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Jonathan Meyer, MD, is a clinical professor of Psychiatry at UC San Diego and nationally recognized psychopharmacology educator.

At the 2025 Southern California Psychiatry Conference at Huntington Beach, CA, from July 11 – 12, Jonathan Meyer, MD, presented on muscarinics and 

, a brand under MJH Life Sciences, Meyer, a voluntary clinical professor at the University of California, San Diego, discussed what’s new in tardive dyskinesia, when to switch medications, and how the only effective treatment for this condition is VMAT2 inhibitors.

In this Q&A, Meyer emphasized the importance of making sure you diagnose tardive dyskinesia correctly, not mixing up tardive dyskinesia with Parkinsonism. Medications for Parkinsonism worsen tardive dyskinesia symptoms, and vice versa. Only 2 FDA-approved medications for tardive dyskinesia sit on the market—tetrabenazine and valbenazine—both vesicular monoamine transporter 2 (VMAT2) inhibitors.

 The big thing that's new is not the medications. We've had two FDA-approved treatments in 2017, but in the early days when they're just approved, I think the focus was more on detecting tardive dyskinesia. We've come to appreciate that it's not just the movements, it's the functional impact, the impact on the person's well-being, the impact on psychosocial functioning.

A big aspect of what I'll be covering today is really how to use some of these newer instruments that have been developed to help you figure out for your patients with TD, how it interferes with what they do on a day-to-day basis, not just physically, but psychologically and socially.

If you have a patient and you're giving the medication for TD, and you don't see that they're improving, what are some of the things that clinicians should be thinking about?

 Well, for one thing, you want to make sure that you have the right diagnosis. There are sometimes movements [that] can happen to people on psychotropic [medications], which may lead the clinician to think they have tardive dyskinesia.

A classic example is a form of Parkinsonism, in which the person has jaw tremors, because it's in this area, we often would assume it's tardive dyskinesia, and most of the time, you're right…if they've been exposed to a D2 blocker, but in this case, it's actually a form of Parkinsonism. The medicines [that] make Parkinsonism better tend to make TD worse. Conversely, for people with Parkinsonism, the medicines for TD tend to make those symptoms worse.

If you assume, though, that you have the correct diagnosis, the most important thing is making sure the person's taking the medication and that you've maximized the dose. If there is no response whatsoever on the maximal dose of one medication, there's really no harm in trying the other one. We only have 2 options right now, which are FDA-approved, but there are a subset of people with TD who don't get adequate improvement with either of the 2 FDA-licensed medications. Those are the types of people who you may refer to a neurologist for further evaluation and treatment.

Between the two, how should a clinician decide which one they're going to start trying? Is there a rhyme or reason to it?

 There really often isn't. One of them has a bit more of a titration schedule, which is tetrabenazine. Does that always cause a problem? Not necessarily. There are actually some people who prefer a lower initiation schedule.

Valbenazine is easier to initiate. 40 milligrams is the starting dose, and it's actually a very effective dose. I say to clinicians: you need to know how to use both, simply because insurance, more than anything, may dictate what you have access to. They are both effective.

We don't have any head-to-head data. There's inferential data from imaging studies that maybe you might get more VMAT2 occupancy, perhaps at the maximal dose of valbenazine versus the maximal dose of tetrabenazine. I can't promise there's always a clinical correlate for that, but it emphasizes a point of [knowing] how to use both. Maybe somebody will respond better, or perhaps a differential tolerability to one or the other.

Any closing thoughts that you want to share with clinicians?

 The only effective treatments for tardive dyskinesia are the VMAT2 inhibitors. In the old days, people used to throw medicines like benztropine against all movement disorders with the D2 blockade. We now know that they're not effective for TD, and in fact, they tend to make it worse.

The only thing I'll say about that is, if you have people on anticholinergics at some point in their treatment, if they have TD, you want to slowly taper them off to allow the VMAT2 inhibitor to give you your maximum benefit for their movements, most importantly, to improve their quality of life related to their tardive dyskinesia.

