This Week in General Medicine — Jun 5, 2026

Welcome to This Week in General Medicine. This week we're covering 10 notable papers spanning major advances in chronic kidney disease, new targeted therapies and treatment intensification in oncology, and important findings in low back pain management. Let's dive in.

We begin with chronic kidney disease, or CKD, where a recent Series paper in The Lancet highlights a new era of therapeutics targeting shared metabolic and inflammatory pathways [4]. Three major trials this week exemplify this trend, offering both new hope and important cautionary tales. First, in The New England Journal of Medicine, the FIND-CKD trial investigated the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with CKD and albuminuria who do *not* have diabetes [1]. This expands on previous trials that showed benefit in patients with diabetes. In this study of nearly 1600 adults, finerenone significantly slowed the rate of kidney function decline over 32 months. The mean annual rate of change in eGFR was negative 3.3 ml per minute with finerenone versus negative 4.0 ml per minute with placebo, a statistically significant difference of 0.7 ml per minute per year. Finerenone also reduced the risk of a composite kidney or cardiovascular outcome by about 23%. As expected, the main adverse event was hyperkalemia, occurring in 17% of the finerenone group compared to 13% in the placebo group, though it rarely led to treatment discontinuation. This study suggests the benefits of finerenone extend to a broader population of patients with proteinuric CKD. Also targeting kidney function preservation, the ALIGN trial in The Lancet assessed atrasentan, a selective endothelin A receptor antagonist, in patients with IgA nephropathy [2]. After two and a half years, there was a trend toward slower eGFR decline with atrasentan compared to placebo in the main group of patients, though the primary endpoint at week 136 did not reach statistical significance, with a p-value of 0.057. However, other measures, like the total eGFR slope, did show a significant benefit. Interestingly, in an exploratory group of patients also taking an SGLT2 inhibitor, the benefit of atrasentan appeared more pronounced. The drug was generally well-tolerated, with fluid retention being a notable adverse event. In stark contrast to these two trials, a third study in JAMA provides a critical negative result for managing cardiovascular risk in this population. The TRACK trial randomized over 1400 patients with advanced CKD—stage 4, 5, or on dialysis—to low-dose rivaroxaban or placebo [3]. The trial was stopped early for futility. Over a median follow-up of 1.7 years, rivaroxaban did not reduce the primary composite outcome of cardiovascular death, MI, stroke, or peripheral artery disease events. In fact, major bleeding was significantly increased, occurring in nearly 9% of the rivaroxaban group versus 6% of the placebo group, which translates to a roughly 50% higher risk. The clear take-home is that low-dose rivaroxaban should not be used for cardiovascular risk reduction in patients with advanced CKD.

Turning to oncology, we have four papers exploring treatment intensification and targeted therapy. Two studies in The New England Journal of Medicine focus on prostate cancer. In high-risk localized disease, the PROTEUS trial investigated adding the androgen receptor inhibitor apalutamide to standard androgen-deprivation therapy, or ADT, both before and after radical prostatectomy [9]. Compared to ADT plus placebo, the apalutamide combination led to a dramatically higher rate of pathological complete response or minimal residual disease—nearly 9% versus just 1% in the placebo group. Over a median follow-up of five years, this translated into better metastasis-free survival and event-free survival. This benefit came at the cost of more side effects, particularly rash. In the metastatic setting, the TALAPRO-3 trial, also in The New England Journal of Medicine, evaluated adding the PARP inhibitor talazoparib to enzalutamide and ADT for patients whose tumors had alterations in homologous recombination repair, or HRR, genes [10]. The combination significantly improved imaging-based progression-free survival compared to enzalutamide alone. At 3 years, 77% of patients in the talazoparib group were progression-free, compared to 56% in the control group, representing a risk reduction of more than 50%. The primary toxicity was hematologic, with over half the patients on talazoparib developing grade 3 or higher anemia. Moving to gastrointestinal cancers, a phase 2 trial in Nature Medicine provides a new option for a specific subset of patients with gastric or gastroesophageal junction adenocarcinoma [7]. In patients whose tumors had MET amplification and who had already progressed on multiple prior lines of therapy, the oral MET inhibitor savolitinib demonstrated an objective response rate of over 32%. This is a promising result in a heavily pre-treated population, supporting further investigation of this targeted agent. Finally, for our older patients with newly diagnosed acute myeloid leukemia, or AML, who are ineligible for intensive chemotherapy, a study in The New England Journal of Medicine reports on an all-oral regimen [5]. Combining oral decitabine-cedazuridine with oral venetoclax led to a complete response in 47% of patients and a median overall survival of 15.5 months. This provides an effective treatment option that avoids the burden of parenteral administration, though myelosuppression, including febrile neutropenia, remains a common and serious side effect.

