Physician and CEO, Chicago Allergy Center, and board director at American Lung Association

ALA State of the Air: Nearly Half of American Children Breathe Poor Air

Nearly half of all children in the United States — 33.5 million, or 46% of those under 18 — live in counties that received a failing grade for at least one measure of air pollution in the 

 (ALA)'s 27th annual State of the Air 2026 report, which evaluates 3 years of EPA-verified monitoring data (2022–2024) across ozone, short-term particle pollution, and long-term particle pollution. Overall, 152.3 million Americans — 44% of the population — live in communities earning a failing grade for at least one pollutant. 

Juanita Mora, MD, an allergist-immunologist at Chicago Allergy Center and attending physician at Advocate Illinois Masonic Medical Center in Chicago, Illinois, and board director of the ALA, described the findings as both a public health indictment and a call to clinical action.

The report grades counties on 3 measures: ground-level ozone (smog), short-term particle pollution spikes, and long-term average particle pollution. Ozone forms when vehicle exhaust, industrial emissions, and chemical compounds react with sunlight; the report found that approximately 4 million more people are now breathing unhealthy ozone levels compared with last year's report — a worsening trend driven in part by warming temperatures that enhance ozone formation. 

Nearly 33 million people live in counties earning failing grades across all 3 measures. Bakersfield, California, ranked as the metropolitan area with the worst year-round particle pollution for the 7th consecutive year; Los Angeles retained its position as the most ozone-polluted city in the nation, a ranking it has held in 26 of the report's 27 years.

Mora described the health consequences of both pollutant categories in clinical terms she communicates directly to patients and families. Ozone causes acute airway inflammation triggering wheezing and cough in children and exacerbating asthma and COPD. Long-term exposure to fine particulate matter has systemic reach that extends well beyond the lung: particles enter the bloodstream and have been associated in the epidemiologic literature with increased cardiovascular risk including heart attack and stroke, dementia and Alzheimer's disease with repeated cerebrovascular exposure, and, in pregnant women, elevated risk of preterm delivery. 

The ALA report frames wildfire smoke as a growing contributor to both ozone and particle pollution burden, with wildfire events in Canada, California, and the eastern United States increasingly affected air quality across broad geographic regions and populations not historically considered at elevated pollution-related risk.

Racial and socioeconomic disparities in air pollution exposure are a central feature of the 2026 report's findings and a theme Mora returned to throughout her comments. According to the report, a person of color is more than 2.4 times as likely as a white individual to live in a community with failing grades across all 3 pollution measures, and Hispanic individuals are more than 3 times as likely. Communities in Texas, California, and across the South carry disproportionate combined ozone and particle pollution burdens. 

Mora called on clinicians to use the report's county-level data — available at 

 — as a tool for contextualizing patient respiratory symptoms and for counseling families about modifiable risk, including indoor air quality, secondhand smoke exposure, and activity timing on high-pollution days. On the policy dimension, Mora expressed concern that current EPA regulatory rollbacks — including changes to economic analyses used to set pollution standards — threaten to undermine the Clean Air Act's multi-decade legacy of reducing air pollution–attributable mortality and morbidity. Children, with developing lungs, are the most biologically vulnerable to the long-term consequences of chronic pollution exposure and continued investment in EPA enforcement and ambient air quality standards are a pediatric health imperative.

“These kids do not have clean air to breathe. Let's do more. We can do more to clean air up,” Mora said. “… Let’s teach our families to keep safe and talk to our legislators about keeping the EPA environmental protection agency funding as is so that way we can continue to make these kids healthy adults.”

Editor’s note: Mora has no relevant disclosures to report.

American Lung Association. State of the Air 2026. 27th ed. Published April 21, 2026. Accessed May 7, 2026. 

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Juanita Mora, MD, discusses The American Lung Association's 2026 report, elucidating a disproportionate burden on people of color.

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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.

, defined as persistently elevated systolic blood pressure (BP) >140 mmHg and/or diastolic BP ≥90 mmHg, is among the leading risk factors for morbidity and mortality worldwide. Nearly half of the adult US population has hypertension – among these individuals, roughly 4 in 5 have blood pressure (BP) above the guideline-directed goal of <130/80 mm Hg. In 2023, hypertension was the primary or contributing cause for roughly 664,000 deaths in the US alone.

