Shahinian is a Dr. Robert H and Eva M Moyad Research Professor of UrologyCo-Chief of Dow Division of Health Services ResearchProfessor of Internal Medicine, and Professor of Urology at the University of Michigan Medical School. 

PCP's Role in Reducing ER Use Among ESKD Patients on Dialysis

Having a primary care physician (PCP) along with a nephrologist for patients with 

 receiving dialysis may help reduce emergency department (ED) utilization, a major driver of healthcare costs in this patient population.

"We kind of hypothesize that having a primary care physician, separate from the nephrologist, might help reduce health care utilization,” said Vahakn Shahinian, MD, MS, Co-Chief of Dow Division of Health Services Research, Professor of Internal Medicine and Urology at the Medical School at the University of Michigan, in an interview with 

. “They might be more available after hours on an urgent basis to see patients and head off issues, and overall just kind of help the management of a lot of the underlying chronic conditions that accompany most patients on dialysis."

The > half a million patients receiving dialysis for ESKD in the US represent 4 times the national mean rate for all Medicare beneficiaries. Furthermore, approximately 98% of patients with ESKD have ≥1 comorbidity, with 83 to 90% living with hypertension and up to 69% living with diabetes. While a majority of these patients see a nephrologist to manage their dialysis, study investigators wondered whether having a PCP would impact ED visits.

To address this gap in the benefit of PCPs in this patient population, Shaninian and colleagues conducted a national, retrospective, cross-sectional study of 181,520 patients receiving maintenance hemodialysis to assess the association between primary care involvement and ED utilization and hospitalization in this population.

Upon analysis, In the instrumental variable model comparing patients estimated to have a 100% probability of having a PCP with those estimated to have a 0% probability of having a PCP, there was not a significant difference in the estimated risk of any hospitalization (51.0%; 95% Confidence Interval [CI], 49.6%-52.4% vs 48.7%; 95% CI, 45.9%-51.4%), but there was a difference in estimated risk of any ED visit (69.4%; 95% CI, 68.1%-70.7% vs 75.0%; 95% CI, 72.5%-77.6%; 

 = .003), particularly in estimated risk of any ED visit not resulting in hospitalization (51.2%; 95% CI, 49.7%-52.7% vs 72.1%; 95% CI, 69.2%-74.9%; 

"What we saw was that having a primary care physician really didn't make a difference with respect to being hospitalized. Where it made its biggest difference was ER visits that didn't result in hospitalization... to me, the story that our paper seems to suggest is that's where primary care can potentially help, in perhaps heading off issues early on before they become very serious or just less serious issues."

Editor’s Note: Shahinian reports no relevant disclosures. 

Bailoor K, Hirth RA, Guro P, Oerline MK, Hollingsworth JM, Shahinian VB. Primary Care Involvement and Health Care Utilization Among Patients With End-Stage Kidney Disease. 

https://doi.org/10.1001/jamanetworkopen.2026.080

MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of prevalence in Scottish primary care. 

Videos

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

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.

Chronic Kidney Disease

Douglas P. Mack, a pediatric allergist and assistant clinical professor at McMaster University

Epinephrine Nasal Spray Shows Strong Patient Preference, With Douglas Mack, MD

2026 American Academy of Allergy, Asthma, & Immunology (AAAAI) 

 a pediatric allergist and assistant clinical professor at McMaster University, on how clinicians can integrate 

into shared decision-making conversations with patients and families. He emphasized that patient preference and real-world usability will likely play a critical role in the success of these therapies.

“We have to, as clinicians, have no preconceptions about what a patient wants,” Mack said. “Some families, we think they're going to want one thing, and they want something separate. Whenever I go into these discussions, I always want to show both options for the families, show how they work, [and] even let them try them. In the end, I know the science. I know what's going to work to some degree, but in the end, if they don't buy into this, it doesn't matter what I give them if they're not going to use it; that dose is never getting into that patient. Shared decision making is absolutely critical in this scenario and having an open mind to what a patient wants.”

New data presented at the meeting found that among 90 participants in a randomized crossover study, 88% reported preferring the intranasal device over injectable epinephrine. Investigators found the preference was consistent regardless of whether participants had prior experience using auto-injectors. Reasons for favoring the nasal spray included the absence of a needle, ease of use, portability, and the perception that it would be easier for bystanders to administer in an emergency.

