Sonalika Khachikian, MD, is an endocrinologist at Monument Health.

Emerging Biologic Targets and Disease Heterogeneity in TED

Rapid advances in immunology are expanding the therapeutic landscape for thyroid eye disease beyond first-in-class IGF-1 receptor inhibition.

In this video, Sonalika Khachikian, MD, an endocrinologist at Monument Health Hospital in South Dakota, anticipates the development of additional IGF-1R–directed therapies with varying molecular properties and dosing schedules, noting that increased competition may broaden treatment options and improve access.

Beyond IGF-1R, Khachikian highlights alternative inflammatory pathways under investigation, including interleukin 6 inhibition and neonatal Fc receptor blockade. Drawing parallels to rheumatologic disease management, she suggests these agents may be particularly useful in patients whose disease phenotype is dominated by inflammatory symptoms rather than structural orbital changes. Such therapies may serve as adjuncts or induction strategies, though infection risk and systemic safety will require careful consideration.

She underscores the heterogeneity of TED, observing that while many patients respond durably to biologic therapy, others experience relapse or fluctuating disease activity. These patterns remain incompletely understood and were the subject of ongoing discussion at recent scientific meetings, including the American Thyroid Association. Her comments highlight the need for continued research to refine long-term management strategies.

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Clinical

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Nancy Reau, MD, is Professor of Internal Medicine, Richard B. Capps Chair of Hepatology, Associate Director of Solid Organ Transplantation, and Section Chief of Hepatology at Rush University Medical Center.

Liver Transplant Access in the MELD 3.0 Era: Progress, Limitations, and Lingering Gaps

As liver transplantation continues to evolve, so too does the scoring system that determines which patients receive access to life-saving organs. In this segment of Liver Lineup: Updates and Unfiltered Insights, hosts Kimberly Brown, MD, and Nancy Reau, MD, unpack new data examining MELD 3.0 and whether it meaningfully addressed long-standing inequities in transplant access, particularly for women and other disadvantaged patient groups.

Check out the full episode on advances in liver transplantation and hepatocellular carcinoma 

Brown opened the discussion by providing context on why MELD 3.0 was developed in the first place. She notes that the MELD score has been repeatedly refined over time, including the addition of serum sodium, in response to concerns that certain patient populations may be unfairly advantaged or disadvantaged.

One of the most prominent concerns, she explains, relates to sex-based differences, largely because serum creatinine is influenced by muscle mass. Because women generally have lower muscle mass than men, Brown emphasizes that they may receive artificially lower MELD scores despite similar disease severity.

She and Reau walk through the design of a study presented at the 

American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025

, which analyzed OPTN data from > 60,000 adult liver transplant candidates between 2020 and 2024, 40% of whom were women. Investigators focused on transplant access, including receipt of a top-5 organ offer and the likelihood of undergoing deceased donor liver transplantation, although Brown cautioned that MELD was originally designed to predict mortality rather than organ offers, a distinction she urges listeners to keep in mind when interpreting the results.

Brown explains that during the MELD 3.0 “burn-in” period, women experienced a significant increase in top-5 offers and transplant rates compared with men. However, she notes that this improvement was not sustained over time, with odds ratios eventually returning to pre-implementation levels, echoing prior discussions suggesting that height and overall size may play a larger role than sex alone.

Reau builds on this observation, highlighting the practical challenges of transplanting very small patients, noting that size mismatch often leads surgeons to decline offers. While women are more frequently affected, she emphasizes that very small men face similar barriers.

Both experts agree that while MELD 3.0 represented progress, it did not fully resolve structural inequities. Brown acknowledges that factors such as age and height continue to influence access, while Reau underscores the importance of maintaining a dynamic scoring system that can adapt to changing indications and patient populations.

Editors’ note: Relevant Disclosures for Reau include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for Brown include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

Tanaka T, Shane D, Lai J. MELD 3.0 Failed to Sustainably Address Sex Disparities in US Liver Transplant Allocation. Presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025. Washington, DC. November 7-11, 2025.

This segment of Liver Lineup features an in-depth discussion on transplant access with MELD 3.0 and new research about potential disparities it introduces.

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.

Hepatology

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.

Susan Weiner, MS, is a diabetes care and education specialist and the founder and owner of Susan Weiner Nutrition, PLLC.

