This video segment synthesizes long-term safety data for JAK inhibitors and biologics, highlights the risks of undertreated inflammation, and closes with practical “art of medicine” pearls for selecting and tracking therapy in atopic dermatitis.

Special Report: Safety, Future Directions, & the Art of Therapy Selection in Atopic Dermatitis

Long-term safety considerations are central to decisions about initiating and continuing advanced systemic therapies in 

In this video, host Mona Shahriari, MD, notes that several years of clinical trial and real-world data with upadacitinib now support its use in diverse patient subgroups, including individuals who smoke, use hormonal contraception or hormone replacement therapy, or have cardiovascular risk factors. She stresses that adverse events of special interest—such as malignancy, major adverse cardiovascular events, and venous thromboembolism—must be interpreted in the context of baseline risk inherent to the general and atopic dermatitis populations. Current data suggest that rates of such events with JAK inhibitors in atopic dermatitis appear broadly consistent with background rates, which helps her counsel patients and colleagues with greater confidence.

 on switching therapeutic classes in atopic dermatitis, expert guest Andrew Mastro, MS, PA-C, underscores the importance of correlating real-world evidence, such as the CorEvitas-type data sets, with clinical trial outcomes to validate both efficacy and safety expectations during therapy switches. The discussion then turns to recent long-term safety data for tralokinumab, which report rates of major cardiovascular events, thromboembolism, and malignancy that are comparable to those observed with upadacitinib. Mastro explains that while these findings did not change his personal practice—because he already viewed these agents as viable long-term options—they provide valuable reassurance for clinicians and patients who may have been hesitant about JAK inhibitors. Shahriari distills this into a practical message: if a clinician is comfortable with the long-term safety of tralokinumab, they should feel similarly comfortable with upadacitinib when used in appropriately selected patients.

The segment broadens to address the risk of not treating atopic dermatitis aggressively enough. Shahriari emphasizes that uncontrolled inflammation is not benign and that atopic dermatitis is associated with systemic comorbidities, including cardiovascular disease and other inflammatory conditions. She frequently discusses this with parents of pediatric and adolescent patients who may be reluctant to start systemic therapy, explaining that persistent, moderate to severe disease is unlikely to “just go away” and that appropriately selected systemic treatment may mitigate long-term consequences. Mastro describes the “light bulb” moment when patients realize their disease is more than “just an itchy patch,” and how connecting internal inflammation to external manifestations facilitates acceptance of injectable or oral therapy. The discussion concludes with practical pearls: Mastro reminds clinicians to see “a person in the room with a problem,” not just a diagnosis, and Shahriari offers a simple “ART of medicine” framework—assess burden beyond BSA, pick the right mechanism of action, and track response using AHEAD recommendations. 

Relevant disclosures for Shahriari include AbbVie, Apogee, Arcutis, Bristol Myers Squibb, Dermavant, Galderma, Incyte, Johnson & Johnson, LEO, Lilly USA, Novartis, Regeneron, Sanofi-Genzyme, Takeda, UCB, Pfizer, and others. Mastro has no relevant disclosures to report.

Silverberg JI, Gooderham M, Katoh N, et al. Combining treat-to-target principles and shared decision-making: International expert consensus-based recommendations with a novel concept for minimal disease activity criteria in atopic dermatitis. 

Silverberg JI, Bunick CG, Hong HC, et al. Efficacy and safety of upadacitinib versus dupilumab in adults and adolescents with moderate-to-severe atopic dermatitis: week 16 results of an open-label randomized efficacy assessor-blinded head-to-head phase IIIb/IV study (Level Up). 

Videos

Explore the long-term safety and efficacy of JAK inhibitors in atopic dermatitis, enhancing patient care and clinician confidence.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

Atopic Dermatitis

Atopic Dermatitis condition center page, audiences can find a variety of coverage mediums for medical news and updates, including articles, video interviews, podcasts, and breaking news on dermatitis research, treatment, and drug development.

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.

This segment addresses the multifactorial causes of therapeutic inertia in atopic dermatitis and outlines practical scripts for discussing JAK inhibitor safety, boxed warnings, and risk–benefit considerations with patients.