Among survey responses addressing barriers to carrying epinephrine, 98–100% of participants rated factors such as device size, weight, and temperature flexibility more favorably for the intranasal product. In addition, 93% of participants reported they could bring the nasal spray with them in daily situations, compared with 43% for auto-injectors.

“We already have preliminary data on real-world use of [epinephrine nasal spray], and it… appears to have very similar outcomes to what we see with injectables,” Mack said. “I think once we get more comfortable with that, we [will] see that more patients are using this. What I do wonder is: are we going to see earlier use of this? In the real world, are people actually using this earlier… or more frequently, simply because of the fact that it's needle-free? I think if we do see…less hesitation in the real-world…that's going to be absolutely golden data.”

New data reveals 9 in 10 people prefer EURneffy, a needle-free nasal adrenaline spray, over auto-injectors. BioSpace. Published March 4, 2026. Accessed March 5, 2026. 

https://www.biospace.com/press-releases/new-data-reveals-9-in-10-people-prefer-eurneffy-a-needle-free-nasal-adrenaline-spray-over-auto-injectors

Research presented at AAAAI 2026 found that 88% of participants preferred intranasal epinephrine over injectables.

Conference

 conference coverage page features articles, videos, and expert-led live coverage from major medical meetings throughout the year.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

Anaphylaxis

The HCPLive anaphylaxis page is a comprehensive resource for clinical news and insights on acute allergic reactions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for preventing anaphylaxis, and more.

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.

 has approved secukinumab for the treatment of moderate to severe 

 in pediatric patients aged 12 and older, positioning it as the only interleukin (IL)-17A inhibitor currently indicated for this population.

The approval adds a differentiated biologic option to an area where treatment choices for younger patients have historically been limited. HS is a chronic, systemic inflammatory condition known to be characterized by recurrent, painful, boil-like nodules, causing significant discomfort among individuals living with the disease.

 The nodules resulting from HS can rupture, cause open wounds, and result in permanent scarring.

“Hidradenitis suppurativa (HS) often begins in adolescence and can cause irreversible scarring and disabilities,” Alexa B. Kimball, MD, MPH, lead investigator of the SUNSHINE and SUNRISE clinical trials in adult HS patients, President and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center, said in a statement.

 “The approval of [secukinumab] represents an important advancement for younger HS patients who have had limited treatment options.”

HS impacts approximately 1 in 100 people globally and frequently makes its first appearance around puberty, with more than 50% of those reporting symptom onset reporting the disease at the time of adolescence. Secukinumab is a fully human monoclonal antibody designed to directly targeting interleukin-17A, a key cytokine known to drive the inflammatory pathways implicated in several immune-mediated diseases.

The drug carries adult approvals across a broad range of indications, including HS, ankylosing spondylitis, psoriasis, psoriatic arthritis (PsA), and non-radiographic axial spondyloarthritis. On the pediatric side, it is now approved for HS alongside existing indications in plaque psoriasis, enthesitis-related arthritis, and juvenile PsA.

For clinicians managing adolescent HS patients, the approval introduces weight-based dosing for those at or above 30 kg, a regimen designed to achieve drug exposure comparable to that seen in adult HS trials. The pediatric indication was supported by a combination of data. Such findings included well-controlled adult HS studies, pharmacokinetic modeling extrapolated from adult data on HS and psoriasis, and clinical trial reslts from other approved pediatric indications.

In dosing analyses, results also validated the weight-adjusted approach as a reliable replication of the systemic exposure established in adults.
The distinct mechanism of IL-17A inhibition provides prescribers with a targeted therapeutic agent designed for individualization and based on patient weight.

“Hidradenitis suppurativa (HS) affects far more than skin; it impacts confidence, emotional well-being and relationships during a formative period for many pediatric patients,” Brindley Brooks, founder and CEO of HS Connect, said in a statement.

 “For families watching their children struggle, this FDA approval brings hope for earlier intervention.”

Novartis Cosentyx® receives FDA approval for pediatric patients aged 12+ with moderate to severe hidradenitis suppurativa. Novartis. March 13, 2026. 

https://www.novartis.com/us-en/news/media-releases/novartis-cosentyx-receives-fda-approval-pediatric-patients-aged-12-moderate-severe-hidradenitis-suppurativa

Montero-Vilchez T, Diaz-Calvillo P, Molina-Leyva A, et al. The Burden of Hidradenitis Suppurativa Signs and Symptoms in Quality of Life: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Jun 22;18(13):6709. doi: 10.3390/ijerph18136709. PMID: 34206415; PMCID: PMC8293810.