US 2025-2030 Dietary Guidelines: Addressing Alcohol Intake Recommendations

The US Department of Health and Human Services and the US Department of Agriculture released the 2025-2030 Dietary Guidelines for Americans on January 7, 2026. Along with establishing the first-ever limit on processed foods, firmly encouraging a focus on whole foods, and recommending a higher proportion of protein, the guidelines come with several uncertainties and limitations.

Prominent among these uncertainties is a significantly broader suggestion of how people should manage their alcohol intake. Rather than explicitly stating a recommended number of drinks, the guidelines now advise patients to limit their alcohol intake. To address and attempt to explain this vague suggestion, Diabetes Dialogue cohosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, met with Susan Weiner, MS, a nationally recognized dietitian and diabetes care and education specialist.

Check out the full episode on the 2025-2030 Dietary Guidelines for Americans 

Weiner opens by raising substantive concerns about revisions to alcohol-related recommendations in the newly released US dietary guidelines, emphasizing the clinical and policy implications of shifting from quantitative to more ambiguous language. She notes that previous guidelines clearly defined alcohol limits—less than two drinks per day for men and one drink per day for women—while also specifying standard drink sizes and citing evidence linking alcohol consumption to adverse outcomes such as cancer, liver disease, metabolic dysfunction, and other chronic conditions. In contrast, the updated guidance broadly advises individuals to “drink less,” without numerical thresholds, detailed definitions, or accompanying references to alcohol-related harms. Weiner argues that this lack of specificity reduces the guidance’s practical value for clinicians and increases the risk of misinterpretation by patients, who may rationalize unsafe drinking behaviors under vague recommendations.

The discussion highlights how this ambiguity is particularly concerning in populations with diabetes or alcohol-induced dysglycemia, where alcohol can acutely and chronically disrupt glucose regulation, exacerbate liver disease, and affect multiple organ systems. Bellini reflects on the importance of having firm, evidence-based language that clinicians can reference directly in counseling and documentation, noting that tighter guidance previously served as a useful clinical tool. Bellini expresses worry that the revised wording may be perceived as a loosening of standards, potentially undermining public health messaging at a time when alcohol consumption increased during and after the COVID-19 pandemic.

Beyond individual patient care, the conversation emphasizes that dietary guidelines function as policy instruments. Weiner notes that these recommendations shape nutrition education curricula taught to children, influence school lunch programs, and may affect federal food and nutrition programs such as WIC, SNAP, and even military food services. From this vantage point, changes to alcohol guidance could have broad societal consequences, reinforcing the need for clarity and scientific rigor.

The segment also explores how professional organizations interpret and adopt federal dietary guidelines. Isaacs observes that groups such as the American Heart Association appear to be maintaining more conservative, established recommendations (such as the plate method, emphasis on lean meats, and limiting saturated fats) despite broader inclusions in the new guidelines, including butter and beef tallow. Weiner anticipates that organizations focused on cardiovascular disease, cancer, and metabolic health will publicly scrutinize and potentially challenge the revised alcohol language, given its established links to disease, mental health outcomes, and excess caloric intake. The discussion concludes with the expectation that further debate and guidance from professional societies will emerge, underscoring that alcohol cannot be excluded from clear, evidence-based dietary recommendations.

Editor’s Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others. Weiner reports no relevant disclosures.

Mozaffarian D. The 2025-2030 Dietary Guidelines for Americans. JAMA. Published online January 14, 2026. 

This segment of Diabetes Dialogue spotlights the new guidelines’ broad suggestion regarding alcohol, as well as how organizations may interpret it.

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.

Podcasts

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

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.

Strategic Alliance Partnership

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. 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.

New data suggest care improvements can be made for patients with skin cancer who have frail skin through collaboration with geriatricians, the use of a geriatric assessment, and an onco-geriatric multidisciplinary team (OMDT).

These results were the conclusion of a recently-published letter to the editor in the Journal of the European Academy of Dermatology and Venereology (JEADV). It was authored by such investigators as Esther Groll, from the University Medical Center Groningen Department of Dermatology.

Groll et al noted the prognostic value of evaluating frailty in a patient’s skin, though the condition is rarely addressed within patient guidelines. Such guidelines, they highlighted, most often prioritize the characteristics of skin cancer tumors instead.

“The University Medical Center Groningen recently introduced a nurse-led frailty assessment to improve care for this population,” the investigators wrote.

 “We investigated how this screening affected treatment choices and time to treatment.”

