1,3,2,3 Schedule May Not Harm Firefighter Sleep, Nicole Bowles, PhD, Says

 in patients who work in the firefighting profession? Nicole Bowles, PhD, assistant professor at Oregon Health & Science University, discussed this topic at 

, the 39th annual meeting of the Associated Professional Sleep Societies, on Tuesday, June 10, in Seattle.

Firefighters must frequently stay awake to respond to late-night calls, putting their sleep on hold, which could lead to circadian misalignment. During the meeting, Bowles discussed the staggered working schedule of 1/3/2/3 among firefighters a part of Portland Fire & Rescue.

“It's 1 day on, 3 days off, 2 days on, 3 days off,” Bowles explained to 

The Portland Fire & Rescue adopted the 1/3/2/3 schedule in March 2022 to better accommodate family and social obligations affected by the need to recover sleep on days off.

This schedule describes 2 days in, 4 off, 4 days in, 8 off.

“For this data set, we've updated it, so we have additional firefighters across Oregon who are working on the 1/3/2/3 schedule,” Bowles said. “For the most part, where our results are still what we're seeing for Portland, we see that on the 1/3/2/3, they're getting slightly less sleep and they have slightly worse performance on a test called the psychomotor vigilance test.”

Bowles pointed out an interesting finding—firefighters on the 1/3/2/3 schedule rate their sleep better than it is, reporting being more alert. This finding was consistent with other observations made with the 1/3/2/3 schedule, including better work-family conflict or fewer conflicts with family and work.

“They're able to recover in different ways,” Bowles said. “So again, maybe not getting as much sleep, but they're feeling their cup in other ways, more hobbies, more engagement with family. They're able to detach more from work, and so that's why they might feel better despite not actually getting more sleep. And so, I conclude the session by discussing that I don't think the 1/3/2/3 is necessarily a worse schedule.”

Still, she said specific actions can be taken to improve firefighters’ sleep health, such as adjusting work start time to later than 8 am or encouraging them to take a nap when they arrive home or to go to bed early.

“We're not seeing huge detriments because of [1/3/2/3], but again, [we should be] encouraging firefighters to get more sleep,” Bowles said.

Bowles N, Billings J, Reichenberger, D, et al. Rest Under Fire: Examining Sleep and Recovery in the Firefighting Profession. Presented at SLEEP 2025 in Seattle on June 9, 2025.

SWIFT: Shiftwork in Firefighters. Oregon Institute of Occupational Health Sciences. 

https://www.ohsu.edu/oregon-institute-occupational-health-sciences/swift-shiftwork-firefighters

Firefighters often face sleep disturbances due to their demanding schedules, leading to potential circadian misalignment. The 1/3/2/3 schedule, adopted by Portland Fire & Rescue, aims to balance work and family life, though it results in slightly less sleep and reduced performance on psychomotor vigilance tests. Despite this, firefighters report feeling more alert and experiencing fewer work-family conflicts. To enhance sleep health, recommendations include adjusting work start times and encouraging naps or early bedtimes. Overall, the 1/3/2/3 schedule is not deemed detrimental.

HCPLive spoke with Bowles at SLEEP 2025 on the staggered schedule, referred to as 1/3/2/3, and how it impacts firefighters' sleep. 

Staggered Schedule May Not Harm Firefighter Sleep, Nicole Bowles, PhD, Says

 Nicole Bowles, PhD

Associate Professor, Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California

Piatek discussed findings from a healthcare resource utilization study and a sentiment analysis study presented at ASH 2024.

Caroline Piatek, MD: High HCRU, Patient Concerns Highlight Great Unmet Need in wAIHA

New research has revealed high unmet needs in people with warm autoimmune hemolytic anemia (wAIHA), as evidenced by high healthcare resource utilization (HCRU) and prevalent concerns about adverse events (AEs) and a lack of treatment efficacy.

