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

New Hope for Hepatitis D? Brelovitug and the AZURE Program

For clinicians managing hepatitis D virus (HDV) infection, the stakes are uniquely high. Unlike many other chronic viral hepatitides, HDV is widely recognized as the most aggressive form of viral hepatitis, often leading to rapid disease progression and severe long-term complications.

, Tatyana Kushner, MD, an associate professor of medicine in the division of gastroenterology and hepatology at Weill Cornell Medicine, explained how the inflammatory nature of the disease drives this aggressive clinical course. Patients frequently experience significant liver inflammation and elevated viral activity, accelerating progression to advanced liver disease.

Check out part 1 of the interview with Kushner 

“Delta hepatitis is the most rapidly progressive form of hepatitis,” Kushner explained, noting that clinicians commonly see complications develop earlier than expected compared with other viral infections.

The consequences can be striking in clinical practice. Kushner noted that she regularly encounters patients in their 30s and 40s who have already developed cirrhosis, an outcome far less common among individuals with isolated hepatitis B infection. Because HDV relies on hepatitis B virus for replication, coinfection can significantly worsen liver outcomes.

Given this aggressive trajectory, treatment goals focus on achieving both virologic and biochemical control. Ideally, she says therapies would reduce HDV RNA to undetectable levels while normalizing liver enzymes such as ALT, which reflect ongoing hepatic inflammation. Achieving these surrogate markers could ultimately translate into reduced risk of cirrhosis, hepatocellular carcinoma, and liver transplantation.

Emerging therapies are now being evaluated with these goals in mind. Kushner highlights brelovitug, an investigational monoclonal antibody being developed by Mirum Pharmaceuticals and currently studied in the AZURE program, as one of the most promising.

The global, registrational phase 3 clinical development program includes multiple open-label studies designed to assess the primary endpoint of combined virologic and biochemical response. Together, the studies are intended to support regulatory filings in the United States and Europe. Topline data from AZURE-1 and AZURE-4 are expected in 2H 2026, with a potential BLA submission and launch in the US in 2027.

The primary endpoint for both studies is the proportion of patients achieving combined virologic response and ALT normalization at week 24, comparing brelovitug with a delayed-treatment control group and consistent with FDA guidance for accelerated approval in HDV.

Patients enrolled in the study will remain on treatment beyond the 24-week primary endpoint, allowing investigators to evaluate longer-term outcomes. Secondary analyses will focus on safety and tolerability, which remain critical considerations given the limitations of historical treatments such as pegylated interferon.

Beyond traditional clinical endpoints, the trial will also examine exploratory measures including patient-reported outcomes and quality of life. Kushner emphasized that these assessments are particularly meaningful in HDV, where patients have historically faced years of uncertainty without effective treatment options.

Looking ahead, Kushner believes the field is approaching an important turning point. While early efforts are focused on establishing therapies that are both effective and tolerable, the long-term goal will be demonstrating improvements in hard clinical outcomes, such as reduced rates of cirrhosis and liver cancer.

“I think we're getting pretty close to having several treatment options that achieve those desired outcomes. Over the years, as patients stay on these treatments longer, we will really want to see hard clinical endpoints, improvement in fibrosis, decreased incidence of cirrhosis and liver cancer in patients who are on these treatments long term,” Kushner said. “I think it will be important to think about not just long term treatment options, but finite treatment options… Before we get there, finding treatments that, even if long term, can have meaningful clinical, beneficial endpoints, it will be a big accomplishment.”

Editors’ Note: Kushner reports relevant disclosures with Gilead, Abbvie, GSK, Ipsen, Mirum, and Madrigal.

World Health Organization. Hepatitis D. July 25, 2025. Accessed March 13, 2026. 

https://www.who.int/news-room/fact-sheets/detail/hepatitis-d

Mirum Pharmaceuticals. Mirum Pharmaceuticals Completes AZURE-1 Enrollment and AZURE-4 Screening in Phase 3 Program of brelovitug in Chronic Hepatitis Delta Virus. March 5, 2026. Accessed March 13, 2026. 

https://ir.mirumpharma.com/news/news-details/2026/Mirum-Pharmaceuticals-Provides-AZURE-Clinical-Program-Update-for-brelovitug-in-Chronic-Hepatitis-Delta-Virus/default.aspx

Videos

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

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.

Clinical

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

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.

 has long been recognized as a major public health challenge, but recent scientific advances and evolving clinical frameworks have brought renewed attention to the condition. Clinicians are increasingly viewing CKD not as an isolated renal disorder but as part of a broader cardio-kidney-metabolic disease spectrum that connects kidney health with cardiovascular and metabolic risk.

