The Rounds Report
Heart failure with preserved ejection fraction gets a solid advance in treatment.
And there’s more.
Between mid-May and early August, there were multiple major clinical trials published results that are making waves in the medical community. These studies span cardiology, endocrinology, oncology, nephrology, and pulmonology
All of which are delivering data that will likely reshape treatment algorithms.
These findings are generating quite a bit of discussion among physicians and researchers. Check them out below.
Five Game-Changers for August
1. HFpEF Gets Its First Evidence-Based Therapy
For decades, we've told heart failure patients with preserved ejection fraction that we could only manage their symptoms. The FINEARTS-HF trial just changed everything.
The results from 6,001 patients are practice-changing: finerenone reduced the composite of cardiovascular death and total worsening heart failure events by 16% across the entire LVEF spectrum of 40-70%. This non-steroidal mineralocorticoid receptor antagonist achieved what spironolactone couldn't—meaningful benefits without the hyperkalemia headaches.
The trial included patients regardless of diabetes status or SGLT2 inhibitor use, giving us broad applicability. FDA approval came in July 2025, making this immediately actionable for the nearly half of heart failure patients we previously had limited options for treating.
Bottom line: Your HFpEF patients now have an evidence-based therapy that actually works. This fills the biggest treatment gap in modern cardiology.
2. Oral GLP-1 Eliminates the Injection Barrier
The ACHIEVE-1 trial delivered what diabetes management has been waiting for: the first oral small-molecule GLP-1 receptor agonist to complete Phase 3 trials successfully.
Orforglipron achieved HbA1c reductions up to 1.48% with dose-dependent weight loss up to 16 pounds in 559 patients with inadequately controlled type 2 diabetes. More than 65% of patients on the highest dose achieved HbA1c levels below 6.5%—essentially normalizing glucose control.
Unlike oral semaglutide's complex dosing requirements, orforglipron needs no food or water restrictions. Scalable manufacturing without cold-chain requirements promises global accessibility that injection-based therapies can't match.
Practice implication: This could transform first-line diabetes management by expanding GLP-1 benefits to injection-averse patients who represent a substantial portion of our diabetes population.
3. Genetic Risk Scoring Revolutionizes Cancer Screening
The BARCODE1 study fundamentally challenges PSA-based prostate cancer screening. Polygenic risk scoring identified clinically significant cancers that conventional screening entirely missed in a landmark UK study.
Among 468 men with high genetic risk scores who underwent comprehensive screening regardless of PSA levels, 187 received cancer diagnoses. Most remarkably, standard UK screening methods would have missed 74 of the 103 clinically significant cancers that warranted immediate treatment.
This represents a paradigm shift from biomarker-based to genetics-based risk stratification that addresses longstanding screening controversies by targeting interventions based on individual genetic susceptibility.
Clinical reality check: Start understanding polygenic risk testing as commercial availability expands. This precision medicine approach could reduce overdiagnosis while catching aggressive cancers earlier.
4. Breakthrough Therapy Conquers Fatal Kidney Cancer
The bevacizumab plus erlotinib combination achieved extraordinary results in hereditary leiomyomatosis-associated renal cell carcinoma: 72% confirmed response rate with median overall survival of 44.6 months in a cancer that was previously uniformly fatal.
This NIH-led study of 43 HLRCC patients delivered meaningful disease control in a population that historically survived less than one year from diagnosis. Even in sporadic papillary RCC cases, the regimen achieved 35% response rates.
What this means: Early recognition becomes critical for patient outcomes. Maintain awareness for patients with family histories of skin leiomyomas and kidney tumors—timely referral can now be genuinely life-saving.
5. Respiratory Care Gets Its First Major Advance in 50 Years
The ABRA trial delivered the first breakthrough in acute asthma and COPD exacerbation treatment since systemic corticosteroids became standard therapy. Benralizumab reduced treatment failure rates from 74% with prednisolone alone to 45% in the benralizumab groups in this precision approach.
