Lancet

Bowman SJ, Fox R, Dörner T, et al. Safety and efficacy of subcutaneous ianalumab (VAY736) in patients with primary Sjögren's syndrome: a randomised, double-blind, placebo-controlled, phase 2b dose-finding trial. Lancet 2022; 399: 161–71—In figure 2E of this Article, the least-squares mean change from baseline in ESSPRI scores of the placebo group and the ianalumab 300 mg group were plotted incorrectly. In figure 2F, the percentages for ianalumab 50 mg at baseline, ianalumab 50 mg at week 24, and ianalumab 300 mg at week 24 were incorrect.

Ageing is a scientifically fascinating and complex biological occurrence characterised by morphological and functional changes due to accumulated molecular and cellular damage impairing tissue and organ function. Ageing is often accompanied by cognitive decline but is also the biggest known risk factor for Alzheimer's disease, the most common form of dementia. Emerging evidence suggests that sedentary and unhealthy lifestyles accelerate brain ageing, while regular physical activity, high cardiorespiratory fitness (CRF), or a combination of both, can mitigate cognitive impairment and reduce dementia risk.

Vaccination remains the most cost-effective public health intervention, preventing millions of deaths and reducing disease burden worldwide.1 However, their impact is rendered meaningless if vaccines are not epidemiologically relevant to the populations they serve, are not accepted by communities, or are not effectively delivered through routine or mass immunisation programmes. As history has shown, immunisation programmes have always faced threats—from political instability to misinformation—and these challenges are growing more severe in today's global landscape.

On March 13, 2025, the UK Government announced that it was disbanding NHS England, the arm's length government body overseeing health-care delivery in England. This was a shock to many people. But there is public support for change in the NHS. Using a sample of 2088 people in the UK, a UCL Policy Labs and More in Common polling report from March, 2025, indicated 72% of people think things in the UK are getting worse and 61% think the NHS needs radical change.1 However, the British public generally do not want the careless and irresponsible actions of US President Donald Trump's executive orders, leading the report to conclude the “British people are looking for change, but not chaos, radicalism, but not recklessness”.

Population-based analyses of new vaccination programmes provide robust real-world evidence for post-licensure vaccine evaluation. A 2023–24 vaccine effectiveness analysis of immunocompetent adults aged 60 years or older in the USA showed 80% (95% CI 71–85) protection against respiratory syncytial virus (RSV)-associated hospital admissions.1 In England, the UK Joint Committee on Vaccination and Immunisation advised an initial programme for those turning 75 years old, with a catch-up to age 79 years, pending further data on protection of those who are older.

Overactive bladder is a chronic condition that affects 10–45% of women worldwide;1 however, more than half of women discontinue conservative and medical treatment.2,3 Predicting which women are better served by more invasive, third-line treatments, such as intradetrusor botulinum toxin A (BoNT-A) or sacral neuromodulation, has been elusive. Urodynamic studies have been used to better assess the cause of lower urinary tract symptoms. Expert societies, such as the European Association of Urology and the Canadian Urology Association, recommend conducting urodynamic studies in the event of treatments that did not work, when the diagnosis of overactive bladder is unclear, or if the choice of invasive treatments might change.

In women with refractory overactive bladder or urgency predominant mixed urinary incontinence, the participant-reported success in the urodynamics plus CCA group was not superior to the CCA-only group, and urodynamics was not cost-effective at the £20 000 per QALY gained threshold.

The US Agency for International Development (USAID) is no more. Marco Rubio, the US Secretary of State, has announced that 83% of programmes funded by USAID are to be ended, with the remainder to be absorbed by the State Department. Notwithstanding legal challenges, these decisions signal the end of an organisation that has brought crucial aid to millions globally. The move confirms the worst fears of the international community, coming 6 weeks after a pause on USAID's work that saw 5200 contracts cancelled, classified documents shredded, and life-saving aid halted.

A 2022 review evaluating the global magnitude of encephalitis burden concluded that low-income and middle-income countries (LMICs) had the highest age-standardised incidence rate worldwide (31·63 per 100 000 compared with 6·17 per 100 000 in high-income countries).1 Reported case fatality rates for Neisseria meningitidis were sometimes 3·5 times higher than in high-income countries.2 Accordingly, the Article in The Lancet by Bhagteshwar Singh and colleagues, reporting simple, context-informed interventions to improve the diagnosis and management of brain infections in Brazil, India, and Malawi, addresses a major public health issue.

