45. The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023.
Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050.
47. Alzheimer's disease outlook: controversies and future directions.
作者: Giovanni B Frisoni.;Emil Aho.;Carol Brayne.;Olga Ciccarelli.;Bruno Dubois.;Nick C Fox.;Kristian S Frederiksen.;Cem Gabay.;Valentina Garibotto.;Thomas Hofmarcher.;Clifford R Jack.;Miia Kivipelto.;Ronald C Petersen.;Federica Ribaldi.;Christopher C Rowe.;Sebastian Walsh.;Henrik Zetterberg.;Oskar Hansson.
来源: Lancet. 2025年406卷10510期1424-1442页
For the first time, reductions in cerebral β-amyloid pathology load and rate of cognitive and functional decline have been achieved in Alzheimer's disease, through pharmacological intervention in randomised controlled trials. However, the results from phase 3 randomised controlled trials of anti-β amyloid monoclonal antibodies are interpreted in different ways, with some experts supporting a clinically meaningful disease-modifying effect, and others judging insufficient benefit-to-risk ratio and opposing market authorisation. In the final paper of this Series, we discuss these contrasting views, all of which wish to contribute to improvements in the quality of life of people with, or at risk of, Alzheimer's disease. We contrast the efficacy, societal costs, and generalisability of monoclonal antibodies for Alzheimer's disease to biologics for other conditions (eg, cancer, multiple sclerosis, and rheumatoid arthritis) and set this debate in the larger context of modern personalised medicine. We discuss current practice implications, future developments directed to β-amyloid and non-amyloid targets that might have more clinical efficacy and less adverse effects for those with the disease, and large-scale prevention interventions for those at risk.
48. Treatment for Alzheimer's disease.
作者: Nick C Fox.;Christopher Belder.;Clive Ballard.;Helen C Kales.;Catherine Mummery.;Paulo Caramelli.;Olga Ciccarelli.;Kristian S Frederiksen.;Teresa Gomez-Isla.;Zahinoor Ismail.;Claire Paquet.;Ronald C Petersen.;Robert Perneczky.;Louise Robinson.;Ozge Sayin.;Giovanni B Frisoni.
来源: Lancet. 2025年406卷10510期1408-1423页
Over the last three decades, the evidence on how to best treat the cognitive and non-cognitive symptoms of patients with Alzheimer's disease has increased. Although these pharmacological and non-pharmacological strategies have significantly improved health outcomes for patients with Alzheimer's disease, many lack stringent evidence of efficacy. In this second paper of the Series, we provide practical and realistic advice on how to prioritise pharmacological and non-pharmacological strategies to ameliorate cognitive impairment and behavioural and psychological symptoms of dementia. In this clinical environment, dementia specialists are faced with the challenge of holistically integrating the much anticipated and, in some respects, controversial anti-β amyloid monoclonal antibodies. Here, we present the current approval scenario of monoclonal antibodies, our view on how they might further contribute to improve patients' quality of life, and how they could be seamlessly integrated with existing best care options.
49. New landscape of the diagnosis of Alzheimer's disease.
作者: Giovanni B Frisoni.;Oskar Hansson.;Emma Nichols.;Valentina Garibotto.;Suzanne E Schindler.;Wiesje M van der Flier.;Frank Jessen.;Nicolas Villain.;Eider M Arenaza-Urquijo.;Lucia Crivelli.;Juan Fortea.;Lea T Grinberg.;Zahinoor Ismail.;Satoshi Minoshima.;Rik Ossenkoppele.;Henrik Zetterberg.;Ronald C Petersen.;Bruno Dubois.
来源: Lancet. 2025年406卷10510期1389-1407页
Alzheimer's disease involves a drastic departure from the cognitive, functional, and behavioural trajectory of normal ageing, and is both a dreaded and highly prevalent cause of disability to individuals, and a leading source of health and social care expenditure for society. Before the advent of biomarkers, post-mortem examination was the only method available to establish a definitive diagnosis. In this first paper of the Series, we review state-of-the-art diagnostic practices and the typical patient journey in specialist settings, where clinicians engage in a differential diagnosis to establish whether Alzheimer's pathology (cerebral deposition of β-amyloid and hyperphosphorylated tau) is a contributor to cognitive impairment. Biomarkers indicating dysregulation of β-amyloid and tau homeostasis, measured with PET and cerebrospinal fluid analysis, allow a molecular-level diagnosis-a mandatory step in defining eligibility for the recently approved anti-amyloid treatments. We anticipate that easily accessible blood biomarkers, already available in some countries, will lead to a new diagnostic revolution and bring about major changes in health-care systems worldwide.