Articles

Jonathan Meyer, MD, presented insights on tardive dyskinesia (TD) at the 2025 Southern California Psychiatry Conference. He emphasized the importance of accurate diagnosis, distinguishing TD from Parkinsonism, as treatments for one can exacerbate the other. The only FDA-approved treatments for TD are VMAT2 inhibitors, tetrabenazine and valbenazine. Meyer highlighted the need to assess the functional impact of TD on patients' lives and suggested trying both medications if one proves ineffective. He advised tapering off anticholinergics to maximize the benefits of VMAT2 inhibitors.

Discover the latest insights on tardive dyskinesia treatment, diagnosis, and the role of VMAT2 inhibitors in enhancing patient well-being.

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What’s New in Tardive Dyskinesia, With Jonathan Meyer, MD

Hypercortisolism in Patients with Treatment-Resistant Type 2 Diabetes, with Richard Auchus, MD, PhD

, Richard Auchus, MD, PhD, presented the results of his deeper examination of the participants of the CATALYST trial for management of 

CATALYST was a phase 4, 2-part, multicenter trial; part 1 examined the prevalence of hypercortisolism in a population of roughly 1000 patients over 36 sites across the US. Each patient had hemoglobin A1c >7.5%, despite using several glucose-lowering therapies such as glucagon-like peptide-1 receptor agonists (GPL-1 RAs). Investigators administered a 1 mg dexamethasone suppression test, the results of which indicated 24% of participants had hypercortisolism.

Part 2 of CATALYST was a randomized, double-blind, placebo-controlled study of mifepristone (Korlym) in select patients from part 1. Patients were randomized to either mifepristone or placebo; the former cohort exhibited a salutary response on glucose, with A1c lowering by roughly 1.5% and roughly 1.3% relative to placebo.

Auchus and colleagues conducted a deeper examination of the patient characteristics highlighted in CATALYST, who had an A1c between 7.5% and 11.5%. Investigating the results from the dexamethasone suppression test, the team stratified patients into 3 major categories: cortisol <1.2, cortisol 1.2-1.8, and cortisol >1.8 after dexamethasone. Auchus and colleagues found substantial worsening of disease, disease control, and comorbidities associated with greater amounts of cortisol after dexamethasone.

“We found that 25% of them failed the dexamethasone suppression test, indicating some form of hypercortisolemia,” Auchus said. “And ‘failed’ conventionally is 1.8 mcg/dL or higher of serum cortisol after the 1mg test. But if you take truly normal people, their cortisol normally suppresses to zero. A couple of groups have looked at what the normal range is for dexamethasone suppression tests in people who are at low suspicion of hypercortisolism, and it turns out that the +2 standard deviation is about 1.2 mcg/dL.”

“Now, we didn’t test the 1.2 to 1.8 people,” Auchus told 

. “So what would happen if we treated those people? And you could also take this one step further and say, ‘What would happen if we treated the people who were less than 1.2?’ I think these are the sort of questions that we need to address.”

Auchus spoke to the lack of variance in response between cohorts. He addressed the alternative approach taken when studying mifepristone and hypercortisolism’s impact on T2D.

“I think it’s comforting but vexing in that the test is an easy way to find people who should respond well, but the reason they respond and the underlying reason that their cortisol doesn’t suppress completely doesn’t seem to matter,” Auchus said. “And it’s a little different than the way we’ve normally thought about it.”

Auchus also mentioned barriers to implementation, chiefly the lack of comfort in drugs like mifepristone and cortisol-directed therapy at large.

“They’ve generally been boutique drugs that only a few endocrinologists use, who specialize in Cushing’s and pituitary centers, adrenal centers,” Auchus said. “I think a barrier to implementation is the comfort level of the average endocrinologist in using cortisol-directed therapy.”

Auchus advised clinicians to keep the possibility of secondary causes in mind when investigating a patient’s treatment-resistant diabetes or high blood pressure. He encouraged broader screening and earlier consideration of alternative causes.

“When the usual things don’t work, don’t keep banging your head against the wall,” Auchus said. “Think about secondary causes. Cortisol and aldosterone are two of the first things you should be thinking of.”

