who had at least one biomarker having an intermediate response.

“Our results suggest that we could boost response rate by using two sets of biomarkers previously identified in the EMBARC study, making an important contribution to advancing the goals of precision psychiatry,” reported Peter Zhukovsky, PhD, from Harvard Medical School, and co-workers in Nature Mental Health.

“Ultimately, we strongly hope these advances will enable personalized treatment guidance to accelerate and boost antidepressant benefits.”

Treatment for depression is often still trial and error, with symptoms improving in only half the people taking an antidepressant. This could be due to treatments not being chosen based on people’s individual characteristics.

Finding markers that predict response to different antidepressants could therefore provide patients and clinicians with valuable information to guide treatment choice.

The trial was among the first to investigate how treatment could be guided using clinical information such as responses to questionnaires, behavioral information such as performance in computerized tasks, and brain data such as magnetic resonance imaging (MRI) scans.

It was carried out as part of the Wellcome Leap Multi-Channel Psych Program effort to double the number of people who respond to the first treatment they try for depression via the integration of multimodal biomarkers.

Firstly, the researchers investigated biomarker models that predicted response to the selective serotonin reuptake inhibitor (SSRI) sertraline or the norepinephrine-dopamine reuptake inhibitor bupropion using the EMBARC study.

The treatment-assignment algorithm that was developed generated two marker-based indications for each patient—one for bupropion and sertraline—with the predictive model achieving a cross-validated area under the curve of 0.86 and 0.66, respectively.

The team then examined whether antidepressant response could be boosted using their created biomarker combination of a functional MRI imaging marker, reward learning and sensitivity, cognitive control, the clinical variables of depression severity and neuroticism, and the demographic variable of employment status.

After analyzing these biomarkers among participants, who had major depressive disorder, the group was randomly assigned to receive a full 8-week course of an SSRI or non-SSRI.

The primary outcome was the change in depression severity from pretreatment baseline to eight weeks after the start of treatment, with no significant differences in treatment outcomes for those assigned a drug consistent versus inconsistent with their biomarkers.

This, the researchers say was possibly due to the limited power to detect moderate effects.

However, significant differences emerged in symptom reduction trajectories for those with positive markers for both medications, with a response rate of 71.4% compared with 65.4% for those with a positive biomarker for either drug and 42.9% for those with two negative markers.

The authors concluded: “We found that, relative to patients with two negative markers, those with one or two markers were characterized by significantly larger reduction in depressive symptoms, showing that biomarker-guided treatment selection can boost efficacy for two of the most widely prescribed antidepressants around the world.”

The post Biomarkers Could Help in Antidepressant Choice appeared first on Inside Precision Medicine.

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Opinion: Stopping doctors from ordering unnecessary diagnostic tests requires a structural fix

American medicine runs more than 14 billion tests a year. While some tests can be lifesaving, many are used at the wrong time or on the wrong patient and are useless or even harmful.

The medical industry has spent enormous effort making more advanced tests but expended little effort learning how to use tests correctly. There is a science for how to better use tests, diagnostic stewardship, but most doctors have never heard of it.

Read the rest…

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Strong Public Support for Embryonic Genome Editing to Eliminate Severe Conditions, European Survey Shows

A European survey launched at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) suggests broad public support for fertility treatment and research, including genome editing in human embryos for specific reasons.

The report, “Fertility, Embryo Research and Genome Editing: Public Attitudes in Europe,” was commissioned by the charity Progress Educational Trust (PET), which aims to improve choices for people affected by infertility and/or genetic conditions, and was supported by ESHRE. It explored public attitudes towards fertility treatment, embryo research, genome editing, surrogacy, and related topics.

The authors say the findings will “inform ESHRE’s ongoing work in Europe, linked to implementation of the European Union’s SoHO (Substances of Human Origin) Regulation and to the ethical considerations that arise in our field.”

The survey included 8688 participants aged 16–75 years across the U.K., Netherlands, Spain and Italy, with more than 2000 respondents in each country.

Across all four countries, a large proportion of respondents supported state-funded fertility treatment for people experiencing infertility and wishing to conceive, ranging from 54% in the Netherlands to 57% in the U.K., 62% in Spain, and 64% in Italy. Support was highest for heterosexual couples (47–59%) and lowest for transgender people (12–18%).

Conversely, most respondents said they did not support people being able to choose the biological sex of their child, based on personal preference. Opposition was strongest in the Netherlands (72%) followed by the U.K. (59%), Italy (55%) and Spain (47%). Nonetheless, there was still a significant minority that expressed support for sex selection. This support was strongest in Spain (32%) followed by the U.K. (26%), Italy (22%) and the Netherlands (18%), and was more common among younger participants than their older counterparts.

