 I want to give us all an opportunity to give some advice or practice pearls to all of our viewers including other hematologists, maybe focusing a bit on red blood cell health or other areas that you think are important including decreasing long term organ damage. I’ll start with you Elna. What advice or practice pearls do you have for our audience?

 I think it is the shifting paradigm that yes sickle cell is an anemia and it causes pain, but the thing that reduces survival and still has maintained the early mortality in sickle cell disease patients compared to the general population is not necessarily the pain or the pain episodes. It is the progressive organ dysfunction and so we should slowly move away from the deception of sickle cell being a mild disease. We should consider it like diabetes or hypertension and that the organ damage is also a silent killer. If we shift that paradigm the way we approach them and how we approach our practice even towards them, we will shift an emphasis in embracing and offering disease-modifying agents to almost all of our patients and having the discussion of the impact of end organ dysfunction and damage in overall longevity and mortality.

 Thank you so much, Elna. Nirmish, you’re next.

 I would just extend the conversation in the sense that educate and be real, continue to educate. I love the descriptions that came up in our conversation today. As I told Matt, I’m going to use some of those. I’m very graphic about drawing pictures and being in the room and getting them to really understand and see what’s happening inside of them because that gives them a little bit of control of knowing what’s happening to themselves. Otherwise, it’s a chronic disease that they have no control of. What control can you give them? It’s educating them about the disease and being able to tell others about what’s happening to them. I think the pearl for me is to educate them and that includes education about these new therapies, and the new drugs that are available now. I even actually started to talk to them about the new drugs that potentially could come.

When we talk about gene therapy, I still kind of give a teaser about it. We’re not there yet. It’s all about being real with them. We don’t have the data. I’m trying to get them to understand that’s why research studies are occurring; this is what we hope that patients can be involved enough with. The patients, I can’t say this enough, they’re really smart. They’re really savvy about connecting to others and they want the information. They just take it up and soak up this information and I think it’s good for the community. Those are some of the pearls. And I mentioned it before, talk about these new medicines when they don’t need it. Talk about everything but pain until you have to talk about pain. Elna brought this up, that there might be the pediatrician inside of us trying to think about the whole world and not the adult side, but I think that our adult colleagues, and I know Biree you do this as well, I think we’re understanding that the quality of life is a big deal. Thus, I think those are some things to consider as we have our colleagues continue to see patients with these new drugs.

 I’ll leave you with 2 more images or analogies that I use because I think that there’s nothing sexy about having a chronic disease and a lot of it is just persistence of the patients, families, and providers in meeting the treatment goals and treatment plan. As I tell families when they’re going for their annual ophthalmology visit or their annual TCD [Trans Cranial Doppler], there’s nothing sexy about this. It’s like changing the oil in your car. It’s a pain. It’s annoying. It costs a little money. But if you don’t do it, what happens to the car? All the kids know the answer to that. It breaks down. Thus, that’s why [there is] this constant persistent pressure to keep on the plan is really very important.

The other one that I find useful to try and sometimes improve adherence to the treatment plan is the idea that organs are like a rock on the beach and the waves every day hit the beach, and they hit that rock and every day you don’t see anything. It’s just like the damage which is done every day with sickling even though you have no symptoms. There’s some clinical inexorable accrual of organ damage is what my mentor used to call it. There’s a little bit of damage every day that’s imperceptible. When you come back to that beach at the end of high school and you see the rock there, it’s still getting pounded by the wave and then you go away to college and then you have kids and you come back and all of a sudden there’s no rock on the beach. It’s just sand. It’s that daily pounding of that rock by a wave that you don’t notice the rock changes, but it’s becoming sand slowly and that’s what we’re trying to prevent with the daily damage of sickle cell disease on your organs.

Hydroxyurea and other disease-modifying agents are trying to prevent that from the daily point of view so that, as Nirmish pointed out or Elna pointed out, we’re trying to improve the overall health and organs of our patients who we present to our adult colleagues so that they can ultimately hopefully have a prolonged life and that sickle will no longer be an either immediately life-threatening or life-limiting disease, but hopefully have normal lifespan and quality of life. That’s really the goal. It’s hard. It’s hard to do that as a child, as a teen, and as an adult with so many other pressures on us but to encourage them to continue to follow the treatment plan with what we have while also being cognizant of what’s coming and what might be until something better comes along, as I say. Let’s follow this plan now. My promise is to keep them informed of what’s potentially available, both experimental and approved, and then they can choose collaboratively with us to potentially take on some of those new therapies.

