CLINICAL UPDATE · FOR HEALTHCARE PROFESSIONALS

Primary Care
Research Brief

2 October 2026

The practice-changing item this week is South Africa's new Adult Primary Care guide and asthma pathway. A major obesity-drug trial is impressive but not yet ready for routine prescribing; two further studies refine mental-health and women's-health discussions.

1 OCTOBER · AUTHORITATIVE SOUTH AFRICAN NATIONAL GUIDANCE

South Africa updates adult primary care and moves asthma away from SABA-only treatment

Question and result. What should public-sector primary care use now? The National Department of Health launched the 2026 Adult Primary Care guide and published an updated respiratory STG/EML. For adults and adolescents aged 12 years or older, steps 1–2 use low-dose inhaled corticosteroid–formoterol as anti-inflammatory reliever only; steps 3–4 use maintenance-and-reliever therapy. SABA-only treatment is no longer the preferred pathway.

Evidence strength and limitations. This is authoritative national guidance underpinned by NEMLC evidence and economic reviews, not a new trial. Availability of the correct inhaler, staff training and provincial implementation may lag; the full APC guide should be used rather than this summary.

GP implication. South African clinicians should replace old asthma algorithms, check that every asthma patient has ICS-containing treatment, teach inhaler technique and confirm the locally stocked budesonide/formoterol device. Review anyone relying on frequent reliever doses.

Verdict: Change South African practice now, subject to local formulary implementation. UK and Irish clinicians should continue their national asthma pathways.

Open the 2026 Adult Primary Care guide → Open the updated STG/EML repository →

29 SEPTEMBER · PEER-REVIEWED PHASE 3 RANDOMISED TRIAL

Retatrutide produced very large weight loss, but it remains investigational

Question and result. In adults with obesity without diabetes, what does weekly retatrutide achieve over 80 weeks? Among 2,339 participants, mean weight change was −17.6%, −23.7% and −25.0% with 4, 9 and 12 mg, versus −3.9% with placebo. The trial also assessed knee-osteoarthritis pain and obstructive sleep apnoea subgroups.

Evidence strength and limitations. Strong double-blind phase 3 evidence with a large effect, but the main outcome is weight rather than cardiovascular events or mortality. The manufacturer funded the trial; gastrointestinal adverse events were common, long-term safety and weight regain after stopping remain uncertain, and availability and cost are unresolved.

GP implication. Acknowledge the result when patients ask, but do not prescribe unregulated or compounded “retatrutide.” Continue licensed obesity treatments and structured lifestyle care according to NICE, Irish and South African policy.

Verdict: Watch closely—no routine practice change until regulatory approval, local guidance and longer-term safety data.

Read the phase 3 trial →

28 SEPTEMBER · PEER-REVIEWED RANDOMISED TRIAL

Peer-supported online CBT modestly reduced anxiety after low-risk chest pain

Question and result. After emergency assessment excludes acute coronary syndrome, can telehealth CBT help patients with low-risk chest pain and anxiety? In 375 US patients, peer-supported internet CBT improved GAD-7 scores by 1.22 points more than primary-care referral over 12 months (effect size 0.25); the difference was 2.8 points in those with severe anxiety. Depression, somatisation and disability did not differ.

Evidence strength and limitations. Randomised comparative-effectiveness evidence with diverse enrolment and 12-month follow-up. The average effect was small and the confidence interval nearly included no effect; outcomes were self-reported, all groups improved, and the US university-emergency setting limits transferability.

GP implication. Once cardiac red flags are addressed, recognise and treat anxiety rather than repeating low-value cardiac tests. Where a supported digital CBT service exists, it is a reasonable option—especially for severe anxiety—but a link without support is not equivalent.

Verdict: Use selectively; do not reorganise care on this trial alone.

Read the PACER trial →

2 OCTOBER · PEER-REVIEWED SYSTEMATIC REVIEW AND META-ANALYSIS

Cardiovascular risk is concentrated after iatrogenic menopause before age 45

Question and result. Does surgical or treatment-induced menopause carry long-term cardiovascular risk, and does age matter? Across 36 studies and 2.62 million women, iatrogenic menopause was associated with stroke (pooled HR 1.22). Cardiovascular mortality was higher when menopause occurred before age 45 (HR 1.20) but not at 45 or older; all-cause mortality showed the same age pattern.

Evidence strength and limitations. Large, carefully analysed synthesis, but most evidence was observational, exposures and comparators varied, heterogeneity was substantial for some outcomes, and hormone-therapy effects could not be established reliably.

GP implication. Record age and cause of menopause, address blood pressure, lipids, smoking and diabetes proactively, and review bone and menopausal-hormone-therapy needs using local guidance. The study supports risk assessment; it does not prove that extra screening or hormone therapy prevents events.

Verdict: Improve risk-factor review now; treatment thresholds and hormone-therapy practice remain unchanged.

Read the meta-analysis →

MOST WORTH READING · RANKED

Four sources for practice

Window: 26 September–2 October 2026. All research selections are peer-reviewed; no preprints or conference-only findings are included. The South African item is authoritative national guidance. No comparably important new NICE or Irish HSE primary-care guideline was verified in this window. Educational summary for healthcare professionals; local guidance and individual assessment take precedence.

Earlier briefings: 25 September · 18 September · 11 September · 4 September.