Stephan Weidinger, MD, PhD, professor and chair for Dermatology at the Christian-Albrechts-University and director of the Department of Dermatology and Allergy at the University Hospital Schleswig-Holstein.

Late-breaking results from the phase 3b ADlong open-label extension (NCT05916365), presented by Almirall at the 

2026 European Academy of Dermatology and Venereology (EADV) Congress

 in Vienna, Austria, showed sustained improvements in skin signs and itch at Week 108 in patients with moderate-to-severe atopic dermatitis.

The study enrolled 174 adults and adolescents in Germany and Poland who had completed the ADjoin long-term extension, representing up to 5 years of cumulative lebrikizumab exposure.

 At the 108-week mark, 92.9% of subjects achieved EASI-75, 73.8% attained EASI-90, 66.7% reached clear or almost-clear skin, and 78.0% saw a Pruritus NRS score of 4 or less, with no new safety signals identified.

The findings extend 4-year interim ADlong data presented earlier in 2026 and reflect Almirall’s broader commitment to medical dermatology, the exclusive focus of its research and development efforts and pipeline. In the following Q&A, Stephan Weidinger, MD, PhD, professor and chair of dermatology at Christian-Albrechts-University of Kiel and director of the Department of Dermatology and Allergy at University Hospital Schleswig-Holstein, discusses the 5-year results:

: What are the key takeaways from the 5-year ADlong data on lebrikizumab in moderate-to-severe atopic dermatitis, and what do they add to the earlier 4-year interim findings?

 For me, the main message is the consistency of the data over time. The 4-year interim analysis had already shown that disease control with lebrikizumab could be maintained long term. The 5-year data now extend this observation by another year and show that high levels of skin response and itch control remain largely stable, without emergence of new safety signals.

I also find it important that most patients were treated with lebrikizumab every four weeks and that the majority did not require rescue treatment or dose intensification. This suggests that, in patients who achieve and maintain a good response, durable disease control with a relatively low treatment burden is possible.

Of course, when interpreting long-term open-label extension studies, we have to take into account a certain degree of selection bias. Patients who continue into and remain in a long-term extension study are not fully representative of all patients starting treatment, and patients doing well are more likely to remain on therapy. Nevertheless, the stability of the responses over such a long period is very reassuring.

: At Week 108, 92.9% of patients achieved EASI-75, 73.8% achieved EASI-90, and 66.7% reached clear or almost-clear skin. Which of these findings stood out most to you, and what do they suggest about the durability of response to IL-13 inhibition over time?

 I would probably focus less on one individual result and more on the overall stability of the responses. However, the EASI-90 result is particularly relevant to me. Achieving EASI-75 is important, but today our treatment goals increasingly go beyond partial improvement. The fact that almost three quarters of patients achieved EASI-90 at Week 108 indicates that a high level of skin clearance can be maintained over several years.

Equally important is that the response curves remained relatively stable rather than indicating a loss of efficacy. Again, we have to keep in mind that there is some selection over time in a long-term extension study, as patients who remain in the study to some extent are a selected population. But even taking this into account, I think these are very convincing long-term results and support the concept that selective inhibition of IL-13 can provide durable control of atopic dermatitis in patients who respond to treatment.

: Itch is one of the most burdensome symptoms for patients with atopic dermatitis. How meaningful is it that 78.0% of patients reported a Pruritus NRS score of 4 or less after this length of treatment?

 I think this is clinically very meaningful. Itch is the symptom that affects patients most directly, including sleep, concentration and overall quality of life. Therefore, sustained control of itch is at least as important as improvement in visible skin lesions.

What I find reassuring is that itch control was maintained over a very long treatment period. A Pruritus NRS of 4 or less does not mean that every patient is completely free of itch, but it indicates that for a large majority the symptom burden remained substantially controlled. We also saw that around one third of patients reached an NRS of 0 or 1, which represents almost complete or complete absence of itch.