Thank you, Matt. I really love the imagery in those analogies. I think we’ll all start to use them. I just wanted to add that I think when I speak to colleagues, clinicians of any specialty, patients, the community, family members who help to support their loves ones living with sickle cell disease; I really tell them that the tide is changing in sickle cell disease and it’s changing pretty quickly. Not only do we have more therapies available now, but our understanding of new potential targets is also growing exponentially and we’re seeing that playing out in the clinical trials that are available and that will be emerging in the near future. I think that sickle cell disease as we know it is changing. It is changing. Our patients may not feel that way today, but I do talk to my pediatric colleagues including some of you on the webinar today and I’m always heart-warmed when I hear the hydroxyurea story, for example. My colleagues say that ever since we’ve been giving it to babies starting at 9 months of age, we have such a healthier kindergarten class when we see those 5-year-old’s go off. That just warms my heart.

I think as an adult practitioner I’ve not yet begun fully to that extent to see the effects of novel agents or disease-modifying therapies or even transplant for that matter because we don’t do enough of it in the adult world. But I think that that tide is really changing. Just like hemophilia, for example, where we’ve come a long way, the expectation in hemophilia management is no leads. When we think about HIV care and we were making people toxic, sick with therapy as we knew it a few decades ago, and now people can be on 1 pill once a day. I think that there’s the potential in the very near future, hopefully in all of our lifetimes, to see that amazing impact on those affected by sickle cell disease. I’d say the future is definitely bright. I want to thank Elna, Nirmish, and Matt. And I want to thank you all for watching this 

. If you enjoyed the content, please subscribe for our E-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

A panel of experts in hematology discuss the future directions for sickle cell disease and share practice pearls for disease management. 

Practice Pearls for the Management of SCD

Biree Andemariam, MD

Key Clinical Trial Insights from ACC 2025 with Deepak Bhatt, MD, MPH, MBA​

Thousands of cardiovascular professionals from around the world converged in Chicago for the 

American College of Cardiology’s 2025 Annual Scientific Session (ACC.25)

, where cutting-edge science and clinical breakthroughs took center stage. With more than 4,750 abstracts accepted, 1,300 expert faculty, and 53 late-breaking clinical trials, the meeting delivered a high-impact snapshot of where cardiology is headed.

As a follow-up to our ACC.25 preview, our editorial team caught up with Deepak Bhatt, MD, MPH, MBA, director of Mount Sinai Heart and the Dr. Valentin Foster Professor of Cardiovascular Medicine at the Icahn School of Medicine, for his take on the most important data to emerge from the meeting. In this video interview, Dr. Bhatt breaks down three headline-grabbing studies (REVERSE-IT, ALPACA, and ADVANCE-HTN) and revisits the trials he flagged as ones to watch ahead of the conference (STRIDE, SOUL, and DapaTAVI).

Bentracimab, an investigational reversal agent for ticagrelor, rapidly restored clotting function in patients facing urgent surgery or major bleeding in the REVERSE-IT trial. Currently under FDA review, bentracimab could address a major clinical gap, as no approved reversal agent exists for ticagrelor.

The study’s primary endpoint—percent inhibition of P2Y12 Reaction Units (PRU)—dropped significantly within hours post-dose (

 < .0001), confirming rapid reversal. Results were consistent across surgery and bleeding groups, and across subgroups by age and sex.

Lepodisiran, a long-acting siRNA therapy, led to profound and sustained reductions in lipoprotein(a) [Lp(a)] levels for up to 18 months in the ALPACA trial. In the placebo-controlled study of 320 patients, those receiving two 400 mg lepodisiran doses experienced a 94.8% reduction in Lp(a) at 180 days, with levels still 74.2% lower at 1.5 years.

With no approved treatments available for elevated Lp(a)—a major cardiovascular risk factor—lepodisiran could represent a significant advance if long-term efficacy and safety are confirmed. Eli Lilly has initiated a Phase 3 clinical development program, ACCLAIM-Lp(a).

Lorundrostat significantly lowered blood pressure in patients with uncontrolled hypertension in the ADVANCE-HTN trial. The randomized, placebo-controlled trial included 285 patients already on 2 to 5 antihypertensive medications who still experienced elevated blood pressure.