These findings are from 2 studies, data from which were presented at the

 66th American Society of Hematology (ASH) Annual Meeting and Exposition

, held December 7-10, 2024, in San Diego, California.

® spoke with Caroline Piatek, MD, Associate Professor, Jane Anne Nohl Division of Hematology, Keck School of Medicine, University of Southern California, who served as an investigator on both studies.

In a retrospective, HCRU study, Piatek and colleagues found that HCRU remained high in both 12-month periods preceding and following initial wAIHA diagnosis in people with both primary and secondary wAIHA.

 In a sentiment analysis study powered by artificial intelligence (AI), they found a dearth of positive sentiments about rituximab treatment or transfusion therapy, notable concerns about AEs and a lack of treatment efficacy, and a prevalence of information seeking, highlighting the importance of healthcare provider support and involvement in implementing a successful treatment strategy.

During the discussion, Piatek emphasized the high unmet need that these studies revealed and the need for better treatment strategies for people with wAIHA.

“There just isn't much [out there for wAIHA]. And so, anything is helpful, but ultimately, we need better therapeutic agents in this setting… Characterizing the disease burden is important, but we kind of have to move forward from that and do something about it,” Piatek said.

Jackson LA, Pesa J, Choudhry Z, et al. A Retrospective Database Analysis of Healthcare Resource Utilization in Patients with Warm Autoimmune Hemolytic Anemia in the United States. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 2324

Piatek C, Jackson LA, Brethenoux C, et al. Sentiment Analysis Applied to Digital Conversations Among Warm Autoimmune Hemolytic Anemia (wAIHA) Patients Receiving Rituximab and/or Blood Transfusion. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 3705

Caroline Piatek, MD

A Novel Approach to Treating Glaucoma and Haab’s Striae with Danielle Trief, MD

2025 New York State Ophthalmological Society (NYSOS) Annual Meeting

, Danielle Trief, MD, associate professor at Columbia University Irving Medical Center, attended by Justin Cheong, an MD candidate at Columbia University, presented a surgical video demonstrating the removal of Haab’s striae and subsequent DSEK treatment of a patient with 

Patients with congenital glaucoma often face progressive ocular complications due to early surgical interventions, such as trabeculectomy and tube shunt placement. Over time, these procedures can contribute to corneal decompensation, resulting in visual decline and complex surgical considerations.

In the video, Cheong and Trief operated on a man in his 40s who presented with corneal edema and prominent Haab’s striae—breaks in Descemet’s membrane associated with congenital glaucoma. He also had a history of vitrectomy and multiple glaucoma surgeries, contributing to a challenging surgical landscape.

“I think it was interesting because we don’t talk too much about the surgical approach in congenital glaucoma to endothelial keratoplasty; those patients are at risk for corneal decompensation over the years, because their cornea is stretched a bit because of the history of glaucoma,” Trief told 

. “And then a lot of times they’ll have other procedures which reduces their endothelial cell count, and then also the breaks and Haab’s striae can damage the endothelium. So, it poses a surgical challenge, which is what we wanted to address.”

Cheong and Trief deviated from the traditional method of endothelial keratoplasty due to the presence of the striae. Haab’s striae often protrude from the posterior corneal surface, which can interfere with graft adherence. Additionally, given the prior glaucoma surgeries the patient had undergone, DSEK was selected over DMEK for its better chances of adhesion.

During the operation, Trief made the novel decision to peel the Haab’s striae before graft placement. The striae detached cleanly, exposing a smooth corneal surface suitable for graft adhesion. A standard 8 mm DSEK graft was used, despite the patient’s enlarged corneal diameter (approximately 14–15 mm) due to buphthalmos. Trief and Cheong employed 20% SF6 gas to last the full recovery period, which proved effective in maintaining anterior chamber stability and graft position, even in the context of prior vitrectomy and the potential for posterior gas migration.