: No new safety signals were identified, and most patients did not require topical or systemic rescue therapy. How might these long-term safety data shape conversations with patients considering a biologic as a multiyear maintenance therapy?

 Long-term safety is a very important topic when we discuss systemic treatment with patients, because atopic dermatitis is a chronic disease and treatment may be required for many years.

The reassuring aspect of these data is not only that no new safety signal emerged, but also that treatment discontinuations due to adverse events were uncommon. This gives us additional information beyond the shorter registration trials and helps us to discuss long-term treatment with more confidence.

Another important aspect is the reduction in overall treatment burden. Most patients did not require additional rescue medication, and in particular the need for anti-inflammatory topical treatment was relatively low. This is something many patients appreciate very much. Patients with moderate-to-severe atopic dermatitis have often spent years applying topical corticosteroids or other anti-inflammatory topical treatmentsover large areas of skin. If a biologic allows them to reduce this substantially, this represents an important practical benefit in everyday life, in addition to controlling the disease itself.

Of course, no long-term extension study can exclude rare adverse events, and continued pharmacovigilance and real-world data remain important.

: What questions about long-term atopic dermatitis management remain unanswered, and where should future research on lebrikizumab focus next, such as dosing intervals, specific patient subgroups, or real-world outcomes?

 There are still several important questions. One is how far treatment can be individualised once stable disease control has been achieved. For example, which patients can remain well controlled with longer dosing intervals, and can we identify them prospectively?

A second area is patient heterogeneity. Atopic dermatitis is biologically and clinically very heterogeneous, and it will be important to understand whether particular phenotypes or molecular endotypes have especially durable responses to IL-13 inhibition.

Finally, we need more real-world evidence. Clinical trials provide very clean efficacy and safety data, but in routine practice patients have different comorbidities, adherence patterns and previous treatments. Long-term registries will therefore be important to understand treatment persistence, effectiveness, safety and optimal sequencing in everyday clinical care.

Editor’s Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Relevant financial disclosures for Weidinger include AbbVie, Almirall, Galderma, Kymab, LEO Pharma, Eli Lilly and Company, Pfizer, Regeneron, La Roche Posay, and Sanofi.

Weidinger S, Irvine AD, Thaçi D, et al. Lebrikizumab showed sustained efficacy and safety through 5 years in patients with moderate-to-severe atopic dermatitis: results from the ADlong long-term extension trial. Abstract LB-313. Presented at: European Academy of Dermatology and Venereology Congress 2026; September 30-October 3, 2026; Vienna, Austria.

Almirall. EADV 2026: long-term disease control for up to five years in patients with moderate-to-severe atopic dermatitis treated with lebrikizumab. News release. Business Wire. September 30, 2026. Accessed October 19, 2026. 

https://www.businesswire.com/news/home/20260930054188/en

Almirall. EADV 2026: long-term disease control for up to five years in patients with moderate-to-severe atopic dermatitis treated with lebrikizumab. News release. October 1, 2026. Accessed October 19, 2026. 

https://www.almirall.com/news-media/newsroom/eadv-2026-long-term-disease-control-five-years-patients-moderate-severe-atopic

Articles

Stephan Weidinger, MD, PhD, discusses 5-year ADlong data showing durable skin clearance and itch control with lebrikizumab in atopic dermatitis.

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5-Year ADlong Data on Lebrikizumab for Eczema, With Stephan Weidinger, MD, PhD

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 various hobbies. You can reach her at vjohnson@mjhlifesciences.com.

 and chronic obstructive pulmonary disease (COPD) often receive systemic corticosteroids from multiple specialties, and that cumulative exposure is rarely tracked in 1 place. At the same time, the options for reducing reliance on oral steroids have grown, with approvals of dupilumab and mepolizumab for eosinophilic COPD and of depemokimab, a twice-yearly anti-interleukin (IL)-5 agent, for severe asthma.

 Clinicians outside pulmonology increasingly manage these patients when specialty access is limited.

