Hilary Ugras, NP, is a nurse practitioner in GI motility at Beth Israel Deaconess Medical Center.

This episode, titled ‘Addressing Diagnostic Delays in EoE,’ features panelists examining barriers that can contribute to delayed diagnosis and the important role advanced practice providers (APPs) can play in promoting earlier recognition of eosinophilic esophagitis. The expert faculty discuss how comprehensive patient histories can uncover adaptive eating behaviors and other clinical clues that may warrant earlier endoscopic evaluation rather than simply treating presenting symptoms.

Addressing Diagnostic Delays in EoE

The panelists highlight opportunities for APPs to collaborate with gastroenterologists and other members of the care team throughout the diagnostic journey. They describe how APPs can support continuity of care by managing patients in the clinic, coordinating with colleagues performing endoscopic procedures, and building trusted relationships with patients over time. The discussion also emphasizes peer education and communication with clinicians in emergency, urgent care, and primary care settings as potential ways to increase awareness of EoE earlier in the patient journey.

The panel then examines the clinical consequences of delayed diagnosis, undertreatment, or inadequate disease control. Persistent inflammation can contribute to progression from an inflammatory phenotype toward fibrostenotic disease, including esophageal rings, narrowing, and strictures. These changes can affect what and how patients eat and may have broader emotional, social, and professional consequences. The expert faculty also discuss the risk of food impaction, which may result in emergency care and urgent endoscopic intervention. Together, these considerations underscore why earlier recognition, appropriate diagnosis, and effective disease control are important for limiting the long-term burden of EoE.

In the next episode, ‘Induction and Maintenance Therapies in EoE,’ panelists will examine how available treatment approaches fit across the induction and maintenance phases of EoE care. The expert faculty also discuss assessing remission, maintaining long-term disease control, and adapting therapy as patients’ needs and preferences evolve.

Videos

Diagnostic delays in EoE can have consequences beyond persistent symptoms. The panel explores how earlier recognition and collaborative care may help address progressive esophageal remodeling and reduce long-term disease burden.

Video Series

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Saakshi Khattri, MD, is a board certified Dermatologist, Rheumatologist and Internist and one of only a handful of triple board-certified physicians across the US.

In "The Next Five Years in Psoriasis: Remission, Access, and Combinations," the panel looks ahead to the advances and the unfinished work of the coming years.

The Next Five Years in Psoriasis: Remission, Access, and Combinations

Dr. Han hopes the field will embrace all components of psoriatic disease equally and reach consensus on remission for the joints, not just the skin. He points out that even very low disease activity still allows up to one joint, so the definitions themselves show how far the joint side has to go. He is encouraged that development has not truly slowed.

Dr. Han previews a next era of biologics using dual inhibition and multi-active designs that target several cytokines at once. He notes patients may soon face a once-a-year injection, something few would have believed five years ago, and stresses that even a strong landscape leaves room to improve quality of life. He returns forcefully to access, describing patients who watch drug commercials with a call to action they cannot fulfill because the nearest dermatologist is a four-hour drive and six months away.

Dr. Wright picks up the access thread, citing recent work showing that where a patient lives shapes which drug they receive first and maps onto disease burden. She calls these the social and commercial determinants of health that decide who ever gets a chance at remission.

Dr. Wright wants the field to unpack what challenging-to-manage and treatment-refractory truly mean, ideally with predictive biomarkers so patients do not cycle through drugs while damage accrues. She insists on treating the whole person, including mental health, obesity, and cardiovascular risk, summed up in her line that bones hurt but heart kills. She predicts combination therapy will be essential for complex patients, even without large randomized trials to guide it.

Thank you for watching this HCPLive Peer Exchange series on psoriasis. Please subscribe to our eNewsletter for information on upcoming video series.

In ‘The Importance of Early Diagnosis in EoE,’ our panel explores why recognizing eosinophilic esophagitis as a chronic, progressive disease reinforces the need for timely diagnosis and disease control. The expert faculty discuss how persistent, untreated inflammation can contribute to esophageal remodeling, fibrosis, and stricture formation over time, emphasizing that the goals of care extend beyond addressing a patient’s immediate symptoms.

