Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for 

. He is also the executive producer of two podcasts: 

. 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.


SCENARIO was a multicenter, randomized, single-blind trial of 200 patients with obesity who had a minor ischemic stroke or TIA. It compared a 15-week structured weight reduction program with a 1-hour nutrition education session.


At 24 months, the weight reduction program lowered the risk of recurrent stroke or TIA, myocardial infarction, death or hospitalization for unstable angina by 67% compared with the control group (relative risk, 0.33).

Which patients benefited most from weight reduction after stroke?


Patients younger than 65 years, those with an mRS score of 0 to 2 and those with metabolic syndrome showed the greatest benefit.

A structured weight-loss program lowered the rate of recurrent vascular events in patients with obesity who had a minor ischemic stroke or transient ischemic attack (TIA). The findings come from the SCENARIO analysis, a trial which was presented during the 

Obesity is a known risk factor for cerebrovascular disease, but there is little evidence on whether deliberate weight loss improves outcomes after a first event. Yaroslav Winter, MD, MSc, head of Mainz Comprehensive Epilepsy and Sleep Medicine Center at Johannes Gutenberg University, presented the multicenter results, which address this gap in secondary prevention.¹

The randomized, single-blind, controlled trial enrolled 200 adults with obesity who had a TIA or a minor ischemic stroke, defined as a modified Rankin Scale (mRS) score of 3 or lower.¹˒² Participants were randomly assigned to a 15-week structured weight reduction program or a single 1-hour nutrition education session.¹ The primary composite end point included recurrent stroke or TIA, myocardial infarction, death and hospitalization for unstable angina.

Did Weight Loss Reduce Recurrent Vascular Events?

At 24 months, patients in the weight reduction arm had a significantly lower risk of the composite end point than the control group (relative risk, 0.33; 95% CI, 0.13-0.83; 

 = .02).¹ Investigators also reported significant improvements in functional outcomes, body measurements, blood pressure and lipid levels with the intervention.¹

The benefit was greatest in 3 subgroups: patients younger than 65 years, those with an mRS score of 0 to 2 and those with metabolic syndrome.¹ Winter and colleagues concluded that structured weight management may help prevent secondary stroke in this population. They added that an individualized approach is needed to get the best results.¹

What Do the Findings Mean for Secondary Stroke Prevention?

Clinicians now have more options for weight management, and these results suggest structured lifestyle programs may deserve a place alongside medications for controlling risk factors after a minor stroke or TIA. The full results, including absolute event rates and details of the intervention, have not yet been published.

Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools.

Winter Y. Secondary prevention of stroke or transient ischemic attack by means of a weight reduction programme (SCENARIO trial). Presented at: 2026 World Stroke Congress; October 21-23, 2026; Seoul, South Korea. Accessed October 28, 2026. 

https://cslide.ctimeetingtech.com/wsc26/attendee/confcal/session/calendar/2026-10-21#presentation-abstract-2598553795606

Secondary prevention of stroke or TIA by means of a weight reduction programme (SCENARIO). ClinicalTrials.gov identifier: NCT01721538. Accessed October 28, 2026. 

https://clinicaltrials.gov/study/NCT01721538

Articles

In the SCENARIO trial, a 15-week weight-loss program cut recurrent vascular events by 67% in patients with obesity after minor ischemic stroke or TIA.

Stroke

On the HCPLive stroke page, resources on the topics of medical news and expert insight into CVA can be found. Content includes articles, interviews, videos, podcasts, and breaking news on stroke medicine, and more.

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.

Conference

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

Weight-Loss Program Cuts Vascular Events by 67% After Minor Stroke, TIA

Christopher G. Bunick, MD, PhD, is an associate professor of dermatology at Yale University School of Medicine.

Lindsay Ackerman, MD, FAAD, is a board-certified dermatologist in Phoenix, Arizona, and founder of Medical Dermatology Specialists, now part of US Dermatology Partners. She created 

, a multimedia educational nonprofit network built to educate how the skin reveals deeper truths of human health, and co-hosts HCPLive’s ABCs in Dermatology podcast. She is clinical faculty at the University of Arizona College of Medicine – Phoenix and has been an AAD delegate to the AMA since 2005.

 care, and phosphodiesterase 4 (PDE4) inhibitors now offer a once-daily option capable of reaching optimal targets for skin and itch.