Articles

FDA approval extends secukinumab to adolescents (≥12 years) with moderate-to-severe hidradenitis suppurativa, making it the only IL-17A inhibitor indicated for this pediatric population. The decision expands biologic optionality in a disease that commonly presents around puberty and can lead to chronic pain, rupturing nodules, open wounds, and irreversible scarring. Support for the pediatric indication leveraged robust adult HS efficacy data, PK modeling and extrapolation from adult HS/psoriasis datasets, and clinical evidence from other pediatric indications, enabling weight-based dosing to match adult exposure targets.

This FDA approval of secukinumab (Cosentyx) for hidradenitis suppurativa (HS) represents the fourth pediatric indication for the drug.

FDA News

Hidradenitis Suppurativa

Hidradenitis Suppurativa condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatology research, treatment, and drug development.

Dermatology

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

FDA Approves Secukinumab for Pediatric Patients 12 Years and Older with HS

Telemedicine use among patients has expanded dramatically in recent years, and the practice’s ability to expand access to patients regardless of location has shifted the way medicine is practiced.

Despite the explosion of telemedicine’s implementation, especially during the COVID-19 pandemic, concerns have arisen regarding the value of this practice as opposed to the value of in-person interactions with clinicians.

 While the practice may have expanded access to care, the limits of telemedicine and telehealth in general have become increasingly more apparent.

, a visually dependent subfield of medicine, is uniquely suited for the virtual health care model, and its integration has been dubbed ‘teledermatology.’ This technological advancement in the field of medicine, commonly involving virtual appointments and app-based instructions, can allow a diverse patient population access to dermatology care.

In this feature, the editorial team reached out to 3 speakers in the field of dermatology to provide commentary on the evolution of teledermatology. One speaker was Harrison Nguyen, MD, MBA, MPH, a double board-certified dermatologist, Mohs micrographic surgeon, and clinical researcher in Houston, Texas. Nguyen also serves as a clinical assistant professor of dermatology at the Baylor College of Medicine.

 also spoke with Sylvana A. Brickley, DNP, FNP-BC, DCNP, a dermatology certified nurse practitioner (NP) at Lahey Health, and Avery Dinallo, DNP, FNP-C, DCNP, a dual board-certified family NP, a dermatology NP, and the president-elect of the Society of Dermatology Nurse Practitioners (SDPA).

These 3 leaders in the dermatology space provided several helpful insights on the ever-changing topic of telemedicine and teledermatology, highlighting the strengths and weaknesses of the practice and describing where improvements can be made to the practice to ensure adequate care.

Although teledermatology exploded in use during the COVID-19 pandemic, the practice predates 2020, with the term initially appearing in medical literature in 1993 and gaining traction in Norway.

 However, the first formal guidelines regarding teledermatology were issued by the American Telemedicine Association in 2007.

As innovations related to home computer use and smartphone adoption increased dramatically in the late 2000s and early 2010s, telemedicine became more and more of a reality. The COVID-19 pandemic was, undoubtedly, the inflection point for teledermatology’s use.

The aforementioned guidelines, when updated in 2016, began referring to 3 forms of consultation typically seen in teledermatology: real-time videoconferencing, store and forward, and a hybrid of these 2 methods.

 Store-and-forward is known to be the most widely utilized, involving taking photographs or videos, which are then evaluated at a different time and location.

In his interview, Nguyen explains how, despite technological advances, inconsistent reimbursement practices kept adoption fragmented in the period before 2020. He also highlights Medicare's reliable reimbursement during the pandemic, describing the move as setting a precedent followed by commercial insurers.

“It had been in existence before, but we had very inconsistent reimbursement, and adoption varied among practice types and varied among regions,” Nguyen explained. “But with COVID, it became a necessity. We started to really use it across more practice types, and we had very strong reimbursement from that, which started when Medicare was reimbursing very, very reliably.”

, Brickley and Dinallo both provide a practitioner's impression of what the COVID-era rush into telehealth actually looked like from within a clinic.