The Importance of Early Diagnosis in EoE

The panelists examine how diagnostic delays may increase the risk of fibrostenotic disease and explain why this is particularly important when counseling younger patients who may have decades of disease ahead of them. They discuss the challenge of communicating long-term risks to patients who may be minimally symptomatic or feel better after an acute event, such as a food impaction that resolves spontaneously. Rather than focusing exclusively on short-term symptom relief, the panel emphasizes the importance of identifying and treating underlying inflammation to help prevent disease progression.

The expert faculty also share practical approaches for helping patients understand the chronic nature of EoE and the value of pursuing diagnostic evaluation. Visual models of the esophagus and relatable analogies can help patients conceptualize inflammation and structural changes that they cannot see or may not yet feel. Throughout the discussion, the panel underscores the importance of patient education and shared understanding in encouraging appropriate evaluation and long-term engagement in care. Ultimately, earlier diagnosis provides an opportunity to address inflammation before progressive structural changes create a greater clinical burden for patients.

Our next episode, ‘Addressing Diagnostic Delays in EoE,’ examines how APPs can help overcome barriers to earlier EoE recognition through comprehensive histories, collaboration, and clinician education. The panelists also discuss how delayed diagnosis and inadequate disease control can contribute to fibrostenotic progression and greater long-term disease burden.

Early EoE diagnosis is about more than relieving symptoms today. The panel explores how timely recognition and treatment of inflammation may help limit progressive structural changes and protect long-term esophageal health.

In topline interim phase 1b findings, a single 720-mg subcutaneous dose of zumilokibart (APG777), Apogee Therapeutics' long-acting anti-interleukin-13 (IL-13) monoclonal antibody, produced rapid and sustained suppression of fractional exhaled nitric oxide (FeNO) in patients with mild to moderate 

, according to Mario Castro, MD, MPH, professor of medicine and chief of the Division of Pulmonary, Critical Care and Sleep Medicine at the University of Kansas School of Medicine. Castro discussed the data, presented at the 

European Respiratory Society (ERS) International Congress, held in Barcelona from September 5-9

Zumilokibart Rapidly Suppresses FeNO in Phase 1b Asthma Data: Mario Castro, MD

The trial (NCT06920901) randomized 19 patients with baseline FeNO of at least 25 ppb 3:1 to zumilokibart or placebo (14 and 5 patients, respectively).¹ By week 2, patients receiving zumilokibart had a mean FeNO reduction of 45.1 ± 15.7 ppb, a 60.2% ± 4.3% decrease from baseline, compared with 10.6 ± 7.5 ppb (10.2% ± 8.7%) with placebo.¹ Castro said the effect was durable, with mean reductions holding above 40 ppb and 50% through week 32; among the smaller subset of patients with extended follow-up, suppression persisted through week 48, though the evaluable sample had narrowed to 2 patients by that point. 

"I consider it a direct measure of airway inflammation," Castro said of FeNO, explaining that the biomarker is believed to reflect IL-13 activity in the airway epithelium and complements lung function testing and phenotyping in guiding treatment.

Zumilokibart was well tolerated: 11 of 14 patients (78.6%) had at least 1 treatment-emergent adverse event, compared with all 5 placebo patients, and neither group had a serious or grade 3/4 event or a discontinuation due to an adverse event.¹ Castro attributed much of the drug's profile to its extended half-life, measured at 75.3 to 77.5 days across doses tested and conferred by a YTE Fc modification that enhances antibody recycling. He said that duration could support dosing as infrequent as every 3 to 6 months, reducing burden on patients and clinicians and potentially helping close the post-exacerbation coverage gap that contributes to hospital readmissions. Apogee is also developing a bispecific candidate combining zumilokibart with an anti-thymic stromal lymphopoietin (TSLP) antibody, aimed at asthma and chronic obstructive pulmonary disease.