 Special Report: Overcoming Therapeutic Inertia and Communicating Safety of JAK Inhibitors

Therapeutic inertia is a recurrent challenge in the management of moderate to severe 

Mona Shahriari, MD, suggests that inertia often stems from clinician comfort with “good enough,” time pressures, and residual uncertainty about newer therapeutic classes such as JAK inhibitors. She notes that until 2017 there were no targeted agents combining high levels of skin clearance with long-term safety suitable for chronic use, which shaped expectations for what was considered acceptable control. Now, with advanced biologics and JAK inhibitors available, she argues that continuing to prioritize convenience over optimal outcomes can inadvertently shortchange patients whose lives might be transformed by deeper disease control.

 on switching therapeutic classes in atopic dermatitis, both Shahriari and expert guest Andrew Mastro, MS, PA-C, emphasize the critical role of communication in mitigating therapeutic inertia. Mastro describes reframing safety conversations so that they are proactive, structured, and time-efficient, rather than a barrier to prescribing. Shahriari shares a concise script she uses when discussing JAK inhibitors: she acknowledges that pursuing greater efficacy and speed of response may involve additional risk, explains her plan for baseline laboratory evaluation, and contextualizes boxed warnings by clarifying that they derive from a different drug in a different disease population with additional immunosuppressive therapies. She reassures patients that, based on their individual medical history, she does not anticipate a heightened risk but invites them to contact her if anything feels concerning once treatment starts.

Mastro complements this with his “three Ps” framework—emphasizing that the situation in which the boxed warning arose is not the same person, problem, or prescription as the atopic dermatitis patient and agent under consideration. He briefly reviews the surveillance study that generated the warning, highlights differences in population and indication, and then explicitly explains why he believes those data do not directly translate to the current atopic dermatitis scenario. Both clinicians stress that these conversations can be conducted in 1 to 2 minutes yet have a profound impact on patient trust, adherence, and willingness to switch. 

Healthcare providers discuss the importance of effective communication when switching patients from biologics to JAK inhibitors.

Special Report: Overcoming Therapeutic Inertia and Communicating Safety of  JAK Inhibitors

This segment examines how to define inadequate response in atopic dermatitis, operationalize treat-to-target concepts, and interpret data from the LEVEL UP trial on switching from biologic to JAK inhibitor therapy.

Special Report: Inadequate Response and When to Switch Systemic Therapy in Atopic Dermatitis

Determining when to maintain, optimize, or switch systemic therapy in 

 requires a nuanced understanding of treatment targets, patient expectations, and evolving evidence.

In this video, expert guest Andrew Mastro, MS, PA-C, describes his approach to defining inadequate response by integrating objective thresholds and patient-reported outcomes. He views a failure to achieve deeper responses—such as EASI 90, IGA 0/1, and near-complete itch control (NRS 0–1)—by approximately 4 months on a biologic as a signal that optimal targets have not been met, especially for moderate to severe disease. He distinguishes primary failure (never achieving moderate or deeper levels of response) from secondary failure (loss of previously adequate control, increased flares, or greater day-to-day disease awareness) and emphasizes that patient dissatisfaction must accompany clinician concern for a switch to be appropriate.

 on switching therapeutic classes in atopic dermatitis, host Mona Shahriari, MD, builds on this framework with a discussion of therapeutic inertia and the importance of not remaining indefinitely at “good enough.” She notes that while some patients may justify longer trial periods, such as 9 months, the AHEAD recommendations explicitly suggest considering a switch if treat-to-target goals are not achieved within 3 to 6 months. Shahriari likens earlier efficacy benchmarks to “first-generation robots” that were impressive at the time but limited in capability; in contrast, contemporary data support aiming for EASI 90 or even EASI 100 and near-complete itch suppression to meaningfully improve quality of life, sleep, and psychosocial outcomes.

A key evidence base discussed is the LEVEL UP study, which evaluated switching from dupilumab to upadacitinib. Shahriari describes the two-period design, beginning with a head-to-head comparison of upadacitinib and dupilumab, where upadacitinib demonstrated superiority at week 16 on a composite endpoint of EASI 90 plus near-complete itch control. The second phase focused on patients with inadequate response to dupilumab (defined as not reaching EASI 75) who then switched to upadacitinib 15 mg. Remarkably, within 4 weeks of switching, nearly 7 in 10 of these prior nonresponders achieved EASI 75, about one-third reached EASI 90, and many had started from a baseline of roughly EASI 50 at the time of switch. These findings reinforce that failure on one advanced therapy does not preclude robust response to another mechanism of action.