"It did explode,” Dinallo expressed. “It exploded during COVID, when everybody was forced to enter into these telehealth spaces.” Brickley concurred with Dinallo, describing the increasing adoption of telemedicine practices as a ‘mad rush’ in light of the pandemic.

Telemedicine has been used for a variety of aims: those working in healthcare settings can use the practice to monitor patient health, to provide clinical services to patients, to consult with other providers, and to allow patients to have access to various educational resources. Perhaps most significantly, in the dermatology world, telemedicine practices can allow for efficient diagnoses of diseases such as psoriasis, rosacea, atopic dermatitis, and skin cancer.

Skin cancer, for example, is a uniquely important condition for dermatologists to diagnose, given the increasing incidence and real concerns over morbidity among patients.

 Multiple studies have demonstrated high concordance between teledermatology and in-person diagnoses, with 1 finding 91% concordance.

Patients have also reported a high level of satisfaction with teleconsultations, with increased savings related to travel, diminished wait times, and time efficiency being cited specifically.

 In his interview, Nguyen generally concurred with these views, outlining the conditions well suited to telehealth and noting medication and biologic monitoring, as well as post-procedure follow-up, are strengthened by the practice.

Brickley and Dinallo reinforced this view as well from their own clinical experience and practice focus, highlighting evidence supporting telemedicine for acne and rosacea specifically. Both also touched on the value telemedicine has brought to underserved communities

"Many dermatology practices, you're waiting three months, six months to get seen, or they live so far away they don't want to make that commute,” Dinallo said. “It's a lot easier just to pop on a call."

Brickley agreed, describing virtual consults as helping to decrease the number of referrals to dermatology practices. Such consults can free up in-person appointments for individuals who more urgently need to be seen by a dermatology provider, she highlighted.

An important consideration of adopting any new technological innovation is awareness of downsides. As tools such as smartphones have become more widely accepted in everyday life by most Americans, for example, the negative effects of their implementation related to emotional and cognitive health have become more apparent.

In the same vein, the limits of teledermatology require exploration to better understand the practice’s long-term impact on the medical field and on patients’ lives. Additionally, understanding these limits can help to improve the different facets of teledermatology’s use, allowing for improvements to the practice.

Despite the previously cited successes of virtual lesion assessments, research suggests in-person diagnostic accuracy remains approximately 11% greater than teleconsultations.

 Additionally, while diagnosing various conditions such as acne, psoriasis, and different skin cancers can be improved by teleconsultations, full body skin exams, melanocytic lesion assessments without dermoscopy, new or unclear rashes, and anything requiring a biopsy or procedure still necessitate in-person meetings.

During her interview, Brickley noted that still photos outperform video for diagnostic purposes. Nevertheless, she noted, modern smartphone cameras fall short of in-person evaluation for anything past classic presentations. Both Brickley and Dinallo note providers practicing solely through telemedicine carry a responsibility to refer patients to in-person care when necessary.

Nguyen frames most issues with telemedicine as a deployment problem, as much as a technology problem. He describes such practices as not inherently flawed, pointing to the placement of teledermatology in the wrong clinical context as producing redundant visits at best and missed diagnoses at worst.

"It falls short whenever it's being deployed under the wrong clinical context, when there's not the right triaging or workflows to identify the appropriate patient and appropriate care processes,” Nguyen expressed.

One of the more pointed critiques emerging from the interview with Dinallo and Brickley was regarding the proliferation of telemedicine platforms described by the 2 speakers as ‘prescription mills,’ wherein individuals can select a treatment, submit a photo or intake form, and be prescribed a medication without clinical conversation.

"There are companies out now where you just go, you click the drug you want, you text someone about it, and they mail it to your house,” Dinallo noted. “That's where it's been for the last 10 years, and it's gone too far in that direction."

Brickley concurred, noting that clinicians “want to satisfy the consumer, but also want to practice good medicine.” Practicing good medicine, Brickley added, is not always giving an individual who is asking for something exactly what they want. In other words, a commitment to scrupulous prescription practices is vital where telemedicine adoption is concerned, and this includes dermatology.

Brickley and Dinallo noted the founding rationale for their own telehealth clinic, AllMe Health, as correcting the market’s tilt toward convenience at the expense of genuine care. Examples include patients given tretinoin without guidance on how to use it, or ordering unnecessary labs with no clinician to interpret the data. Their clinic, they assert, will help to address these types of situations while still providing access to dermatologic care for underserved communities.

