Initiating Injectable Buprenorphine During Hospitalization for Infection in Patients with Opioid Use Disorder
Hospitalizations due to infections associated with opioid use disorder (OUD) are rising in the United States, yet few patients begin medication treatment for OUD (MOUD) during their hospital stay. A randomized clinical trial, called the Coordinating Opioid Use Treatment Through Medical Management with Infection Treatment (COMMIT) trial examined whether starting long-acting injectable buprenorphine (LAB) alongside infectious disease care during hospitalization improves MOUD use at 12 weeks compared to usual care. Buprenorphine, a partial opioid agonist, is a medication approved to treat OUD by reducing withdrawal symptoms, cravings, and the risk of relapse while lowering the risk of overdose compared with full opioids.
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The trial enrolled 171 adults hospitalized with moderate to severe OUD and a concurrent infection across three U.S. hospital systems in Connecticut, Pennsylvania, and South Carolina between August 2020 and October 2023. Participants were randomly assigned to receive either infectious disease care with LAB (ID-LAB) or treatment as usual (TAU) during hospitalization or soon after discharge. All patients also received nurse-delivered medical management for their infection. The primary outcome was the proportion of patients receiving any form of MOUD at 12 weeks after randomization.
Participants in the ID-LAB group and TAU group were similar at baseline, with a median age of 39 years (IQR, 33–47), and 51.5% were men. At 12 weeks, 59.3% of patients in the ID-LAB group and 54.1% in the TAU group were receiving MOUD. This difference was not statistically significant (adjusted rate ratio, 1.01; 95% CI, 0.78–1.30).
Findings from the study showed that starting LAB during hospitalization did not significantly increase MOUD uptake at 12 weeks compared to usual care. However, over half of patients in both groups did initiate or continue MOUD. These results highlight ongoing opportunities to integrate MOUD with infection treatment in hospitalized patients with OUD, with nurse-led management potentially playing an important role in care delivery. (Seval, N., et al. [2025]. Initiating injectable buprenorphine in people hospitalized with infections: a randomized clinical trial. JAMA Netw Open, 8(5), e2513000. Retrieved June 2025 from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2834656)
Released: July 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Empagliflozin Preserves Kidney Function and Reduces Heart Failure After Acute Myocardial Infarction
A secondary analysis of the EMPACT-MI trial (Study to Evaluate the Effect of Empagliflozin on Hospitalization for Heart Failure and Mortality in Patients with Acute Myocardial Infarction) evaluated the effects and safety of empagliflozin on kidney function, heart failure, and mortality in patients hospitalized with acute myocardial infarction (MI). Empagliflozin is a sodium–glucose co-transporter 2 (SGLT2) inhibitor used to lower blood sugar in type 2 diabetes, and has been shown to protect the heart and kidneys in patients with heart failure or chronic kidney disease. Nevertheless, the cardiovascular and kidney benefits of empagliflozin in patients after acute MI have not been well studied.
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EMPACT-MI was a double-blind, multicenter trial that randomized 6,522 adults at risk of heart failure to receive either empagliflozin or placebo shortly after an MI. The analysis focused on kidney outcomes in a subset of 1,152 patients with longitudinal kidney function data, along with cardiovascular outcomes across the full cohort. At baseline, the average estimated glomerular filtration rate (eGFR) was 76.1 ml/min/1.73 m2 (SD 19.9).
The results showed that over 24 months, kidney function remained stable in the empagliflozin group, while the placebo group experienced a decline in eGFR (P = 0.01). Empagliflozin also reduced the combined risk of heart failure events or all-cause mortality, and this benefit was consistent regardless of baseline kidney function (P for interaction = 0.30). Adverse event rates at 30 days were similar between the two groups and did not vary by kidney function, suggesting that empagliflozin was safe to start soon after an acute MI.
These findings suggest that empagliflozin may preserve kidney function, lower the risk of heart failure, and improve survival when initiated early in patients with recent MI, including those with reduced kidney function. (Aggarwal, R., et al. [2025]. Secondary analysis of the EMPACT-MI trial reveals cardiovascular–kidney efficacy and safety of empagliflozin after acute myocardial infarction. Nat Cardiovasc Res, 4, 761–772. Retrieved June 2025 from https://www.nature.com/articles/s44161-025-00657-7?utm_source=chatgpt.com#citeas)
Released: July 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Drug Discovered Using Artificial Intelligence, Rentosertib, Appears Safe and Effective in Idiopathic Pulmonary Fibrosis
Few drugs discovered using artificial intelligence (AI) have advanced to human clinical trials. A recent study reports the first phase 2a trial of rentosertib, a novel AI-generated small-molecule inhibitor of TNIK, a TRAF2 and NCK-interacting protein kinase, in idiopathic pulmonary fibrosis (IPF). IPF is a progressive lung disease marked by scarring and inflammation, with no therapies available to reverse its course. Traditional drug discovery for complex diseases like IPF is slow, costly, and constrained by the need to manually evaluate thousands of molecular pathways and compounds. In the study, researchers used an AI-driven discovery platform to systematically identify disease-driving targets, pinpointing TNIK as a critical regulator of IPF because it regulates both fibrotic and inflammatory pathways that worsen lung damage.