Effective therapies for hypertension have been available for several years. Antihypertensive medications, such as ACE inhibitors and calcium channel blockers, enable BP control and can reduce mortality risk in patients with hypertension. However, recent research has shown that only 2 in 3 US adults with hypertension receive medical treatment – this percentage has not improved from 2009-2010 (66.6% [95% CI, 63.7 to 69.5%]) to 2021-2023 (65.1% [95% CI, 62.8 to 67.4%).

Check out the American Heart Association’s 2026 Heart Disease and Stroke Statistics, explained by Latha Palaniappan, MD, MS

Catch up on recent efforts to make home BP monitoring more accessible, with Ozan Unlu, MD

Find out more about the interplay between hypertension and other critical, life-threatening diseases

Additionally, lifestyle interventions such as diet, exercise, and sleep have been shown to significantly impact BP. The International Society of Hypertension guides patients to prioritize healthy eating, increase aerobic exercise and muscle strengthening, and improve sleep quality and hygiene. Environmental factors, such as pollution and exposure to smoking, are also major contributors that can to some extent be modified.

Despite this, treatment has stagnated over the past 15 years, with hypertension-related cardiovascular death rates almost doubling since 2000. Given the accessibility and proven efficacy of therapies, as well as the plethora of potential lifestyle interventions, experts have shifted their focus to encouraging further patient and clinician education in recent years, citing a communication breakdown as the driving force behind poor outcomes and insufficient treatment.

“We talk about blood pressure a lot, but I don’t know that we’ve made it clear to patients that one thing leads to another,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health, as well as editor-in-chief at the American College of Cardiology, told 

 in an exclusive interview. “We’re not translating appropriately what it means when blood pressure is elevated. And then, I think, people mistakenly think it’s static, that this one number is the only number that happens.”


The actual treatment plan for hypertension often involves the implementation of multiple medications at once. Current guidelines recommend initiating therapy with a combination of an ACE inhibitor or ARB, a calcium channel blocker, and a diuretic. If these medications do not prove effective, clinicians are then advised to layer on additional treatments including alpha and beta blockers, central sympatholytic drugs, and direct vasodilators.

“The reality is that most patients actually need multiple medicines,” Deepak Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital and Dr. Valentin Fuster Professor of Cardiovascular Medicine at the Icahn School of Medicine at Mount Sinai, told 

 in an exclusive interview. “What many of us learned in medical school was to start a medicine, take it to the maximum dose, and if the blood pressure is not controlled, then start medicine number 2 and do the same thing. That is logical, but it is not what the data or the guidelines support.”

The rationale behind multiple medications being administered simultaneously is sound – 2 drugs targeting separate potential control pathways may have a more significant benefit than a single medication at a higher dose. However, the pill burden posed by these baseline treatment strategies are often considered daunting by both patients and clinicians alike, leading to what many believe is a driving force behind their underutilization.

“If patients are getting routine wellness checkups at the doctor’s office, hopefully blood pressure screening is occurring,” Bhatt said. “But even then, when patients do have high blood pressure, they don’t really want to go on medicines, and the doctor doesn’t really want to start them on medicine. Typically, what happens is that the doctor concludes, oh, well, you’re in the doctor’s office, it must be anxiety or white coat hypertension, so that blood pressure elevation isn’t real. Let’s check again in 6 months.”

This “white-coat hypertension” phenomenon is often cited as a major barrier to treatment – in essence, it describes an instance in which a patient presents with increased BP in clinic due to anxiety associated with the setting. Although demonstrably genuine, this effect is nonetheless a significant blockage in helping patients achieve BP control. To this end, at-home BP monitoring technologies have become a cornerstone of therapy in recent years, aiming to promote frequency and regularity of measurements.

Home BP monitors, which have been endorsed by hypertension guidelines since 2017, allow patients to collect data on their condition independent from the potential anxiety of the clinic. Additionally, these measurements allow for more accurate medication titration, potentially addressing the treatment burden posed by the sheer volume of necessary drugs.

However, despite the wide range of devices and the volume of recommendations, home BP monitors are underused among patients with hypertension. This reflects the broader need for further education directly from clinicians and providers, which has a proven history of improving patient awareness of and adherence to both monitoring and treatment of BP.