In this episode of ABCs in Dermatology, hosts Lindsay Ackerman, MD, and Chris Bunick, MD, PhD, examined where topical PDE4 inhibitors fit and how to measure meaningful response.

On this episode of ABCs in Dermatology, Lindsay Ackerman, MD, and Chris Bunick, MD, PhD, talk through the growing role of nonsteroidal topical therapy in eczema care and how they set treatment goals with patients.

ABCs in Dermatology: Understanding PDE4 Inhibition in Atopic Dermatitis

PDE4 hydrolyzes cyclic adenosine monophosphate (cAMP), a second messenger driving anti-inflammatory programming. Because inhibition acts upstream of the Janus kinase (JAK)-STAT pathway, it dampens Th1, Th2, Th17, and Th22 signaling. Roflumilast (Zoryve) more closely mimics cAMP than crisaborole (Eucrisa) or apremilast (Otezla), with roughly 25-fold to more than 300-fold greater in vitro potency.

In the phase 3 INTEGUMENT-1 and INTEGUMENT-2 trials, 1337 patients aged 6 years or older applied roflumilast cream 0.15% or vehicle once daily for 4 weeks.

 Validated Investigator Global Assessment success reached 32.0% vs 15.2% and 28.9% vs 12.0%, respectively, with 75.8% entering with moderate disease.

 Itch improved within 24 hours of the first application.

Application-site pain occurred in 0.9% and 2.1% of roflumilast-treated patients, and none of 47 patients who previously stopped crisaborole for stinging or burning developed application-site adverse events.

 One hypothesis attributes part of crisaborole's irritation to its boron-containing structure. Nausea affected 2.0% or fewer of treated patients,

 and moderate to severe hepatic impairment remains the key contraindication.

In the INTEGUMENT open-label extension, patients reaching clear skin switched to twice-weekly proactive application and maintained clear or almost clear skin for a median of 281 days.

 The regimen mirrors proactive corticosteroid maintenance without cumulative steroid exposure, useful on the face, eyelids, and skin folds. In children aged 2 to 5 years, roflumilast cream 0.05% likewise improved pruritus within 24 hours.

Unlike ruxolitinib cream (Opzelura), limited to short-term use on 20% or less of body surface area, roflumilast carries no duration or surface area cap. Clinicians increasingly pair it off label with biologics or oral JAK inhibitors for residual disease, often persistent itch.

Treat-to-target goals now define minimal disease activity as clear or almost clear skin plus an itch score of 0 or 1 on a 0-to-10 scale. Reduction of 4 or more points on the Worst Itch Numeric Rating Scale marks a moderate target, signaling response while deeper improvement accrues.

Collectively, once-daily topical PDE4 inhibition positions nonsteroidal therapy as a credible route to minimal disease activity in atopic dermatitis. The data reinforce corticosteroid stewardship for long-term and sensitive-site use.

Relevant disclosures for Bunick include AbbVie, South Beach Symposium, Almirall, Apogee Therapeutics, Arcutis Biotherapeutics, Daiichi Sankyo, Eli Lilly, LEO Pharma, US, Novan, Novartis, Ortho Dermatologics, Palvella Therapeutics, Pfizer Inc., Sanofi, Sun Pharmaceutical Industries Ltd., Timber Pharmaceuticals, and UCB. Relevant disclosures for Ackerman include AbbVie, Alumis, Amgen, Arcutis, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Dermavant, Galderma, L'Oréal, Novartis, Sun Pharmaceutical, and UCB.

Simpson EL, Eichenfield LF, Alonso-Llamazares J, et al. Roflumilast cream, 0.15%, for atopic dermatitis in adults and children: INTEGUMENT-1 and INTEGUMENT-2 randomized clinical trials. 

Simpson EL, Eichenfield LF, Papp KA, et al. Long-term safety and efficacy with roflumilast cream 0.15% in patients aged ≥6 years with atopic dermatitis: a phase 3 open-label extension trial. 

