Medical Bulletin 09/September/2025 - Video

A new clinical trial, published in JAMA Internal Medicine has shown that azelastine nasal spray may significantly reduce the risk of SARS-CoV-2 infection. The phase 2 randomized, double-blind study, titled CONTAIN, involved 450 participants and revealed a threefold lower infection rate in the treatment group using azelastine compared to those given a placebo.

The trial divided participants into two groups. The treatment group, consisting of 227 individuals, used an azelastine nasal spray three times daily for 56 days. The 223 participants in the control group used a placebo spray over the same period. “During the observation period, 2.2% of the participants in the azelastine group became infected with SARS-CoV-2; in the placebo group, it was 6.7% — three times as many,” said Professor Robert Bals, Director of the Department of Internal Medicine V at Saarland University Medical Center and Professor of Internal Medicine at Saarland University. All infections were verified through PCR testing.

Beyond reducing SARS-CoV-2 infections, the azelastine group also showed fewer symptomatic COVID-19 cases, fewer overall respiratory infections, and—unexpectedly—a reduced incidence of rhinovirus infections. Only 1.8% of the treatment group developed a rhinovirus infection, compared to 6.3% in the placebo group, mirroring the findings seen with coronavirus cases.

Professor Bals sees practical implications for these findings: “Azelastine nasal spray could provide an additional easily accessible prophylactic to complement existing protective measures, especially for vulnerable groups, during periods of high infection rates, or before travelling.” However, he emphasized the need for further investigation: “Our results highlight the need for larger, multicentre trials to continue exploring the use of azelastine nasal sprays as an on-demand preventive treatment.”

Reference: Thorsten Lehr, Peter Meiser, Dominik Selzer, Torben Rixecker, Frank Holzer, Ralph Mösges, Sigrun Smola, Robert Bals, Veronika Alberg, Florian Bub, Nicholas Biwank, Charlotte Dette, Lale Dastgir, Alina Kuntz, Christopher Hale, Johanna Sophie Kapp, Kathrin Litzenburger, Henning Morr, Johanna Wagner, Hacer Sahin, Nelli Schröder, Martina Seibert, Katrin Thieser, Quirin Werthner. Azelastine Nasal Spray for Prevention of SARS-CoV-2 Infections. JAMA Internal Medicine, 2025; DOI: 10.1001/jamainternmed.2025.4283

WHO Updates Essential Medicines List, Adds Cancer, Diabetes and Obesity Drugs

Launched in 1977, the WHO Model Lists serve as a critical global policy tool for guiding the selection and coverage of essential medicines, particularly in public procurement and insurance systems. The 24th edition of the EML and the 10th edition of the EMLc were informed by a rigorous review of 59 applications, including 31 proposals for new medicine inclusions. As a result, 20 new medicines were added to the EML and 15 to the EMLc, bringing the total to 523 medicines for adults and 374 for children.

Cancer continues to be a major global health burden, and the updated EML reflects a stronger emphasis on therapies that show significant clinical benefit. Pembrolizumab was added to the EML as a first-line monotherapy for metastatic cervical cancer, metastatic colorectal cancer, and metastatic non-small cell lung cancer. For the latter, atezolizumab and cemiplimab are included as therapeutic alternatives. The Expert Committee backed strategies to optimize dosage and implement reforms aimed at improving cancer treatment access, especially in low-resource settings.

Diabetes and obesity treatments were another key focus. GLP-1 receptor agonists—semaglutide, dulaglutide, liraglutide—and the dual receptor agonist tirzepatide were added based on robust evidence of improved outcomes in patients with type 2 diabetes and comorbidities. “Achieving equitable access to essential medicines requires a coherent health system response backed by strong political will, multisectoral cooperation, and people-centred programmes that leave no one behind,” said Deusdedit Mubangizi, WHO Director of Policy and Standards for Medicines and Health Products.

The updated lists underscore WHO’s commitment to global health equity by identifying cost-effective, clinically proven treatments with the greatest potential public health impact.

Reference: https://www.who.int/news/item/05-09-2025-who-updates-list-of-essential-medicines-to-include-key-cancer--diabetes-treatments

Insomnia affects nearly one in three adults, with around 10% meeting clinical criteria for a disorder. Standard treatments are often difficult to access or come with risks of dependency. In this context, researchers sought to understand whether cannabis-based medicinal products could provide a viable alternative. The study observed 124 patients using these products and tracked their progress over time.

Participants self-reported their sleep quality, levels of anxiety and depression, pain, and overall quality of life between one and 18 months after beginning treatment. The findings showed sustained improvements in sleep and mental health symptoms throughout the treatment period. Pain levels also declined, adding to the evidence of broader benefits.

Although about 9% of participants experienced side effects such as fatigue, dry mouth, or even worsening insomnia, none of the adverse effects were life-threatening. The researchers emphasized that while these early results are promising, randomized controlled trials are necessary to fully confirm safety and efficacy.

“Over an 18-month period, our study showed that treatment for insomnia with cannabis-based medicinal products was associated with sustained improvements in subjective sleep quality and anxiety symptoms,” said co-author Dr. Simon Erridge, Research Director at Curaleaf Clinic. “These findings support the potential role of medical cannabis as a medical option where conventional treatments have proven ineffective, though further randomised trials are needed to confirm long-term efficacy.”

He further noted, “It was particularly interesting to observe signs of potential tolerance over time, which highlights the importance of continued monitoring and individualized treatment plans.”

The study adds to growing real-world evidence supporting the medical use of cannabis, particularly in cases where traditional therapies fall short.

Reference: Arushika Aggarwal, Simon Erridge, Isaac Cowley, Lilia Evans, Madhur Varadpande, Evonne Clarke, Katy McLachlan, Ross Coomber, James J. Rucker, Mark W. Weatherall, Mikael H. Sodergren. UK Medical Cannabis Registry: A clinical outcomes analysis for insomnia. PLOS Mental Health, 2025; 2 (8): e0000390 DOI: 10.1371/journal.pmen.0000390