Although the Comprehensive Geriatric Assessment (CGA) is considered the reference standard for assessing older oncology patients, Groll and colleagues pointed to the substantial time and resources needed for the CGA’s use. Consequently, this nurse-led frailty screening program was evaluated in its aim to make improvements to older patient care, specifically among those living with skin cancer. They used a retrospective case–control study design, assessing the program’s effects on treatment decision-making and treatment timelines.

There were 290 patients aged 65 years or older involved in this study, all of whom were described as having head and neck skin malignancies.In specific, the study subjects had either cutaneous squamous cell carcinoma, lentigo maligna, or basal cell carcinoma. 145 of the study subjects were screened for frailty in the timeframe between 2022 - 2023. The study’s outcomes were compared with those of a matched historical control cohort of 145 individuals treated between 2018 - 2019 at the same institution.

Matching was done by Groll and coauthors based on sex, diagnosis, and age. The identification of the study’s control cohort was done via the Netherlands Cancer Registry. Individuals included in the control arm of the analysis were not provided with this frailty screening as part of their course of care. The frailty evaluation was conducted through the use of a shortened geriatric evaluation covering 4 domains:

If a participant was shown to have impairments in 2 or more domains, they would be described as frail. Reviews of treatment plans and decisions related to referrals for CGA by a geriatrician were done by an OMDT. This OMDT was made up of a specialized nurse, a dermatologist, a geriatrician, and a radiotherapist. Assessments in this analysis looked at estimated life expectancy, frailty status, and preferences among patients.

114 of the screened patients were labeled by Groll et al as frail (78.6%). The investigative team pointed to functional and psychocognitive impairments as the most commonly observed contributors to frailty. They found 53.8% were reviewed by the OMDT. Changes to treatment were made in 20.7% of these cases. In 1 notable finding, 83.3% of the treatment changes were described as having involved a shift toward less invasive therapeutic choices.

A strong association was identified between the use the OMDT and treatment modifications (OR 5.85, 95% CI 2.09–16.35, 

 < .001). Additionally, a strong link was identified with the selection of less invasive treatments (OR 0.16, 95% CI 0.05–0.52, 

 = .002). Overall, 17.2% of the subjects screened by Groll and colleagues were referred for a CGA. Among 44% of these individuals, Mohs micrographic surgery was replaced with a less invasive alternative.

In contrast, only 4.8% of those inclucded in the historical cohort were provided with treatment diverging from guideline-based recommendations. This was described by the team as a significant difference versus those involved in the screened cohort (

Those who underwent this frailty screening attended more hospital visits on average (median 6 versus 4, 

 < .001), reported longer median interval to initiation of their treatment compared with those in the control arm (62 versus 41.5 days, 

 < .001), and presented with larger median tumor diameters (14 versus 9 mm, 

 < .001). Overall, frailty screening identified a high prevalence of patient frailty and, via the integration of geriatric expertise and patient-centered considerations, supported the implementation of treatment actions considered less aggressive.

“This aligns with prior research that stresses the importance of shared decision-making and incorporation of comorbidities, functional status and life expectancy to guide care and reduce treatment burden,” Groll and coauthors wrote.

Groll E, Hetényi Z, Rácz E. Personalized care for older skin cancer patients: Impact of frailty screening on treatment decisions. J Eur Acad Dermatol Venereol. 2026 Jan 16. 

van Winden MEC, Garcovich S, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol. 2021 Jan;35(1):95-104. doi: 10.1111/jdv.16607. Epub 2020 Jul 1. PMID: 32403174; PMCID: PMC7818261.

Articles

Recent findings indicate that integrating geriatric assessments and multidisciplinary teams can enhance care for older skin cancer patients with frail skin. A study involving 290 patients aged 65 and older with head and neck skin malignancies demonstrated that nurse-led frailty screenings influenced treatment decisions, often leading to less invasive options. The study highlighted the importance of considering frailty, functional status, and life expectancy in treatment planning. The use of an onco-geriatric multidisciplinary team was associated with significant treatment modifications and improved patient-centered care.

These data suggest improvement of care for patients with skin cancer and frail skin through geriatrician use, along with a nurse-led geriatric assessment, may be beneficial.

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.