Our final section covers two practice-changing trials in other specialties. First, a major trial in JAMA Internal Medicine addresses the prevention of chronic low back pain [8]. The PACBACK trial randomized 1000 adults with acute or subacute low back pain who were at high risk of developing a chronic problem. It compared four approaches: standard medical care, spinal manipulation, clinician-supported biopsychosocial self-management, and a combination of manipulation and self-management. At one year, supported self-management, delivered by physical therapists and chiropractors, resulted in a small but statistically significant improvement in pain impact scores compared to medical care. Critically, spinal manipulation alone was no better than medical care, and adding it to supported self-management provided no additional benefit. The supported self-management group also had better results on most secondary outcomes, with 12% fewer patients reporting chronic pain that frequently interfered with activities. This suggests that focusing on biopsychosocial factors like self-efficacy and kinesiophobia is a key strategy for this common problem. Lastly, for the fibroinflammatory condition IgG4-related disease, The New England Journal of Medicine brings results of the phase 3 INDIGO trial [6]. Patients with active disease received weekly subcutaneous obexelimab, a monoclonal antibody that inhibits B-cell activity without causing depletion, or placebo. Glucocorticoids were tapered off by week 8 in both groups. The results were striking: obexelimab significantly prolonged the time to a disease flare, with flares occurring in just 27% of the obexelimab group compared to 55% of the placebo group. This represents a 56% reduction in the risk of flare. Patients on obexelimab also achieved complete remission more often and required significantly less cumulative rescue glucocorticoid therapy. The treatment was well-tolerated, with the most common adverse events being arthralgias and hypersensitivity.

If you only have time for one paper this week, make it the PACBACK trial on preventing chronic low back pain in JAMA Internal Medicine [8]. It provides clear, actionable evidence for what to offer high-risk patients: clinician-supported biopsychosocial self-management, which outperformed both standard medical care and spinal manipulation.

Here are the key takeaways from this week in General Medicine: First, for patients with chronic kidney disease and albuminuria but without diabetes, consider the nonsteroidal MRA finerenone to slow eGFR decline, while carefully monitoring potassium levels [1]. Second, in patients with advanced CKD, do not use low-dose rivaroxaban for cardiovascular prevention. The TRACK trial showed it offers no benefit and significantly increases the risk of major bleeding [3]. Third, for patients with acute or subacute low back pain at high risk of chronicity, the most effective strategy to prevent long-term impact is clinician-supported biopsychosocial self-management. Adding spinal manipulation does not appear to provide further benefit [8]. Fourth, in prostate cancer, treatment intensification with newer hormonal agents or PARP inhibitors continues to improve outcomes, both in the high-risk localized setting with perioperative apalutamide [9] and in the metastatic, HRR-mutated setting with talazoparib [10]. Finally, a new all-oral combination of decitabine-cedazuridine plus venetoclax is an effective option for older adults with AML who are not candidates for intensive chemotherapy, improving outcomes while avoiding parenteral therapy [5].

That's your roundup for This Week in General Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.