At 12 weeks, patients receiving lorundrostat experienced greater reductions in 24-hour average systolic blood pressure (SBP) compared to placebo, with placebo-adjusted drops of -7.9 mmHg and -6.5 mmHg in the 50 mg and 50–100 mg dose groups, respectively. At week 4, patients on lorundrostat were also three times more likely to reach a 24-hour average SBP below 125 mmHg.

Oral semaglutide reduced major adverse cardiovascular events (MACE) by 14% over 4 years in high-risk patients with T2D in the SOUL trial. Among 9650 patients with ASCVD, CKD, or both, oral semaglutide lowered the composite rate, primarily driven by a 26% reduction in non-fatal heart attacks.

As the first trial to confirm cardiovascular benefit with an oral GLP-1, SOUL could offer a meaningful alternative for patients unwilling or unable to use injections. While gastrointestinal side effects were more common with oral semaglutide, serious adverse events were slightly less frequent than with placebo.

Semaglutide 1.0 mg (Ozempic) significantly improved functional outcomes in patients with peripheral artery disease (PAD) and type 2 diabetes (T2D) in the STRIDE trial. Over 52 weeks, patients receiving semaglutide experienced a 13% improvement in walking distance versus placebo (P = .0004), with improvements in pain-free walking distance, ankle-brachial index, and quality-of-life gains versus placebo.

STRIDE marked the first trial of a GLP-1 receptor agonist in PAD and could position semaglutide as the first therapy in over 20 years to improve PAD function.

Daily dapagliflozin reduced the risk of death or worsening heart failure by 28% at one year in patients undergoing transcatheter aortic valve implantation (TAVI) in the DapaTAVI trial. The benefit was driven by a 37% reduction in worsening heart failure, while all-cause mortality was numerically lower but not statistically significant.

Conducted across 39 centers in Spain, the study included a mostly elderly population, often excluded from prior SGLT2 trials. Dapagliflozin showed a favorable safety profile overall, although it was linked to higher rates of genital infections and hypotension.

Relevant disclosures for Bhatt include Amarin, AstraZeneca, Sanofi, Pfizer, Roche, Amgen, and Eli Lilly and Company, among others.

Deepak Bhatt, MD, MPH, MBA, explores high-impact trials from ACC.25, including REVERSE-IT, Alpaca, ADVANCE-HTN, SOUL, STRIDE, and DapaTAVI.

Key Clinical Trial Insights from ACC 2025, with Deepak Bhatt, MD, MPH, MBA​

Deepak Bhatt, MD, MPH, MBA

To watch the video series component of this episode, click here.

0:01:21 The definition and prevalence of agitation in Alzheimer’s disease

0:05:17 The International Psychogeriatric Association Agitation Workgroup agitation reduction and prevention psychogeriatric consensus algorithm

0:13:15 Managing agitation in long term care facilities

0:17:52 Nonpharmacological treatment options

0:20:49 Pharmacological treatment options

0:22:32 Brexpiprazole for treatment of agitation

0:23:17 Mechanism of action and clinical trial data of brexpiprazole

0:26:58 Managing expectations with brexpiprazole

0:28:28 Managing acute breakthrough agitation

0:31:10 Emerging agitation agents on the horizon

0:32:27 Collaborating with Centers of Medicare and Medicaid on using antipsychotic agents in long term care facilities

Expert geriatric psychiatrists explore a frequently encountered symptom in Alzheimer’s disease, agitation. We will discuss its impact on patient’s and care giver’s quality of life, the current standard of care and the first FDA approved agent for treatment of agitation symptoms in Alzheimer’s disease.

Advances in Treatment of Agitation Associated with Dementia Due to Alzheimer’s Disease

George Grossberg, MD

Gregory Cote, MD, is a professor of medicine and head of the division of gastroenterology and hepatology at Oregon Health and Science University.

ERCP Sphincterotomy Does Not Reduce Acute Pancreatitis Risk in Pancreas Divisum

New research suggests endoscopic retrograde cholangiopancreatography (ERCP) with minor papilla endoscopic sphincterotomy (miES) does not reduce the risk of 

 or related sequelae in patients with acute recurrent pancreatitis and pancreas divisum.