Trief mentioned key surgical considerations such as graft size selection—opting for a standard 8 mm graft despite the patient’s enlarged cornea—and the use of 20% SF6 gas. Postoperative outcomes were positive, with reduced edema, improved astigmatism, and stable intraocular pressure despite steroid use. The patient’s vision improved from count fingers to 20/80 during the postoperative period.

“We have to keep watch on our patients with congenital glaucoma,” Trief said. “Obviously, the pressure control is paramount, but we should understand that these patients are at risk for corneal decompensation, so if we’re going to do something surgically, we should be careful about the endothelium and our manipulations in the anterior chamber.”

Trief, D, Cheong, J. DSAEK in a patient with congenital glaucoma, Haab striae, and corneal edema. Presented at the 2025 New York State Ophthalmological Society Annual Meeting, May 16, 2025. New York, NY.

Trief and MD candidate Justin Cheong physically peeled the Haab’s striae from a patient’s eye, allowing for better adherence and maintenance of the DSEK graft.

Danielle Trief, MD

Brensocatib, currently under US Food and Drug Administration (FDA) Priority Review, could become the first approved treatment for non-cystic fibrosis bronchiectasis and the first dipeptidyl peptidase 1 (DPP1) inhibitor, offering a novel approach to management of neutrophil-driven inflammation.

 on brensocatib from the ASPEN study were highlighted by James D. Chalmers, MBChB, PhD, professor of respiratory research at the University of Dundee, in a recent interview at the 

American Thoracic Society (ATS) International Conference

 in San Francisco, with consistent efficacy and safety being identified across all key patient subgroups. In this video segment, Chalmers highlighted several more unique takeaways from the subgroup analysis findings.

Unmet Needs for Non-Cystic Fibrosis Bronchiectasis, with James D. Chalmers, MBChB, PhD

“We have so many unmet needs in bronchiectasis, it's hard to know where to start,” Chalmers said. “This has been an incredibly neglected disease. It's been very little research over the last 20 to 30 years. It's great that we're starting to see an uptick in interest in this disease, recognizing it's a disease with a very high burden. It's really common, which means we really need to invest more into tackling some of these unmet needs. If you talk to a patient, what are the biggest concerns: frequent exacerbations, daily symptoms, and the concern that they're going to get worse over time. So it's really encouraging that brensocatib, if approved, looks like it would be able to address a lot of that.”

Chalmers highlighted additional unmet needs among patients with non-cystic fibrosis bronchiectasis. He noted the need for more treatments for people with bronchiectasis and the necessity of a concerted effort to diagnose the condition earlier and intervene in this condition earlier.

“Because unfortunately, that remains a big problem and many patients are undiagnosed,” Chalmers explained. “Many patients are misdiagnosed as having other conditions.”

Chalmers was also asked about what he hopes will be the biggest takeaways from the ASPEN trial findings on brensocatib, the subgroup analysis findings, and non-cystic fibrosis bronchiectasis in general.

“I'll start with brensocatib,” Chalmers said. “This is the first therapy that's been shown to be effective, and if approved, I hope that these data will reassure people that the efficacy is there. So there's a significant effect on exacerbations and on progression of disease, and it's consistent across all patient subpopulations, suggesting this can be a broadly applicable therapy. The second message, I would say, is inflammation. This is an anti-inflammatory therapy, and this validates the concept that targeting inflammation is a key way to treat people with bronchiectasis.”

In terms of what this would mean for clinicians and patients, Chalmers clarified that it would allow a reduced reliance on antibiotic implementation. He added that this is many patients’ biggest frustration, with constant consumption of antibiotics and their related side effects.

“The third thing I want to say as a key message is that we could have all the effective therapies in the world, but if we don't diagnose patients and get patients to the right care, they will never get access to those therapies and they won't have the effect they should,” Chalmers explained. “...Now that we have effective therapies, we should be prioritizing identifying these patients, diagnosing them earlier, and giving them access to the treatments that they need.”

To learn more about this data, view the full interview segment posted above. For more on late-breaking data and interviews at ATS, view our 

The quotes implemented in this summary were edited for clarity.