This anti-IL5 monoclonal antibody specifically benefits patients with eosinophilic exacerbations—comprising 30% of COPD and 50% of asthma exacerbations—when eosinophil counts exceed 300 cells/μL.
Paradigm shift: Phenotyping acute exacerbations by eosinophil count allows targeted intervention that addresses underlying inflammatory pathways while offering steroid-sparing approaches.
The Clinical Pearls That Matter
1. Broad-spectrum antibiotics in moderately immunocompromised patients without multidrug-resistant risk factors worsen outcomes compared to standard community-acquired pneumonia coverage. Empiric escalation may paradoxically increase morbidity when targeted therapy suffices. Clinical Infectious Diseases July 2025
2. Cefepime neurotoxicity threshold identified at 36.7 mg/L in continuous infusion protocols. The TOXEPIM study provides the first prospective neurotoxic cutoff for high-dose continuous cefepime in non-critically ill patients. Clinical Infectious Diseases June 2025
3. Glucocorticoid dosing definitions for vaccination guidance evolve beyond the traditional >20mg/day threshold.Low- to medium-dose steroids (7-20mg/day) show inconclusive vaccine efficacy impact, while evidence for unified pediatric thresholds remains insufficient. Clinical Infectious Diseases May 2025
4. 2025 cholesterol guidelines formally adopt non-fasting lipid panels as preferred screening for adults over 40. Age 40 emerges as the new threshold for statin consideration, reflecting evidence that atherosclerotic processes begin decades before clinical manifestations. Global RPH July 2025
Monday Morning Rounds: 5 Key Discussion Points
1. HFpEF treatment revolution - FINEARTS-HF proved finerenone reduces the composite of cardiovascular death and total worsening heart failure events by 16% in patients with preserved ejection fraction, filling cardiology's biggest treatment gap.
2. Oral GLP-1 accessibility breakthrough - ACHIEVE-1 demonstrated orforglipron delivers injectable-level efficacy without injection barriers or complex dosing restrictions.
3. Genetic cancer screening paradigm - BARCODE1 showed polygenic risk scoring identified 71.8% of clinically significant prostate cancers that conventional UK screening protocols would have missed entirely.
4. Precision respiratory care emerges - ABRA trial showed benralizumab reduced treatment failure rates from 74% to 45% compared to prednisolone alone for eosinophilic asthma and COPD exacerbations.
5. Fatal cancer becomes treatable - Bevacizumab plus erlotinib achieved 72% response rates in previously incurable hereditary kidney cancer.
Before You Go...
This quarter delivered breakthrough research that addresses some of medicine's most challenging treatment gaps. From the first proven HFpEF therapy to genetic-based cancer screening, these studies represent evidence-based paradigm shifts with immediate clinical applications.
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The pace of medical advancement continues accelerating. The question isn't whether these breakthroughs will influence your practice. It's how quickly you'll integrate them to deliver better patient outcomes.
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Essential Reading for Deep Dives
Cardiology Breakthroughs: • FINEARTS-HF - Finerenone for HFpEF • Heart Failure Treatment Guidelines Update
Endocrinology Advances: • ACHIEVE-1 - Oral GLP-1 Orforglipron • GLP-1 Therapeutic Expansion
Oncology & Genetics: • BARCODE1 - Polygenic Prostate Cancer Screening • Hereditary Kidney Cancer Breakthrough
Pulmonology Innovations: • ABRA Trial - Benralizumab for Exacerbations • Precision Respiratory Medicine
Disclaimer: The content provided in The Rounds Report is for educational and informational purposes only and does not constitute medical advice, diagnosis, treatment recommendations, or professional medical guidance. This newsletter presents summaries and analysis of published medical research and should not be used as a substitute for professional medical judgment, clinical decision-making, or consultation with qualified healthcare providers. Always consult with appropriate medical professionals and refer to original research sources before making any clinical decisions. The Rounds Report does not establish a doctor-patient relationship and readers should not rely on this content for patient care decisions.