Personalized Care Improvements Identified for Older Patients with Skin Cancer

Michael E. Thase, MD, of the University of Pennsylvania

Adjunctive Lumateperone Improves Remission Rates in MDD, With Michael E. Thase, MD

Achieving sustained remission remains a central challenge in the management of 

, particularly for patients who fail to respond adequately to antidepressant therapy (ADT) alone. New pooled analyses evaluating lumateperone 42 mg as an adjunct to ADT provide encouraging evidence for both short-term efficacy and long-term durability, as discussed by Michael E. Thase, MD, of the University of Pennsylvania, in a recent interview.

“[Patients who do not respond easily to antidepressants are not only at grave risk for continuing to suffer and continuing to do poorly at work and in their social roles, but they are also more likely to then become chronically depressed,” Thase told 

. “It's not just enough to help them feel better over 6 weeks or 8 weeks or in the short run, but it's really important for the benefits to be sustained and for the treatment benefit not to dissipate.”

He provided the example of weight gain, which can appear relatively small in 6 weeks but large over 6 months.

“I'm glad to say that in the long term…the benefits were sustained,” Thase continued. “People did, on average, continue to improve if they had not had a full remission with the first 6 weeks of treatment [and] that that could happen with continued treatment. There was very little cost for the continued treatment in terms of the risk of weight gain or the development of new side effects.”

In pooled short-term studies, presented at the American College of Neuropsychopharmacology (ACNP) Annual Meeting in the Bahamas from January 12 – 15, 2026, lumateperone 42 mg plus ADT demonstrated significantly greater Montgomery–Åsberg Depression Rating Scale (MADRS) total score remission rates compared with placebo plus ADT by day 43 (25.5% vs 13.6%; 

 <.0001). Complete remission was achieved by 10.6% of patients receiving lumateperone versus 5.6% of those receiving placebo, highlighting the clinical relevance of early symptom resolution in patients with an inadequate response to ADT (

 <.01). In a separate long-term trial, complete remission was achieved by 44.1% of patients.

During the open-label phase, 65.4% of patients achieved remission. In each subgroup analysis, over 55% of patients receiving lumateperone plus ADT achieved remission at the end of the trial. Remission rates were similar despite age, ADT treatment, or baseline disease severity.

Tolerability further distinguishes lumateperone from other adjunctive options. Across studies, treatment was associated with minimal weight gain, low discontinuation rates, and a favorable neurologic safety profile, with little evidence of akathisia or extrapyramidal symptoms—concerns that often limit long-term use of other adjunctive agents.

“I want clinicians to know that we not only have a new therapy that's been approved for this purpose now, lumateperone has been approved for several years for the treatment of schizophrenia, but now it's approved for the adjunctive treatment of major depressive disorder and that it is effective… [and] effective relatively quickly,” Thase said. “There's only a single therapeutic dose, 42 milligrams, so it's easy to get the dose right. It's really well tolerated; very few patients drop out there. There's little, if [any], weight gain associated with the treatment. Patients are unlikely to have uncomfortable, neurologic side effects such as restlessness or stiffness…We're delighted that the results turned out so well.”

Relevant disclosures for Thase include Otsuka Pharmaceutical, Janssen Scientific Affairs, E.R. Squibb & Sons, Eli Lilly and Company, H. Lundbeck A S, Boehringer Ingelheim International GmbH, and ITI, Inc. (d/b/a Intra-Cellular Therapies, Inc.).

Bhagwagar Z, Durgam S, Earley W, et al. Remission with lumateperone 42 mg adjunctive to antidepressant therapy in patients with Major Depressive Disorder: Analysis of Short-Term and Long-Term Trials. Presented at the American College of Neuropsychopharmacology (ACNP) Annual Meeting in Bahamas from January 12 – 15, 2026

Lumateperone 42 mg plus antidepressants boosts remission rates and sustains symptom improvement in MDD patients, says Michael E. Thase, MD.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

In this episode, ‘Addressing Bone Health in the Management of Hypoparathyroidism,’ the experts explore approaches to managing hypoparathyroidism in patients with osteoporosis.

Addressing Bone Health in the Management of Hypoparathyroidism

This episode, titled ‘Evaluating the Efficacy and Safety of Palopegteriparatide in Hypoparathyroidism from the PaTHway Trial,’ features panelists discussing the efficacy and safety data of palopegteriparatide in hypoparathyroidism from the phase 3 PaTHway trial as well as the limitations of the trial.

Evaluating the Efficacy and Safety of Palopegteriparatide in Hypoparathyroidism from the PaTHway Trial

In ‘Novel Approaches in Hypoparathyroidism Management,’ our experts delve into novel treatment options for patients who are inadequately controlled on conventional therapy and the mechanism of action of palopegteriparatide.

