Rapid recommendations

Guideline updates

The American Headache Society recommends calcitonin gene-related peptide (CGRP)–targeting therapies (monoclonal antibodies or gepants) as a first-line option for migraine prevention alongside other established options (no level of evidence indicated).¹ While other first-line options such as specific antihypertensives, antiseizure medications, and antidepressants remain available, CGRP therapies have improved tolerability and compliance. In some studies, CGRP therapies were found to be superior to older treatments like topiramate. In addition, gepants can also be used for acute migraine treatment in those who cannot tolerate triptans.^2,3

The American Academy of Orthopaedic Surgeons recommends the Carpal Tunnel Syndrome–6 (CTS-6) clinical evaluation tool as a valid diagnostic alternative for carpal tunnel syndrome (strong recommendation, high-quality evidence).⁴ The CTS-6 score (maximum 26 points) is determined through numbness predominantly in the median distribution, nocturnal symptoms, presence of thenar atrophy, a positive Phalen test, a positive Tinel sign, and a loss of 2-point discrimination.⁵ The CTS-6 demonstrates high diagnostic correlation with an electromyography (EMG) test (r=0.9), supporting its use for clinical diagnosis, with EMG reserved for cases with low pretest probability or uncertainty. Additionally, there is strong evidence that corticosteroid and platelet-rich plasma (PRP) injections do not provide long-term benefits. Routine splinting and supervised physiotherapy after carpal tunnel release do not improve outcomes.

The Global Initiative for Asthma (GINA) recommends all patients with asthma, including those with infrequent symptoms, receive inhaled corticosteroids (ICS) to reduce the risk of exacerbations (Grade A or B evidence, depending on severity of symptoms).⁶ This replaces earlier recommendations allowing short-acting β-agonist (SABA) monotherapy for patients with symptoms less than twice per month and no risk factors. For adolescents and adults, the preferred first-line therapy remains low-dose combination ICS and formoterol, used either as needed or as maintenance-and-reliever therapy, depending on symptom burden and risk of complications. For children aged 6 to 11 years, or for patients unable to use ICS-formoterol inhalers, GINA recommends taking ICS whenever SABA is used, either as separate or combination inhalers. This approach ensures patients with mild asthma receive anti-inflammatory treatment, as SABA-only regimens are no longer considered safe due to increased risk of severe exacerbation, hospitalization, and asthma-related death. Additionally, when a spirometry test is unavailable, assessing peak expiratory flow is now preferred over symptom assessment alone—such as presence of wheezing—for confirming asthma, given the limited specificity of symptoms alone.

Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines recommend using combined creatinine and cystatin C–based estimated glomerular filtration rate (eGFRcr-cys) instead of eGFRcr alone when cystatin C is available (level 1B evidence).⁷ Combining creatinine and cystatin C improves accuracy and strengthens risk prediction, making it particularly useful when creatinine-based estimates are uncertain. This approach is beneficial in patients with altered muscle mass (eg, those who are elderly, malnourished, or have extreme body composition), chronic illnesses, or conditions affecting creatinine production (eg, cirrhosis, paraplegia). In cases of diagnostic uncertainty, obtaining eGFRcr-cys or eGFRcys helps reduce misclassification, particularly in borderline eGFR cases (45 to 60 mL/min/1.73 m²), and supports more precise chronic kidney disease diagnosis, staging, and treatment decisions.

The 2024 KDIGO guidelines emphasize that hyperkalemia is often manageable with potassium-lowering strategies, allowing continued use of renin-angiotensin system inhibitor (RASi) therapy without dose reduction or discontinuation (no level of evidence provided).⁷ First-line measures include dietary potassium restriction and medication review to identify contributing agents (eg, nonsteroidal anti-inflammatory drugs, trimethoprim). Second-line options include diuretics, sodium bicarbonate, and potassium binders (eg, patiromer, sodium zirconium cyclosilicate). Discontinuation of RASi or mineralocorticoid receptor antagonist should be reserved for cases where hyperkalemia persists despite optimal management. Regular potassium monitoring (within 2 to 4 weeks of RASi initiation or dose adjustment) ensures safe and effective therapy continuation.

The 2024 KDIGO guidelines now recommend sodium-glucose cotransporter-2 inhibitors (SGLT2Is) for adults with chronic kidney disease (CKD) (eGFR of 20 to 45 mL/min/1.73m²) and low albuminuria (albumin-to-creatinine ratio <20 mg/mmol) (level 2B evidence).⁷ While benefits are well-established in high-albuminuria CKD, trials such as Study of Heart and Kidney Protection With Empagliflozin suggest SGLT2Is slow disease progression, reduce risk of acute kidney injury, and lower hospitalization rates in low-albuminuria CKD. Long-term benefits remain uncertain due to short trial follow-ups, but analyses suggest delayed kidney failure and dialysis initiation. Additional advantages include blood pressure reduction, improved fluid balance, lower uric acid levels, and hyperkalemia prevention.

The Canadian Coalition for Seniors’ Mental Health recommends aripiprazole, brexpiprazole, or risperidone for treating severe agitation in dementia (conditional recommendation, moderate-quality evidence).⁸ If a patient is already taking a cholinesterase inhibitor or memantine, these medications can be optimized (conditional recommendation, very low-quality evidence). For patients unable to tolerate antipsychotics, citalopram may be considered. The guideline does not recommend trazodone, sertraline, mirtazapine, fluoxetine, paroxetine, fluvoxamine, tricyclic antidepressants, or valproic acid due to lack of efficacy and safety concerns. For refractory symptoms, quetiapine, carbamazepine, or synthetic cannabinoids may be considered, though evidence is limited. Olanzapine is reserved for short-term emergency treatment. Nonpharmacologic options include music therapy, exercise, massage, and robotic pets.

The Lancet standing Commission on Dementia Prevention, Intervention, and Care added 2 new modifiable risk factors—untreated vision loss and high low-density lipoprotein cholesterol—to the list of factors associated with dementia risk (no level of evidence provided).⁹ This brings the total number of modifiable risk factors to 14, alongside established factors like hearing loss, hypertension, depression, undereducation, social isolation, and air pollution. The population attributable fraction for these 14 factors is estimated to be approximately 45%, meaning that addressing these factors could prevent nearly half of all cases of dementia. Prevention can benefit all patients, including those with genetic risk factors (such as APOE gene status).