During a recent clinical forum led by Muthiah Vaduganathan, MD, MPH, codirector of the Center for Cardiometabolic Implementation Science at Brigham and Women’s Hospital, experts discussed how these shifting perspectives are reshaping CKD care. The discussion highlighted the growing role of multidisciplinary collaboration, the impact of emerging therapies that can slow disease progression, and the persistent gaps that continue to limit early diagnosis and optimal treatment.

A central theme was the recognition of CKD as part of an interconnected cardiometabolic disease network. Conditions such as diabetes, hypertension, obesity, and cardiovascular disease frequently coexist with kidney dysfunction, creating overlapping pathways that accelerate disease progression. As a result, clinicians across cardiology, endocrinology, primary care, and nephrology increasingly share responsibility for identifying and managing CKD.

Panelists noted that this broader perspective elevates the importance of kidney health within chronic disease prevention and management while underscoring the need for stronger collaboration among specialties that have traditionally worked in parallel.

Another major focus of the forum was the rapid expansion of disease-modifying therapies for CKD. In recent years, several treatment classes have demonstrated the ability to slow kidney disease progression while also reducing cardiovascular risk. These advances represent a shift from managing complications toward directly targeting mechanisms of disease progression.

Experts noted that clinical trial data supporting these therapies have been compelling, leading guidelines to increasingly recommend earlier use in appropriate patients. However, panelists acknowledged that real-world adoption has not kept pace with the evidence.

Many eligible patients with CKD still do not receive guideline-recommended therapies, reflecting a persistent gap between evidence and clinical practice. Participants pointed to several contributing factors, including the complexity of modern CKD care and the challenge clinicians face in keeping pace with rapidly evolving evidence and treatment recommendations.

Fragmented care across specialties may also contribute to inconsistent treatment patterns. Patients with CKD often receive care from multiple providers, including primary care physicians, cardiologists, endocrinologists, and nephrologists. Without clear coordination, opportunities to initiate kidney-protective therapies may be missed. Addressing these challenges will require both clinician education and health system strategies that support more consistent implementation of guideline-directed care.

Throughout the discussion, experts emphasized that improving CKD outcomes depends on identifying the disease earlier. Because CKD often progresses silently, many patients remain undiagnosed until kidney function has declined substantially.

Routine laboratory testing, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR), can help clinicians identify patients earlier and assess risk more effectively. Early detection also allows for more aggressive management of underlying drivers such as diabetes and hypertension.

As therapeutic options expand, earlier diagnosis may play an increasingly important role in altering the long-term trajectory of kidney disease.

Looking ahead, participants agreed that improving outcomes will require a more integrated approach to CKD care. No single specialty can address the full complexity of cardio-kidney-metabolic disease alone.

Instead, effective management will depend on collaboration across primary care, cardiology, endocrinology, and nephrology to identify at-risk patients earlier, coordinate treatment strategies, and ensure consistent use of kidney-protective therapies.

The discussion ultimately highlighted a key inflection point for CKD care. Scientific advances have created new opportunities to slow disease progression and reduce complications, but realizing those benefits will require closing persistent gaps in awareness, screening, and treatment.

US Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2023. May 15, 2024. Accessed March 13, 2026. 

https://www.cdc.gov/kidney-disease/php/data-research/index.html

American Kidney Fund. Risk factors for kidney disease. Accessed March 13, 2026. 

https://www.kidneyfund.org/all-about-kidneys/risk-factors

Articles

Chronic kidney disease is increasingly conceptualized within a cardio-kidney-metabolic continuum, reflecting shared pathobiology with diabetes, hypertension, obesity, and cardiovascular disease. This framing expands accountability beyond nephrology and elevates the need for coordinated, multidisciplinary care. Multiple disease-modifying drug classes now show robust renal and cardiovascular risk reduction, prompting guideline support for earlier initiation, yet real-world uptake lags. Persistent underdiagnosis—driven by asymptomatic progression and inconsistent eGFR/UACR testing—limits timely intervention, underscoring implementation gaps in screening, education, and care integration.

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

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

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

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

Although the overall nature of addressing 

 in clinics has shifted to a more holistic approach, improvements can still be made to the patient’s side of treatment, including pill burden and patient education.

“Unfortunately, there’s a major gap between evidence and widespread, broad understanding,” Anuradha Lala, MD, professor of medicine, cardiology, and population health, director of the ACGME Fellowship in Advanced Heart Failure and Transplant, and Director of the Heart Failure Clinical Trials program at Mount Sinai Hospital, told 

 in an exclusive interview. “Despite patient behavior having an influence on outcomes, there are studies after studies that show that patients often leave a heart failure hospitalization without a clear understanding of what the disease is, why their medications matter, and what warning signs should prompt them to call us.”