Correction: The adolescent data highlighted in the video was from a pre-specified analysis, not a post-hoc analysis.

Brensocatib Shows Consistent Efficacy and Safety Across Three Prespecified Subgroups in New Data from Landmark ASPEN Study. Insmed Incorporated. May 21, 2025. 

https://www.prnewswire.com/news-releases/brensocatib-shows-consistent-efficacy-and-safety-across-three-prespecified-subgroups-in-new-data-from-landmark-aspen-study-302462008.html?tc=eml_cleartime

In this interview, Chalmers highlights the implications of his team’s subgroup analysis findings in the ASPEN trial, as well as unmet needs for non-cystic fibrosis bronchiectasis.

James Chalmers, MBChB, PhD

 What else is out there? We have hydroxyurea. We have voxelotor, crizanlizumab, Endari, transfusions. What’s next? There’s a plethora of treatment options to treat the variety of patients who have who have sickle cell disease. We’re stuck with 4 or 5 options. What else is in the pipeline to treat sickle cell disease?

 If we had this conversation 5 years ago, it wouldn’t be much of a conversation. It’s a good time to be in sickle cell, and the future is bright. Gene therapy, despite the issues, is there. There are many ways to do that. As someone had mentioned, science will prevail with time. The curative options are there, but it’s important to recognize that they’re not going to be there tomorrow, and they’re not going to be there next year for the masses.

There are a number of other therapies out there. Fetal hemoglobin is out there. Fetal hemoglobin is a good target. We know about BCL11A. There are groups trying to make fetal hemoglobin higher using a medication that is in development, and I’m sure there are many ways that’s being tried. There’s a class of medications, called PKR activators, that were designed for pyruvate kinase deficiency. It’s is a very small population, but they can be repurposed to reduce hemolysis in sickle cell disease in ways not too unsimilar to voxelotor. Crizanlizumab is medicine that targets P-selectin.

Several other medications in that class are in development or are being repurposed to see if they can address pain. Because even though we’re trying to address the root cause, when a patient comes with pain, what can you do to abort that pain? We have nothing, except for opiates, which are not the solution. It’s a tough battle, but there are efforts trying to do that with P-selectin and all selectins, and many ways with inflammation. But there are many classes. This is a bigger conversation than it could have been even a couple of years ago. It’s an exciting time, and we’ll get to a point where sickle cell disease treatment is a cocktail approach. You take a couple of things, and as long as we can work on it, if we can address things from different angles, then we’ll make our patients have better lives.

Absolutely. Well, thank you so much. This has been an amazing conversation. I want to thank Abdullah, Wally, and Pat. Before we close, tell the audience your 1 big dream, or 1 final thought, that you want everybody who sees or hears or takes care of patients with sickle cell disease to know as a takeaway message from this conversation. I’m going to start with Abdullah. Your 1 final word that you want them to know about?

As you said, this has been a really exciting conversation. Wally, you, and Pat contributed greatly. Considering this discussion, there are 2 things. It’s important, scientifically, to pursue curative options like gene therapy. I’ll repeat that science will prevail. We will have to overcome the risks, understand them better, and remedy them. That’s 1 thing. 

Coming back to Wally’s point, we need more disease-modifying agents that we can use in Africa or India. The typical approach would be—I agree with Pat—new F-inducing agents or a combination of F-inducing agents. Maybe a combination of F-induction with some downstream modifications like anti-inflammatory or antiadhesion therapies. These are going to be important, and I believe these have to be pursued in sickle cell, along with these high-tech, higher-source modalities. This includes swallowing a pill, which can easily be conveyed to Africa or low-resource countries.

Thank you so much, Abdullah. I’m going to follow up with Wally. Wally, what are your 1 or 2 big-picture, take-home thoughts?