Findings from the multicenter, sham-controlled SpHincterotomy for Acute Recurrent Pancreatitis (SHARP) trial were presented during a late-breaking session at Digestive Disease Week (DDW) 2025 by Gregory Cote, MD, a professor of medicine and head of the division of gastroenterology and hepatology at Oregon Health and Science University, and suggest the procedure does not ameliorate acute pancreatitis risk in this patient population.

“Physicians would report on the safety of the procedure, the technical success of the procedure, and they would observe that anywhere between 20 to 40% of patients would develop another episode of acute pancreatitis… so more than half of patients would do well,” Cote explained to 

. “So it has basically been concluded, until now, that this is a reasonable procedure to offer to patients who have acute pancreatitis, who have [pancreas divisum] and don't have another clear explanation for their acute pancreatitis.”

Citing recent criticisms of this approach, Cote and colleagues conducted a sham-controlled, single blinded with a blinded outcome assessment, multicenter, randomized clinical trial of ERCP with miES in patients with a history of ≥ 2 documented episodes of idiopathic acute pancreatitis, ≥ 1 within 24 months prior to randomization, and pancreas divisum confirmed by magnetic resonance cholangiopancreatography. Patients with other etiologies for acute pancreatitis, main pancreatic duct stricture, or chronic calcific pancreatitis were excluded.

After informed consent, patients were randomly assigned to undergo a diagnostic endoscopic ultrasound (EUS) with sham ERCP, including photodocumentation of minor papilla and placement of a pancreatic duct stent into the duodenal lumen, or EUS with ERCP and miES with placement of a prophylactic pancreatic duct stent. Of note, participants were blinded to their treatment group and a blinded physician evaluated patients >30 days after randomization when acute pancreatitis was suspected.

The primary outcome was development of acute pancreatitis, defined by revised Atlanta Classification as a time-to-event measure. Secondary outcomes included the incidence rate ratio of acute pancreatitis before and after randomization, development of chronic pancreatitis, and pancreas-related adverse events. Participants were followed for ≥ 6 and ≤ 48 months.

From September 2018 to August 2024, 148 patients were randomly assigned to miES (n = 75) or sham ERCP (n = 73). Participants had a median of 3 acute pancreatitis episodes prior to randomization, and the median age at first acute pancreatitis was 51 (12-89 years)

“What we discovered in this study, where we actually hoped to prove once and for all that it would be helpful, was that it in fact is not helpful,” Cote said.

Deep cannulation and miES were achieved in 92% of those randomized to miES and post-ERCP acute pancreatitis occurred in 7.4%. During a median follow-up of 33.5 months, 34.7% patients in the miES arm had an acute pancreatitis event compared with 43.8% in the sham arm (adjusted hazard ratio, 0.83; 95% CI, 0.49-1.41). The incidence rate ratio was 0.230 for miES compared with 0.277 for sham, indicating acute pancreatitis episode frequency after randomization reduced in both study arms.

Investigators did not observe any differences in incident chronic pancreatitis, diabetes mellitus, and exocrine pancreatic insufficiency during follow-up. The occurrence of pancreas-related abdominal pain > 30 days post-randomization or follow-up ERCP 33.3% for miES versus 31.5% for sham participants.

“This is very important for primary care providers, radiologists, and gastroenterologists like myself who do these procedures, and even general surgeons who see patients with acute pancreatitis, because now, when pancreas divisum is discovered on imaging studies, the knee jerk reaction should not be that this patient should be referred, or I should perform, an ERCP with sphincterotomy, as has been offered for many, many years now,” Cote said. “We should take a step back and put it into the context of the whole patient, and at this point, withhold a potentially harmful and what now appears to be a very unhelpful procedure.”

Editors’ note: Cote has relevant disclosures with Olympus.

Cote GA, Durkalski-Mauldin V, Fogel EL, et al. MINOR PAPILLA SPHINCTEROTOMY DOES NOT REDUCE THE RISK OF ACUTE PANCREATITIS IN PATIENTS WITH ACUTE RECURRENT PANCREATITIS AND PANCREAS DIVISUM: THE SHARP TRIAL. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

Gregory Cote, MD, reviews SHARP trial data suggesting ERCP with miES does not reduce acute pancreatitis risk in acute recurrent pancreatitis and pancreas divisum.

Gregory Cote, MD

 I’d love for you to share with the viewers what strategies you have implemented based on your experiences to educate patients about their journey. Because that’s so important, as John has said, about making this a patient-centered diagnosis. What’s a day in the life of Dr Maron and Dr Ommen in how you approach these issues?