On October 6, 2026, Mollie Chartoff, FNP-BC, a nurse practitioner on the advanced COPD team at Vanderbilt Lung Institute in Nashville, Tennessee, moderated a virtual clinical forum for advanced practice providers on asthma and COPD. Participants included nurse practitioners and physician assistants in pulmonology, allergy and asthma, dermatology, oncology, and interventional pain practices in Tennessee, Texas, Missouri, and North Carolina. The discussion covered biomarkers, oral corticosteroid (OCS) exposure, biologic selection, and access barriers.

Cumulative Oral Steroid Exposure Across Specialties

Participants described patients who consider 1 or 2 steroid courses per year normal and who prefer intermittent oral steroids to daily inhaled therapy. Chartoff noted that cumulative exposure of 500 to 1000 mg of prednisone has been associated with increased risk of diabetes, osteoporosis, cataracts, and other adverse effects. Participants from dermatology, oncology, and pain medicine described steroids prescribed for skin disease, chemotherapy regimens, and orthopedic conditions, and 1 participant described avascular necrosis in patients in their 30s to early 50s with lung disease.

Several participants said they now ask patients about any steroid use since the last visit rather than only steroids for breathing. Participants noted that few health systems flag outside prescriptions automatically, and some suggested pharmacists could alert patients and prescribers to repeated courses. For patients already on oral steroids from another prescriber, Chartoff and others described switching to nebulized inhaled corticosteroid therapy during exacerbations, though 1 rural participant said cost limits that option.

Biomarkers and Biologic Selection in Asthma

Participants described trending eosinophil counts over time, accounting for steroid use, time of day, and season, and several pair them with IgE, allergen panels, and inflammatory markers. In polling, 46% of participants cited comorbid conditions as the main driver of biologic choice, reflecting the group's mix of specialties. Participants from dermatology described coordinating with pulmonology to select a single agent that addresses both asthma and atopic dermatitis.

Participants reported generally good tolerability with dupilumab, with injection site pain the most common complaint and the reason several pediatric patients stopped therapy. Suggested mitigations included bringing the syringe to room temperature, icing the skin, and using the prefilled syringe instead of the pen.

For depemokimab, participants described using twice-yearly dosing for a patient who struggled with injection adherence and for a rural Medicare patient who lived more than an hour from any site that could administer biologics. Tezepelumab was described as a common next step after inadequate response to other biologics, though Chartoff said she receives the most payer pushback on it.

Participants said they now draw eosinophil counts earlier in COPD. In BOREAS and NOTUS, dupilumab reduced exacerbations in patients with chronic bronchitis and eosinophil counts of 300 cells/µL or higher on triple therapy, and in MATINEE, mepolizumab reduced moderate or severe exacerbations by 21% in a broader population.

 Chartoff said she considers biologics for any patient hospitalized for COPD or with 2 moderate exacerbations, and that she favors dupilumab for patients with chronic bronchitis and mucus hypersecretion, while noting that mepolizumab offers an option when eosinophil counts fall between 150 and 300 cells/µL.

Participants outside pulmonology said agent choice often reflects familiarity and supervising physician preference. Access dominated the discussion of unmet needs, with participants in Chattanooga and Dallas-Fort Worth describing shortages of outpatient pulmonologists, and others describing difficulty affording any maintenance inhaler before a biologic can be considered. Participants also described specialty pharmacy teams and electronic prior authorization services as reducing administrative burden.

In closing, participants emphasized educating primary care and urgent care clinicians about repeated steroid courses and referring earlier. Chartoff described how she frames inhaled therapy for patients. 

"I describe it to patients all the time that taking an inhaler is like putting a cream on your skin," Chartoff said.

Jackson DJ, Wechsler ME, Jackson DJ, et al. Twice-yearly depemokimab in severe asthma with an eosinophilic phenotype. 