The actual mechanics behind patient education are multitudinous. Direct intervention from clinicians is, of course, the primary form – however, multiple clinical trials have examined the effectiveness of interventions such as text message reminders and electronically delivered educational content.

 enrolled patients via retail outlet health kiosks, which took patients’ email addresses in addition to measuring their BP. After randomly sampling a total of 2000 individuals, who were subsequently contacted and asked to participate in the study, the investigative team enrolled 140 to receive either standard care or standard care plus intervention.

Intervention in this trial took the form of general educational information messages, addressing topics such as the importance of follow-up BP measurements, the potential health risks of elevated BP, the effectiveness and availability of BP medications, and the need to take these medications daily, among other factors. Interactive text messages were also sent according to the subject’s most recent kiosk BP level.

At the trial’s combined 6- and 12-month endpoint, 23 or 61 patients in the intervention group had achieved BP control compared with 17 of 62 in the usual care arm (difference in proportions, 10.3%; 95% CI, -6.2% to 26.8%). Mean systolic BP was also 5.8 mmHg lower in the intervention group. Although the study was only a pilot trial, these data point to the overall effectiveness of educational material in aiding patients to achieve BP control. Furthermore, much of the difference between the groups was attributed to adherence to therapy, which was driven by the delivery of repeated and direct educational information.

“If we pull back the root of adherence, often, when you ask a patient, they don’t understand what blood pressure is and what the complications that we’re trying to help reduce are, whether it’s kidney disease, whether it’s stroke, et cetera,” Le said. “We have to educate simply and say, ‘this is blood pressure, this is why we’re measuring it, this is why we want it this level, and these are the complications that occur.’”

Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon. Bhatt reports disclosures with GSK, Merck, Cereno Scientific, Angiowave, Boehringer Ingelheim, Novo Nordisk, and others.

Hardy ST, Jaeger BC, Emanuel E, Muntner P. Blood Pressure Above Goal Among US Adults With Hypertension. 

Wadhera R, Dhruva S, Bikdeli B. et al. Cardiovascular Statistics in the United States, 2026: JACC Stats. 

https://doi.org/10.1016/j.jacc.2025.12.027

Charchar FJ, Prestes PR, Mills C, et al. Lifestyle management of hypertension: International Society of Hypertension position paper endorsed by the World Hypertension League and European Society of Hypertension. 

Jones DW, Ferdinand KC, Taler SJ, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM guideline for the prevention, detection, evaluation and management of high blood pressure in adults: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025;82(10). 

Townsend RR, Cohen JB. White Coat Hypertension & Cardiovascular Outcomes. Curr Hypertens Rep. 2024;26(10):399-407. 

Shea S, Thompson JLP, Schwartz JE, Chen Y, de Ferrante M, Vanderbeek AM, Buchsbaum R, Vargas C, Siddiqui KM, Moran AE, Stockwell M. The Retail Outlet Health Kiosk Hypertension Trial (ROKHYT): Pilot Results. Am J Hypertens. 2022 Jan 5;35(1):103-110. 

Articles

Hypertension remains highly prevalent and inadequately controlled in the US, driving substantial mortality despite effective pharmacologic and lifestyle options. Treatment rates have plateaued for over a decade, coinciding with rising hypertension-related cardiovascular deaths, suggesting implementation failures rather than therapeutic limitations. Contemporary guidelines emphasize early combination therapy, yet pill burden, clinical inertia, and misattribution to white-coat effects delay escalation. Home BP monitoring can improve diagnostic accuracy and titration but is underutilized. Scalable, repeated patient education—including digital messaging—may improve adherence and BP control.

Patient education may be the missing piece needed to bridge the gap between hypertension treatments and improved outcomes.

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...

Hypertension

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.

Filling the Gaps: Educating Patients in Hypertension Risk, Detection, and Management

Ayah Matar, MD, is a postdoctoral researcher at Mayo Clinic.

Could a Smoking Cessation Drug Treat IBS Pain? New Data on Varenicline

 is widely considered to be one of the most challenging conditions to treat in gastroenterology, with chronic abdominal pain representing a particularly difficult therapeutic target. Existing options for centrally mediated visceral pain in IBS are limited, and the mechanisms driving pain sensitivity remain incompletely understood.