This segment reviews the modern systemic treatment landscape in atopic dermatitis and discusses how the AHEAD recommendations and tools like ADCT can support treat-to-target care.

Special Report: Treat-to-Target in Atopic Dermatitis—Applying the AHEAD Recommendations

The systemic treatment landscape for moderate to severe 

 has shifted from broad immunosuppression to targeted therapies supporting both short-term control and long-term disease modification.

In this video, host Mona Shahriari, MD, contrasts historical reliance on nonselective immunosuppressants, which often had challenging safety profiles, with current options that include biologics and JAK inhibitors offering higher efficacy thresholds and more favorable long-term safety. She frames the central clinical question as, “What is the end game?” and introduces the AHEAD treat-to-target recommendations as a framework for defining what “good” long-term control should look like, beyond simply being “better than baseline.”

 on switching therapeutic classes in atopic dermatitis, Shahriari explains that AHEAD is a global consensus initiative encompassing approximately 100 clinicians from 44 countries, designed to raise the standard of atopic dermatitis care worldwide. The recommendations set ambitious targets within 3 to 6 months of therapy initiation, emphasizing high levels of both clinician-reported and patient-reported outcomes. Targets include EASI 90, IGA 0/1, and low body surface area (BSA) involvement on the clinician side, and nearly complete resolution of itch on patient-reported scales. Expert guest Andrew Mastro, MS, PA-C, highlights how these treat-to-target thresholds align clinical expectations with patient goals and embed shared decision-making into routine care rather than treating it as an optional add-on.

Mastro then discusses practical implementation using both traditional measures (IGA, BSA, itch numeric rating scale) and the Atopic Dermatitis Control Tool (ADCT). He notes that ADCT can be embedded in electronic medical records and administered by support staff or via tablets before the visit, providing a six-item, 30-second assessment of symptoms, sleep, mood, and overall bother. Shahriari echoes her preference for ADCT and adds that she often supplements objective metrics with a direct question about whether patients are satisfied with their current level of control or wish it were better. This simple phrasing can uncover residual disease burden in individuals who may fear losing partial gains if therapy is changed. 

Explore the evolving landscape of atopic dermatitis treatment, focusing on advanced therapies and long-term patient management strategies.

This segment focuses on practical language and interviewing techniques clinicians can use to elicit meaningful information about skin pain and its impact on daily life in patients with atopic dermatitis.

Special Report: Practical Communication Strategies for Skin Pain in Atopic Dermatitis 

Eliciting accurate information about skin pain in 

 requires more than a generic symptom checklist. 

In this video, Andrew Mastro, MS, PA-C, describes a deliberate approach to patient interviewing that normalizes skin pain and invites deeper reflection on its impact. Rather than asking, “How are you doing?” he begins by explaining many individuals with eczema experience more than itch and then asks directly whether the skin ever feels painful. He supplements this with targeted questions about pain location (surface vs deeper), functional limitations, and activities patients avoid because of discomfort. This structured yet conversational approach can be particularly valuable for populations less likely to report pain, such as male patients, or those who have never had their symptoms framed as “pain” rather than a routine itch.

 on switching therapeutic classes in atopic dermatitis, host Mona Shahriari, MD, reflects on how her own patient interviews have evolved with the expansion of targeted therapies. She notes in the pre–biologic and pre–small molecule era, clinicians often limited follow-up to a brief assessment of “Is it better?” without probing specific symptom domains. Now, with more nuanced treatment options, both she and Mastro emphasize the importance of asking about burning, soreness, and other qualitative descriptors of skin pain, as well as using multiple adjectives so patients can better recognize and articulate their experience. Shahriari underscores patients do not always know which symptoms are relevant to report, making clinician-led inquiry essential.

The discussion also highlights a broader mindset shift: moving from viewing “eczema in room 8” to viewing “a person with eczema in room 8.” Mastro describes consciously referring to patients by name rather than diagnosis to counteract dehumanization in busy, high-volume settings. He teaches trainees to see each visit as an opportunity to connect emotionally, not just clinically, and to avoid skipping deeper questions during seemingly “routine” biologic or small-molecule checks. 