 I’ll go first. Like I’m sure Steve does, we spend a lot of time with patients when they come and do our own education with them, along with our health care team and nurse practitioners to educate patients about the disease. We spend a lot of time on education, reassurance, putting these issues that we’ve talked about in perspective, and doing a lot of shared decision-making, going through treatment options. At the end of the day, we try to deliver the message that hypertrophic cardiomyopathy [HCM] is a highly treatable disease. It’s going to probably be more so in the future, but even today it’s very treatable and a disease that’s compatible with normal life expectancy and good quality of life for the vast majority of patients. That’s the messaging that we give to patients the best that we can.

 I’d echo the same thing. Patients come to us after having done their own education attempts on the internet, freaked out with wide eyes because they’ve read all the dramatic stories that are available, and we have to remind them that people who have normal lives don’t usually blog about it.

I’d like to reiterate the same words about HCM in the modern era. We’ve gone from an era where it was 100% fatal in 1958 when Donald Teare described it to a 6% annual mortality in the 1980s to an annual mortality that’s the same as the general population. It’s a highly treatable disease for most patients. There are patients in whom there are issues. This discussion wasn’t about sudden cardiac arrest, which would be another 2 hours. Then there are quality-of-life issues that some patients have. But it’s a highly treatable disease and we’re getting more tools in our toolbox for the future, which is exciting.

 That’s super. Javed, any final thoughts you want to share?

 My final thought is that we have these therapies and we want to do anything and everything that we can for the patients to not unnecessarily suffer. The question is how do we educate the clinical community at large to refer the patients to the appropriate centers and to diagnose and screen these patients? While the specialists are very interested in and have a lot of these tools, more mass education about this disease would also be needed.

 From an administrator’s point of view, let me ask you to put that hat on for a second. When you’re looking at making recommendations for clinicians who are interested in getting involved in this, what things would you say are needed in terms of understanding things like catheter-based approaches, surgical approaches, and volume, which you talked a bit about? What do you think about setting certain expectations?

 You can modify behavior quite a lot by creating appropriate incentive structures in terms of education, screening, and quality metrics. You can also set up tools. We live in this digital age and everybody is on an electronic health record. A lot of the education and best practice advisories can be had for our patients in this era. Education and reminder systems are easier in the current day and age.

 Super. John, I’m going to turn to you last. You always keep the patient in the center. I’m curious to hear your final thoughts.

 First, I’m humbled by the expertise at this panel and not being an HCM expert. I feel a tremendous need to think about the infrastructure for elevating the quality of care throughout the nation. What does that entail? Does it entail thinking about algorithms, building shared decision-making tools, integrating routine assessments of health status with the KCCQ [Kansas City Cardiomyopathy Questionnaire], and coming up with very practical management strategies so that you don’t have to be in Boston or Rochester, Minnesota, to get high-quality care?

 Or Kansas City. That’s what I’m left with. It’s a complicated disease, but it’s an exciting disease. As more treatment options become available, there’s a greater call for thinking about the infrastructure of delivering high-quality patient-centered care. That’s what I’d like to see us move toward so that we can all benefit from the advances being made.

 Super. That’s a great way to conclude. I want to thank all of you for this rich and informative discussion. I want to thank you, our viewers, for watching this 

. If you enjoyed the content, please subscribe for our e-newsletters to receive upcoming 

 and other great content right in your inbox. I’m Jim Januzzi from the Massachusetts General Hospital. Thanks very much for joining.

Expert cardiologists share strategies for educating patients on the treatment and management of hypertrophic cardiomyopathy. 

Patient Education of HCM

John A. Spertus, MD, MPH

 For take-home messages, the first and foremost is that people with sickle cell disease want to live normal, active lives. They don’t want to spend their time in the hospital. If you’re seeing them in front of you, there’s a reason, and there are always strategies to try to improve the overall quality of life for people with sickle cell disease. We should provide them with all of the opportunities available to try to make their lives better. There has been a lot of structural racism that has affected how patients with sickle cell disease are treated, both in the emergency department and in lots of places. We have to overcome that structural racism and make sure our patients have every opportunity to live a long healthy life.