Obstacles to Teledermatology’s Expansion

Some of the most important issues related to teledermatology as a practice in today’s world lie not in its implementation, when warranted, but in the obstacles preventing its implementation.

Specifically, teledermatology reimbursement has been less than optimal for some dermatology clinicians, attributed to inconsistent payment parity between in-person consultations and teleconsultations. Reimbursement, Nguyen noted in his 

 interview, is the single biggest barrier to teledermatology’s more widespread use among those who need it.

"Teledermatology often takes as much time and resources to be able to do it as in-person visits,” Nguyen said. “It is not so different from a time and resource perspective."

Prior to the COVID-19 pandemic, inconsistent reimbursement kept teledermatology use limited, with fewer than 4% of dermatologists utilizing live video conferencing.

 During the pandemic, the Centers for Medicare & Medicaid Services (CMS) expanded payment parity under public health emergency waivers, a move driving 43 US states to adopt permanent coverage parity laws and 22 states to initiate explicit payment parity legislation.

Nevertheless, given the benefits cited by Nguyen and a significant amount of available data on telemedicine’s implementation, the appropriate reimbursement for asynchronous teledermatology assessment services remains a concern for many clinicians.

Adding to the discussion of obstacles to teledermatology, Brickley and Dinallo described an NP-specific licensure issue: the lack of a multi-state compact for NPs and the current presence of individual state licensing for every jurisdiction where NPs see patients. This, they note, is a time-consuming and expensive process.

“We don't have a compact for nurse practitioners where we can,” Brickley highlighted. “We have to get every single state license individually. You can only see a patient [for whom] you're licensed in the state where the patient is located."

Such obstacles remain a concern among dermatology clinicians and, in the coming years, may need to be addressed by US public health organizations.

Looking Toward the Future of Telemedicine

The demand for dermatology clinicians is high, due to population aging and increasing skin cancer rates. Teledermatology is uniquely positioned as a necessary response to such concerns and concerns over financial costs among patients.

The geographic maldistribution of clinicians is not likely to self-correct, making sustained teledermatology infrastructure a significant long-term priority for policymakers. Additionally, the value of maintaining the patient-centric nature of medicine has been described by clinicians as vital to medicine’s future.

Brickley and Dinallo’s interview concluded with a prediction of what is to come for teledermatology practices, with Brickley predicting a trend toward niche, specialized teledermatology services rather than broad general platforms. Dinallo echoes this sentiment, framing passion-driven specialty care as the model most likely to provide genuinely improved outcomes.

“The future is going to be similar to what we're doing, where we're focusing more on specialty care, where people that are really passionate about this one specific topic [are] then providing it to more people,” Dinallo concluded in her interview.

Nguyen concluded his discussion of teledermatology by, first and foremost, reiterating his pro-telemedicine views. He describes such practices as an important tool in the modern medical world for maintaining access among underserved patients, provided it is used efficiently and with the patient’s best interests in mind.

“Efficiency depends on whether the practice, the health system, or the clinician has the infrastructure set up so that telemedicine is done in an efficient manner,” Nguyen explained. “I would say that access is something that has been demonstrated to improve with telemedicine. How do we continue to maintain the viability of it? We come back to the reimbursement aspect, making sure that clinicians are reimbursed appropriately for their efforts in teledermatology.”

Teledermatology's future may not be determined by the innovation itself, but by whether the policymakers, the payers, and the clinicians involved ensure its success. The screen is likely not to fully replace the exam room, but its helpfulness as a tool for clinicians may increase over time.

Kimball AB, Porter ML. Impact of the COVID-19 Pandemic on the Delivery of Dermatological Care. Curr Dermatol Rep. 2022;11(4):313-317. 

. Epub 2022 Dec 9. PMID: 36532663; PMCID: PMC9734629.

Pala P, Bergler-Czop BS, Gwiżdż JM. Teledermatology: idea, benefits and risks of modern age - a systematic review based on melanoma. Postepy Dermatol Alergol. 2020 Apr;37(2):159-167. 

. Epub 2020 May 5. PMID: 32489348; PMCID: PMC7262815.