HF is a product of several lifestyle factors including sleep, diet, exercise, and lipid levels. However, data from a past meta-analysis have shown that roughly 60% of premature deaths from HF could be attributed to unhealthy lifestyle factors. Additionally, roughly half of patients with HF do not follow recommended treatment procedures, limiting their chances of improvement.

Prior research has emphasized the importance of informing patients of the potential risks of HF and how to manage them in their everyday life. A study from 2021, during which a proportion of patients were given 4-step education sessions to address misconceptions and potential lifestyle improvements, indicated increased capacity for self-management of risk factors afterwards. Patients who received education on their condition were more open to clinician suggestions for management.

Another well-documented issue facing patients and clinicians alike is the pill burden present in HF treatment. The main medication cascade currently consists of 4 main drugs, known as the pillars of heart failure: angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors. Standard GDMT recommends using all 4 treatments in every patient – given the sheer number of pills this requires, coupled with the disease’s implicit effects on quality of life, patients face a substantial burden simply from managing HF.

“The average patient with heart failure with reduced ejection fraction is taking somewhere between 6 and 10 meds when you account for all their comorbid conditions or other risk factors like 

, depression, et cetera,” Lala said. “And then the 4 pillar GDMT on top of that is not trivial.”

Despite these limitations, the ongoing shift towards a more multidisciplinary means of treatment – including nephrology and endocrinology, among other specialties – is an encouraging step towards better HF care. Chief among this movement is the cardio-kidney-metabolic framework put forth by the American Heart Association in 2023, highlighting the interplay between cardiovascular health and major comorbidities like 

“I think that adopting this cardio-kidney-metabolic framework really emphasizes the various aspects of the disease,” Lala said. “It’s about underlying inflammation, altered physiology and hormone health, coupled with poor diet, lack of exercise, and so on, that leads ultimately to the manifestations of heart disease, heart failure being one of its most prominent forms. I think us shifting to understand that we need to treat patients holistically and not in our silos of expertise is huge, and I pray that patients will stand to do better from our more holistic standards of care.”

Editors’ Note: Lala reports disclosures with Abiomed, AstraZeneca, Merck & Co., Novo Nordisk, Sequana, Bayer, and others.

1: Podvorica E, Bekteshi T, Oruqi M, Kalo I. Education of the Patients Living with Heart Disease. Mater Sociomed. 2021;33(1):10-15. 

2: Smith JL, Killian JM, Shippee N, et al. Burden of treatment in patients with heart failure. Journal of the American Heart Association. 

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.

Natasha Mesinkovska, MD, PhD, is a dermatologist and researcher at the University of California, Irvine School of Medicine Department of Dermatology.

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

, host Mona Shahriari, MD, an assistant clinical professor of dermatology at Yale University School of Medicine and a practicing dermatologist in Connecticut, is joined by Natasha Mesinkovska, MD, PhD, a dermatologist and researcher at the University of California, Irvine School of Medicine Department of Dermatology, for a wide-ranging conversation on visibility, resilience, mentorship, and the art of commanding a room recorded in recognition of Women's History Month.

Mesinkovska opens by describing her journey as an immigrant from the former Yugoslavia who arrived in the US as a high school exchange student and built her career through state schools, Mayo Clinic, and Cleveland Clinic. She credits her early breakthrough to a residency-era presentation at Winter Clinical Dermatology, delivered, memorably, in a beach dress and flip flops, where she placed second and received her first invitation to return to a national stage. From there, she describes her career as a product of persistence, gratitude, and a willingness to simply ask for opportunities, encouraging listeners to put their names forward without fear of rejection.

The conversation turns to Mesinkovska's distinctive approach to medical education on the podium, one Shahriari describes as simultaneously scientifically rigorous and genuinely funny. Mesinkovska attributes her communication style to years spent translating complex science for patients as chief scientific officer at the National Psoriasis Foundation, an experience she credits with sharpening her ability to make dense material accessible without sacrificing depth.

On the subject of women navigating visibility and judgment in professional settings, Mesinkovska is characteristically direct. She encourages women to embrace what makes them feel confident on the podium, whether bold fashion choices or a quiet, understated presence, and to resist any pressure to perform inauthenticity for the sake of broader appeal. She also reflects on her own deliberate distance from social media and influencer culture, noting she values the credibility of evidence-based independence over pharma-friendly positioning.

Closing with advice for women seeking a national platform, Mesinkovska urges listeners to build genuine connections with people they admire, identify what truly excites them clinically or scientifically, and pursue that niche with focus and flexibility. "Carve your own path," she says, "but carve a whole lot of paths."

Editor’s note: This episode was produced with the help of AI tools.

Want to join The Medical Sisterhood community? Click here to join our LinkedIn Group!

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.

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.

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!