. 2024;391(24):2337-2349. doi:10.1056/NEJMoa2406673

Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with type 2 inflammation indicated by eosinophil counts. 

. 2023;389(3):205-214. doi:10.1056/NEJMoa2303951

Bhatt SP, Rabe KF, Hanania NA, et al. Dupilumab for COPD with blood eosinophil evidence of type 2 inflammation. 

. 2024;390(24):2274-2283. doi:10.1056/NEJMoa2401304

Sciurba FC, Criner GJ, Christenson SA, et al. Mepolizumab to prevent exacerbations of COPD with an eosinophilic phenotype. 

. 2025;392(17):1710-1720. doi:10.1056/NEJMoa2413181

Clinicians described how steroid exposure from multiple prescribers shapes biologic decisions in asthma and COPD.

Asthma

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

COPD

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

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

Examining the Oral Steroid Burden in Asthma and COPD

Abigail Brooks is a strategic content lead overseeing 

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.

Thousands of gastroenterologists, hepatologists, advanced practice providers, and trainees gathered at the Music City Center in Nashville, Tennessee, October 9-14 for the 

American College of Gastroenterology (ACG) 2026 Annual Scientific Meeting and Postgraduate Course

, which featured 12 scientific symposia, more than 70 oral abstract presentations, and thousands of posters spanning gastroenterology, hepatology, and endoscopy.

Featured lectures ranged from humanistic medicine in an AI-driven world and 

metabolic dysfunction-associated steatohepatitis (MASH)

 to the Rome V criteria and advanced endoscopy. Colorectal cancer (CRC) prevention was a recurring theme, anchored by the Emily Couric Memorial Lecture.

Dedicated plenary sessions on CRC prevention, 

, and the esophagus, along with late-breaking abstract sessions, addressed long-standing gaps in care. These ranged from limited oral and pediatric options in ulcerative colitis (UC) to the many eligible patients who never complete screening.

 highlights 7 trials from the meeting clinicians should know, spanning interleukin (IL)-23 pathway therapies, infliximab delivery, fecal immunochemical test (FIT) performance, blood-based screening, eosinophilic esophagitis (EoE), and Barrett’s esophagus (BE).

Oral Icotrokinra Sustains UC Response Through 76 Weeks in ANTHEM-UC LTE

ANTHEM-UC long-term extension (LTE) data show once-daily oral icotrokinra maintained clinical efficacy with no new safety signals for approximately 1.5 years in adults with moderately to severely active UC. Results showed most of the 136 icotrokinra-treated participants entering the extension achieved clinical response, clinical remission, and endoscopic improvement at week 76, and 87% remained on treatment through week 78.

Oral Icotrokinra for Ulcerative Colitis: 76-Week ANTHEM-UC Data

Mirikizumab Shows Early Efficacy in Pediatric UC in SHINE-2 Trial

Week 12 data from the phase 3 SHINE-2 study highlight early clinical, endoscopic, and symptomatic improvements in children and adolescents with moderately to severely active UC following mirikizumab induction. At week 12, 41.3% of participants aged 2 to 17 years achieved clinical remission, and 81.0% achieved clinical response.

Subcutaneous Infliximab Outperforms IV in Ileal Crohn’s Disease Analysis

Subcutaneous (SC) infliximab was associated with higher rates of clinical remission and better endoscopic outcomes than intravenous (IV) infliximab in patients with ileum-involved Crohn’s disease (CD), according to a pooled, propensity score-matched analysis of 4 registrational trials, including LIBERTY-CD, PLANETCD, and a pair of phase 1 studies of SC infliximab. In the matched population, 65.7% of patients receiving SC infliximab achieved endoscopic response at week 54, compared with 27.1% of those receiving IV infliximab.

FIT Misses More CRCs in Women; Could Sex-Specific Thresholds Help?