Okobi OE, Abreo E, Okafor AA, et al. Trends in Melanoma Incidence, Prevalence, Stage at Diagnosis, and Survival: An Analysis of the United States Cancer Statistics (USCS) Database. Cureus. 2024 Oct 2;16(10):e70697. 

Piccolo D, Smolle J, Soyer HP, et al. Face-to-face diagnosis vs telediagnosis of pigmented skin tumors: a teledermoscopic study. Arch Dermatol. 1999 Dec;135(12):1467-71. 

Loane MA, Bloomer SE, Wootton R, et al. Patient satisfaction with realtime teledermatology in Northern Ireland. J Telemed Telecare. 1998;4(1):36-40. 

Wacks Y, Weinstein AM. Excessive Smartphone Use Is Associated With Health Problems in Adolescents and Young Adults. Front Psychiatry. 2021 May 28;12:669042. 

Gilmour E, Campbell SM, Wootton R, et al. Comparison of teleconsultations and face-to-face consultations: preliminary results of a United Kingdom multicentre teledermatology study. Br J Dermatol. 1998 Jul;139(1):81-7. 

Wahezi SE, Kohan LR, Kaye AD, et al. Telemedicine and current clinical practice trends in the COVID-19 pandemic. Best Pract Res Clin Anaesthesiol. 2021 Oct;35(3):307-319. 

. Epub 2020 Nov 16. PMID: 34511221; PMCID: PMC7667401.

Wang RH, Barbieri JS, et al. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol. 2020 Jul;83(1):299-307. 

. Epub 2020 Feb 5. PMID: 32035106; PMCID: PMC7302990.

Fleming DA, Edison KE, Pak H. Telehealth ethics. Telemed J E Health. 2009 Oct;15(8):797-803. 

Teledermatology has matured from early store-and-forward models into a pandemic-accelerated access modality with strong fit for visually driven disease assessment and longitudinal therapy monitoring. High diagnostic concordance and patient satisfaction are counterbalanced by measurable gaps versus in-person accuracy and clear limitations for total-body exams, equivocal eruptions, melanocytic lesions without dermoscopy, and procedural needs. Misdeployment and poor triage can create redundant visits or missed diagnoses. Sustained growth hinges on reimbursement parity, robust workflows, and curbing “prescription mill” practices.

In this feature, 3 experts discuss the expansion of telehealth and telemedicine use, including their positive and negative aspects in dermatology today.

Where Teledermatology is Today: Expanding Access and Navigating Limits

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

 has not arrived evenly across care settings. While academic pulmonologists have been prescribing IL-5 antagonists and IL-4/IL-13 blockers for nearly a decade, the translation of that expertise into primary care, advanced practice, and multi-specialty clinical teams has lagged — shaped by differing prescribing privileges, patient populations, payer dynamics, and familiarity with rapidly evolving evidence. That translation gap matters enormously, because primary care and advanced practice providers represent the front line where severe asthma and chronic obstructive pulmonary disease (COPD) are most often first encountered, undertreated, and repeatedly managed with the short-term tool that remains most dangerous in the aggregate: oral corticosteroids (OCS). 

The approval of mepolizumab in 2015 established the first durable eosinophil-targeting option for severe asthma, followed by dupilumab's landmark FDA approvals — first for atopic dermatitis, then asthma in 2018, and most significantly for COPD in 2023, the first biologic ever cleared for that indication.

These milestones have changed what is pharmacologically possible; the harder task is ensuring that the right providers, across the full breadth of clinical practice, know when and how to deploy them.

To further explore potential gaps in care, 

a clinical forum discussing the evolving landscape of targeted therapy in asthma and COPD, moderated by Alanna Kavanaugh, MSN, BSN, CCRN, Assistant Dean of Graduate Nursing and Chair of the Family Nurse Practitioner Program, College of Mount Saint Vincent, and attended by a diverse group of nurse practitioners, advanced practice providers, and clinical educators from institutions including Weill Cornell, Stanford, Mount Sinai's World Trade Center Health Program, and a range of primary care and integrative practices across the Northeast. The forum touched on a number of subjects, particularly the cumulative harm of OCS use, the practicalities of biologic selection, and the growing need for structured steroid stewardship in outpatient practice.