 It is so important for hematologists and primary care providers who take care of patients with sickle cell disease to first, establish the trust. Many of our patients suffer from what they perceive to be bias against them when they come in for crisis. Please take the time to listen to them and to get to know them because once you can establish that trust, we can really improve the lives of our patients with sickle cell. Second, sickle cell disease-modifying therapies are needed. We can no longer think that sickle cell pain is simply, “Am I in a painful event, or am I not in a painful event?” Please understand the importance that the organ complications over time are the life-limiting complications of sickle cell. Getting patients to accept sickle cell disease-modifying therapies from an early stage of life is vital.

Third, understand the impact of sickle cell on quality of life. Please pay attention to schoolwork, how sickle cell affects their relationships, how it can affect them holding a job, and view our patients in the whole because sickle cell impacts every aspect of their lives. In several cases, we’re the only providers they have to turn to for addressing this multi-socioeconomic impact of sickle cell. Please look out for the entire patient, not just the sickle cell pain event.

 It’s important that we take a life span perspective when we treat people with sickle cell disease. Many of the complications that we see in adulthood start in pediatrics, but don’t necessarily cause problems for children. But that doesn’t mean that they aren’t important. I’ll take the kidney as an example. We start seeing a lot of microscopic proteinuria, the microalbuminuria in children with sickle cell disease as adolescents. It can be almost a third of adolescents who have sickle cell anemia who develop microalbuminuria, but they don’t have renal insufficiency as children. Many of them still have hyperfiltration, where their creatinine levels are lower than normal. As those patients move into their 20s and 30s, we see the development of chronic renal disease, and with that, worsening anemia and disease progression in other ways. It’s important that we intervene when people with sickle cell disease are children because that’s where these end-organ complications start.

Sophie M. Lanzkron, MD, MHS; Jeffrey D. Lebensburger; and John J. Strouse, MD, PhD, share key takeaways and closing thoughts for the management of sickle cell disease.

Advice for Sickle Cell Disease Management

John J. Strouse, MD, PhD

This month’s Lungcast features a discussion on lung cancer screening guidelines and pulmonary nodule management. 

Lung Cancer Screening: A Decade of Lessons Learned with Mary Pasquinelli, DNP

Lung cancer remains the leading cause of cancer-related death worldwide, accounting for nearly 2 million deaths annually, which is more than those caused by breast, colorectal, and cervical cancers combined. Despite this burden, only 15% of patients survive 5 years post-diagnosis, largely due to late-stage detection in the majority of cases. It has been more than a decade since lung cancer screening guidelines via low-dose CT, based on the USPSTF’s B recommendations, have been put into place. 

In the latest episode of Lungcast, host Albert Rizzo, MD, chief medical officer of the American Lung Association (ALA), discussed this topic on the monthly respiratory health podcast series. Rizzo spoke with Mary Pasquinelli, DNP, a nurse practitioner in the Division of Pulmonary, Critical Care, Sleep, and Allergy at University of Illinois Health. She also serves as the director of the Lung Screening Program at the University of Illinois Chicago.

In this episode of Lungcast, Rizzo and Pasquinelli discussed the guidelines’ ambitions and obstacles. They also discussed pulmonary nodule management, which, while a lifesaving procedure for at-risk individuals, has seen slower than expected the uptake of screening on a population-level, although this is increasing. Pasquinelli also outlined a number of efforts and tools to increase screening rates.

“Screening truly saves lives, and we have all these efforts underway to really enhance screening through refined criteria, risk stratification, integration of emerging tools like biomarkers and AI such as Sybil, which holds really great, great promise for improving early detection and outcomes. So, it's just so important that we remember that anybody with lungs can get lung cancer. And thankfully, the narrative around lung cancer is changing. There's more awareness, there's more innovation, and more, most importantly, there's more hope,” Pasquinelli stressed.

Lungcast is a monthly respiratory news podcast series hosted by Albert Rizzo, MD, chief medical officer of the ALA, and produced by 

Mary Pasquinelli, DNP

 What’s really important—and we’re not here to give advice to the manufacturer of inclisiran—is the reputation a drug develops when it’s brought to the marketplace. It sticks. To Dean’s point, if you look at data published by Seth Baum and others, they found that the utilization of PCSK9 was somewhere about 0.3% of those who were eligible.