Fecal immunochemical test (FIT) sensitivity for colorectal cancer (CRC) and advanced precancerous lesions (APLs) was lower in women than in men at the standard 100 ng/mL positivity threshold, according to findings from an analysis of > 30,000 screening participants. Results showed FIT detected 62.0% of colorectal cancers in women vs 77.4% in men, with proximal tumors driving much of the gap.

Updated SimpleScreen CRC Blood Test Improves Precancerous Lesion Detection

An updated version of the SimpleScreen CRC blood test detected APLs with 18.2% sensitivity, up from 13.7% with the previous version, while maintaining 80.4% sensitivity for CRC in a new clinical validation study. The test, developed by Freenome, received US Food and Drug Administration (FDA) approval based on the PREEMPT CRC study. In that study, the original test achieved 79.2% CRC sensitivity, but its APL sensitivity missed the prespecified acceptance criterion.

Can Blood Tests Catch Precancerous Lesions? Updated CRC Screening Test

Tezepelumab Meets Co-Primary End Points in Phase 3 CROSSING Trial in EoE

Tezepelumab, an antibody targeting thymic stromal lymphopoietin (TSLP), significantly improved histologic remission and dysphagia symptoms versus placebo in adults and adolescents with eosinophilic esophagitis (EoE) in the phase 3 CROSSING trial. At week 24, histologic remission was achieved by 64.8% of patients receiving tezepelumab 210 mg and 68.9% receiving 420 mg, compared with 3.5% receiving placebo.

Tezepelumab for Eosinophilic Esophagitis: Phase 3 CROSSING Results

DETECT-ME: Swallowable Sponge Test for Barrett’s Esophagus Screening

A swallowable capsule-sponge device paired with a DNA methylation biomarker panel detected Barrett’s esophagus (BE) with 90% sensitivity and 86% specificity in the prospective, multicenter DETECT-ME study. Results showed the overall sensitivity was 90% (163/181; 95% CI, 84%-94%), and specificity was 86% (123/143; 95% CI, 79%-91%).

DETECT-ME: Can a Swallowable Sponge Fix Barrett’s Esophagus Screening?

From oral IL-23 blockade in UC to sex-specific FIT thresholds and a swallowable Barrett’s test, these are 7 trials from ACG 2026 clinicians should know.

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Hepatology

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ACG Annual Scientific Meeting 2026 Recap: 7 Trials to Know

 or chronic obstructive pulmonary disease (COPD) and type 2 inflammation, advanced practice providers (APPs) are often the clinicians tracking exacerbations, reviewing biomarkers, and writing the appeal letters that biologic therapy requires. The range of options has widened with approvals of dupilumab and mepolizumab for eosinophilic COPD and of depemokimab, a twice-yearly anti-interleukin (IL)-5 agent, for severe asthma.

 How quickly patients reach these therapies depends heavily on recognition, documentation, and payer policy.

In October 2026, Haley Hoy, PhD, CRNP, a nurse practitioner who practices at the University of Alabama in Huntsville and Vanderbilt University Medical Center, moderated a virtual clinical forum for APPs on type 2 inflammation and biologic therapy. Participants included nurse practitioners and physician assistants from pulmonary practices in Virginia, Georgia, Alabama, Massachusetts, Colorado, and Missouri, including clinicians in pediatric, bronchiectasis, rural, and lung transplant settings. The discussion covered escalation triggers, biologic selection, mucus plugging, and unmet needs in COPD.

Participants said type 2 biomarkers have allowed them to escalate therapy sooner rather than cycling through inhalers and steroid bursts. Several described documenting eosinophil counts and baseline IgE at the first visit so that a biologic option is ready if control worsens. Participants cited 2 or more oral corticosteroid (OCS) courses, sometimes within 3 to 6 months, as a common threshold, and 1 noted that this matches what payers typically require.

Participants described searching electronic health records for urgent care and emergency department steroid prescriptions to document exacerbation patterns in appeal letters. Others said claims-based prior authorization reviews miss sample inhalers given in clinic, and 1 participant described "sample-dependent" patients who exacerbate when they cannot afford maintenance inhalers. Participants also stressed quality of life, noting that many patients have accepted activity limitations as normal.