DeFronzo RA, Auchus RJ, Bancos I, et al. Study protocol for a prospective, multicentre study of hypercortisolism in patients with difficult-to-control type 2 diabetes (CATALYST): prevalence and treatment with mifepristone. BMJ Open. 2024;14(7):e081121. Published 2024 Jul 16. doi:10.1136/bmjopen-2023-081121

Diabetes Care Publishes Results from Prevalence Phase of Corcept’s CATALYST Trial in People with Difficult-to-Control Type 2 Diabetes. Corcept Therapeutics. April 21, 2025. Accessed July 14, 2025. https://ir.corcept.com/news-releases/news-release-details/diabetes-care-publishes-results-prevalence-phase-corcepts

Videos

Auchus discusses his recent presentation on the CATALYST trial, investigating the characteristics of patients with difficult-to-treat T2D because of hypercortisolism.

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 2 Diabetes

nt Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

Understanding Indolent Systemic Mastocytosis: A Chronic Mast Cell Disorder

Indolent systemic mastocytosis (ISM) is a lifelong chronic disease characterized by the clonal expansion of aberrant mast cells in the bone marrow, skin, and other tissues. This condition is driven by the 

 D816V mutation, which occurs somatically in more than 90% of cases. The disease fundamentally alters the normal function of mast cells, leading to widespread tissue infiltration and dysfunction that affects multiple organ systems throughout the body.

Patients with ISM experience a constellation of debilitating symptoms caused by mast cell mediator release, including flushing, itching, tachycardia, lightheadedness, abdominal pain, diarrhea, and brain fog. These chronic symptoms can escalate to severe, acute episodes known as anaphylaxis, which pose serious medical risks. Most patients develop a characteristic chronic skin rash called urticaria pigmentosa, while approximately one-third suffer from osteoporosis, significantly increasing their fracture risk. The unpredictable nature of these symptoms creates substantial anxiety and further compromises patient well-being.

The quality of life for ISM patients is severely impacted due to the chronic nature of the disease and the current lack of curative treatment options. First-line symptom management relies on anti–mast cell mediator drugs, including H1 and H2 antihistamines, but these medications often provide inadequate relief. Many patients continue to experience residual symptoms or develop adverse effects from their medications, contributing to ongoing disability. The unpredictability of symptom flares creates a cycle of anxiety and reduced quality of life, making ISM a particularly challenging condition to manage from both medical and psychological perspectives.

A panelist discusses how indolent systemic mastocytosis presents with chronic, mast cell–mediated symptoms that significantly reduce quality of life, often persist despite treatment, and may lead to serious complications like anaphylaxis and osteoporosis.

Video Series

Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

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.

Image Credit: US Food and Drug Administration

 has approved an update to the VARIPULSE Platform’s irrigation flow rate, which is designed to optimize irrigation and support consistent successful operations with low adverse event rates.

Announced on July 14, 2025, by parent company Johnson & Johnson MedTech, the approval follows the significant milestone of >10,000 VARIPULSE procedures across all approved countries. The platform has also maintained a neurovascular adverse event rate of <.5% - although the release notes this statistic is calculated from internal customer reported data/complaints rather than a prospective clinical investigation. The rate reported is preliminary and pending publication.

More than 8 million people in the US and 50 million globally experience 

; 1 in 4 adults ≥40 years of age are at risk of development. However, 1 in 3 are unaware of the condition. Catheter ablation is a safe and effective method of restoring incorrect electrical signals in the heart when traditional therapies are incapable of generating change.

“With a growing prevalence of atrial fibrillation around the world, innovative solutions are critical in expanding options for patients and helping electrophysiologists treat AFib effectively and efficiently,” said Andrea Natale, MD, executive medical director, Texas Cardiac Arrythmia Institute, St. David’s Medical Center. “The VARIPULSE Platform enables efficient procedures with a favorable safety profile, allowing me to treat more patients and get them back to their normal lives.”

The VARIPULSE device is a Pulsed Field Ablation (PFA) system which was initially approved for drug refractory paroxysmal atrial fibrillation on November 7, 2024. It combines PFA therapy with the CARTO 3 system, the world’s leading 3D electroanatomical cardiac mapping system. The device provides real-time visualization of catheter positioning while delivering treatment confidence through tissue proximity indication and lesion tagging.