The age differential across responses could mean that with time, there will be a shift in views and potential changes in policy, the authors note.

The survey also found public backing for the use of human embryos in research to better understand and develop treatments for congenital diseases. Support ranged from 41% in Italy to 48% in the Netherlands and Spain, substantially exceeding opposition in all four countries (15–24%), including Italy, where research uses of human embryos are currently prohibited.

Respondents were then asked whether they supported or opposed the use of genome editing in human embryos, in three different scenarios:

  1. For scientific and medical research to help understand or develop treatments for congenital disease, without human implantation.
  2. In human embryos that will be transferred to a human to establish pregnancy to help eliminate a severe or life-threatening condition, like cystic fibrosis, in the resulting child.
  3. In human embryos that will be transferred to a human to establish pregnancy to help eliminate a common or medically manageable condition, like asthma, in the resulting child.

In all four of the countries, more respondents supported than opposed all three of the uses of genome editing, with the highest level of support given if the technique helps eliminate a severe or life-threatening condition.

It is important to note that this use of genome editing—which was supported by 55% in the Netherlands, by 53% in Spain, by 52% in the U.K. and by 46% in Italy—is not permitted by law in any of these four countries at present.

PET commented: “It is heartening to see such substantial support for uses of genome editing in human embryos, across all four of the countries surveyed. That said, these findings present an interesting conundrum. Respondents seem to be more ready to countenance the use of genome-edited embryos in treatment—at least, if helps to eliminate a severe or life-threatening condition—than they are to countenance the use of genome-edited embryos in research. Realistically, research must occur first. There is therefore a need for wide-ranging public conversations, where the vital role played by research—in enabling treatment, and ensuring that treatment is safe and effective—can be conveyed.”

Professor Karen Sermon, immediate past chair of ESHRE, said, “Reproductive medicine and embryo research are advancing rapidly, and these findings show the importance of understanding how the public views those developments. It is particularly striking that support for some applications extends beyond what is currently permitted in certain countries. As science advances, it is essential that public awareness keeps pace, so that decisions about future treatments are informed by both evidence and societal values.”

The post Strong Public Support for Embryonic Genome Editing to Eliminate Severe Conditions, European Survey Shows appeared first on Inside Precision Medicine.

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Knowledge, Attitudes, and Practices Related to AI in Learning and Research Among Medical Students in Vietnam: Cross-Sectional Study

Background: In recent years, artificial intelligence (AI) has ushered in a promising era in medicine, particularly in medical education. However, studies assessing the knowledge, attitudes, and practices related to AI among medical students in Vietnam remain limited. Objective: This study aimed to evaluate AI knowledge, attitudes, and practices among Vietnamese medical students in learning and research, and to identify factors associated with their AI practices. Methods: A cross-sectional study was conducted among medical students at Thai Binh University of Medicine and Pharmacy from November to December 2025. Data were collected using an online structured questionnaire covering demographic characteristics and AI knowledge, attitudes, and practices. The main outcome of interest was AI practices in learning and research. Descriptive statistics and multivariable linear regression were used to examine associated factors. Regression coefficients (β), 95% CIs, and values are reported. Results: A total of 1002 medical students (mean age 21.00, IQR 19.00-23.00 years; n=596, 59.5% female) were included. The median percentage of maximum possible (POMP) score of AI knowledge was 66.67 (IQR 33.33‐83.33), with a high level of familiarity with common tools (n=798, 79.6%). AI attitudes were generally positive (median POMP score 70.00, IQR 53.33‐76.67). AI-related practices were lower (median POMP score 50.00, IQR 46.88-71.88), with AI being used primarily for information retrieval and literature research support. In the multivariable analysis, knowledge POMP score (β=0.12, 95% CI 0.08-0.16) and attitudes POMP score (β=0.42, 95% CI 0.34-0.51) were significantly associated with AI practices POMP score (<.001). Age, gender, major, grade point average classification, and having participated in an AI seminar or training were not associated with AI practices. Conclusions: Medical students showed favorable knowledge and positive attitudes, but their AI practices remained limited. Integrating AI into medical curricula, including fundamentals, applications, and ethical aspects, is essential to prepare future physicians for AI-driven health care.
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From sympathetic storm to systemic inflammation: spatiotemporal dynamics of the brain-lung axis in neurogenic pulmonary edema