Castro noted that elevated FeNO combined with elevated blood eosinophils has separately been shown to predict roughly 2 to 2.5 exacerbations per patient over the following year, reinforcing the biomarkers' combined prognostic value, a relationship also described in a biomarker risk-scale model developed by other investigators.² Looking ahead, Castro said the field is moving toward disease-modifying, and potentially remission-inducing, therapy in severe asthma and COPD, with future interest in earlier use of long-acting biologics, even in childhood, pending additional safety data.

Castro M, Cole J, DeAngelo J, et al. A single dose of zumilokibart (APG777) durably suppresses FeNO through 32 weeks in patients with mild-to-moderate asthma. Poster presented at: European Respiratory Society (ERS) International Congress; September 5-9, 2026; Barcelona, Spain. Poster PA339.

Couillard S, Laugerud A, Jabeen M, et al. Derivation of a prototype asthma attack risk scale centred on blood eosinophils and exhaled nitric oxide. 

. 2022;77(2):199-202. doi:10.1136/thoraxjnl-2021-217325

Castro, of University of Kansas discusses interim phase 1b data showing rapid, durable suppression in patients with mild to moderate asthma.

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John Oppenheimer, MD, clinical professor of medicine at Rutgers New Jersey Medical School and allergist at Pulmonary and Allergy Associates of New Jersey

Explanatory phase 3 trials of single-inhaler triple therapy (SITT) in

have enrolled patients with moderate to severe disease, impaired lung function, and a history of exacerbations, leaving infrequently exacerbating patients outside the evidence base.¹ Even among patients adherent to medium- and high-dose ICS/LABA, 63.8% and 70.0%, respectively, remain uncontrolled, underscoring the unmet need in this population.¹ PERFORM was designed to close this gap using a pragmatic, open-label design reflecting routine clinical practice, without restricting patients by treatment history, smoking status, comorbidities, or exacerbation frequency.

PERFORM randomized 1236 adults with uncontrolled asthma 1:1 to once-daily FF/UMEC/VI via the ELLIPTA inhaler or non-ELLIPTA usual care ICS/LABA More than 80% of enrolled patients reported no severe exacerbation in the prior year.¹

At week 24, FF/UMEC/VI produced a significantly greater improvement in trough FEV

 versus usual care ICS/LABA (least squares mean difference, 68 mL [95% CI, 36-99]; 

<.001).¹ Overall, 79.0% of patients achieved a clinically meaningful ACQ-7 response with FF/UMEC/VI versus 71.8% with usual care (odds ratio, 1.47 [95% CI, 1.13-1.92]; 

 =.004).¹ These results mark the first pragmatic randomized controlled trial evidence for FF/UMEC/VI in patients with uncontrolled, infrequently exacerbating asthma, a population historically excluded from SITT trials.¹

European Respiratory Society (ERS) Congress 2026

 in Barcelona, Spain, John Oppenheimer, MD, clinical professor of medicine at Rutgers New Jersey Medical School and allergist at Pulmonary and Allergy Associates of New Jersey, presented a late-breaking abstract on PERFORM.

ahead of the meeting about how the secondary endpoint data reshape thinking on triple therapy escalation.

Q&A: PERFORM Data Support Earlier Triple Therapy in Milder Uncontrolled Asthma

 Why has this uncontrolled, infrequently exacerbating population been overlooked in prior SITT trials, and why does pragmatic RCT data here matter clinically?

We’ve generally examined new medicines by [conducting] a very rigid phase 3 trial, so we exclude people that may smoke or may have other comorbidities. We also exclude people that are not adherent [to treatments] because, obviously, this diminishes the efficacy of the study when you're trying to get FDA or EMA approval.

The analogy I draw is when I have somebody that tells me how many miles per gallon and how good a car is, it's done under ideal conditions. We drive it with somebody that's got their foot in the pedal, not escalating up and down. That's just consistent. I look at pragmatic trials as kicking the tire and letting it be in the real world, and it really shows if the signal can translate from a well-controlled trial to the real world, and that's exactly what this pragmatic study did.

How did the secondary endpoint findings presented at ERS change your interpretation of the PERFORM data?