We would like to express our sincere gratitude to the many dedicated peer reviewers who provided insightful and thoughtful comments on manuscripts submitted to The Lancet in 2024. With the rise in misinformation, together with the challenges posed by paper mills and other research integrity issues,1,2 we depend more than ever on peer reviewers to help uphold the standards of academic research and facilitate The Lancet's goal to publish the best science for better lives. In 2024, more than 1700 peer reviewers from 76 countries volunteered their time to critically assess submissions to the journal.

Kristin Moberg Aakre

After a series of senior departures from NHS England, the UK Prime Minister has caused shockwaves by abolishing the body entirely. Jacqui Thornton reports.

German drugmaker Grünenthal pushed its latest opioid as a safer option. People around the world got hooked. Madlen Davies, Hristio Boytchev, and Rafael Cabrera report.

Why would John Green, a best-selling American novelist, write a book about tuberculosis? The answer can be found in his new book Everything is Tuberculosis: The History and Persistence of Our Deadliest Infection. In this highly readable book, Green writes about how he saw first-hand and learnt that “tuberculosis is both a form and expression of injustice”, and decided to do something about it. The book focuses on the story of Henry Reider, a young tuberculosis patient in Sierra Leone, and his journey to recover from drug-resistant tuberculosis.

“Girls' bodies were fair game”, Sarah Moss writes. “You all knew which were the gropey dads…whom you shouldn't visit when the grandfather was there.” The teenage girls protected each other, she says, until they could not. “Jen's dad's got Cathy in the spare room and we can't get in. Be quiet, Suzy's dad said, the man's a doctor, you could ruin his career saying things like that.” Moss is well admired as a writer of fiction and non-fiction, but My Good Bright Wolf: A Memoir is distinct. Born in Glasgow and brought up in England, the book explores her early life and its adult repercussions.

Former President of the Planned Parenthood Federation of America and defender of sexual and reproductive health and rights. Born on July 15, 1957, in Waco, TX, USA, she died from glioblastoma in New York City, NY, USA, on Jan 20, 2025, aged 67 years.

Bretherton CP, Achten J, Jogarah V, et al. Early versus delayed weight-bearing following operatively treated ankle fracture (WAX): a non-inferiority, multicentre, randomised controlled trial. Lancet 2024; 403: 2787–97—In this Article, the spelling of author Henry Claireaux's name has been corrected. This correction has been made to the online version as of March 20, 2025

Almost 40 years ago, the discovery of the vasoactive neuropeptide calcitonin gene-related peptide (CGRP) and its role in migraine pathophysiology ushered in a new era in migraine treatment. Since 2018, monoclonal antibodies (mAbs) targeting the CGRP pathway are available for migraine prevention. The approval of these drugs marks a pioneering development, as they are the first pharmacological agents specifically tailored for migraine prevention. Introduction of these agents contrasts the historical reliance on traditional preventive medications initially formulated for other indications and later repurposed for migraine therapy.

The recent outbreak of Guillain–Barré syndrome in Pune (India) has become a matter of increasing national concern and has warranted the involvement of international agencies.1 As of March 8, 2025, the total number of Guillain–Barré syndrome cases in Pune was 225, with 197 confirmed diagnoses and 28 suspected cases, and can be considered as one of the largest Guillain–Barré syndrome outbreaks.2,3 The death toll has risen to 23 people in India, and Pune continues to be the worst affected with 11 deaths from Guillain–Barré syndrome.

Traditional solid fuels, such as coal and biomass, continue to be widely used to meet daily cooking energy needs, with particularly widespread consumption persisting in many low-income and middle-income countries (LMICs).1 Incomplete burning of these solid fuels yields various hazardous particles that pollute ambient and indoor air.2 Prolonged indoor exposure to household air pollution (HAP) substantially elevates the risk of developing severe respiratory and cardiovascular diseases, such as lung cancer, chronic obstructive pulmonary disease, and ischaemic heart disease.