 I’d like to put my public health hat on. I want our audience to know about a report that came out in November from the National Academies of Sciences, Engineering, and Medicine. Ify, you and your colleagues did wonderful preparing 512 pages about all that is wrong in sickle cell care in the United States and what needs to be done to make sickle cell care better. There were 7 pillars that you pointed out, and they had to do with education and social policy. They had to do with patient empowerment and disparities. You declared sickle cell to be a disparities disease, as Pat said earlier. They had to do with therapy as well. But it wasn’t just therapy that you focused on. You focused on social determinates of health, you focused on policy, racism, and changes in the fabric of the health care system, especially for adults with sickle cell. We don’t even have an adult sickle cell disease health care system. We have a shack instead of a home for adults with sickle cell disease. That’s the 1 thing I want to take away. None of this discussion we just had will matter is there’s nobody to care for the patients. And in many parts of the country, there’s nobody—doctor, nurse, or other—to care for these patients.

Very well said. Thank you so much, Wally. 

I’m going to add to that because it’s so important. The names of the medicines don’t matter. Whether you live in Cincinnati, or Angola, or India, if we have good therapies, they should be available. We need to leverage that equity to global treatment of sickle cell disease. Hydroxyurea was developed in the 1980s and ’90s and is only now becoming available in Africa. Not really, even. I don’t want to give a talk when I’m retiring in a few decades telling patients about all these new therapies that we’re using in the United States and how sickle cell disease is history, except in Africa, where 90% of kids are still dying before they’re adults. That can’t happen. As these therapies are developed, by Bill Gates or whomever, we’re going to need a lot of people. We need to be sure that these are truly equitable in a timely manner, or we’re doing a huge disservice to the global sickle cell community.

Thank you so much. I’m going to give my thoughts. The first thing I want the audience to recognize is that sickle cell disease is a lifetime genetic disorder. It doesn’t go away when you become a teenager or when you leave pediatrics. It doesn’t disappear when you get married. It’s there for the rest of your life. It does shorten your life span. 

The second thing is pain with sickle cell disease. It’s important, but it’s not the only important thing. Organ damage, that chronic, slow slump of devastation to the organs is a reality, and no patient will die because of pain. They will die from strokes, kidney disease, pulmonary hypertension, infection, heart problems, lung problems. It’s important to look at them as treating not just pain but the entire person. That entire person will also involve their quality of life. Ask them how they’re doing, how are they functioning. Do they get up and go to work? If not, why not? When you’re giving treatment, look at the impact of treatment. Not just on their pain, as we talked about, but on their overall quality of life. 

We talked about screening for sickle cell disease at birth, screening for complications following the guidelines, and early intervention. For example, retinopathy picked up early can prevent blindness, treating hyposthenuria early prevents ESRD [end-stage renal disease], and picking up pulmonary hypertension can prolong life by putting the right treatment in place. But there’s also supportive care. And let’s not forget the role of the primary care provider. The last time I checked, having sickle cell disease does not protect you from getting breast cancer, colon cancer, high blood pressure, diabetes, or diverticulitis, or any other thing that anybody else gets. My patients have all this, and they deserve whole care—not sickle cell care but all-around holistic medical care.

Thank you so much for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to the e-newsletter to receive upcoming Peer Exchanges and other great content right in your in-box.

Experts look into what is next for sickle cell disease and provide key thoughts on the space. 

What’s Next and Final Thoughts in SCD 

Patrick McGann, MD, MS, Cincinnati Children’s Hospital  

The Connection Between Gut Health and Dermatologic Diseases

 Special Report series, Raj Chovatiya, MD, PhD, clinical associate professor at Rosalind Franklin University Chicago Medical School and director of the Center for Medical Dermatology and Immunology Research, sits down with his wife, Adalina Hung, MD, a board-certified gastroenterologist and hepatologist. Hung is known for her role as director of the IBD Program at Sinai Health System Chicago and as a clinical assistant professor at the Rosalind Franklin University Medical School.