Novel Approaches in Hypoparathyroidism Management

In this episode, ‘Challenges of Conventional Therapy in Hypoparathyroidism,’ the expert endocrinologists explore conventional therapy for chronic hypoparathyroidism, symptom control, and the risk of complications. 


Challenges of Conventional Therapy in Hypoparathyroidism

In ‘Acute and Long-Term Complications of Hypoparathyroidism,’ our panel delves into the potential renal, neuromuscular, cognitive, and bone complications that impact patients.

Quality of Life Impact in Hypoparathyroidism

In ‘Acute and Long-Term Complications of Hypoparathyroidism,’ our panel delves into the potential renal, neuromuscular, cognitive, and bone complications that impact patients.

Led by the moderator, Dr. Kohlmeier, the expert panel, Dr. Rubin, Dr. Warren, and Dr. Al-Dallal, examines the following critical questions: 

1.	How is hypoparathyroidism diagnosed? 
2.	What are the key challenges in both diagnosing and monitoring patients with hypoparathyroidism? 

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, ‘Acute and Long-Term Complications of Hypoparathyroidism,’ features the panelists advancing their conversation on hypoparathyroidism and focusing on the potential renal, neuromuscular, cognitive, and bone complications that impact patients.

Acute and Long-Term Complications of Hypoparathyroidism

The panel concludes by discussing the future of ATTR-CM care. They highlight continued progress in disease-modifying therapies, with growing interest in determining how best to sequence or potentially combine treatments as evidence evolves. The group notes that as patients are diagnosed earlier, the goals of therapy may increasingly shift from slowing decline to preserving long-term function and quality of life.
They emphasize the importance of expanding awareness and education across specialties so that more patients are recognized before advanced cardiac dysfunction develops. Improving access to therapy remains an essential area of focus, as cost and insurance barriers continue to influence treatment decisions. The panel also anticipates advances in monitoring disease progression, including the use of biomarkers and imaging to better assess response over time.
Ultimately, the experts express optimism that ongoing research, broader recognition, and more refined care pathways will continue to improve outcomes for individuals living with ATTR-CM.


Future Directions in ATTR-CM

 In this episode, ‘Hypoparathyroidism Diagnosis and Challenges,’ the panelists explore how hypoparathyroidism is diagnosed as well as key diagnostic and monitoring challenges that clinicians face.

Led by the moderator, Dr. Kohlmeier, the expert panel, Dr. Rubin, Dr. Warren, and Dr. Al-Dallal, examines the following critical questions: 

1.	How is hypoparathyroidism diagnosed? 
2.	What are the key challenges in both diagnosing and monitoring patients with hypoparathyroidism? 

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

The next episode in this series, ‘Acute and Long-Term Complications of Hypoparathyroidism,’ features the panelists advancing their conversation on hypoparathyroidism and focusing on the potential renal, neuromuscular, cognitive, and bone complications that impact patients.

Hypoparathyroidism Diagnosis and Challenges

See how shared EHRs support collaborative care and review newer steroid-sparing topical therapies for pediatric atopic dermatitis and psoriasis.

EHR Collaboration and New Steroid-Sparing Topicals in Pediatric Dermatoses

Welcome back to another HCPLive Peer Exchange series. In this opening episode, panelists highlight the underlying causes of hypoparathyroidism and the impact of the loss of parathyroid hormone function by examining the following critical questions:

1.	What is chronic hypoparathyroidism, and how is it defined? 
2.	How does the loss of parathyroid hormone (PTH) function disrupt calcium and phosphate homeostasis in hypoparathyroidism? 
3.	What are the causes of chronic hypoparathyroidism, and is there any way to predict or prevent it? When might genetic testing be appropriate?

In the next episode, panelists will continue their discussion on hypoparathyroidism and highlight how it is diagnosed and the key challenges in the diagnosis and monitoring of patients with hypoparathyroidism.

Latest News

Emerging Biologic Targets and Disease Heterogeneity in TED

Liver Transplant Access in the MELD 3.0 Era: Progress, Limitations, and Lingering Gaps

US 2025-2030 Dietary Guidelines: Addressing Alcohol Intake Recommendations

Personalized Care Improvements Identified for Older Patients with Skin Cancer

Adjunctive Lumateperone Improves Remission Rates in MDD, With Michael E. Thase, MD