It reinforces a lot of PERFORM data. What we've done in this particular study is we've looked at things like asthma control. If you think about many of the studies with regard to more severe asthmatics, the outcome we look at is exacerbation because that's an easy signal. It really is very palpable, and it's very expensive.

Only about 10% of patients with moderate disease with ongoing symptoms have [an] exacerbation once a year, and only 22% of those people having 1 exacerbation will go on to another exacerbation. Meaning that when we look at the exacerbation population, it is a real small minority of those patients with uncontrolled asthma.

What's really neat about PERFORM is we're looking at the average patient that really has moderate to severe asthma that needs to have their therapy escalated to gain control, and what PERFORM does is show that moving from dual therapy ICS/LABA to triple therapy ICS/LABA/LAMA translates to better outcomes [and] translates to better control.

 Is PERFORM data sufficient to shift guideline conversations for milder uncontrolled disease?

Yes. What the study shows us is that many patients that are uncontrolled can do better if we step up therapy.

We need to be more aggressive early on in treating patients with triple therapy versus dual therapy, and if they do fail, then we would move to biologics if they're appropriate candidates.

 How does heterogeneity in the usual care arm affect interpretation of the findings?

That's part of the problem. When you have a pragmatic study, it may not be as controlled as, say, a phase 3 trial, so heterogeneity will exist. But it just shows that a very diverse population still shows a signal of efficacy [with] triple versus dual.

Why might that be? You're already on dual therapy. What does adding the LAMA do? I don't know that we have a good answer, but there's interesting data that's translated from studies looking at small airways’ disease. What they do is they look at the ability for the inhaled therapy to result in less heterogeneity of the lung.

A study done by Tetsch-Kirschner in Advanced Therapeutics 2025 looks at visualized improvements of airway dysfunction comparing dual to triple therapy. People on dual therapy had areas of their lungs that weren't ventilating, and adding the LAMA resulted in a greater improvement in their ability to ventilate the peripheral airway compared to dual therapy.

Maybe we're getting the medicine to where the problem is, and we're opening up the lungs. It's exciting new data showing that adding this third arm on our controller therapy really translates to improve ventilation of the lung, improve symptoms, [and] improve lung function.

Do patients with this infrequently exacerbating phenotype notice lung function improvements day to day, or does symptom benefit stem from another mechanism?

 It’s all over the page. There's real heterogeneity in lung function changes in patients’ perception of their shortness of breath. There were several studies done, one by Magdle in Chest almost 20 years ago, showing that a subgroup of people will perceive change in their lung function profoundly, while others may not.

The nice thing about PERFORM, by looking at the asthma control patient perception, [it] really speaks to the fact that they felt better on this therapy. You could see a difference in their feeling of control.

 Did regional differences in asthma management affect generalizability of PERFORM findings for US allergists and pulmonologists?

The main thrust of controller therapy, whether we look at GINA or NHLBI, so ex-US versus US, is really very similar. It's controller therapy and escalation of the controller arm. I don't think it varies enough to make a big difference in the outcome.

 Is there anything else about PERFORM you would like to highlight?

One of the things that I think is very exciting right now is the concept of remission in asthma. Remission is the nirvana of asthma. It is our goal. It's aspirational from the standpoint of doctors having to work harder than ever before, and it's inspirational because patients realize that they have the ability to have a level of control that nobody ever perceived before. What's exciting is PERFORM demonstrated that remission was more likely to occur with triple versus dual therapy.

Penz E, Noorduyn SG, Moore AC, et al. Effectiveness of FF/UMEC/VI versus ICS/LABA in patients with uncontrolled asthma treated in routine clinical practice (PERFORM): a pragmatic randomized controlled trial. 

Oppenheimer J. The PERFORM Pragmatic RCT Comparing FF/UMEC/VI Versus ICS/LABA in Asthma. Late-breaker presented at the European Respiratory Society (ERS) Congress 2026 in Barcelona, Spain from September 5 – 9.