What happened was you had the insurance payers creating these incredible speed bumps. It didn’t really matter. The manufacturers of PCSK9 inhibitors cut their price in half. As Dean, Manesh, and Linda have said, the access to the PCSK9 inhibitors has certainly become easier. But the doctors just aren’t interested in prescribing. As far as they’re concerned, it’s a drug that’s very difficult for patients to access. It’s an “expensive” drug. I urge the manufacturer of inclisiran to think the process through, so that when this drug finally comes to market, it is accessible. 

Otherwise, you’re going to have the same issues that we face with PCSK9 inhibitors. Perhaps we need to inject some artificial intelligence into value-based care instead of what seems to be artificial insanity. We need to be able to count on really good algorithms to determine appropriate use for these compounds.

I still have heterozygotes being turned down for PCSK9 inhibitors. It’s insanity out there. What we really need is really good artificial intelligence, not artificial insanity, in terms of making sure these drugs are being used in the appropriate patient at the appropriate time.

 Norman, that was a wonderful take-home message. In fact, I’m going to start with Dean, Manesh, and Linda; you’ll be last. Give me a similar take-home message, something you think our audience needs to hear from you. Dean?

 In secondary prevention, the LDL [low-density lipoprotein] goal is less than 70 mg/dL and probably lower for all our patients. That’s going to require combination therapy, the best statin dose you can get them on, and then other drugs.

If the cost of the medicine is too expensive, then use ezetimibe. For primary prevention, family history, pay attention to risk-enhancing factors in the guidelines and calcium scoring. That’s how we can get these patients treated earlier, so we’re not in the situation where they’ve already had events and you’ve got to be that much more intensive with regard to their treatment.

 We’re at the age where we have an explosion of possible therapies for our patients, which is great. The take-home message for me is this isn’t about cardiology or specialty care; it’s about primary care. This is about getting the message and the care pattern and the access to the primary care. That’s how we’re going to affect the population health, by getting these therapies—statin, inclisiran if it comes on the market, PCSK9 as we’ve just heard—into the hands of our primary care doctors and getting them comfortable with having the conversation with patients to get the therapies to them.

 That’s a great comment. Linda, you have the last take-home.

I just want to reemphasize lifestyle. Diet is absolutely critical. You can have somebody who is not at goal and they’re eating a terrible diet, and they can have really good results from changing that diet. Using our licensed nutrition folks and getting these people to improve their diet is very much a part of the picture.

 Thank you very much. I’m Dr Keith Ferdinand for HCPLive®. We’ve had a rich and informative discussion. Linda, Dean, Norm, and Manesh have given us a wealth of ideas and information, reviewed data, and given some opinions on where we are now with the intent of lowering risk in patients who are high risk, including the FH [familial hypercholesterolemia] patients, patients with ASCVD [atherosclerotic cardiovascular disease].

If you enjoyed watching this HCPLive® 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 in-box. Thank you very much for listening to this program.

Final thoughts from expert KOLs regarding treatment decisions and how they relate to patient accessibility when manage dyslipidemia. 

Treatment Decisions and its Relation to Patient Accessibility  

Norman Lepor, MD, FACC, FAHA, FSCAI

The panel offers their final recommendations for physicians managing patients with asthma.

Advice for Clinicians Managing Asthma

Robert Sporter, MD

developments in the treatment landscape of plaque psoriasis, novel oral systemic treatment options to alleviate the burden of this chronic disease.

A Patient-Centric Medcast on the Journey Through Moderate Plaque Psoriasis

07:48 Absence of treatment or under treatment of plaque psoriasis

12:50 Prescribing novel systemic medications in plaque psoriasis as an advanced practice provider

15:46 Classifying moderate disease in plaque psoriasis

19:43 Getting payer approval for your patients with plaque psoriasis

23:18 Novel oral systemic treatments for plaque psoriasis

25:03 Pivotal clinical trial data on deucravacitinib

27:58 Deciding on aprimilast versus deucravacitinib for your patients with plaque psoriasis

31:53 Mechanism of action of deucravacitinib

38:13 Selecting a therapy in the evolving treatment landscape for your patient with plaque psoriasis

43:08 Educating your patients on injectables and orals systemic treatments

Advanced practice providers in dermatology discuss exciting developments in the treatment landscape of plaque psoriasis. Listen to their insights into the often-challenging journey patients go on. The arrival of novel oral systemic treatment options offers opportunities to alleviate the burden of this chronic disease.

Authors