Jenniskens K, Huis In 't Veld LF, Lokerse ME
… +8 more, Idema DL, Kusters MPT, van der Braak K, Spijker R, Vernooij RWM, Oerbekke MS, Hooft L, Damen JAA
Ann Intern Med
· 2026 Jun · PMID 42296505
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BACKGROUND: A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. PURPOSE: To evaluate cost-effectiveness of pharmacologic treatments in adults with overweig...BACKGROUND: A comprehensive overview of the cost-effectiveness of pharmacologic treatments for overweight or obesity is lacking. PURPOSE: To evaluate cost-effectiveness of pharmacologic treatments in adults with overweight or obesity in a U.S. setting. DATA SOURCES: MEDLINE, Embase, and economic databases, searched on 13 October 2025. STUDY SELECTION: Non-industry-sponsored U.S. trial-based and model-based cost-effectiveness evaluations of pharmacologic treatments in adults with overweight or obesity. DATA EXTRACTION: Data on clinical characteristics, economic characteristics (for example, model type), and study outcomes were extracted by one reviewer and verified by a second reviewer. Study quality was assessed using the CHEQUE (Criteria for Health Economic Quality Evaluation) tool; value was assessed using incremental cost-effectiveness ratios (ICERs), with thresholds for high value (<$100 000 per quality-adjusted life-year [QALY], or dominant), intermediate value ($100 000 to $200 000 per QALY), low value (>$200 000 per QALY), and no value (strict or extended dominance, or less costly and less effective); and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. DATA SYNTHESIS: Four out of 9 included studies were at low risk of bias. None of the 42 pairwise comparisons that were reported had high certainty. In the 6 studies with moderate certainty, liraglutide had low value and phentermine-topiramate and tirzepatide had high value when each was compared with lifestyle modification. Semaglutide had low value compared with naltrexone-bupropion and phentermine-topiramate and high value compared with liraglutide. LIMITATIONS: All studies were model-based. ICERs were not reported for all potential treatment comparisons. Most studies had incomplete reporting or were at high risk of bias. CONCLUSION: Current evidence on cost-effectiveness of pharmacologic treatment of overweight or obesity is hampered by poor-quality studies, limiting the ability to draw conclusions. PRIMARY FUNDING SOURCE: American College of Physicians. (PROSPERO: CRD42023491646).
Damen JAA, Idema DL, Vernooij RWM
… +9 more, Huis In 't Veld LF, Kusters MPT, Lokerse ME, de Kanter E, Spijker R, van der Braak K, Jenniskens K, Oerbekke MS, Hooft L
Ann Intern Med
· 2026 Jun · PMID 42296503
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BACKGROUND: Overweight and obesity are closely linked to diseases such as type 2 diabetes, coronary heart disease, and stroke and have been shown to increase mortality risk. PURPOSE: To conduct a living systematic review...BACKGROUND: Overweight and obesity are closely linked to diseases such as type 2 diabetes, coronary heart disease, and stroke and have been shown to increase mortality risk. PURPOSE: To conduct a living systematic review of pharmacologic treatments for weight management in overweight or obesity in adults. DATA SOURCES: MEDLINE and Cochrane Central Register of Controlled Trials until October 2025. STUDY SELECTION: Randomized controlled trials that compared pharmacologic treatments for weight management (dulaglutide, exenatide, liraglutide, lixisenatide, naltrexone-bupropion, orforglipron, phentermine, phentermine-topiramate, retatrutide, semaglutide, semaglutide-cagrilintide, tirzepatide, or any combination with or without lifestyle intervention [LI]) for overweight or obesity (body mass index ≥25 kg/m) in adults for outcomes such as mortality, weight loss, and quality of life. DATA EXTRACTION: One reviewer extracted data and assessed risk of bias and certainty of the evidence; a second reviewer verified these data. DATA SYNTHESIS: The review included 69 studies with a total of 112 511 participants. Thirty-seven studies were at low risk of bias. In meta-analyses, nearly all studied interventions were more effective than placebo and/or LI in reducing weight, but more discontinuations due to adverse events were observed. Semaglutide probably reduced mortality and major adverse cardiovascular events (MACE), and both semaglutide and tirzepatide led to the greatest weight loss compared with placebo and/or LI in pairwise and network meta-analyses. Evidence for outcomes such as mortality, MACE, and serious adverse events was limited. LIMITATION: Direct head-to-head comparisons of different treatments were limited. CONCLUSION: Nearly all studied interventions were more effective than placebo and/or LI in reducing weight. Semaglutide and tirzepatide showed the most favorable results across outcomes. PRIMARY FUNDING SOURCE: American College of Physicians. (PROSPERO: CRD42023491646).