Early-phase data presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, by Ayah Matar, MD, a postdoctoral researcher at Mayo Clinic, suggest varenicline, a nicotinic acetylcholine receptor partial agonist currently approved for smoking cessation, may offer a novel mechanism for addressing both pain and bowel symptoms in non-constipation IBS.

"Pain might be due to sensitivity at the nicotinic receptors," Matar told 

. "Since varenicline is a partial agonist at those receptors, we thought it might help with IBS — specifically the pain component."

The study was a prospective, open-label, 8-day trial of oral varenicline at doses approved for smoking cessation in eight patients with non-constipation IBS and chronic abdominal pain. Each participant served as their own control, given the wide variance in rectal sensation in IBS patients.

A 2-week run-in period preceded treatment, during which daily diary data were collected; eligibility to proceed required an average pain score of ≥ 3 over 7 consecutive days. At baseline and end of treatment, participants underwent barostat-based rectal compliance and sensory testing, and completed daily symptom diaries and the Hospital Anxiety and Depression questionnaire.

After 8 days of varenicline treatment, participants showed significant improvements across multiple symptom domains compared to baseline. Abdominal pain decreased on both the 100mm visual analog scale and the 0–4 Likert scale, and anxiety scores also improved, though depression scores did not change significantly. Bowel symptoms including bloating, urgency, stool frequency, and ease of passage all improved at the end of treatment.

Of note, varenicline did not alter rectal compliance, a finding Matar described as clinically meaningful rather than a limitation.

"The minimal effect on rectal compliance suggests a central afferent modulation effect," she said. "That is really interesting, and addresses an unmet need when it comes to pain and IBS."

Varenicline did significantly decrease rectal sensation at 24 mmHg distension for gas, but not at other sensory thresholds, further supporting a centrally mediated rather than peripherally mediated mechanism of action.

Matar said the rationale for investigating varenicline in IBS draws on prior evidence showing its efficacy for pain associated with opioid withdrawal, as well as preclinical data implicating nicotinic acetylcholine receptor signaling in visceral pain sensitivity. The current findings add a clinical signal to that mechanistic foundation, though the small sample size and open-label design require prospective confirmation.

She noted that next steps should include a placebo-controlled trial with a longer follow-up period to further characterize both efficacy and the safety profile beyond 8 days, a critical step before varenicline can be considered for broader clinical application in IBS.

Editor's note: Matar reports no relevant disclosures.

Matar A, Busciglio I, Linden DR, et al. Effect of Varenicline in Patients With Non-Constipation Irritable Bowel Syndrome and Pain. Presented at Digestive Disease Week (DDW) 2026; Chicago, IL; May 2–5, 2026.

Singh D, Saadabadi A. Varenicline. StatPearls. October 5, 2024. Accessed May 7, 2026. 

https://www.ncbi.nlm.nih.gov/books/NBK534846/

Early data suggest varenicline may improve abdominal pain, bloating, and bowel symptoms in patients with IBS.

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, IBS and IBD, Crohn's disease, and more.

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On the HCPLive irritable bowel syndrome page, resources on the topics of medical news and expert insight into IBS can be found. Content includes articles, interviews, videos, podcasts, and breaking news on IBS, IBD, and more.

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Varenicline Shows Early Promise for Pain, Bowel Symptoms in IBS, With Ayah Matar, MD

Menno C. van Zelm, PhD, professor of immunology at Monash University.

house dust mite sublingual immunotherapy (SLIT)

 was associated with sustained symptom improvement and biphasic changes in allergen-specific type 2 memory B cells in patients with allergic rhinitis and asthma, according to a recent study.

Investigators longitudinally evaluated 38 patients with house dust mite allergy, including 21 treated with SLIT and 17 managed with standard pharmacotherapy alone. All patients had allergic rhinitis, and approximately 55% in each group had concomitant asthma.

Across 18 months, the SLIT group demonstrated significant reductions in visual analog scores, symptom diary scores, and medication scores, whereas the non-AIT group did not show comparable reductions in symptoms or medication use. Lung function remained stable throughout the study, with median FEV1 values above 90% predicted in both groups.