In polling, 63% of participants cited clinical phenotype and 36% cited biomarkers as the main driver of biologic choice. Participants said comorbidities such as chronic rhinosinusitis with nasal polyps and atopic dermatitis often guide selection, and several described dupilumab as a frequent choice given its range of indications. Others said very high eosinophil counts lead them first to rule out eosinophilic granulomatosis with polyangiitis and hypereosinophilic syndrome and then to favor an anti-IL-5 agent.

Participants described strong responses to anti-IL-5 agents in severe eosinophilic asthma and said longer dosing intervals, including benralizumab's every-8-week maintenance and twice-yearly depemokimab, can improve adherence in adolescents and young adults. Tezepelumab was described as an option for patients without biomarkers for other agents or after failure of other biologics, and 1 pediatric participant described a patient with cystic fibrosis and severe asthma whose admissions declined after more than a year of work to secure coverage. Most participants said insurance ultimately determines the agent.

Participants said radiologists at some centers routinely report mucus plugging, and others request it when ordering computed tomography. Mucus plugging data for dupilumab and tezepelumab were reviewed, and participants in bronchiectasis care said plugging influences their biologic selection.

COPD Biologics and Specialty Pharmacy Support

Participants described a shift toward identifying eosinophilic COPD, including in patients with asthma-COPD overlap. In BOREAS and NOTUS, dupilumab reduced exacerbations and improved prebronchodilator FEV1 in patients with eosinophil counts of 300 cells/µL or higher, and in MATINEE, mepolizumab reduced moderate or severe exacerbations on top of triple therapy.

 Participants who commented on the data generally described the dupilumab trials as more robust, citing replication and secondary end points, while noting that insurer formularies largely determine which agent patients receive.

Participants said roflumilast and azithromycin remain more familiar to patients than biologics, and older patients on multiple injectables can be reluctant to add another. Participants with embedded specialty pharmacists said they handle benefit checks, prior authorizations, and follow-up, while a rural participant described a system pharmacy unwilling to manage injectables until approval is obtained. Some described using an AI-based clinical reference tool to draft appeal letters.

For unmet needs, participants cited better exacerbation predictors, faster diagnosis, biomarkers for patients below current eosinophil thresholds, and access to pulmonary rehabilitation, including virtual programs that Medicare Advantage plans may not cover. Hoy called for trial end points that capture health care use. 

"I think if we could, as a secondary endpoint in a study, look at trips to the physician's office, trips to our office, trips to urgent care, calls to the office for the dreaded Friday afternoon prednisone, antibiotic, that would be huge, not only for the patient but for us," Hoy said.

APPs described earlier recognition of type 2 disease, documentation strategies for payers, and the role of specialty pharmacy in biologic access.

APP Experts Discuss Earlier Biologic Use in Asthma and COPD

 (PAH) now spans 5 therapeutic pathways, and the options within them continue to expand. Recent developments include FDA approval of a once-daily single-tablet combination of macitentan and tadalafil, supported by the phase 3 A DUE trial, and a September 2026 European Respiratory Society (ERS) guideline update recommending add-on sotatercept for patients who remain at intermediate-low, intermediate-high, or high risk.

 How clinicians sequence oral, inhaled, parenteral, and injectable therapies in practice increasingly depends on risk assessment, payer requirements, and patient preference.

In September 2026, Marc Simon, MD, MS, director of pulmonary vascular disease and the Pulmonary Hypertension Comprehensive Care Center at the University of California, San Francisco (UCSF), moderated a clinical forum in San Francisco. Participants included pulmonologists, advanced heart failure and critical care cardiologists, and a nurse practitioner from UCSF, Kaiser Permanente, and California Pacific Medical Center. The discussion covered initial combination therapy, risk reassessment, escalation beyond dual therapy, and long-term monitoring.