Together, the duo explores the overlapping immunologic and barrier-based mechanisms shared between dermatologic and gastrointestinal diseases. Hung describes how both the skin and gut serve as immunologically active barrier organs, and how disruption in either can activate similar inflammatory pathways—such as TNF and interleukin (IL)-23—highlighting the clinical overlap seen in conditions like inflammatory bowel disease and psoriasis or hidradenitis suppurativa (HS).

The couple reflects on the bidirectional relationship between skin and GI diseases and stresses the importance of dermatologists recognizing extracutaneous signs of GI disease, including alopecia, dermatitis herpetiformis, or pruritus as potential presenting symptoms. Hung and Chovatiya advocate for increased interdisciplinary collaboration in diagnosis and management, noting that such conversations can lead to better treatment strategies, improved patient education, and more cohesive care across specialties.

 has reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc, Regeneron, RAPT, Sanofi, Sitryx, and UCB. 

This summary was created with the help of artificial intelligence tools.

In this HCPLive Special Report series, Raj Chovatiya, MD, PhD, and Adelina Hung, MD, discuss the connection between GI and dermatologic care.

Raj Chovatiya, MD, PhD

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

Skin of Color Savvy: News Update—SOCS Awards, My Best Winter Skin, & TORPEDO Program, with Robert Brodell, MD

Skin of Color Savvy: News Update—SOCS Awards, My Best Winter Skin, & TORPEDO Program

In the inaugural Skin of Color Savvy: News Update, host Robert Brodell, MD, introduces the 

 and its mission to promote excellence in skin of color dermatology. Founded in 2004 by Susan C. Taylor, MD, SOCS is a global leader with members in over 30 countries. Through its pillars of research, education, mentorship, and advocacy, SOCS is committed to advancing dermatologic care, increasing diversity in the field, and addressing the unique needs of patients with skin of color.

SOCS initiatives designed to support innovation and diversity in dermatology

. These include the Sanofi and Regeneron Diversity, Equity, and Inclusion Mid-Career Award, the Institutional Research Fellowship Grant for underrepresented minority physicians, and the Early Career Innovations Award, which fosters creative solutions in the field. SOCS also supports cutting-edge research through its annual Scientific Symposium, where experts present the latest findings in skin of color dermatology.

The episode also introduces SOCS’s “My Best Winter Skin” campaign, launched to promote optimal winter skincare practices and raise awareness about skin health. This initiative includes an international awareness day, volunteer events, educational materials, and product donations sponsored by Clinique. Brodell encourages dermatologists to participate in outreach efforts within their communities to promote skin health and support SOCS’s broader mission.

In the final update, Brodell shares details about TORPEDO (Training Opportunities and Residency Programs to Enhance Diversity and Outcomes), an initiative at the University of Mississippi to foster diversity in dermatology. Through mentoring, away rotations, and research opportunities, TORPEDO supports students from historically Black colleges and universities, addressing gaps in mentorship and training.

The January 15, 2025 SOCS News Update highlights research ongoing/upcoming initiatives and awards, the My Best Winter Skin Campaign, and the TORPEDO program.

Robert Brodell, MD

 Looking forward, how do you envision implementing therapies in a more aggressive fashion? I’m going to go to each of you to share some clinical pearls about how you envision the heart failure world getting its arms around the need to take a chemotherapy-like approach to our patients in getting them on therapy. Since you were the last to speak Muthiah, I’ll ask you to be the next to speak.

I’m going to jump forward, I’m going to look to the future. I think we are looking at an environment in which these drugs are going to be accessible, affordable, easy to administer, and I think we should start to engage our patients and have patients have a more active role in the initiation and titration of these drugs. We can envision a system much like insulin titration, in which at least some patients who are engaged in their care could modulate dosing, could initiate new drug therapy, in their home environments with relatively limited monitoring structures.

We’ve got a cancer analogy, now we have an endocrinology analogy, that’s great. Rob, what do you think? What does the future hold in structuring rapid titration and getting patients to target?