The discussion arrived at a moment when the biologic toolbox has never been more full. Dupilumab's long-term data continues to accumulate across asthma, nasal polyps, and now COPD; tezepelumab has established itself as the agent for biomarker-negative severe asthma; and the December 2024 approval of depemokimab — a 6-month IL-5 agent — has introduced a dosing interval that could meaningfully change the adherence calculus for certain patient populations.

 At the same time, GOLD 2026 guidelines have stiffened COPD escalation criteria, removing prior tolerance for a single moderate-to-severe exacerbation and pushing the field toward earlier biologic consideration.

 The forum's participants reviewed clinical trial data, debated real-world prescribing strategies, and shared cases that illustrated both the transformative potential of these therapies and the persistent systemic barriers — insurance, infrastructure, patient reluctance, and incomplete provider awareness — that continue to leave eligible patients undertreated.

The forum's most viscerally impactful discussion centered not on biologic selection but on what precedes it: the cumulative harm of oral corticosteroids and the lack of systematic infrastructure to track it. Maureen George, PhD, AE-C, RN, Columbia School of Nursing’s framing of lifetime milligram thresholds — 500 mg as a caution zone, 1,000 mg as a serious-risk threshold reachable in as few as three high-dose courses — was new information for several primary care panelists, some of whom acknowledged they had not previously thought in cumulative terms. Panelists proposed a dedicated OCS tracking system analogous to New York's I-STOP narcotics registry, and the concept of "steroid stewardship" resonated broadly. 

“First of all, when you're getting a lot of prednisone, looking at the anxiety and the other type of dysregulation that takes place I think we need to be looking that here and seeing if a person responds in that way as well. I know it's not something that people usually talk about because we're so busy looking at the biomarkers because we want to get rid of the disease, but there is a relationship that exists between the dysregulation and the disease,” one participant said.

The group reviewed the full approved biologic landscape for asthma — dupilumab, mepolizumab, benralizumab, omalizumab, tezepelumab, and depemokimab — with dupilumab generating the most vivid clinical anecdotes, including a patient who regained their sense of smell after 20 years and another whose externally visible nasal polyps resolved within 4 to 6 months. Tezepelumab drew attention for its efficacy in biomarker-negative patients, with 1 panelist describing an oxygen-dependent patient who came off daytime oxygen entirely after starting the drug. Depemokimab's 6-month dosing was discussed primarily through the lens of adherence — specifically for college students, travelers, elderly patients, and those with logistical barriers to frequent injections.

In COPD, the conversation reflected both growing momentum and persistent uncertainty. The GOLD 2026 update — which now places any single moderate-to-severe exacerbation into Group E, eliminating prior tolerance — was highlighted as a meaningful escalation of urgency, and several panelists noted they are actively working to capture eligible patients before exacerbations compound. Dupilumab remained the preferred COPD biologic based on stronger FEV1 improvement data from BOREAS and NOTUS; mepolizumab's lower EOS threshold of 150 was noted as potentially useful in borderline patients, though FEV1 gains were comparatively modest. The forum's final polling question found that clinical workflow tools and training — followed closely by clearer patient selection algorithms — were the resources practitioners most needed to prescribe COPD biologics with confidence. 

Closing takeaways revealed an appetite for expanded scope: attendees raised questions about biologics in cystic fibrosis, the potential for probiotic/prebiotic co-therapy to reduce the immune suppression side effects of biologics, and the urgent need for long-term lung function trajectory data. For many in the room, the night's most durable lesson was simpler: far too many patients who would benefit from these therapies are still receiving repeat prednisone instead.

Eger K, Hashimoto S, Braunstahl GJ, et al. Mepolizumab for eosinophilic COPD with exacerbations (MATINEE). 

. 2024;391(1):21-31. doi:10.1056/NEJMoa2401300

Bhatt SP, Rabe KF, Hanania NA, et al; NOTUS Investigators. Dupilumab for COPD with type 2 inflammation. 

. 2024;390(24):2275-2283. doi:10.1056/NEJMoa2401304

Price DB, Trudo F, Voorham J, et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. 

. 2018;11:193-204. doi:10.2147/JAA.S176026

Wechsler ME, Menzies-Gow A, Brightling CE, et al. Evaluation of the efficacy and safety of depemokimab in patients with severe asthma with an eosinophilic phenotype (SWIFT-1 and SWIFT-2). 

