Mishaela Rubin, MD, MS, is a professor of medicine at Columbia University Irving Medical Center.

Managing Renal Function and Serum Calcium in Hypoparathyroidism, With Mishaela Rubin, MD, MS

Published in October 2025, a new set of best practice recommendations for the treatment of 

 has updated the existing 2022 international guidelines by incorporating therapeutics from the past 3 years, including the recently approved molecule palopegteriparatide.

HypoPT is a metabolic disorder occurring as a result of hypocalcemia and hyperphosphatemia, which are in turn caused by either a failure of the parathyroid glands to secrete sufficient amounts of active PTH or an inability of PTH to induce a biological response in target tissues. 75% of all cases are caused by surgery, but nonsurgical causes can include autoimmune, genetic variants, metastatic, and radiation.

These updated best practice statements were drafted by a team of international HypoPT experts and resulted from an initiative launched by the Canadian Society of Endocrinology and Metabolism (CSEM) in partnership with several other international endocrine societies. The document aims to provide a practical framework to guide PTH replacement therapy usage with palopegteriparatide in chronic HypoPT.

 editorial team sat down with Mishaela Rubin, MD, MS, professor of medicine at Columbia University Irving Medical Center and a contributing author to the new recommendations, to discuss her thoughts on optimal HypoPT care, including postsurgical risk assessment, genetic evaluation, and dose titration of parathyroid hormone (PTH) therapies.

“I think that clinicians who aren’t sensitized or aren’t aware of hypoparathyroidism might not think about lab results that might be suggestive or what they might mean,” Rubin told 

. “I oftentimes see patients who’ve had symptoms and been seen by different doctors, but nobody made the diagnosis.”

The recommendations open by covering challenges presented by HypoPT, both in diagnosis and treatment. In addition to the disease’s own effects, conventional therapies, such as oral calcium supplements, can potentially increase serum phosphorus, hypercalciuria, and hypercalcemia, and could contribute to renal function declines.

The document goes on to establish optimal uptake and dose titration for PTH and PTH analogues, emphasizing its proven efficacy in reducing urine calcium excretion and maintaining eucalcemia. Ultimately, however, the recommendations shift to palopegteriparatide, a recently approved treatment consisting of PTH (1-34) linked to a polyethylene glycol moiety. With a half-life of roughly 60 hours and providing a sustained release of active PTH, palopegteriparatide allowed patients in multiple phase 2 and 3 trials to achieve total independence from conventional therapy.

The guidelines then turn to emerging therapies, such as eneboparatide, which is a long-acting PTH/PTHrP analog with evidence for lowering urine calcium, normalizing bone remodeling, and achieving eucalcemia. Eneboparatide has received fast track designation from the US Food and Drug Administration (FDA) and is currently under investigation in phase 3 clinical trials.

Ultimately, the guideline encourages close monitoring of serum calcium and renal function, outlining the risks and benefits of each potential therapy and highlighting potential upcoming treatments. The document also emphasizes that updates are expected in 5 years, provided that further long-term data is made available.

“The most important medical complication, I would say, is renal,” Rubin said. “Patients should have some type of renal imaging, at least at baseline, whether that’s a renal ultrasound or a CT scan, to look for nephrocalcinosis and nephrolithiasis. We worry about their hypocalcemic symptoms, about their struggles with neurocognitive function, but I think that careful renal screening sometimes falls under the radar.”

Editor’s Note: Rubin reports disclosures with Amgen, Ascendis, Radius, and NPS Pharmaceutical/Shire.

Khan AA, Ali DS, Bilezikian JP, et al. Best practice recommendations for the diagnosis and management of hypoparathyroidism. Metabolism. 2025;171:156335. 

Hakami Y, Khan A. Hypoparathyroidism. Front Horm Res. 2019;51:109-126. 

https://pubmed.ncbi.nlm.nih.gov/30641528/

Videos

Rubin discusses the recently released best practice recommendations for HypoPT treatment, explaining how clinicians can help turn this dangerous disease around.

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Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

A systematic review of the global disease burden in 

 suggests a rapid rise among young adults but a gradual decline among children by 2050.