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The multicenter, double-blind, randomized, placebo-controlled trial evaluated the safety and early efficacy of rentosertib in 71 adults with IPF. Participants were randomized to receive 30 mg rentosertib once daily, 30 mg twice daily, 60 mg once daily, or placebo for 12 weeks. The primary outcome of the study was the proportion of patients experiencing at least one treatment-emergent adverse event (TEAE). Secondary outcomes included pharmacokinetics, lung function, symptom scores, exercise capacity, and frequency of IPF exacerbations.
Results of the study showed that TEAEs occurred at similar rates across all groups, ranging from 72.2% to 83.3% in the rentosertib groups and 70.6% in the placebo group. Serious treatment-related adverse events were rare, with liver toxicity and diarrhea being the most common reasons for discontinuation. Notably, regarding lung function, patients receiving the highest dose (60 mg once daily) showed a mean increase in forced vital capacity (FVC) of +98.4 mL over 12 weeks, compared to a mean decrease of −20.3 mL in the placebo group.
These findings suggest that rentosertib, a first-in-class TNIK inhibitor designed with AI, is safe, well tolerated, and potentially beneficial in improving lung function in IPF. Further research in larger, longer trials is warranted to confirm these results and assess long-term outcomes. If validated, this approach could represent an important advance in the treatment of a disease with limited therapeutic options. (Xu, Z., et al. [2025]. A generative AI-discovered TNIK inhibitor for idiopathic pulmonary fibrosis: a randomized phase 2a trial. Nat Med, (2025). Retrieved June 2025 from https://www.nature.com/articles/s41591-025-03743-2?utm_source=chatgpt.com#citeas)
Released: July 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.
Investigational Drug Ziresovir Improves Symptoms in Infants Hospitalized with Respiratory Syncytial Virus
Respiratory syncytial virus (RSV) is a serious respiratory infection in certain populations, especially very young infants. A randomized, double-blind, placebo-controlled trial in infants aged 6 months or younger who were hospitalized with RSV examined the safety and efficacy of ziresovir, an investigational oral antiviral agent being specifically developed to treat RSV.
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The study was conducted at 28 hospitals in China between September 2020 and January 2022, with follow-up through February 2024. A total of 188 infants (125 receiving ziresovir and 63 receiving placebo) were included in the safety analysis, while the intention-to-treat infected population (ITT-i) included 150 infants (100 on ziresovir and 50 on placebo). All participants were hospitalized with RSV, began treatment within 7 days of symptom onset, and had a baseline Wang bronchiolitis clinical score (WBCS) of at least 5, indicating moderate disease severity. The WBCS is a standardized scoring system used to assess the severity of bronchiolitis in infants and young children.
Patients were administered ziresovir orally, dosed by weight, twice daily for 5 days. The primary outcome was change in WBCS from baseline to day 3. Patients receiving at least one dose of ziresovir were monitored for any treatment-emergent adverse events throughout the study.
At baseline, the mean age of participants was about 3.4 months, and the mean WBCS was approximately 6.8–6.9 in both groups. On day 3, the least-squares mean change in WBCS was −3.5 points in the ziresovir group versus −2.2 points in the placebo group, a statistically significant difference of −1.2 points (95% CI, −1.9 to −0.6; p=0.0004). Drug-related adverse events occurred in 18% of infants receiving ziresovir and 11% receiving placebo, but no serious drug-related events or deaths were reported.
These findings suggest that ziresovir, an investigational antiviral designed for respiratory syncytial virus (RSV), is safe and well tolerated in infants aged 6 months or younger who are hospitalized with RSV. Moreover, treatment with ziresovir was associated with meaningful improvement in respiratory symptoms compared to placebo during the trial period. These results support further investigation of ziresovir as a potential therapeutic option for this vulnerable population. (Zhang, H., et al. [2025]. Efficacy and safety of ziresovir in hospitalised infants aged 6 months or younger with respiratory syncytial virus infection in China: findings from a phase 3 randomised trial with 24-month follow-up. Lancet Child Adolesc Health, 9(5), 325–336. Retrieved June 2025 from https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(25)00067-7/abstract)
Released: July 2025
Nursing Drug Handbook
© 2025 Wolters Kluwer N.V., its subsidiaries and/or its licensors. All rights reserved.