Immunologically, SLIT was associated with early increases in house dust mite–specific IgE, IgG2, and IgG4 levels. Median allergen-specific IgE levels peaked at 4 months before declining at 12 and 18 months, while IgG4 levels continued to rise over the treatment period. The team reported that increased IgG4 expression on Der p 1– and Der p 2–specific type 2 memory B cells correlated with lower symptom scores (Spearman rho, −0.5794; 

Investigators concluded that allergen immunotherapy may involve 2 immunologic phases: an early expansion and phenotypic shift of allergen-specific type 2 memory B cells, followed by later reduction of these populations as IgE production declines. They noted that additional studies are needed to determine whether these cellular changes predict long-term remission or treatment response.

In the accompanying Q&A, investigator Menno C. van Zelm, PhD, professor of immunology at Monash University in Australia, discussed the potential implications of these findings for understanding long-term immune remodeling during allergen immunotherapy.

 What is the key clinical takeaway from the biphasic response of allergen-specific type 2 memory B cells during HDM-SLIT?

: Sublingual allergen immunotherapy for house dust mite (HDM-SLIT) effectively ameliorates symptoms. However, at least 18 months and often 3 to 5 years of continuous treatment are needed for patients to have sustained effects, i.e., durable relief of symptoms after discontinuation of therapy. It is currently unknown why this takes so long and what immunological changes underlie sustained unresponsiveness.

Recently, a subset of immune cells was identified that carries the pathogenic immune memory to allergies. These are type 2 memory B cells. Those type 2 memory B cells that recognize the allergen are thought to respond upon allergen exposure and maintain the pathogenic IgE antibody levels.

In previous work, we demonstrated that early on treatment, allergen-specific type 2 memory B cells expanded, but changed their phenotype. Increased expression of IgG4 and CD29 seemed to keep these cells in check and reduce symptoms on treatment. We here studied what happened early (4 months) and later (12 and 18 months) on treatment and found that after expansion at 4 and 12 months, patients showed fewer allergen-specific Type 2 memory B cells at 18 months. This paralleled the decline in serum IgE, and it seems that this late change is needed for sustained treatment effects.

 What motivated you to focus on allergen-specific type 2 memory B cells as a target of allergen immunotherapy?

: Type 2 memory B cells were recently found to hold the pathogenic immune memory to allergies. Hence, we hypothesized that these cells should be diminished or their functionality changed to relieve allergy symptoms in patients.

 How do the early increases in allergen-specific type 2 B cells align with the rapid symptom improvement seen in patients?

: The early increase in allergen-specific type 2 B cells was initially a surprise to us in previous studies (PMID: 39268605), as these were thought to be pathogenic cells. However, we did show that these expanded cells showed a unique immunophenotype with increased expression of IgG4 and CD29, which likely inhibits their responses, thereby underlying the symptom relief.

 What mechanisms may explain the reduction in type 2 memory B cells by 18 months, and how does this relate to sustained tolerance?

: We are still unsure about the mechanism by which type memory B cells are diminished at 18 months. This might be a depletion due to cell death and/or a change in their phenotype towards conventional memory B cells, which are not prone to produce IgE upon stimulation/activation.

 How should clinicians interpret the observed increases in IgE early in treatment alongside clinical improvement?

: The early increases of serum IgE on treatment are well-described and commonly known. While still a paradigm, the concurrent increases in serum IgG2 and IgG4 are thought to inhibit the IgE responses on treatment.

 What role do IgG4 and CD29 expression on type 2 memory B cells play in modulating allergic responses?

: Both IgG4 and CD29 are thought to inhibit pathogenic IgE responses by type 2 memory B cells. IgG4-expressing B cells are the source of serum IgG4, which inhibits the effects of IgE. CD29 on the surface of memory B cells inhibits their activation and thus prevents further production of pathogenic IgE.

Hsin L, Reinwald S, von Borstel A, et al. Biphasic Effects on Allergen-Specific Type 2 Memory B Cells Over 18 Months Sublingual Immunotherapy for House Dust Mite Allergy. 

In 38 patients with house dust mite allergy, 18 months of SLIT was linked to early expansion and later reduction of allergen-specific type 2 memory B cells.