Upfront Combination Therapy and PAH Risk Assessment

Participants described upfront dual therapy with a phosphodiesterase 5 (PDE5) inhibitor and an endothelin receptor antagonist (ERA), consistent with the 2022 European Society of Cardiology (ESC)/ERS guidelines,

 as their default for newly diagnosed patients without high-risk features. Several said they deviate from calculated risk categories when clinical concern outweighs the score, particularly in young patients with high hemodynamic burden, a group in which 1 participant said risk scores tend to underestimate risk. Heritable disease, poor right ventricular (RV) function, and a cardiac index below 2 L/min/m

 were cited as triggers for earlier escalation.

For reassessment, 1 participant said they repeat the full initial ESC risk stratification at follow-up rather than relying on abbreviated noninvasive tools, which omit imaging. Participants noted that echocardiographic RV assessment varies considerably between readers, and several said they push their echo labs to report tricuspid annular plane systolic excursion, fractional area change, and free wall strain routinely. Telemedicine was described as a barrier to obtaining 6-minute walk tests, leaving some clinicians more reliant on natriuretic peptides and functional class.

Single-Tablet Combinations, Adherence, and Access

Participants described lower pill burden and a single refill as reasons patients prefer the single-tablet combination, and 1 participant who offers patients the choice said most select it. Others noted that some patients receive their PDE5 inhibitor and ERA from separate pharmacies on mismatched refill cycles, which a single tablet avoids. Participants practicing in an integrated health system said they typically start generic ERA and PDE5 inhibitor combinations without delay.

Payer coverage was described as variable. According to 1 participant, an upfront denial delayed a patient's PAH therapy by about 2 months, and that participant now starts the components separately before transitioning. Another noted that when an ERA is added as part of a combination tablet, it can be harder to identify which component is responsible for new edema.

Escalation Beyond Dual Oral Therapy in PAH

Participants who manage patients admitted in cardiogenic shock, many with methamphetamine-associated PAH, described defaulting to triple therapy with selexipag when parenteral therapy is not pursued, and several said these patients often do well in follow-up. Selexipag was also described as the most common oral option when transitioning stable patients off infusion therapy. Participants recommended slower selexipag titration with a step back when adverse effects emerge, noting that specialty pharmacies often titrate aggressively toward the maximum dose.

Several participants said their threshold for adding sotatercept has fallen, while others said they hesitate to use it in young patients given limited long-term data. For inhaled treprostinil, participants reported titrating dry powder formulations well above starting doses, citing the absence of a ceiling effect for prostacyclins, and some described combining oral selexipag with inhaled treprostinil in patients who decline parenteral therapy.

Long-Term Safety Monitoring Across PAH Therapies

Participants emphasized agent-specific adverse event monitoring. For sotatercept, whose efficacy was established in the phase 3 STELLAR trial,

 participants reported pericardial effusions, gastrointestinal bleeding, and hypoxemia from intrapulmonary shunting, and some described monitoring hemoglobin every 3 months. For oral and inhaled prostacyclin pathway agents, participants cited gastrointestinal effects, jaw pain, myalgias, cough, and throat irritation as the main drivers of dose limitation.

"But these meds have side effects, and I think a key part of the follow-up is not just how's your breathing, how far are you walking, what's your BNP, what are your side effects, it's specific to the drug, right?" Simon said.

Participants also expressed caution about transitioning stable patients off parenteral prostacyclin, noting that US patients on infusion therapy are often those who most need it. In 1 participant's practice, therapy was successfully withdrawn in a patient with methamphetamine-associated PAH who achieved abstinence, with assessments every 3 months, though others characterized such outcomes as exceptions.

Grünig E, Jansa P, Fan F, et al. Randomized trial of macitentan/tadalafil single-tablet combination therapy for pulmonary arterial hypertension. 