I’m really hopeful on a couple of fronts. One is that we strike this term “consider.”“We’ll consider starting ARNI [angiotensin receptor-neprilysin inhibitor] at follow up.” We’ve got to eliminate that from our vernacular, that can’t be in a discharge summary. We need to start these therapies in the hospital, and I think it’s all as others have highlighted, this multidisciplinary team. We’ve learned about the tremendous success of having a pharmacist who can help a case manager if there’s paperwork and other financial limitations. So the future is multidisciplinary teams, it’s rapid sequence. We’ve got to do better for our patients.

Javed, what do you think? At Baylor Scott and White [Health], how are you thinking about this?

No, I don’t have much to add on top of what Muthiah and Rob said. Let me just take a moment and make a plea to all our listeners. Symptoms should be targets of therapy in heart failure, not a guide for therapy. Things like high blood pressure, diabetes, lipids, these diseases by definition are asymptomatic. We have many cancers that are diagnosed on screening, and that comes as a surprise to patients, they are asymptomatic. We would never leave these patients alone because their symptoms are OK. You treat the biology of the disease. Heart failure is the same thing. Whether you have a lot of symptoms or you have few symptoms, we need to target the underlying biology and treat them aggressively with appropriate indicated therapies. Just because somebody says they’re doing OK is not a reason to not treat them appropriately.

Absolutely, an important take-home message from Dr Javed Butler. At our institution at [Massachusetts General Hospital], we recognize the need for infrastructure for rapid sequence initiation and titration, even before STRONG-HF trial data came out. We have a clinic called the GDMT [guideline-directed medical therapy] clinic, and it is in existence for one job, which is education, initiation, and titration of GDMT. We’ll either start outpatients or we will take patients who have just been discharged in continuity to get them to target. It’s a 12-week process or shorter. We utilize many of the tools Dr Vaduganathan mentioned, not only education, but home-based titration, including virtual care, virtual laboratory testing as well, in order to get patients to target, because by and large that’s really the most important monitoring piece in this process. Blood pressure matters to be sure, but provided patients are not symptomatically hypotensive, we will continue titrating. We get patients in the office periodically, however, we have a nurse practitioner-based approach but we also have a pharmacist, as Dr Mentz mentioned. In our patients in our GDMT clinic, we are achieving quadruple therapy in over 90% of our patients, with nearly 90% on sacubitril/valsartan, and over 60% on target doses of all 4 drugs.

We’ll close with the point, Rob, in the CHAMP-HF Registry, how many patients were at target dose?

 This is striking, you can count it on a couple of hands.

It was single digits. The point is that it can be done. GDMT works for our patients, it reduces morbidity and mortality. We should not wait for initiating and titrating, getting patients feeling better and living longer. Four drugs, 5 pathways, 6 years of extra survival.

Thanks to all of you for this rich and informative discussion, and thank you for watching this peer exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox. I’m Jim Januzzi, thanks for watching.

Drs James Januzzi, Javed Butler, Robert Mentz, and Muthiah Vaduganathan share practice pearls for treating patients with heart failure, focusing on the future of treatment.

Clinical Pearls for the Treatment of Heart Failure

Robert J. Mentz, MD

Final Insights

Video content above is prompted by the following:

Are there any final insights you’d like to share regarding LDL-C and Lp(a) screening and management of high-risk cardiovascular patients?

Pediatric lipid screening is crucial for early detection and management of dyslipidemia, which can prevent cardiovascular diseases later in life. Current guidelines recommend universal lipid screening for children between ages 9-11 and 17-21, with selective screening for those with risk factors. However, implementation remains inconsistent due to barriers such as lack of awareness and time constraints in clinical practice. To improve uptake, strategies include integrating screening into routine pediatric visits, utilizing electronic health records for reminders, and educating healthcare providers and families about the importance and benefits of early lipid screening.