Eichenfield LF, Serrao R, Prajapati VH, et al. Efficacy and safety of once-daily roflumilast cream 0.05% in pediatric patients aged 2-5 years with mild-to-moderate atopic dermatitis (INTEGUMENT-PED): a phase 3 randomized controlled trial. 

Podcasts

Lindsay Ackerman, MD, and Chris Bunick, MD, PhD, discuss where topical PDE4 inhibitors fit in atopic dermatitis and how to measure skin and itch response.

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.

Atopic Dermatitis

Atopic Dermatitis 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 dermatitis research, treatment, and drug development.

ABCs in Dermatology

Welcome to ABC’s in Dermatology, HCPLive’s newest dermatology podcast, hosted by a pair of the field’s leading minds in Lindsay Ackerman, MD, and Chris Bunick, MD, PhD.

Created by the same team behind The Medical Sisterhood and Skin of Color Savvy, ABCs in Dermatology is a monthly podcast designed to deliver candid conversations, clinical insight, and forward-looking perspectives from the voices shaping dermatology today.

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

ABCs in Dermatology: Topical PDE4 Inhibition in Atopic Dermatitis

Shannon C. Trotter, DO, is a dermatologist and podcast host from Springfield, Ohio.

Physicians often find it easier to discuss clinical failures than personal exhaustion.

People-pleasing and fear of lost opportunities can push women physicians toward burnout.

Women in medicine can be excellent clinicians while still exhausted or imperfect.

, host Mona Shahriari, MD, associate clinical professor of 

 at Yale University and a practicing dermatologist in Connecticut, is joined by Shannon C. Trotter, DO. Trotter is a dermatologist from Springfield, Ohio, a speaker and educator, and host of the ‘

This podcast episode is a sequel to Shahriari’s appearance on Trotter’s own show. It explores the gap between the polished podium version of physicians and the real-life version that emerges over coffee, in hotel lobbies, and in group chats with trusted colleagues.

The Medical Sisterhood: How to Approach Burnout, Boundaries, and Authenticity in Medicine

Shahriari opens with a series of candid statements for Trotter to react to. The first is that expertise alone does not earn someone a microphone. Trotter agrees that research or clinical expertise and the ability to communicate it are separate skill sets, and that only some clinicians have both. The two discuss the challenge of co-presenting with colleagues whose energy and style differ from their own. Trotter describes how a spontaneous live demonstration with a more reserved co-presenter became one of the session’s strongest moments.

Why Do Physicians Hide Exhaustion More Than Clinical Failures?

Trotter suggests physicians find clinical failures easier to discuss because they can be explained by outside factors, such as incomplete patient histories, adherence issues, or a trial that missed its end point. Personal exhaustion, by contrast, tends to be seen as a flaw in oneself. Both clinicians note that women in medicine often hold themselves to especially high standards, a pattern reinforced by curated social media feeds.

Shahriari describes canceling a lunch meeting after a cross-country lecture schedule left her running on minimal sleep, and notes how long she hesitated before admitting she was tired. Trotter links this hesitation to people-pleasing and to fear that declining a commitment could cost future opportunities. That cycle, she says, can push clinicians toward burnout. Survey data continue to show higher rates of burnout among women physicians than among men.

How Can Physicians Handle Missteps When Speaking in Public?

Trotter emphasizes the power of pausing before speaking and asking whether a comment adds value. Criticism of a colleague’s presentation, she notes, belongs in a private conversation rather than a public chat. She acknowledges that jokes sometimes fall flat on stage and that constant recording makes such moments feel more permanent, but encourages speakers to keep going and accept imperfection. Both agree that speakers are usually their own harshest critics, and Shahriari has stopped listening to recordings of herself for that reason. Trotter adds that learning not to take rejection personally is especially hard for younger clinicians.

What Should More Women in Medicine Say Out Loud?

Trotter describes herself as a serious physician who is not always a serious person. She uses humor to build rapport with patients while reading each room to decide how far to take it. The two share lighthearted confessions about conference life, including pretending to recognize colleagues, slipping out of events unnoticed, and the effort behind polished social media photos. Trotter also recounts responding to emergencies outside the clinic, including a stroke on an airplane, as an example of physicians’ innate drive to help others. She closes by urging women physicians to acknowledge that they can be excellent clinicians while still feeling exhausted or disorganized. She also encourages them to promote themselves without making themselves smaller for others’ comfort.