The data also suggest countries with a lower sociodemographic index (SDI) carry a disproportionately higher CKD burden. Investigators reported broader society should provide greater attention, support, and resources to low SDI regions.

“Notably, despite persistent disparities in regional burden distribution, the global trend indicates a progressive reduction in the CKD burden among children,” wrote study investigator Nina Zhang, from the Department of Nursing at Shanghai Sixth People’s Hospital. “This optimistic projection holds particular significance for economically disadvantaged regions currently experiencing a disproportionate disease impact.”

The clinical and public health implications of CKD remain substantial. In 2017, CKD affected approximately 850 million people worldwide and accounted for 1.2 million deaths. Investigators cited projections suggesting CKD may become the fifth leading cause of death globally by 2040.

To evaluate long-term trends, investigators conducted a systematic analysis using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2021. The analysis assessed incidence, mortality, and disability-adjusted life years (DALYs) at global, regional, and SDI levels.

Investigators also evaluated attributable risk factors, annual percent change (APC), and average annual percent change (AAPC), and projected CKD incidence from 2022 through 2050. Risk factors were categorized into environmental or occupational, behavioral, and metabolic domains, including exposures such as low temperature, elevated systolic blood pressure, and high-sodium diets. Countries were grouped into 21 geographic regions and stratified into SDI quintiles using 2021 values.

The study population included children aged 0–14 years and young adults aged 15–39 years.

Among children, investigators observed a modest decline in global CKD incidence, decreasing from 31.6 (27.0–37.4) per 100,000 population in 1990 to 30.6 (26.4–35.9) in 2021, although this change was not statistically significant. Over the same period, investigators reported a 45.1% reduction in mortality, from 1.5 (1.0–1.7) to 0.8 (0.6–0.9), and a 43.2% decline in DALYs, from 132.6 (96.1–151.1) to 75.3 (60.8–87.2).

Trend analyses showed a significant overall reduction in pediatric CKD burden from 1990 to 2021. Investigators reported an AAPC of −0.095 (−0.139 to −0.051) for incidence, with notable declines during 1990–1995 and 2016–2021. Mortality declined with an AAPC of −1.925 (−2.129 to −1.720), while DALYs decreased with an AAPC of −1.820 (−2.002 to −1.638).

In contrast, investigators observed a substantial increase in CKD incidence among young adults. From 1990 to 2021, incidence rose by 33.6%, increasing from 27.0 (20.4–34.6) to 36.1 (28.3–45.2). Mortality increased from 2.6 (2.3–2.9) to 2.8 (2.5–3.1), while DALYs rose from 198.3 (176.8–223.9) to 211.1 (188.7–236.7). Investigators noted these changes were not statistically significant.

Across the study period, investigators reported an AAPC of 0.941 (0.927–0.955) for CKD incidence in young adults, with the most rapid growth occurring during 2019–2021. Smaller but significant increases were also observed for mortality (AAPC, 0.256 [0.035–0.477]) and DALYs (AAPC, 0.187 [0.005–0.368]).

Regionally, investigators reported the highest CKD incidence among children in 2021 in Central Latin America [49.9 (43.1–58.5)], Central Asia [48.6 (40.6–57.8)], and North Africa and the Middle East [40.5 (34.8–47.9)]. Among young adults, the highest incidence rates were observed in Central Latin America [70.2 (58.8–83.9)], Central Asia [67.8 (53.6–82.7)], and Eastern Europe [64.6 (47.6–83.6)].

Across SDI strata, investigators observed CKD burden in high-middle and high SDI regions remained lower than the global average. In 2021, age-standardized incidence showed a moderate positive correlation with SDI (r = 0.482; P = 0.028). In contrast, age-standardized mortality (r = −0.719; P <.001) and DALYs (r = −0.835; P <.001) were strongly negatively correlated with SDI.

Investigators reported the proportion of deaths attributable to all CKD risk factors increased from 39.2% in 1990 to 53.9% in 2021. This increase was driven primarily by metabolic risks, which rose from 23.7% to 35.4%, representing a 49.4% increase. Investigators also reported diets high in processed and red meat accounted for a higher proportion of CKD-related deaths in high SDI regions.