Panelists discuss how effective cardiovascular risk management requires comprehensive screening for both LDL-C and Lp(a), along with aggressive treatment strategies for high-risk patients.

Seth Baum, MD

Stuart Gordon, MD, is a professor of medicine at Wayne State University School of Medicine and director of the division of hepatology at Henry Ford Hospital.

Exploring Seladelpar as Monotherapy for PBC, with Stuart Gordon, MD

New research is shedding light on the safety and efficacy of seladelpar (Livdelzi) as monotherapy in patients with 

 and an intolerance to ursodeoxycholic acid (UDCA).

The data were presented at Digestive Disease Week (DDW) 2025 by Stuart Gordon, MD, a professor of medicine at Wayne State University School of Medicine and director of the division of hepatology at Henry Ford Hospital, and suggest use of the selective PPARδ agonist as monotherapy yields similar safety and efficacy results as those observed for seladelpar combined with UDCA.

“The treatment landscape for PBC has evolved remarkably over the past year,” Gordon told 

, citing the US Food and Drug Administration approvals of 2 new second-line agents.

In August 2024, the US Food and Drug Administration approved seladelpar for the treatment of PBC in combination with UDCA in adults who have had an inadequate response to UDCA, or as monotherapy in patients unable to tolerate UDCA.

 In a pair of phase 3 placebo-controlled studies, ENHANCE and RESPONSE, treatment with seladelpar led to a significantly greater rate of composite biochemical response and alkaline phosphatase (ALP) normalization compared to placebo.

Gordon and colleagues conducted a post hoc analysis of pooled efficacy and safety data for seladelpar 10 mg monotherapy versus placebo from ENHANCE and RESPONSE through month 3 to assess the effects of treatment with seladelpar alone. In these studies, patients intolerant to UDCA were eligible if their last dose was >3 months before study entry.

In total, 369 patients were randomly assigned to seladelpar 10 mg or placebo across both studies, 16 of whom received seladelpar monotherapy and 6 of whom received placebo without UDCA. Investigators noted mean baseline ALP was similar between monotherapy patients receiving seladelpar vs placebo.

At month 3, 62% of patients receiving seladelpar monotherapy demonstrated a composite biochemical response compared with 17% receiving placebo, and 23% of patients on seladelpar achieved normalized ALP versus no patients on placebo. Additionally, the mean percent change from baseline in ALP at month 3 was −46% with seladelpar versus −2% with placebo.

At month 3, 56% of patients on seladelpar monotherapy experienced an adverse event (AE) compared with 83% on placebo, but no serious AEs and no discontinuations due to AEs occurred through month 3 with seladelpar monotherapy.

However, Gordon notes there is still much work to be done when it comes to PBC treatment research and education.

“There's so many unmet needs. We have very good therapy, and now we have even better therapy, but we need to see how that therapy plays out in terms of improvement of outcomes… we're anxious to look at real-world evidence outcomes,” he explained, additionally calling attention to the importance of educating both patients and physicians on PBC.

Editors’ note: Gordon has relevant disclosures with AbbVie, Arbutus, CymaBay, DURECT, Genfit, Gilead, GSK, Hightide, Intercept, Mirum, Pliant, and Merck.

Gordon SC, Neff G, Rodriguez M, et al EFFICACY AND SAFETY OF SELADELPAR AS MONOTHERAPY IN PATIENTS WITH PRIMARY BILIARY CHOLANGITIS AND INTOLERANCE TO URSODEOXYCHOLIC ACID. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

Brooks A. FDA Grants Accelerated Approval to Seladelpar (Livdelzi) for Primary Biliary Cholangitis. 

. August 14, 2024. Accessed May 5, 2025. 

https://www.hcplive.com/view/fda-grants-accelerated-approval-to-seladelpar-livdelzi-for-primary-biliary-cholangitis

Findings from a posthoc analysis of 2 phase 3 trials suggest seladelpar monotherapy has similar safety and efficacy to seladelpar combined with UDCA.

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