Allergy

Allergy condition center page is a comprehensive resource for clinical news and insights on allergic and inflammatory diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for food and seasonal allergies, as well as allergic asthma and related conditions.

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Biphasic Memory B-Cell Changes Seen During HDM SLIT, With Menno C. van Zelm, PhD

Jean-Frederic Colombel, MD, is the Director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at the Icahn School of Medicine at Mount Sinai.

Mirikizumab Demonstrates Sustained Disease Clearance Through 4 Years in Ulcerative Colitis

Long-term results from the LUCENT clinical trial program suggest that mirikizumab maintains consistent and sustained disease clearance over 4 years in patients with moderately to severely active

2026 by Jean Frédéric Colombel, MD, Professor Of Medicine and the Director of the Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at the Icahn School of Medicine at Mount Sinai.

Mirikizumab, an interleukin-23 (IL-23) p19 inhibitor, has demonstrated efficacy across both induction and maintenance phases in ulcerative colitis, aligning with its role in a growing class of advanced biologics targeting key inflammatory pathways.

“As a matter of fact, there are now a lot of data that have established efficacy for induction and maintenance of response and remission with mirikizumab,” Colombel said in an interview with 

, situating the agent within the current treatment landscape.

Disease Clearance as a Multidimensional Treatment Target

The analysis focused on patients who achieved clinical remission at week 52 and entered the open-label extension study, LUCENT-3 (NCT03519945), with outcomes assessed through 4 years of maintenance therapy.

Colombel emphasized the evolving framework for defining treatment success in UC, describing a layered model of disease activity.

“You know, at the top you have what we call a clinical remission. And then if you go deeper, you have endoscopic, and then if you go even deeper, you have histological remission,” he explained. “When you combine all these different endpoints, you arrive to this concept… disease clearance includes symptomatic, endoscopic, and histologic remission. So it's basically the most stringent endpoint that you can think about in ulcerative colitis.”

Disease clearance (DC) was defined as symptomatic remission combined with histologic-endoscopic mucosal remission (HEMR), including histologic remission (Geboes score ≤2B.0) and endoscopic remission (Mayo endoscopy subscore of 0 or 1, excluding friability).

A more stringent endpoint (sDC) required symptomatic remission, histologic remission, and endoscopic normalization (score of 0).

Among week 52 maintenance remitters, disease clearance remained durable through 4 years of continuous mirikizumab therapy.

75.6% / 75.4% (mNRI / observed cases) at year 1

For stringent disease clearance (sDC), rates were:

Despite expected attrition over time, more than 60% of patients maintained DC at year 4 using observed cases, and over 40% achieved sDC.

Colombel noted that these results are consistent with what is seen in good responders to IL-23–targeted therapy.

“Very simple message is that there was very good maintenance of this disease clearance endpoint at four years, which I think is quite remarkable, which is a testimony of the efficacy of this drug for maintaining patients in long-term remission,” he said.

He added that early response appears to be a key marker of long-term durability, though predictive factors remain unclear.

“If you are able to achieve remission and even further disease clearance relatively early, there is good likelihood that you will be able to maintain it,” Colombel said. “What we still don't know is who are those patients… how can we predict short-term remission and then maintenance of long-term remission?”

Clinical Implications and Disease Modification Potential

The findings also contribute to ongoing discussions around whether modern biologics are altering the natural history of ulcerative colitis.

Colombel pointed to broader population-level trends suggesting reduced rates of colectomy and complications in the biologic era.

“Yes, I’m almost certain that we are changing the natural history of the disease thanks to the new drugs that we have,” he said. “We already have data showing that the rate of colectomy has decreased in population-based studies.”

However, he emphasized that unmet need remains, particularly among patients with multiple lines of treatment failure who still progress to surgery.

Safety Profile Remains Stable Over 4 Years

In addition to efficacy, long-term safety remained consistent across the 4-year observation period, with no new safety signals identified.

Colombel highlighted the importance of sustained tolerability in chronic therapy.

“Even though it’s not mentioned here, the safety of this drug looks very good,” he said. “When we observed those patients for four years, we didn’t see any new safety signal, which I think is very good.”