Looking ahead, investigators projected pediatric CKD incidence will decline to 25.20 per 100,000 population by 2050, corresponding to 552,469.7 incident cases and a 17.65% reduction compared with 2021. By age group, projected incidence rates include 62.19 in children younger than 5 years, 12.48 in those aged 5–9 years, and 17.80 in those aged 10–14 years.

In contrast, investigators projected CKD incidence among young adults will increase from 36.06 per 100,000 population in 2021 to 47.92 in 2050, with total incident cases reaching 1,768,601. Age-stratified incidence rates were projected at 37.10 (15–19 years), 36.15 (20–24 years), 40.12 (25–29 years), 59.23 (30–34 years), and 99.58 (35–39 years), representing increases of 37.76% to 68.69% compared with 2021.

He Y, Qian Y, Xu Q, Lu Q, Zhang N. Global trends and risk factors of chronic kidney disease in children and young adults from 1990 to 2021: a systematic analysis of the global burden of disease study 2021. 

https://doi.org/10.3389/fpubh.2025.1696021

Kovesdy CP. Epidemiology of chronic kidney disease: An update 2022. Kidney International Supplements. 2022;12(1):7-11. doi:

https://doi.org/10.1016/j.kisu.2021.11.003

Articles

Chronic kidney disease (CKD) is projected to rise among young adults but decline among children by 2050, with a higher burden in low sociodemographic index (SDI) regions. Despite a global reduction in pediatric CKD, young adults face increasing incidence and mortality rates. The study highlights significant regional disparities, with Central Latin America and Central Asia experiencing the highest CKD rates. Metabolic risks, particularly high-sodium diets, are major contributors to CKD-related deaths. Projections indicate a continued decline in pediatric CKD but a substantial increase in young adult cases by 2050.

According to new research, investigators project a rising chronic kidney disease burden in young adults and a declining incidence in children by 2050.


Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

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Global CKD Burden Projected to Rise in Young Adults and Decline in Children by 2050

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

 treated with vunakizumab can expect a favourable clinical response, recent post hoc data suggest, though early response can predict the long-term efficacy of this medication.

Xiaoying Sun, MD, from Shanghai Academy of Traditional Chinese Medicine’s Institute of Dermatology, authored this study alongside a team of other researchers. In the background portion of the study, Sun and colleagues describe vunakizumab as an interleukin (IL)-17A monoclonal antibody approved for the systemic treatment of psoriasis.

The team also highlighted a previous phase 3 analysis (NCT04839016) pointing to vunakizumab’s efficacy at Week 12 and up to Week 52.

 Nevertheless, prior to this analysis, it had been unclear whether those with early response have superior long-term outcomes versus patients without an early response to the medication.

“[This] post hoc study used data from a Phase III trial (NCT04839016), with the aim of investigating the effect of early response on long-term efficacy in vunakizumab-treated moderate-to-severe plaque psoriasis patients,” Sun et al noted.

The investigators’ post hoc analysis involved assessing individuals who were given vunakizumab therapy in a phase 3 clinical study. Those evaluated were categorized based upon their Psoriasis Area and Severity Index (PASI) response at the 2-week mark following the initiation of the drug. They defined early response as attainment of 50% improvement in PASI (PASI 50) by Week 2. This definition was established by the team in advance and documented in the statistical analysis plan.

Those who did not reach PASI 50 at the 2-week mark were classified as not showing an early response to vunakizumab. There were 461 individuals with moderate-to-severe disease who Sun and colleagues included in their analysis. Among these subjects, 249 had met the investigators’ criteria for an early response and 212 were not able to. All of the data implemented in this evaluation were gathered by Sun et al from the original phase 3 trial, and no additional data were needed.

Clinical variables and characteristics were assessed at baseline, with the team paying attention to any previous medication exposure, demographic variables, comorbid conditions, baseline PASI score, duration of psoriasis, static physician’s global assessment (sPGA), and body surface area (BSA) involvement. Long-term clinical efficacy measures, patient-reported outcomes, and safety findings were also investigated by Sun and coauthors.