Editor’s note: This summary was edited for the purposes of grammar and clarity using AI tools. Shahriari and Trotter highlighted no relevant financial disclosures of note. 

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

Berg S. What’s behind the persistent gender gap in physician burnout. American Medical Association. Published April 30, 2026. Accessed October 28, 2026. 

https://www.ama-assn.org/practice-management/physician-health/what-s-behind-persistent-gender-gap-physician-burnout

Ortega MV, Hidrue MK, Lehrhoff SR, et al. Patterns in physician burnout in a stable-linked cohort. 

. 2023;6(10):e2336745. doi:10.1001/jamanetworkopen.2023.36745.

Shannon C. Trotter, DO, and Mona Shahriari, MD, discuss burnout, people-pleasing, public speaking, and the real life behind physicians’ polished personas.

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!

In "New International IgG4-RD Guidelines and the Road Ahead," the panel considers how new recommendations may standardize care worldwide.

New International IgG4-RD Guidelines and the Road Ahead

Dr. Culver asks which recommendations in the new international guidelines are most novel or practice changing. Dr. Katz says the most important development is that well-designed guidelines now exist. They were developed by a large international group spanning many countries and specialties. Clinicians, pathologists, radiologists, and patients all took part. He considers consensus across such a varied group to be their most valuable feature.

He sees several practice-changing elements, especially for clinicians with less experience in the disease. Among his favorites are recommendations on glucocorticoids. The guidelines explicitly limit both the maximum dose and the duration to a few months, which is enough for most patients. They also emphasize using B-cell-targeted therapies up front in many patients.

Dr. Della Torre adds that these are the first guidelines to incorporate evidence from randomized clinical trials. They encourage a consistent worldwide approach regardless of the organ involved. That approach covers both currently available treatments and agents expected to become available. Earlier guidelines, which the group also developed, lacked this evidence. He views the new guidelines as a hallmark and a starting point for homogenizing care.

Dr. Culver welcomes the new emphasis on managing complications of the disease. Earlier guidelines focused largely on active disease, glucocorticoids, conventional disease-modifying drugs, and B-cell therapies. The new guidelines also address multispecialty care for complications and attention to patients' quality of life.

Finally, Dr. Culver asks what will make the greatest difference for patients going forward. Dr. Della Torre points to the expanding range of treatment options now available and expected over the next few years. He tells patients that research is moving fast. Treatment for someone diagnosed in 2026 will likely differ in 2, 3, or 4 years. He says the discussion leaves him trusting the future and hopeful for more individualized care.

Thank you for watching this HCPLive Peer Exchange series on IgG4-related disease. Please subscribe to our eNewsletter for information on upcoming video series.

Videos

New international guidelines bring randomized trial evidence and multidisciplinary consensus to IgG4-related disease. The panel highlights practice-changing recommendations and the treatment advances most likely to help patients.

Video Series

"Malignancy Risk in IgG4-RD: Interpreting Conflicting Evidence" takes up a question that has divided the field.

Malignancy Risk in IgG4-RD: Interpreting Conflicting Evidence

Dr. Katz explains that the malignancy debate is heated because the answer remains unknown. Several cohorts show higher malignancy prevalence, meaning patients more often have a cancer history than people without the disease. Less clear is whether patients face higher risk after disease onset. A previous cancer does not change disease management. Future risk, however, matters greatly to them.

Data on post-onset risk are mixed, and many studies have important limitations. Detection bias is a major concern. Extensive imaging at diagnosis may uncover cancers that would otherwise have remained hidden for years. Some studies do not separate existing cancers from new ones. Claims-based studies showing higher incidence cannot easily separate the disease itself from treatment effects. Some treatments used in IgG4-related disease, such as cyclophosphamide, are known to increase cancer risk.

