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COVID-19 Update: 2025-2026 Vaccine Formulations and Recommendations
The Medical Letter on Drugs and Therapeutics • October 13, 2025; (Issue 1739)
The FDA has licensed new 2025-2026 formulations
of the mRNA COVID-19 vaccines manufactured by
Pfizer/BioNTech (Comirnaty) and Moderna (Spikevax,
mNEXSPIKE) and the adjuvanted protein subunit
COVID-19 vaccine manufactured by Novavax
(Nuvaxovid). The new formulations are indicated
for use in all adults ≥65 years old and in persons
6 months (Spikevax), 5 years (Comirnaty), or 12
years (mNEXSPIKE, Nuvaxovid) through 64 years old
who are at high risk for severe COVID-19 because
of an underlying condition. An Emergency Use
Authorization allowing administration of the Pfizer
vaccine to children 6 months through 4 years old has
been withdrawn.
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In Brief: Vybrique — Sildenafil Oral Film for Erectile Dysfunction
The Medical Letter on Drugs and Therapeutics • May 11, 2026; (Issue 1754)
The FDA has approved Vybrique (IBSA), an oral film
formulation of the phosphodiesterase type 5 (PDE5)
inhibitor sildenafil, for treatment of erectile dysfunction
(ED). Sildenafil oral tablets (Viagra, and generics)
have been available since 1998. The manufacturer is
promoting the new product as a "discreet, on-the-go"
option that can be taken without water.
3
In Brief: RSV Vaccine (Arexvy) for Ages 18-49
The Medical Letter on Drugs and Therapeutics • May 11, 2026; (Issue 1754)
The FDA has expanded the licensed use of the recombinant
respiratory syncytial virus (RSV) vaccine Arexvy (GSK) to
include adults 18-49 years old. Arexvy and the two other
available RSV vaccines, Abrysvo and mResvia, are now all
licensed for prevention of RSV lower respiratory tract disease
in persons ≥60 years old and in those 18-59 years old who
are at increased risk of lower respiratory tract disease caused
by RSV. Abrysvo is also licensed for use in pregnant women at 32-36 weeks' gestation to prevent RSV-associated lower
respiratory tract disease in their infants from birth to 6 months.
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In Brief: Wegovy HD – High-Dose Injectable Semaglutide for Weight Loss
The Medical Letter on Drugs and Therapeutics • May 11, 2026; (Issue 1754)
The FDA has approved Wegovy HD, a 7.2-mg dose of the
injectable glucagon-like peptide-1 (GLP-1) receptor agonist
semaglutide, for use in adults who have tolerated the 2.4-mg dose for at least 4 weeks and require additional weight
reduction.
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In Brief: An Expanded Indication for Enhertu
The Medical Letter on Drugs and Therapeutics • May 25, 2026; (Issue 1755)
Fam-trastuzumab deruxtecan (Enhertu – Daiichi Sankyo/AstraZeneca) has now been approved by the FDA for use in
combination with pertuzumab (Perjeta) for first-line treatment
of HER2-positive unresectable or metastatic breast cancer.
The drug was approved earlier for use as monotherapy in
adults with previously treated HER2-positive unresectable or
metastatic breast cancer.
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Insect Repellents
The Medical Letter on Drugs and Therapeutics • July 7, 2025; (Issue 1732)
The Centers for Disease Control and Prevention
(CDC) and the Environmental Protection Agency (EPA)
recommend using insect repellents to avoid being
bitten by mosquitoes, ticks, and other arthropods
that transmit disease-causing pathogens. Repellents
applied to exposed skin should be used in conjunction
with other preventive measures such as wearing long-sleeved
shirts, pants, and socks and avoiding outdoor
activities during peak mosquito-biting times. Some
insect repellents are listed in Table 1.
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Orforglipron (Foundayo) – A Second Oral GLP-1 Receptor Agonist for Weight Loss
The Medical Letter on Drugs and Therapeutics • May 25, 2026; (Issue 1755)
The FDA has approved orforglipron (Foundayo – Lilly), an
oral small-molecule, nonpeptide glucagon-like peptide-1
(GLP-1) receptor agonist, to reduce excess body weight and
maintain weight reduction long term in adults with obesity, or
with overweight and at least one weight-related comorbidity.
Orforglipron is the second oral GLP-1 receptor agonist to be
approved in the US for this indication; an oral formulation of
the peptide semaglutide (Wegovy) was approved in 2025.
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Treatment of Allergic Rhinitis and Allergic Conjunctivitis
The Medical Letter on Drugs and Therapeutics • March 31, 2025; (Issue 1725)
Initial treatment of allergic rhinitis (AR) depends
on the severity of symptoms and whether they are
intermittent or persistent (see Table 1).
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Yuvezzi — A Carbachol/Brimonidine Solution for Presbyopia
The Medical Letter on Drugs and Therapeutics • May 25, 2026; (Issue 1755)
The FDA has approved Yuvezzi (Tenpoint), an ophthalmic
solution containing the cholinergic agonist carbachol 2.75%
and the alpha-adrenergic receptor agonist brimonidine 0.1%,
for treatment of presbyopia. Carbachol and brimonidine have
been available in single-ingredient ophthalmic solutions for
other indications for years.
10
Lerodalcibep (Lerochol) for Hypercholesterolemia
The Medical Letter on Drugs and Therapeutics • May 11, 2026; (Issue 1754)
The FDA has approved lerodalcibep (Lerochol – Lib
Therapeutics), a subcutaneously injected proprotein
convertase subtilisin/kexin type 9 (PCSK9) inhibitor, to
reduce low-density lipoprotein cholesterol (LDL-C) in adults
with hypercholesterolemia, including heterozygous familial
hypercholesterolemia (HeFH). Lerodalcibep is the fourth
subcutaneously injected PCSK9-directed therapy to be
approved in the US; the monoclonal antibodies alirocumab
(Praluent) and evolocumab (Repatha) and the small interfering
RNA inclisiran (Leqvio) were approved earlier (see Table 3)