Their efficacy assessments focused on PASI 75, PASI 90, and PASI 100 response rates. Additionally, they looked at achievement of sPGA scores of 0 or 1. Safety outcomes were assessed in this post hoc analysis in both of the early and non-early responding cohorts.

Findings on Response Timing and Vunakizumab for Psoriasis

Participants by the 12-week mark showing an early response were noted by Sun et al as showing a significantly higher rate of response across all efficacy endpoints versus those without an early response. In specific, the investigative team observed PASI 75 responses in 98.4% of those labaled as early responders.

This was compared to 88.2% of those labaled as non-early responders. They also highlighted PASI 90 responses in 88.0% as opposed to 66.0%, PASI 100 responses in 50.2% as opposed to 25.0%, and sPGA 0/1 responses among 84.7% as opposed to 64.6%, respectively. In all of these comparisons, the data were statistically significant (

These observed differences continued to be seen over time, as a greater proportion of early responders maintained sPGA 0/1, PASI 75, PASI 90, PASI 100 responses from the 12 through 52-week points, versus individuals without an early treatment response (68.7% versus 54.2%, 88.8% versus 76.4%, 74.7% versus 54.7%, 39.4% versus 20.8%; 

In Sun and coauthors’ multivariate logistic regression analysis, they noted early response achievement among subjects was independently linked with PASI 100 attainment at Week 52, with an odds ratio of 1.772 (

 = .027). Adverse events rates were noted as comparable between the 2 arms of the post hoc analysis. Overall, vunakizumab treatment led to favorable clinical outcomes in individuals with moderate-to-severe psoriasis. This was regardless of early response status. However, those who had such a response by Week 2 were significantly more likely to report superior long-term treatment efficacy.

“In conclusion, this post hoc study shows that vunakizumab provides good efficacy and safety in patients with moderate-to-severe plaque psoriasis, whether these patients achieve early response or not,” the investigators wrote.

Sun X, Zhang Y, Li X, et al. Early Response to Vunakizumab at Week 2 Predicts Favourable Long-Term Efficacy in Patients With Moderate-To-Severe Plaque Psoriasis: A Post Hoc Analysis of a Phase III, Randomised Controlled Trial. Immunology. 2026 Jan 1. 

Yan K, Li F, Xu J, et al. Efficacy and safety of vunakizumab in moderate-to-severe chronic plaque psoriasis: A randomized, double-blind, placebo-controlled phase 3 trial. J Am Acad Dermatol. 2025 Jan;92(1):92-99. 

Vunakizumab, an IL-17A monoclonal antibody, shows promising results in treating moderate-to-severe plaque psoriasis, with early response predicting long-term efficacy. A post hoc analysis of a phase 3 trial assessed patients based on their Psoriasis Area and Severity Index (PASI) response at two weeks. Early responders demonstrated significantly higher long-term efficacy across various endpoints compared to non-early responders. Despite similar adverse event rates, early responders were more likely to achieve superior outcomes. Vunakizumab provides effective treatment regardless of early response status, but early responders benefit more.

In this post hoc analysis, investigators used phase 3 data on vunakizumab to investigate the impact of early response on long-term efficacy in those with psoriasis.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Early Vunakizumab Response at 2 Weeks Predicts Long-Term Efficacy in Psoriasis

Linda Stein Gold, MD, is a dermatologist at Henry Ford Health. 

Highlights from Fall Clinical 2025, including emerging IL-23 and real-world data shaping the next phase of psoriasis research.

APEX Trial Results: Radiographic Prevention Among Patients With Psoriatic Arthritis

, despite the expanding therapeutic landscape. Linda Stein Gold, MD, and her colleagues analyze patient- and provider-reported data from the 

 surveys, revealing that many patients remain dissatisfied with current therapies and that oral agents are overwhelmingly preferred over injectables. The experts discuss how patient lifestyle, comorbidities, and psychosocial burden influence shared decision-making and treatment adherence. They also interpret the 

International Psoriasis Council’s (IPC)

 and explore its implications for reducing “topical churn” and advancing systemic therapy earlier in the disease course.

 and its potential to close current gaps in care. The panel provides an in-depth review of the 

 clinical development program, summarizing the 

 trials, which demonstrated superior efficacy versus deucravacitinib at both 16 and 24 weeks, with favorable safety and tolerability. They also discuss new 

 showing sustained clearance and no new safety signals in adults and adolescents. The faculty reflect on ICO’s implications for adolescent psoriasis and how early, aggressive oral intervention may help prevent progression to psoriatic arthritis, marking a significant milestone in the evolution of oral IL-23–targeted therapy.