. 2024;404(10471):2373-2385. doi:10.1016/S0140-6736(24)02063-4

Global Initiative for Chronic Obstructive Lung Disease. 

Global Strategy for Prevention, Diagnosis and Management of COPD: 2026 Report

Biologic therapy has expanded dramatically for severe asthma and now COPD, yet adoption remains uneven outside academic pulmonology. Primary care and advanced practice settings still rely heavily on repeated oral corticosteroid bursts, often without tracking cumulative exposure or appreciating lifetime risk thresholds. Newer agents broaden eligibility—tezepelumab for biomarker-negative asthma and depemokimab with 6‑month dosing to improve adherence—while COPD guidance is tightening, prompting earlier escalation. Persisting barriers include payer friction, workflow limitations, and unclear selection algorithms.

New biologics transform severe asthma and COPD, yet prednisone overuse persists—see practical selection tips and outpatient steroid stewardship gaps.

COPD

COPD condition center page, resources on the topics of medical news and expert insight into chronic obstructive pulmonary disease can be found. Content includes articles, interviews, videos, podcasts, and breaking news on COPD research, treatment, and drug development.

Asthma

The HCPLive asthma page is a comprehensive resource for clinical news and insights on asthmatic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for allergic and severe asthma, and more.

Steroid Stewardship in Severe Airway Disease: The Case for Earlier Biologic Escalation

Tatyana Kushner, MD, is an associate professor of medicine in the division of gastroenterology and hepatology at Weill Cornell Medicine.

With new therapies emerging for hepatitis D, Kushner discusses brelovitug’s potential and what will be learned from the phase 3 AZURE program.

Hepatology

Hepatitis C

Hepatitis C page, resources on the topics of medical news and expert insight into HCV can be found. Content includes articles, interviews, videos, podcasts, and breaking news on hepatitis C virus research, treatment, and drug development.

Inside the AZURE Program of Brelovitug for Hepatitis D, With Tatyana Kushner, MD

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.

New CKD therapies and a cardiometabolic care model are reshaping kidney disease management.

Integrating Kidney Health Across the Cardio-Kidney-Metabolic Care Spectrum

Lala discusses ongoing challenges in the HF treatment cascade, highlighting widespread misunderstandings among patients and the issue of extreme pill burden.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Heart Failure

The HCPLive heart failure page is a resource for medical news and expert insights on HF. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for heart disease, reduced and preserved ejection fraction, and more.

Improving Patient Education and Pill Burden in Heart Failure Treatment, With Anuradha Lala, MD

Podcasts

This March episode of The Medical Sisterhood, in honor of Women's History Month, covers building influence in the dermatology field as a woman physician.

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

The Medical Sisterhood, with Mona Shahriari, MD

The Medical Sisterhood, hosted by Mona Shahriari, MD, is a podcast dedicated to empowering female physicians by providing a platform for shared experiences, mentorship, and support. 

Each episode delves into the unique challenges women in medicine face, including work-life balance, leadership roles, and overcoming gender biases. Shahriari aims to inspire women to lead fulfilling professional and personal lives on their own terms through candid discussions and expert interviews. 

e as we foster a community where women can uplift and support each other in achieving their goals!

The Medical Sisterhood: Building Influence in Medicine as Women Physicians, With Nastasha Mensikovzka, MD, PhD

Clinicians share practical tips to boost colorectal screening, comparing colonoscopy and stool tests while addressing fears.

Video Series

Comparing Colorectal Cancer Screening Test Performance and Prep Options

Doctors share tactics to boost colorectal screening: compare colonoscopy vs stool tests, address fears, and prevent cancer before symptoms.

Shared Decision-Making in Colorectal Cancer Screening

Shara Bialo, MD, is the senior medical director of T1D immunology at Sanofi.

Bialo discusses her perspective on the importance of T1D screening and its capacity to reduce the risk of disease progression and eventual complications later in life.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Latest News

PCP's Role in Reducing ER Use Among ESKD Patients on Dialysis

Epinephrine Nasal Spray Shows Strong Patient Preference, With Douglas Mack, MD

FDA Approves Secukinumab for Pediatric Patients 12 Years and Older with HS

Where Teledermatology is Today: Expanding Access and Navigating Limits

Steroid Stewardship in Severe Airway Disease: The Case for Earlier Biologic Escalation