As treatment is delivered through tissue proximity and lesion tagging, electrophysiologists receive critical feedback for lesion durability and long-term outcomes with the platform. VARIPULSE could provide a comprehensive solution to address both routine and complex AF ablations, according to Johnson & Johnson MedTech.

The VARIPULSE Platform’s initial approval in 2024 was based on 12-month outcome data from the prospective, non-randomized, multi-center admIRE trial, which consisted of 291 patients from 30 US healthcare centers. By week 12, all patients achieved acute procedural success, including 98% with first-pass isolation recorded per vein. Roughly 85% of patients reached peak primary effectiveness when 73-96 applications were given per vein with few adverse events observed.

“By learning from real-world experience and working closely with clinicians, we are continuously enhancing our technologies to improve patient care,” said Michael Bodner, company group chair, electrophysiology and neurovascular, Johnson & Johnson MedTech. “This update to the VARIPULSE Platform reflects our ongoing commitment to lead the evolution of PFA through meaningful, data-driven improvements that advance product performance and build procedural confidence.”

The Platform includes the VARIPULSE Catheter, TRUPULSE Generator, and CARTO 3D Mapping System VARIPULSE Software. It is available for use in the US and several other nations including Europe, China, and Canada.

Johnson & Johnson Receives FDA Approval for Updated VARIPULSE Platform Irrigation Rate. J&J MedTech. July 14, 2025. Accessed July 14, 2025. 

https://www.jnjmedtech.com/en-US/news-events/johnson-johnson-receives-fda-approval-updated-varipulse-platform-irrigation-rate

MedTech J & J. Johnson & Johnson Medtech receives FDA approval for the VARIPULSETM pulsed field ablation platform for the treatment of atrial fibrillation. PR Newswire. November 7, 2024. Accessed July 14, 2025. 

https://www.prnewswire.com/news-releases/johnson--johnson-medtech-receives-fda-approval-for-the-varipulse-pulsed-field-ablation-platform-for-the-treatment-of-atrial-fibrillation-302298232

Iapoce C. FDA Approves VARIPULSE Platform for Treatment of Atrial Fibrillation. 

. November 7, 2024. Accessed July 14, 2025. 

https://www.hcplive.com/view/fda-approves-varipulse-platform-for-treatment-of-atrial-fibrillation

The FDA has approved an update to the VARIPULSE Platform's irrigation flow rate, enhancing its operational consistency and safety profile. This follows over 10,000 procedures performed globally, with a neurovascular adverse event rate of less than 0.5%. The VARIPULSE Platform, a Pulsed Field Ablation system, is used for treating atrial fibrillation, a condition affecting millions worldwide. It integrates with the CARTO 3 system for real-time visualization and feedback, supporting both routine and complex ablations. The platform's initial approval was based on successful outcomes from the admIRE trial.

The previously approved technology has already accomplished over 10,000 procedures for patients with various heart diseases, primarily including atrial fibrillation.

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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...

FDA News

FDA Approves Updated VARIPULSE Platform Irrigation Flow Rate for Heart Disease

Post-Doctoral Fellow at the Emory Global Diabetes Research Center

Concurrent Lifestyle Intervention Enhances Semaglutide Weight Loss, with Qiaochu Xue, PhD, MPH

Concurrent lifestyle intervention was associated with greater weight loss in people with overweight or obesity receiving semaglutide treatment and less regain following discontinuation.

These findings were from an emulated trial from data from the VA MOVE! Program, a Diabetes Prevention Program (DPP)-style lifestyle intervention (LI) led by Hui Shao, MD, PhD, associate professor in the Hubert Department of Global Health, and the School of Public Health at Emory University. They were presented by Qiaochu Xue, PhD, MPH, Post-Doctoral Fellow at the Emory Global Diabetes Research Center,at the 

2025 American Diabetes Association (ADA) Scientific Sessions

The analysis included 2,403 participants from VA MOVE! who initiated semaglutide from 2019 to 2024 that were matched 1:3 to those without LI, using high-dimensional propensity score matching to balance baseline characteristics. Xue and colleagues used generalized mixed-effects models to assess body weight trajectories from semaglutide initiation through 12 months following discontinuation.

