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Fewer breathing pauses, better pacing, lower pressure: four fresh trial results

ResearchDigest · 4 storiesMedicine and treatment

4 stories this week: sleep apnoea in people with overweight or obesity, where a pacemaker should stimulate the heart, blood pressure control in ordinary clinics and lupus. Four randomised trials, each with what it does not yet show.

In 712 adults with excess weight and moderate to severe sleep apnoea, a daily tablet cut breathing pauses by 12–13 an hour more than placebo

A dim bedroom at night with an unmade bed, white linen and a softly glowing bedside lamp beside a glass of water

On 9 November 2026 JAMA published ATTAIN-OSA, two 52-week phase 3, double-blind, placebo-controlled trials of orforglipron, a once-daily oral GLP-1 receptor agonist, at 66 sites in nine countries. All participants had moderate to severe obstructive sleep apnoea and a body mass index of 27 or more. Trial 1 enrolled 363 people who were not using a positive airway pressure (CPAP-type) machine; trial 2 enrolled 349 who were.

The main measure was the apnoea-hypopnoea index, the number of breathing pauses and shallow-breathing episodes per hour of sleep. It started at about 51 and 58 events an hour. After a year it fell by 17.8 versus 4.5 on placebo in trial 1, a difference of 13.2, and by 17.3 versus 5.3 in trial 2, a difference of 12.0. Six of seven key secondary measures, including sleep apnoea-specific hypoxic burden and patient-reported sleep-related impairment, also favoured the tablet.

Gastrointestinal side effects were common: about 68–71% on the tablet versus 37% on placebo. The average index was still well above the usual normal range of under 5 events an hour. The abstract reports no heart attack or stroke outcomes, and several authors list Eli Lilly affiliations.

In 685 people with heart block, pacing the left bundle branch halved a combined outcome of death, heart failure admissions and pacing-related heart damage

A small modern cardiac pacemaker with a thin coiled lead resting on a blue sterile drape under soft clinical light

On 8 November 2026 the New England Journal of Medicine published OptimPacing, an investigator-initiated, international, open-label randomised trial in people with atrioventricular block, where the electrical signal does not pass properly from the upper to the lower chambers of the heart. Standard pacing of the right ventricle is associated with the heart contracting out of step and with weakening of the left ventricle; left bundle-branch pacing preserves electrical and mechanical synchrony. Of 702 people randomised, 685 were analysed; mean age was 68.4 years.

The trial was stopped early on the advice of its data monitoring committee. Over a median of 35 months, death from any cause, hospital admission for heart failure or pacing-induced cardiomyopathy occurred in 16 people with left bundle-branch pacing and 35 with right ventricular pacing: an estimated 8.5% versus 19.2% at four years (hazard ratio 0.41; 95% CI 0.23 to 0.75). Serious adverse events not related to the implant procedure occurred in 11.8% and 9.3%.

There were only 51 primary-outcome events in total, trials stopped early can overstate a benefit, and neither patients nor doctors were blinded. The abstract does not say which part of the combined outcome drove the difference. The trial was funded by a Jiangsu Province new-technology programme and others.

In adults with uncontrolled hypertension in Colombia and Jamaica, combination pills with team-based care lowered systolic pressure by 10 mm Hg more than usual care

A home blood pressure monitor with a dark blank screen on a wooden kitchen table beside a small pill organiser and a cup of tea

On 8 November 2026 JAMA published a pragmatic cluster randomised trial in 40 primary care clinics, 20 in Colombia and 20 in Jamaica. It enrolled 1706 adults whose blood pressure stayed uncontrolled even though 98.2% were already taking blood pressure medicines; mean age was 61.4 years and 69.9% were women. In half of the clinics, staff were trained to use single-pill combinations, several medicines in one tablet, supported by health coaching, home blood pressure monitoring and audit and feedback, and the pills were provided to patients. The other clinics continued usual care.

Among the 1574 people in the main analysis, over 18 months systolic pressure fell from 145.9 to 126.8 mm Hg in the intervention clinics and from 145.0 to 136.1 mm Hg with usual care, a difference of 10.1 mm Hg (95% CI 6.9 to 13.3). A reading below 130/80 mm Hg was reached by 69.5% versus 29.2%. Serious adverse events, deaths and hospital admissions, occurred in 7.9% and 9.9%.

The trial tested a package, so it cannot say how much came from the combined pill and how much from coaching, home monitoring and the provided medicines. It was unblinded, and the abstract reports blood pressure, not heart attacks or strokes.

In 123 people with active lupus, an anti-CD20 antibody in phase 2 testing raised the response rate at 12 weeks from 34% to 52%

A pair of hands resting on a soft knitted blanket in warm afternoon light in front of a sunlit window

On 8 November 2026 The Lancet Rheumatology published a phase 2, double-blind, placebo-controlled trial of obinutuzumab β, a glycoengineered type II anti-CD20 antibody aimed at B cells, immune cells that play a central role in systemic lupus erythematosus. The trial ran at 30 hospitals in China and included 123 adults with active disease who continued their usual lupus treatment; mean age was 36 years and 93% were women.

At week 12, 52% of people on the antibody and 34% on placebo met the SLE Responder Index-4, a standard composite measure of improvement (adjusted difference 19 percentage points; 95% CI 3 to 36). Over 52 weeks, serious adverse events occurred in 20% and 23%; one death from sepsis occurred in the placebo group.

This is a small phase 2 trial in which 95% of participants were of Han Chinese ethnicity, and its main result was measured after only 12 weeks. Larger and longer trials are needed to know whether the benefit lasts. The trial was funded by Beijing Mabworks Biotech.

This article is for information only and does not replace a consultation with a doctor. Nothing in it is a recommendation to start, stop or change treatment.

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