Don't Just Read the Abstract

Apixaban vs rivaroxaban: the trial we've all been waiting for

On this episode, Pip and Rich discuss the COBRRA trial: Castellucci et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. NEJM. 2026. [https://www.nejm.org/doi/full/10.1056/NEJMoa2510703] The trial showed a convincing reduction in clinically relevant bleeding in patients treated with apixaban (3.3% vs 7.1%) and no difference in efficacy. It's a compelling study but there were important exclusion criteria and as ever, there are some nuances beyond the abstract. This episode also includes an update on Pip's daughter's school science project where unwitting families were invited for dinner to find out whether there is, indeed, always time for pudding. ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

ENERGIZE: Mitapivat in thalassaemia

Following its recent US FDA approval, on this episode, Pip and Rich discuss mitapivat, an allosteric activator of red-cell pyruvate kinase. They focus on ENERGIZE, a randomised controlled trial of mitapivat vs placebo (2:1) randomisation in people living with transfusion dependent thalassaemia. It met its primary endpoint of achieving significantly more patients reaching a haemoglobin rise of at least 1 g/L. However, Pip and Rich discuss the relevance of this surrogate endpoint as well as the small effects on fatigue and quality of life. Taher et al. Mitapivat in adults with non-transfusion-dependent α-thalassaemia or β-thalassaemia (ENERGIZE): a phase 3, international, randomised, double-blind, placebo-controlled trial. Lancet. 2025 Jul 5;406(10498):33-42. doi: 10.1016/S0140-6736(25)00635-X. [https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2825%2900635-X/fulltext] ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Ianalumab for ITP: VAYHIT2

On this episode, Pip and Rich VAY-HIT2, a trial recently published in the New England Journal of Medicine [https://www.nejm.org/doi/abs/10.1056/NEJMoa2515168]. This study randomised patients with relapsed/refractory ITP after first line corticosteroids to eltrombopag + ianalumab or placebo.   As the thrombopoietin receptor agonists such as eltrombopag are often given for extensive periods, there's a lot of interest in giving additional treatment that can result in a relatively short course of treatment. Ianalumab is an anti-B-Cell Activating Factor (BAFF) Receptor monoclonal antibody.   VAY-HIT2 was a phase 3, randomised, double-blind trial, assigning, in a 1:1:1 ratio, adults with primary ITP and an insufficient response or a relapse after first-line glucocorticoid therapy to receive eltrombopag + ianalumab at a dose of 9 mg or 3 mg per kilogram of body weight or placebo once monthly for 4 months.   The trial did meet its primary endpoint but there's a lot to discuss, most importantly the quality of life end points - and the interpretation is not straight forward! Conflict of interest disclosure here: Pip has received travel expenses and payment for attending an advisory board for Novartis. Pip is also leading a Novartis-sponsored UK audit of the treatment of warm autoimmune haemolytic anaemia on behalf of HaemSTAR (www.haemstar.org/TRUTH [www.haemstar.org/TRUTH]). ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Highlights of 2025 (Episode 2)

In this second of a two-part episode, Pip and Rich discuss their highlights of 2025. They discuss a wide range of developments across medical haematology with a focus on red cells disorders and a bit less naval gazing than the first episode. ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Highlights of 2025 (Episode 1)

In this first of a two-part episode, Pip and Rich discuss their highlights of 2025. They discuss a wide range of developments across medical haematology with a focus on bleeding disorders and immuno-haematology. ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.