Neurogenic pulmonary edema (NPE) is a life-threatening complication of acute central nervous system (CNS) injury, characterized by the rapid onset of hypoxemia and pulmonary fluid accumulation in the absence of underlying cardiopulmonary disease. In recent years, emerging integrative frameworks such as the “neuroimmunoaxis” and “brain-lung axis” have provided new perspectives on how CNS injury leads to systemic immune dysregulation and pulmonary dysfunction. However, critical questions remain regarding the interplay between excessive sympathetic activation, immune homeostasis disruption, and lung tissue injury. This narrative review proposes a neurotransmitter-immune-inflammatory model that integrates mechanical, adrenergic, and inflammatory pathways across the spatiotemporal evolution of NPE. We identify four progressive stages involving sympathetic storm initiation due to central autonomic network disinhibition, pulmonary vascular barrier disruption through Piezo channel activation and angiotensin II-norepinephrine synergy, inflammatory amplification from loss of the cholinergic anti-inflammatory reflex, and systemic progression involving gut-lung axis dysregulation. The model generates three testable predictions. Lesions disrupting the nucleus tractus solitarius-ventromedial hypothalamus-intermediolateral column projection should produce more severe NPE. And selective activation of TRPA1+ dorsal root ganglion neurons should attenuate sympathetic outflow and pulmonary edema. Enhancing α7 nicotinic acetylcholine receptor signaling should mitigate systemic inflammation. These predictions offer experimental avenues for validating the hijacking hypothesis. Translational implications include stage-specific interventions, early sympathetic blockade, mid-phase anti-inflammatory and neuro-modulatory strategies, and late-stage lung-protective ventilation. This study aims to offer a comprehensive analysis of NPE by exploring its pathological mechanisms—from central sympathetic signaling to peripheral lung damage. Emphasis is placed on examining the interactions between neural signals, neurotransmitters, and immune responses to uncover the spatiotemporal dynamics of NPE. By identifying potential pathways for early diagnosis and targeted therapies, the research seeks to improve disease management and contribute to better clinical outcomes for affected patients.
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Intranasal esketamine plus oral antidepressant for treatment-resistant depression: acute induction and maintenance relapse-prevention outcomes in a systematic review and meta-analysis

Treatment-resistant depression (TRD) remains a major clinical challenge. Intranasal esketamine, used adjunctively with an oral antidepressant, has been evaluated in randomized trials, but uncertainty persists regarding the magnitude and consistency of benefit, durability, and key harms. This systematic review and meta-analysis included randomized controlled trials comparing intranasal esketamine plus an oral antidepressant versus placebo nasal spray plus the same oral antidepressant in TRD. Acute induction (≈4 weeks) and maintenance randomized-withdrawal phases were analyzed separately. Depression outcomes were assessed primarily using the Montgomery–Åsberg Depression Rating Scale (MADRS), and functional outcomes using the Sheehan Disability Scale (SDS). Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2.0. Random-effects models pooled mean differences (MD) for continuous outcomes, risk ratios (RR) for binary outcomes, and hazard ratios (HR) for relapse prevention. Certainty of evidence was rated using GRADE. From 1,518 records, nine reports representing six unique RCTs (1,836 participants) were included. Four acute induction RCTs (n=937) showed greater symptom reduction at day 28 with esketamine (MADRS MD −2.99, 95% CI −5.10 to −0.89; I²=48.5%). Rapid improvement was evident by day 2 (MD −3.25, 95% CI −4.65 to −1.85). Esketamine increased day-28 response (RR 1.44, 95% CI 1.20–1.74) and remission (RR 1.52, 95% CI 1.20–1.92), corresponding to approximately +154 responders and +106 remitters per 1,000 patients, respectively, based on pooled control risks. Functioning improved (SDS MD −1.70, 95% CI −2.61 to −0.79). Two maintenance randomized-withdrawal RCTs (n=899) demonstrated reduced relapse risk with continued esketamine (HR 0.51, 95% CI 0.42–0.62; I²=0%). In acute induction, esketamine increased any treatment-emergent adverse event (TEAE) (RR 1.37, 95% CI 1.25–1.50) and discontinuation due to adverse events (RR 2.68, 95% CI 1.35–5.29), with notable increases in dissociation (RR 7.33, 95% CI 4.49–11.98) and blood pressure increased events (RR 3.96, 95% CI 2.24–7.01). Maintenance TEAE rates were similar between groups (RR 1.07, 95% CI 0.99–1.17). Intranasal esketamine plus an oral antidepressant provides rapid, modest acute improvement and reduces relapse risk during maintenance among stabilized responders/remitters, but increases acute adverse events, supporting use within supervised care and individualized benefit–risk assessment.
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Why high scores do not mean application readiness for health AI

Nature Medicine, Published online: 02 July 2026; doi:10.1038/s41591-026-04500-9

Large language models achieve high scores on health application benchmarks, yet adversarial stress tests now reveal prevalent brittleness — shortcut reliance, fragile visual grounding and fabricated reasoning traces — which exposes substantial gaps between benchmark performance and the robustness evidence needed to support claims of readiness for medical decision-support and patient-facing applications.