Articles

Pragmatic evidence is emerging for single-inhaler triple therapy in uncontrolled asthma that seldom exacerbates. PERFORM randomized 1,236 adults to once-daily FF/UMEC/VI or non-ELLIPTA usual-care ICS/LABA without typical phase 3 exclusions; >80% had no prior-year severe exacerbation. At 24 weeks, triple therapy improved trough FEV1 by 68 mL versus dual therapy and increased clinically meaningful ACQ-7 responses (79.0% vs 71.8%). Secondary analyses support earlier escalation, potential remission gains, and benefits plausibly linked to improved peripheral-airway ventilation despite broad heterogeneity in background regimens across routine-practice settings.

At ERS 2026, John Oppenheimer, MD, discusses how PERFORM supports earlier escalation in patients with uncontrolled, infrequently exacerbating asthma.

Q&A: PERFORM Data Support Triple Therapy in Milder Uncontrolled Asthma

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

ADVANCE Outcomes at ERS 2026 demonstrated improved odds of improvement and reduced odds of worsening.

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...

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Ralinepag Improves Clinical Outcomes in Contemporary PAH Population

Charalambos Antoniades, MD, PhD, is the director of the Acute Multidisciplinary Imaging & Interventional Centre and BHF chair of cardiovascular medicine at the University of Oxford and founder and chief scientific officer at Caristo Diagnostics.

Charalambos Antoniades, MD, PhD, discusses the recent trial investigating an AI-powered stroke and atrial fibrillation predictor.

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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.

Arrhythmia

ORFAN-MAESTRIA: AI Predicts Cardioembolic Stroke, Atrial Fibrillation from CT Scans

The oral RARβ/γ agonist improved FVC and reduced fibrotic biomarkers over 12 weeks in a phase 2a trial presented at the ERS Congress 2026.

Pulmonary Fibrosis

GRI-0621 Improves FVC, Reduces Fibrotic Biomarkers in IPF

A COPD genetic risk score was linked to reduced lung function growth from birth to age 6, but only in children with high air pollution exposure.

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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.

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Childhood Pollution Exposure May Trigger COPD Polygenic Risk

Kyle Hogarth, MD, professor of medicine and medical director of the Pulmonary Rehabilitation Program and director of the Alpha-1 Antitrypsin Deficiency Clinical Resource Center at University of Chicago Medicine. 

Kyle Hogarth, MD, urges physicians to complete Alpha-1 testing during every COPD or asthma workup, warning that skipped tests delay diagnosis.

Why Doctors Need to Complete the COPD or Asthma Workup to Rule Out Alpha-1

Deepak Bhatt, MD, MPH, MBA, discusses the next steps for pacibekitug in cardiovascular disease following its success in the phase 2 trial.

Chronic Kidney Disease

Next Steps for Pacibekitug Following Positive TRANQUILITY Results

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.

Novartis announced pelacarsen did not meet its primary endpoint in the phase 3 Lp(a)HORIZON cardiovascular outcomes trial despite Lp(a) lowering.

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Pelacarsen Misses Primary Endpoint in Lp(a)HORIZON Phase 3 Trial

Paired airway and tissue sampling from 100 patients found greater microplastic burden in those with lung cancer.

Lung Cancer

Lung Cancer Diagnosis Linked to Lung Microplastic Presence, Quantity

Ross M. Levy, MD, serves as a dermatologist at Endeavor Health in Illinois, specializing in cosmetic and surgical dermatology with expertise in Mohs surgery for skin cancer.

Ross Levy, MD, explains why the LEADderm Skin Angels panel matters and what dermatology innovation looks like in daily practice.

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.

Dermatology's Path From Idea to Innovation, With Ross Levy, MD

August 2026 pulmonology highlights include deupirfenidone's positive phase 2b ELEVATE-IPF results, FDA Fast Track for LTI-03, and more.

Latest News

Addressing Diagnostic Delays in EoE

The Next Five Years in Psoriasis: Remission, Access, and Combinations

The Importance of Early Diagnosis in EoE

Zumilokibart Rapidly Suppresses FeNO in Phase 1b Asthma Data: Mario Castro, MD

Q&A: PERFORM Data Support Triple Therapy in Milder Uncontrolled Asthma