In our article on Drugs for Chronic Insomnia, we said there is little evidence that antidepressants such as trazodone, mirtazapine, or amitriptyline are effective in treating insomnia not associated with depression. We received a comment from a reader who has prescribed the tricyclic antidepressant amitriptyline for insomnia, particularly for patients with headache disorders, and finds that most patients are satisfied with the treatment.

Ocrevus Zunovo (Genentech), a subcutaneous (SC) formulation of the anti-CD20 monoclonal antibody ocrelizumab plus human recombinant hyaluronidase-ocsq has been approved by the FDA for treatment of primary progressive and relapsing forms of multiple sclerosis (MS). Intravenous ocrelizumab (Ocrevus), which was approved for the same indications in 2017, is one of the most commonly prescribed drugs for treatment of MS. Ocrelizumab remains the only drug approved for treatment of primary progressive MS.

Optune Pax (Novocure), a portable device that delivers low-intensity alternating electrical fields to the abdomen, has been approved by the FDA for use with gemcitabine and nab-paclitaxel (GnP) for treatment of locally advanced pancreatic cancer in adults. It is the first device to be approved in the US for treatment of pancreatic cancer. Similar devices are available for treatment of certain lung cancers (Optune Lua) and glioblastoma (Optune Gio).

The oral Janus kinase (JAK) inhibitor baricitinib (Olumiant – Lilly), which was previously approved by the FDA for treatment of moderately to severely active rheumatoid arthritis and treatment of COVID-19 in certain hospitalized adults, has now been approved for treatment of severe alopecia areata in adults. Baricitinib is the first systemic treatment to be approved in the US for this indication.

The FDA has approved tremelimumab-actl (Imjudo – AstraZeneca), a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) blocking antibody, for use in combination with the programmed death-ligand 1 (PD-L1) blocking antibody durvalumab (Imfinzi) and platinum-based chemotherapy for treatment of metastatic non-small cell lung cancer (NSCLC) in adults with no sensitizing epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) genomic tumor aberrations.

Two cell-based gene therapies – exagamglogene autotemcel (Casgevy – Vertex) and lovotibeglogene autotemcel (Lyfgenia – Bluebird Bio) – have been approved by the FDA for treatment of sickle cell disease in patients ≥12 years old with recurrent vaso-occlusive crises. They are the first gene therapies to be approved in the US for use in sickle cell disease; Casgevy is the first treatment to be approved in the US that uses CRISPR/Cas9 gene-editing technology.

The oral adenosine triphosphate-citrate lyase (ACL) inhibitor bempedoic acid was approved by the FDA in 2020 for use alone (Nexletol – Esperion) and in a fixed-dose combination with the cholesterol absorption inhibitor ezetimibe (Nexlizet) as an adjunct to maximally tolerated statin therapy in adults with heterozygous familial hypercholesterolemia (HeFH) or established atherosclerotic cardiovascular disease (ASCVD) who require additional LDL-cholesterol (LDL-C) lowering. The indication has now been expanded to include reducing the risk of myocardial infarction (MI) and coronary...

Vyalev (Abbvie), a solution for continuous subcutaneous infusion containing the prodrugs foscarbidopa and foslevodopa, has been approved by the FDA for treatment of motor fluctuations in adults with advanced Parkinson's disease (PD). Vyalev is the first subcutaneously administered product to become available in the US for treatment of PD symptoms. Duopa, a carbidopa/levodopa enteral suspension infused via a nasojejunal tube or percutaneous gastrostomy, was approved in for the same indication 2015.

Mitapivat (Aqvesme – Agios), an oral pyruvate kinase activator, has been approved by the FDA for treatment of anemia in adults with alpha or beta thalassemia. It is the first product to be approved in the US for treatment of alpha thalassemia and the first oral option for beta thalassemia. Mitapivat was approved in 2022 as Pyrukind for treatment of hemolytic anemia in adults with pyruvate kinase deficiency.

The FDA has approved olezarsen (Tryngolza – Ionis), a subcutaneously injected apolipoprotein C-III (apoC-III)-directed antisense oligonucleotide, to reduce triglyceride levels and the risk of acute pancreatitis in adults with severe hypertriglyceridemia. Olezarsen and the apoC-III-directed small interfering RNA plozasiran (Redemplo) were approved earlier to reduce triglyceride levels in adults with familial chylomicronemia syndrome (FCS).