Across 4 years of follow-up in the LUCENT-3 extension study, mirikizumab demonstrated sustained disease clearance in a substantial proportion of patients with moderately to severely active ulcerative colitis. These results reinforce its role as a durable therapeutic option capable of maintaining deep remission across clinical, endoscopic, and histologic domains, while supporting ongoing efforts to refine treat-to-target strategies in UC.

Editor’s Note: Colombel reports relevant disclosures with AbbVie, Janssen Pharmaceuticals, Takeda, and others.

Magro F, Danese S, Siegmund B, Kobayashi T, Siegel CA, Jairath V, et al. Mirikizumab demonstrates consistent and sustained disease clearance at four years of treatment in patients with moderately to severely active ulcerative colitis. Presented at: 

Sands BE, D’Haens G, Clemow DB, et al. Four-year efficacy and safety of mirikizumab in moderately to severely active ulcerative colitis: results from the LUCENT-3 open-label extension study. 

Colombel discusses long-term LUCENT extension data showing durable clinical, endoscopic, and histologic outcomes with mirikizumab in moderately to severely active UC.


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.

Dellon explains phase 4 REMODEL trial data showing dupilumab’s impact on esophageal distensibility and the underlying remodeling process in eosinophilic esophagitis.

Dupilumab Improves Esophageal Distensibility in EoE, With Evan Dellon, MD, MPH

Miguel Regueiro, MD, Chief of Cleveland Clinic’s Digestive Disease Institute

ICI colitis linked to high rehospitalization, ICU use, and mortality even after therapy discontinuation.

ICI-Associated Colitis Linked to Persistent Morbidity After Therapy Discontinuation

Nicole Beaulieu Perez, PhD, RN, PMHNP-BC, an assistant nursing professor at NYU Rory Meyers College of Nursing

Perez discusses the next steps before a marker like monocyte epigenetic age acceleration could be considered clinically actionable for precision psychiatry in depression.

Psychiatry

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Major Depressive Disorder

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Monocyte Epigenetic Age Links to Depression Symptom Subtypes, With Nicole Perez, PhD

Learn how to personalize systemic psoriasis care, weigh comorbidities, and aim for rapid clearance to reduce heart and joint risks.

Closing Thoughts on TYK2 Inhibition in Psoriasis 

Learn key chelation therapy risks—penicillamine skin and lupus-like reactions, zinc GI upset, trientine tolerability—and adherence tips.

Video Series

Evaluating Safety Profiles and Adherence Challenges in Wilson Disease Therapy

Why EPI outcomes improve when GI, primary care, nutrition and pain teams coordinate—streamlining labs, vitamins and follow-ups for patients.

Team-Based EPI Care: Why Multidisciplinary Coordination Matters

Learn how dermatologists tailor psoriasis treatment—topicals, phototherapy, pills or biologics—using shared decisions, severity and comorbidities.

Emerging Updates in Psoriasis from 2026 AAD Annual Meeting 

Learn how clinicians tailor pancreatic enzyme therapy: insurance, dosing, PPIs, and fixes for nonresponse—plus limits of OTC enzymes.

Optimizing PERT: Dosing, Adjustments, and Managing Non-Responders in EPI

New copper chelator offers twice-daily, room-temp dosing and stable results vs penicillamine, boosting adherence for Wilson disease care.

Evaluating Trientine Tetrahydrochloride in Wilson Disease from the CHELATE Trial 

Andrew Sauer, MD, is a cardiologist and the codirector of Cardiovascular Research as well as the executive director of the Cardiometabolic Center Alliance at Saint Luke's Health System. 

Podcasts

Hear Andrew Sauer, MD, discuss how he broke through mental health challenges to become one of the leading voices in transplant cardiology.

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.

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

Moving the Needle in Medicine

Moving the Needle in Medicine is a monthly podcast from HCPLive Cardiology exploring the backstories and nuanced career paths that led the field’s movers and shakers to where they are today. Hosted by Alex Hajduczok, MD, the show will offer listeners insight into the biggest names in cardiology and beyond. 

This podcast is available via video on YouTube and on the HCPLive Cardiology podcast platforms on popular audio players.

Latest News

ALA State of the Air: Nearly Half of American Children Breathe Poor Air

Filling the Gaps: Educating Patients in Hypertension Risk, Detection, and Management

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