Comparing Colorectal Cancer Screening Test Performance and Prep Option

In this episode, ‘Comparing Colorectal Cancer Screening Test Performance and Prep Options,’ the panelists review the performance characteristics of available colorectal cancer screening modalities, including colonoscopy, FIT, multi-target stool DNA, RNA-based tests, and blood-based assays. The faculty compare sensitivity and specificity across tests, emphasizing that colonoscopy remains the most sensitive and uniquely therapeutic option. They highlight variability in FIT performance depending on assay type and cutoff thresholds, underscoring the importance of understanding which test is being used. Advances in next-generation stool DNA testing are discussed, with improved sensitivity and specificity compared to earlier versions. The conversation also addresses practical considerations such as bowel preparation options, patient adherence, and tailoring prep regimens to comorbidities to optimize both safety and diagnostic quality.

The next episode in this series, ‘Overcoming Barriers and Advancing Precision in Colorectal Cancer Screening,’ features expert faculty reviewing the barriers to colorectal cancer screening uptake, the evolving role of blood- and DNA-based testing, and the ongoing discussions around precision risk stratification and potentially lowering the screening age amid rising early-onset disease globally.

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.

Type 1 Diabetes

T1D Screening is Effective but Underused Among Patients With No Disease History, With Shara Bialo, MD

Sayantani Sindher, MD, is a clinical associate professor at the Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine.

Data presented at AAAAI 2026 showed that adding dupilumab to omalizumab-facilitated oral immunotherapy improved desensitization and reduced gastrointestinal adverse events.

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.

Food Allergy

Dupilumab Improves Desensitization Outcomes in OIT, With Sayantani Sindher, MD

Experts discuss gaps in CKD detection, the role of albuminuria testing, and the need for earlier, risk-based care to improve outcomes.

Improving Early Detection of CKD in an Evolving Cardio-Kidney-Metabolic Era

Mary K Roberts, PhD is a Post Doctoral Researcher at the Leverhulme Centre for Demographic Science at the University of Oxford.

7 experts come together to address neighborhood disadvantage and its impact on kidney health in the latest Crisis Point. 

Crisis Point

Welcome to Crisis Point, a comprehensive look at the public health crises affecting the United States today, with global implications tomorrow.

Shows

video shows page features a feed of exclusive series, including Crisis Point and Rethinking Psychiatry with Dr. Steve Levine.

Crisis Point: The Cause and Calamity, Neighborhood Disadvantage and Kidney Disease

Wood discussed the potential of BTK inhibition for peanut allergy and beyond.

Remibrutinib Enables Peanut Tolerance in as Little as 1 Week, With Robert Wood, MD

Kushner discusses the global burden of hepatitis D, gaps in testing, and emerging therapies reshaping the treatment landscape.

New Momentum in Hepatitis D Research and Treatment, With Tatyana Kushner, MD

Mark G. Lebwohl, MD, the dean for Clinical Therapeutics at the Icahn School of Medicine at Mount Sinai,

At AAAAI 2026, Lebwohl discussed REMIX trial data showing oral remibrutinib reduced CSU symptoms within 12 hours and improved disease control.

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.

Strategic Alliance Partnership

Remibrutinib Shows Rapid Symptom Relief in CSU, With Mark Lebwohl, MD

Melissa Wallach, MD, is a pediatrician at K. Hovnanian Children’s Hospital, Hackensack Meridian Jersey Shore University Medical Center.

Tozzi and Wallach discuss ways to omit artificial sweeteners and added sugars from children’s diets and minimize risk for T2D and MASLD later in life.

Type 2 Diabetes

Obesity Management

Obesity Management condition center page, resources on the topics of medical news and expert insight into clinical weight management can be found. Content includes articles, interviews, videos, podcasts, and breaking news on obesity research, treatment, and drug development.

Sugar-Sweetened Beverages in Childhood Increases Diabetes, MASLD Risk, With Melissa Wallach, MD, and Meghan Tozzi, MD

Rose Onyeali, MD, clinical assistant professor at Penn Medicine.

In Medical Ethics Unpacked, hosts and guest Rose Onyeali, MD, discuss how solitary confinement in prisons may accelerate physical decline and worsen cognitive health.

Medical Ethics Unpacked

Medical Ethics Unpacked is a regular multimedia series hosted by Dominic Sisti, PhD, and Steve Levine, MD, spotlighting a spectrum of topics within the field of medical ethics. Throughout the year, hosts will sit down for an in-depth discussion on a specific ethical dilemma within modern healthcare, with some episodes also featuring a special guest. 

Check back throughout the year for discussions on a variety of topics, including data privacy in health apps, euthanasia and medical assistance in dying, reproductive rights and technologies, and more!

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

Latest News

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

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

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

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

Comparing Colorectal Cancer Screening Test Performance and Prep Options