. 2024;83(4):473-484. doi:10.1016/j.jacc.2023.10.045

Kovacs G, Zeder K, Humbert M, et al. European Respiratory Society clinical practice guidelines update for the treatment of pulmonary arterial hypertension. 

. Published online September 7, 2026. doi:10.1183/13993003.01178-2026

Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. 

. 2022;43(38):3618-3731. doi:10.1093/eurheartj/ehac237

Hoeper MM, Badesch DB, Ghofrani HA, et al. Phase 3 trial of sotatercept for treatment of pulmonary arterial hypertension. 

. 2023;388(16):1478-1490. doi:10.1056/NEJMoa2213558

Participants described how they use risk assessment, payer requirements, and patient preference to sequence PAH therapies.

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...

PAH Combination Therapy and Escalation: Clinical Forum Perspectives

Jennifer Vittorio, MD, associate professor of pediatrics and medical director of pediatric liver transplantation at NYU Langone Health

Videos

Jennifer Vittorio, MD, on transient diarrhea, the meaning of a one-point itch change, and screening children with cholestasis.

Maralixibat Side Effects and What Clinicians Should Know From EXPAND

David T. Rubin, MD is a professor of medicine at the University of Chicago, director of the Inflammatory Bowel Disease Center, and chair of the International Organization for the Study of IBD (IOIBD).

David Rubin, MD, discusses GALAXI and GRAVITI data showing guselkumab improved non-passable intestinal stenosis in Crohn’s disease through 2 years.

Inflammatory Bowel Disease

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Guselkumab and Intestinal Stenosis in Crohn’s Disease, With David Rubin, MD

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.

Oral bitopertin met all primary and secondary endpoints in the phase 3 APOLLO trial in EPP, cutting PPIX and increasing pain-free time in light.

Bitopertin Meets All Endpoints in Phase 3 APOLLO Trial for EPP

Alex Hillenbrand is an assistant editor for 

. She earned her BA in English from Lafayette College in 2023 and went on to write for pop culture, entertainment, and sports media outlets before joining MJH Life Sciences in 2025. In her free time, Alex enjoys cooking, going on walks, and meeting new people. Contact her at mjhlifesciences.com.

Phase 4 VERDICT data show a 67% lower hazard of UC complications with disease clearance versus symptomatic remission among target achievers.

Ulcerative Colitis

Ulcerative Colitis condition center page, resources on the topics of medical news and expert insight into colitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on UC research, treatment, and drug development.

VERDICT Links Vedolizumab Disease Clearance to Fewer UC Complications

Chelsie Derman is an associate editor for 

who covers allergy and  psychiatry. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

Check out highlights from news published on day 1 of CHEST 2026, spanning asthma, COPD, bronchiectasis, pulmonary rehabilitation, and fibrotic ILD.

CHEST 2026: Day 1 Recap — 5 Headlines to Know

Prince Adotama, MD, is a board-certified dermatologist and an assistant professor at the Ronald O. Perelman Department of Dermatology at New York University Grossman School of Medicine.

Podcasts

Yoseph Dalia, MD, discusses diagnosing and treating pseudofolliculitis barbae, its occupational impact, and barriers to care in skin of color.

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

Skin of Color Savvy: The Art and Science of Treating Patients of Color

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally intelligent care practices in dermatology with leading experts. 

Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

Skin of Color Savvy: Razor Bumps—Treating Pseudofolliculitis Barbae in Skin of Color

A real-world ACG 2026 study found 23.4% of patients with PBC on elafibranor reached ALP of 120 U/L or lower, versus 14.6% on obeticholic acid.

Cholangitis

cholangitis page, resources on the topics of medical news and expert insight into cholangitis can be found. Content includes articles, interviews, videos, podcasts, and breaking news on research, treatment, and drug development in PBC, PSC, and more!

Elafibranor Bests Obeticholic Acid for ALP Normalization in PBC

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.

Catch up on any data and key clinician perspectives presented at the Heart Failure Society of America Annual Scientific Meeting 2026.

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.

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