Healthcare professionals explore effective questioning techniques to uncover deeper emotional and physical impacts of skin pain in patients.

The panel explores strategies to improve collaboration across specialties to accelerate diagnosis of ATTR-CM. They note that while clinicians who frequently treat cardiac amyloidosis easily recognize red flags, most patients initially present in orthopedic, neurology, or primary care settings where awareness may be limited. The group emphasizes the importance of education rather than universal screening: common conditions like bilateral carpal tunnel syndrome are widespread, and only a minority will be linked to amyloid. Instead, these findings should be viewed as risk factors that prompt thoughtful clinical review rather than routine tissue sampling.
Effective models of care involve strengthening communication channels between specialists and building workflows that encourage referral when constellation patterns emerge. Advanced practice providers often serve as key connectors, helping evaluate history, coordinate testing, and reinforce awareness. The panel highlights that integrating these teams can enable earlier identification, reduce missed opportunities, and help patients access disease-modifying therapies before significant cardiac decline occurs.



Video Series

Streamlining ATTR-CM Diagnosis Through Multidisciplinary Collaboration

Explore the complexities of psoriasis treatment, including advanced therapies, mechanisms of action, and the potential of molecular testing for personalized care.

Role of Mechanisms of Action in Treatment Decisions and Personalized Care in Psorias

Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

Panelists break down the potential role of plozasiran in FCS based on the PALISADE trial. 

Dyslipidemia

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...

Special Reports

RX Review: Understanding Plozasiran’s Role in FCS Management

Understanding severe hypertriglyceridemia is crucial for preventing pancreatitis and managing triglyceride levels effectively.

RX Review: Updates in Diagnosis and Testing for FCS

Discover effective strategies to shorten the diagnostic window for pancreatitis and manage high triglyceride levels in FCS.

RX Review: Delays, Clinical Features, and Raising Awareness for FCS

Explore the challenges and advancements in managing FCS with expert insights on treatment and patient care.

RX Review: Updates and Unmet Needs for Familial Chylomicronemia Syndrome

Diana Isaacs, PharmD, is an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic.

Podcasts

Discover the latest advancements in diabetes technology from November 2025, including Omnipod updates and the new Pivot pump.

Type 1 Diabetes

Type 2 Diabetes

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Diabetes Dialogue

Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives is a monthly podcast hosted by Diana Isaacs, PharmD, and Natalie Bellini, DNP, aimed at providing a regular roundup of the latest clinically applicable insights across diabetes and metabolic diseases, with a focus on leveraging technology to improve care.

Diabetes Dialogue: Upcoming Upgrades for Omnipod Technology

Robert Lookstein, MD, is the executive vice chairman of the department of diagnostic, molecular, and interventional radiology at the Icahn School of Medicine at Mount Sinai.

CAVT effectively reduced right-to-left ventricular diameter ratio within 48 hours, with earlier vital sign normalizing and similar adverse event rates to AC.

Venous Thromboembolism

The HCPLive venous thromboembolism page is a resource for medical news and expert insights on VTE. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for thrombotic disease, and more.

STORM-PE: Computer-Assisted Vacuum Thrombectomy Outperforms Anticoagulation, With Robert Lookstein, MD

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.

Articles

FDA grants accelerated approval for sibeprenlimab for reducing proteinuria in IgA nephropathy.

IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

FDA News

FDA Awards Accelerated Approval to Sibeprenlimab in IgA Nephropathy 

Kassandra Holzem, MD, is an assistant professor of Dermatology at the Medical College of Wisconsin.

Holzem spoke in this interview about several additional highlights from her session at SDPA Fall regarding red flags in dermatology and when to admit from the clinic.

Conference

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

Latest News

Special Report: Safety, Future Directions, & the Art of Therapy Selection in Atopic Dermatitis

Special Report: Overcoming Therapeutic Inertia and Communicating Safety of JAK Inhibitors

Special Report: Inadequate Response and When to Switch Systemic Therapy in Atopic Dermatitis

Special Report: Treat-to-Target in Atopic Dermatitis—Applying the AHEAD Recommendations

Special Report: Practical Communication Strategies for Skin Pain in Atopic Dermatitis