His center studied malignancy risk from the first clinical signs of disease rather than diagnosis. Reassuringly, it found no increased risk. He notes that it is the largest study of its kind but is single-center. Given conflicting results, larger longitudinal studies are needed.

In his practice, imaging monitors disease activity only. Evidence does not support extra cancer surveillance. He recommends routine, age-appropriate cancer screening. Pancreatic imaging is an exception in practice. Some data suggest autoimmune pancreatitis may raise pancreatic cancer risk, though findings conflict. Chronic gastrointestinal inflammation is linked to local cancer, which supports continued pancreatic imaging, as most clinicians already do.

Dr. Della Torre agrees about study limitations. His retrospective cohort showed a slight increase in malignancy in the 3 years around diagnosis. Notably, his team has never seen cancer arise in an organ affected by IgG4-related disease. He suggests that treatment may suppress local inflammation that might otherwise promote cancer. He has seen no dominant tumor type, so he does not use disease-specific cancer screening.

In "New International IgG4-RD Guidelines and the Road Ahead," the panel will close the series with a look at new international guidelines and what may make the greatest difference for patients.

Studies disagree on whether IgG4-related disease raises future cancer risk. The panel separates prevalence from incidence, explains common study biases, and describes their approach to cancer screening.

Treatment success in IgG4-related disease depends on the patient and the perspective. The panel discusses balancing disease control with treatment harm, reasons to switch therapy, and multidisciplinary complication management.

Defining Treatment Success, Switching Therapy, and Managing IgG4-RD Complications

Because relapse is so common, monitoring in IgG4-related disease is indefinite. Dr. Katz details how he tailors imaging and laboratory intervals and explains surveillance to asymptomatic patients.

Long-Term Monitoring in IgG4-RD: Imaging, Serology, and Visit Frequency

Oral agents, novel biologics, and cellular therapies are advancing in IgG4-related disease. The panel weighs their promise against toxicity and considers whether lasting remission or cure is achievable.

Emerging IgG4-RD Therapies: Cellular, Oral, and Pathway-Targeted Approaches

With both B-cell depletion and B-cell inhibition now studied in phase 3 trials, treatment selection becomes a shared decision. The panel discusses induction, maintenance, and what reversibility offers.

Positioning B-Cell Depletion and B-Cell Inhibition in IgG4-RD Care

A first-in-class agent inhibits B cells without depleting them. The panel reviews its mechanism and the largest randomized trial yet conducted in IgG4-related disease.

B-Cell Inhibition in IgG4-RD: Phase 3 Trial Design and Outcomes

The first phase 3 trial in IgG4-related disease showed an unusually strong reduction in flares with anti-CD19 B-cell depletion. The panel reviews the design, safety signals, and early clinical experience.

Anti-CD19 B-Cell Depletion in IgG4-RD: Phase 3 Data and Practice

Between anti-CD20 courses, clinicians combine clinical, serologic, radiologic, and B-cell data to anticipate relapse. The panel also addresses infection risk, hypogammaglobulinemia, and the irreversibility of depletion.

Monitoring and Safety Considerations With Anti-CD20 Therapy in IgG4-RD

Anti-CD20 therapy has been used off-label for years in IgG4-related disease. Dr. Della Torre describes which patients receive it first-line, the dosing protocol, and how responses vary.

Anti-CD20 B-Cell Depletion for Inducing Remission in IgG4-RD

Multi-organ disease and certain serologic markers predict relapse, but timing remains unpredictable for individual patients. Dr. Katz explains why close monitoring continues even during apparent remission.

Predicting Relapse in IgG4-RD: Risk Factors and Ongoing Surveillance

In older patients with diabetes, cardiovascular disease, and osteoporosis, glucocorticoid harms are magnified. The panel explains why minimizing steroid exposure is central to treating a relapsing disease.

Latest News

Weight-Loss Program Cuts Vascular Events by 67% After Minor Stroke, TIA

ABCs in Dermatology: Topical PDE4 Inhibition in Atopic Dermatitis

The Medical Sisterhood: How to Approach Burnout, Boundaries, and Authenticity in Medicine

New International IgG4-RD Guidelines and the Road Ahead

Malignancy Risk in IgG4-RD: Interpreting Conflicting Evidence