The final portion of the series shifts focus to 

managing active psoriatic arthritis (PsA)

. The experts discuss new findings from the 

 demonstrated the first clear evidence of IL-23–mediated inhibition of structural joint damage, reinforcing the rationale for early biologic use in high-risk patients. They compare APEX to prior IL-23 studies, discuss implications for therapy sequencing, and highlight other emerging data from 

 studies. In closing, Stein Gold and colleagues emphasize a forward-looking approach that integrates personalized therapy selection, early detection of PsA, and cross-specialty collaboration to elevate standards of psoriasis care

Video Series

Comparison of APEX findings to prior IL-23 trials such as KEEPSAKE-1 and their implications for clinical practice.

Current Treatment Landscape in Psoriatic Arthritis

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

A study found tahini was associated with lower reaction thresholds and higher anaphylaxis rates than whole seeds, suggesting it may better reflect true sesame allergy risk.


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Tahini May Be the Preferred Form for Pediatric Sesame Oral Food Challenges

Ryan Livingston joined the MJH Life Sciences team in March of 2025, shortly after graduating from TCNJ with a bachelor’s degree in English. He enjoys creative writing, reading, and scuba diving. He can be reached at rlivingston@mjhlifesciences.com.

The Q4 recap for cardiology spotlights major FDA decisions, key clinical trial updates, and more.

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This rheumatology month in review emphasizes new data and impactful approvals.

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5 Rheumatology Headlines You Missed in December 2025

December 2025 saw new data on asthma therapies and new insights from experts on continuing trends in the field.

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5 Pulmonology Headlines You Missed in December 2025

A retrospective cohort analysis reports data on a two-sided relationship between depression diagnosis and chronic kidney disease progression. 


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Depression's Implied Bilateral Link With Chronic Kidney Disease Progression

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

The document outlines 14 best-practice advice statements for diagnosing and managing refractory constipation, with an emphasis on surgical intervention. 

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, IBS and IBD, Crohn's disease, and more.

AGA Urges Caution Around Surgery for Refractory Constipation in Clinical Practice Update

A study links caregiver beliefs, mental health challenges, multiple allergens, and prior anaphylaxis to worse food allergy–related quality of life in pediatric patients.

Food Allergy

Parental Illness Perceptions Drive Poor QoL in Children with Food Allergies

Jasper Therapeutics has released new, positive findings on the use of briquilimab, a novel antibody therapy targeting KIT (CD117), in patients with CSU.

Urticaria

The HCPLive urticaria page is a comprehensive resource for clinical news and insights on chronic idiopathic urticaria and chronic spontaneous urticaria. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for urticaria, and more.

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BEACON: Positive Results Announced for Briquilimab in Chronic Spontaneous Urticaria

Rubin discusses an analysis of Ascendis’s program for patients who had received PTH treatment but weren’t eligible for clinical trials of palopegteriparatide.

Palopegteriparatide Allows for PTH Tapering in Hypoparathyroidism, With Mishaela Rubin, MD, MS

A trio of professional societies voice concerns about certain elements of the Dietary Guidelines for Americans, 2025–2030, and their potential negative health impacts.

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Latest News

Managing Renal Function and Serum Calcium in Hypoparathyroidism, With Mishaela Rubin, MD, MS

Global CKD Burden Projected to Rise in Young Adults and Decline in Children by 2050

Early Vunakizumab Response at 2 Weeks Predicts Long-Term Efficacy in Psoriasis

APEX Trial Results: Radiographic Prevention Among Patients With Psoriatic Arthritis

Current Treatment Landscape in Psoriatic Arthritis