Wang S, Wang P, Li J
… +17 more, Han D, Zhao Y, Zhang Y, Li Z, Du Y, Briggs N, Wang Y, Wang W, Li X, Wang Q, Diwan AD, Zhang Z, Wang T, Yang Y, Li C, Chen X, Lu S
Ann Intern Med
· 2026 Jun · PMID 42296500
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BACKGROUND: Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. OBJECTIVE: To evaluate the efficacy of multimodal prehabilitation plus...BACKGROUND: Older adults often have impaired physiologic reserve and are at higher risk for postoperative complications after spinal fusion surgery. OBJECTIVE: To evaluate the efficacy of multimodal prehabilitation plus Enhanced Recovery After Surgery (PREERAS) versus ERAS alone on 90-day postoperative complications in older adults undergoing elective spinal fusion. DESIGN: Multicenter, open-label, assessor-blinded, 1:1 parallel-group randomized controlled trial. (ClinicalTrials.gov: NCT06140797). SETTING: 3 tertiary hospitals in China. PARTICIPANTS: Adults aged 75 years or older undergoing elective spinal fusion surgery between May 2024 and May 2025. INTERVENTION: Participants were randomly assigned to receive either preoperative Vivifrail-based, multimodal PREERAS (PREERAS group) or ERAS alone (ERAS group). The 4-week prehabilitation program integrated supervised group sessions, Vivifrail multicomponent exercise, nutritional optimization, and psychological interventions. MEASUREMENTS: The primary outcome was the occurrence of any postoperative complication within 90 days of surgery, recorded and graded per the Clavien-Dindo classification system. RESULTS: A total of 312 patients were assessed for eligibility, with 164 randomly assigned. Of the 159 patients included in the final analysis (mean age, 78.7 years; 59% women), 59 patients (74.7%) in the PREERAS group and 73 patients (91.2%) in the ERAS group experienced at least 1 complication (risk ratio, 0.80 [95% CI, 0.67 to 0.95]; risk difference, -18.0% [CI, -27.0% to -9.0%]). LIMITATIONS: Unblinded participants and clinicians. Generalizability may be limited with longer hospital stays in the Chinese health care system. CONCLUSION: The implementation of multimodal prehabilitation in 3 tertiary hospitals in China reduced 90-day postoperative complications in older adults undergoing enhanced recovery after spinal fusion surgery. However, individual sites will need to consider applicability of findings and resource requirements of prehabilitation before implementation. PRIMARY FUNDING SOURCE: Capital's Funds for Health Improvement and Research.
Hayes KN, Harris DA, McConeghy KW
… +10 more, Grove LR, Joshi R, Han L, Davidson HE, Chachlani P, Bayer TA, Singh M, Abul Y, DeVone F, Gravenstein S
Ann Intern Med
· 2026 Jun · PMID 42296498
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BACKGROUND: Observational studies report a protective association between herpes zoster (HZ) vaccination and dementia, but they have methodological limitations or examined a live attenuated vaccine no longer available in...BACKGROUND: Observational studies report a protective association between herpes zoster (HZ) vaccination and dementia, but they have methodological limitations or examined a live attenuated vaccine no longer available in the United States. OBJECTIVE: Among older adults recently admitted to a skilled-nursing facility for postacute or long-term care, to estimate the association between dementia and receipt of the recombinant HZ vaccine (RZV) within 12 months of entering the facility or after discharge. DESIGN: The researchers conducted a cohort study using target trial emulation and the clone-censor-weight approach. Participants were followed for up to 4 years until the outcome of dementia, Medicare disenrollment, or death. Inverse probability of clone-censoring weights were applied to pooled logistic regression models to estimate effects. SETTING: Medicare claims linked to nursing home electronic health record (EHR) data. PARTICIPANTS: Medicare fee-for-service beneficiaries aged 66 years or older who were admitted to a skilled-nursing facility between 1 January 2017 and 31 December 2022, had linked EHR data, had no diagnosed dementia, and were eligible for RZV. INTERVENTION: Receipt of at least 1 RZV in the facility or, if discharged, by 12 months after admission versus no receipt of RZV. MEASUREMENTS: Validated dementia diagnosis and 57 baseline and time-varying covariates. RESULTS: The study cohort included 509 926 participants (mean age, 79 years); 8843 (1.73%) received at least 1 RZV dose within 12 months after admission, and of these, 87.0% received RZV after discharge. Receipt of RZV was associated with risk for dementia being 5.8 percentage points lower (95% CI, 3.9 to 7.5 percentage points lower; risk ratio, 0.76 [CI, 0.69 to 0.84]; 4-year risk, 18.8% with ≥1 RZV vs. 24.6% with no RZV). Associations were attenuated in men and those with prior live HZ vaccination. LIMITATION: Negative control analyses suggest some residual confounding. CONCLUSION: Receipt of RZV during admission to a skilled-nursing facility or within 12 months was associated with lower dementia risk. PRIMARY FUNDING SOURCE: GlaxoSmithKline.