52. The future of type 1 diabetes therapy.
The treatment of type 1 diabetes is entering a transformative era. Teplizumab, the first immunotherapy treatment to delay the onset of clinical type 1 diabetes, has been approved by the US Food and Drug Administration. Other immune-based therapies show promise in preserving β-cell function. Public health screening using islet autoantibodies is expanding, enabling earlier diagnosis, reducing diabetic ketoacidosis, and allowing timely introduction of disease-modifying treatments before the need for insulin therapy. β-cell replacement is shifting from traditional transplantation of organ donor islets and the pancreas to stem cell-derived β cells. Bioengineering methods, such as encapsulation, and gene editing to create hypoimmune cells could reduce the need for immunosuppression that has hampered β-cell replacement, and patient-derived stem cells open doors to personalised therapies. Although these innovations have been made available to a small number of patients, scaling them to widespread use remains a challenge. Meanwhile, glucose regulation is improving through the use of automated insulin delivery systems that combine glucose monitoring with insulin pumps. New-generation insulins (those that are ultrarapid, ultralong, and glucose-responsive) improve outcomes by minimising blood sugar fluctuations. Together, these breakthroughs offer renewed hope for improving long-term management and quality of life for people living with type 1 diabetes.
56. Once-daily oral icotrokinra versus placebo and once-daily oral deucravacitinib in participants with moderate-to-severe plaque psoriasis (ICONIC-ADVANCE 1 & 2): two phase 3, randomised, placebo-controlled and active-comparator-controlled trials.
作者: Linda Stein Gold.;April W Armstrong.;Robert Bissonnette.;Nina Magnolo.;Ronald B Vender.;Michael Sebastian.;Maria Laura Galimberti.;Athanasios Tsianakas.;Marcelo Arnone.;Paul Wallace.;Margrit Simon.;Josep Riera-Monroig.;Sascha Gerdes.;Jill Waibel.;Alvaro Gonzalez-Cantero.;Beate Schwarz.;Yayoi Tada.;Michael Cecchini.;Benjamin Ehst.;Leon Kircik.;Lea Kephart.;Ofelia Reyes-Servin.;Bassey Effiom Edem.;Jennifer H Campbell.;Yaung-Kaung Shen.;Kellen Cresswell.;Shu Li.;Cynthia M C DeKlotz.;Fabio Nunes.;Kim A Papp.
来源: Lancet. 2025年406卷10510期1363-1374页
Monoclonal antibodies targeting interleukin-23 and interleukin-12 are efficacious in treating plaque psoriasis but must be delivered via intravenous or subcutaneous injection. Here, we aimed to evaluate the efficacy and safety of icotrokinra (JNJ-77242113), a targeted oral peptide that selectively binds the interleukin-23 receptor, compared with both placebo and deucravacitinib in adults with moderate-to-severe plaque psoriasis.
57. Minimum effective low dose of antithymocyte globulin in people aged 5-25 years with recent-onset stage 3 type 1 diabetes (MELD-ATG): a phase 2, multicentre, double-blind, randomised, placebo-controlled, adaptive dose-ranging trial.
作者: Chantal Mathieu.;Julie Wych.;A Emile J Hendriks.;Lisa Van Ryckeghem.;Timothy Tree.;Piotr Chmura.;Christopher Möller.;Kristina Casteels.;Thomas Danne.;Felix Reschke.;Darja Šmigoc Schweiger.;Tadej Battelino.;Jesper Johannesen.;Birgit Rami-Merhar.;Thomas Pieber.;Christophe De Block.;Mark Evans.;Robert Hilbrands.;Emanuele Bosi.;Ruben H Willemsen.;Supriyo Basu.;Mari-Anne Pulkkinen.;Mikael Knip.;Miriam Cnop.;Almut Nitsche.;Anke M Schulte.;Elisabeth Niemöller.;Mark Peakman.;Charlotte Wilhelm-Benartzi.;David Gillespie.;Lut Overbergh.;Adrian P Mander.;M Loredana Marcovecchio.; .
来源: Lancet. 2025年406卷10510期1375-1388页
Type 1 diabetes remains an important health-care problem, with no disease-modifying therapies available in people with recent-onset, clinical type 1 diabetes. Adaptive trial designs, allowing faster evaluation of treatment modalities, remain underexplored in this stage of the disease. We aimed to identify the minimum effective dose of antithymocyte globulin (ATG) in people aged 5-25 years with recent-onset, clinical type 1 diabetes.
60. Oncolytic viruses as anticancer agents: clinical progress and remaining challenges.
作者: Elizabeth Appleton.;E Antonio Chiocca.;Guy Ungerechts.;Alan Melcher.;Richard Vile.
来源: Lancet. 2025年406卷10509期1295-1312页
Immunotherapy has transformed the treatment of cancer, yet many patients do not have response or lasting benefit. Strategies to overcome resistance remain of crucial importance. Oncolytic viruses offer a promising approach, with the unique ability to selectively replicate within (and to destroy) cancer cells, remodel the immunosuppressive tumour microenvironment, and stimulate antitumour immunity. Interest in the potential of oncolytic viruses has grown steadily over the past two decades, fuelled by advances in cancer immunology and viral engineering. However, clinical translation has not kept pace, and although a plethora of promising new constructs have entered clinical testing, several barriers continue to restrict widespread clinical implementation. This Therapeutics paper highlights key milestones in oncolytic virus clinical development, discusses the challenges that remain, and, through clinical reflection, considers how future research might be streamlined to achieve meaningful benefit for patients.
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