The investigators found that individuals with concurrent LI achieved greater weight loss before semaglutide discontinuation (-8.3% vs. -7.4%, 

<.001). Furthermore, at 12 months following discontinuation, LI participants had greater net weight loss (-5.8%) compared to nonparticipants (-3.3%; 

"Most of the phase 3 clinical trials have reported that semaglutide has some weight loss effect for most of the type 2 diabetes patients, or even overweight or obesity patients, but we don't know if during their semiglutide usage period if adding the MOVE program, that combined lifestyle intervention and the medication will increase the weight loss benefits,” Xue told 

Xue Q, Li P, Staton E, et al. 2199-LB: Weight Loss Maintenance following Semaglutide Discontinuation—The Role of Concurrent Lifestyle Intervention. 

. 2025;74(Supplement_1). doi: 10.2337/db25-2199-lb

Lifestyle intervention yielded greater maintained weight loss 12 months after discontinuing semaglutide than without.

BaxHTN trial results showed baxdrostat led to a significant reduction of systolic blood pressure compared to placebo, with a favorable safety profile.

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The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Baxdrostat Meets Efficacy Endpoint in Phase 3 Trial for Resistant Hypertension

Abigail Brooks is an assistant 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.

Treatment with baxdrostat resolved or reduced the severity of hypertension, excessive aldosterone production, and hypokalemia in the phase 2a SPARK trial.

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Phase 2a Baxdrostat Data Show Promise for Primary Aldosteronism

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

This systematic review evaluated current research on dual biologic treatments in patients living with inflammatory skin conditions.

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Review Highlights Benefits, Drawbacks of Dual Biologic Therapy in Dermatology

Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

Finerenone gains FDA approval for heart failure treatment, offering new hope for patients with reduced ejection fraction and improving care options.

Heart Failure

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Chronic Kidney Disease

FDA Approves Finerenone (Kerendia) for Heart Failure with Ejection Fraction of 40% or More

Evan Dellon, MD, MPH, is a professor in the division of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine.

Panelists discuss how first-line eosinophilic esophagitis (EoE) treatment involves shared decision-making between proton pump inhibitors, topical swallowed steroids, or food elimination diets, with therapy selection based on patient preferences, lifestyle factors, developmental stage in children, and the understanding that treatment approaches can evolve over time as circumstances change.

Choosing a First- Line Therapy for EoE

A panelist discusses the potential of remibrutinib as an effective oral alternative to omalizumab for chronic spontaneous urticaria (CSU), noting its rapid onset, promising trial results, and anticipated use in patients who prefer oral therapy or have not responded to biologics.

Insights

 Insights page is a resource for professional video interviews with leading clinical experts and investigators across all specialties of medicine.

Remibrutinib for CSU Treatment

Panelists discuss how proper eosinophilic esophagitis (EoE) diagnosis requires at least 6 biopsies from 2 esophageal levels due to the patchy nature of the disease, and how severity assessment using tools such as the AGA IC score incorporates symptoms, endoscopic findings, and histologic features to guide treatment decisions and potentially prevent progression to fibrosis and structuring through earlier intervention.

Recommended Biopsies in EoE and Assessing Severity

A panelist discusses the limited role of dupilumab in omalizumab-refractory chronic spontaneous urticaria (CSU), noting variation in its use across specialties and highlighting ongoing unmet needs for more diverse, effective treatment options—including oral agents and longer-acting injectables—to support individualized care.

Dupilumab for CSU Therapy

Podcasts

An audio recap of the top 5 stories in healthcare news from the week of 06/30-07/06.



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HCPLive 5 Stories in Under 5: Week of 07/06

These data resulted from a sub-study of the open-label extension (OLE) of the randomized, placebo-controlled phase 3 ‘Balance’ analysis.

Latest News

What’s New in Tardive Dyskinesia, With Jonathan Meyer, MD

Hypercortisolism in Patients with Treatment-Resistant Type 2 Diabetes, with Richard Auchus, MD, PhD

Understanding Indolent Systemic Mastocytosis (ISM): Symptoms and Impact

FDA Approves Updated VARIPULSE Platform Irrigation Flow Rate for Heart Disease

Concurrent Lifestyle Intervention Enhances Semaglutide Weight Loss, with Qiaochu Xue, PhD, MPH