Continuous glucose monitors (CGM) used by people with 

 have been a focus of recent conversations both inside and outside the healthcare space. Superstar Nick Jonas has been raising awareness of this technology through his platforms and in new TV commercials, and companies like Apple are exploring glucose monitoring as an indicator for general health and wellness. All this attention has led to more people with diabetes becoming aware of this life-changing technology, and in turn, heading to their primary care provider to ask for a CGM.

With 34.2 million Americans living with diabetes, nearly every primary care provider is guiding treatment plans for people with type 1, type 2 and even pre-diabetes, but many healthcare providers are still not aware of CGM technology and how it can benefit patients. As healthcare providers, we work to keep pace with the latest treatments, technologies and tools available to be prepared to address patient questions and ultimately improve health outcomes. This is more important now than ever, as we’re starting to see a gap in healthcare provider knowledge and consumer awareness in an era where endless healthcare resources and information is at our patients’ fingertips.

While patients are doing their own research, they still expect us, as their healthcare provider, to be the experts on what tools and treatments we believe will best help them. A recent survey

 of people with insulin-treated diabetes found that patients believe it is the responsibility of their healthcare provider to bring new standards of care to their attention, like CGM systems.

CGM technology is widely considered the standard of care and clinically proven to improve outcomes for people with diabetes taking insulin. For those of us who may not be as familiar with the technology but want to inform future conversations with patients, here are 3 things you need to know about CGM systems:

How CGM systems differ from blood glucose monitoring: fingersticks

A CGM uses a small, wearable sensor and transmitter to measure and send real-time glucose values wirelessly to a smart device or receiver every five minutes. It eliminates the need for multiple daily fingersticks used in blood glucose monitoring (BGM).

A BGM shows glucose values at a single moment in time and patients may often miss or forget to take a reading, leaving many unknowns. A CGM connects the dots and provides a complete picture of glucose management, filling in the gaps for both patients and healthcare providers. The data gleaned from CGM technology show trends in glucose levels, the rate of change in readings and even alerts users of dangerously low or high glycemic levels. 

These data arm patients with real-time insights to inform short-term actions like taking medication or insulin, and long-term lifestyle adjustments as they can see how their body reacts to certain foods, physical activities or behaviors.

The benefits of CGM technology for people with type 1 and type 2 of all ages

The benefits of CGM systems for people of all ages have been clinically proven, from two years old to Medicare patients. The recent 

 study has shown the benefits of CGM technology for children ages 2-7 with type 1 diabetes in reducing hypoglycemia and parental burden and fear. The 

 study of adults ages 60 and older with type 1 diabetes found that CGM systems help to significantly lower A1C, reduce hypoglycemia and increase the amount of time a user spends in target glucose ranges. The technology is truly easy to use for all demographics.

We are also now seeing more evidence of the benefits of CGM for broader populations, including people with type 2 diabetes. Earlier this year the 

 study was the first of its kind to affirm that people with type 2 diabetes on basal insulin benefit from the use of CGM technology, with study participants showing significant increases in time in range and decreases in A1C. These outcomes occurred independent of direct provider interventions, so even getting a patient on the device to learn for themselves can be a win.

A CGM makes appointments more tailored and efficient

Not only does CGM technology give the power back to patients by arming them with information to make treatment decisions in real-time, it also provides healthcare providers with the insights and data needed to develop tailored medication and treatment regimens. The reports available to providers help make appointments with patients more efficient as you can quickly see potential issues, leaving more time to get to know the patient and discuss together ways to improve diabetes management and outcomes.

Diabetes patients are making healthcare treatment decisions nearly every minute of every day and are looking for new and better ways to ease the burden of managing their condition. Patients are asking, and it’s up to us as healthcare providers to educate and provide them with the best tools available to manage their diabetes.

 (Study of Improved Glucose Monitoring and Assessment) and 

 have great resources available to help you learn more about CGM technology and better understand how it can support your patients.

The demand for CGM technology will only continue to grow, and now is the time for healthcare providers to educate themselves on the proven benefits of the technology.

Aaron King, MD, is a family practitioner and diabetes specialist with Baptist Health System.

Authors and clinicians interested in being published on HCPLive can 

1. Dexcom, U.S. data on file, November 2020

3 Things Primary Care Providers Need to Know About Continuous Glucose Monitoring Technology

Aaron King, MD

Andrew Bomback, MD, MPH, is an assistant professor of medicine at Columbia University Medical Center.

 has been a disease without a targeted treatment, leaving patients and clinicians to deal with a devastating disease course with no clear standard of care.

Caused by dysregulation of the alternative complement pathway, C3G often leads to progressive kidney failure, with many patients ultimately requiring transplantation—only to see the disease recur.

The US Food and Drug Administration approval of Novartis’ oral iptacopan (Fabhalta) for the treatment of adults with C3 glomerulopathy (C3G) marks a turning point in C3G care, offering the first FDA-approved drug for patients with the ultra-rare kidney disease.

The decision was based on data from the phase 3 APPEAR-C3G trial, where iptacopan met the primary endpoint of reducing 24-hour urine protein-to-creatinine ratio (UPCR) by 35.1% (95% CI, 13.8% to 51.1%; 

 = .0014), with sustained reductions at 12 months.

Additional analyses revealed use of iptacopan was associated with a higher proportion of patients meeting the composite renal endpoint—defined as a ≥50% UPCR reduction and ≤15% eGFR decline—occurring in 43.5% of iptacopan-treated patients versus 25.0% of those who switched from placebo at 6 months. A favorable effect on eGFR trajectory was also observed relative to historical trends.

Not only does this approval provide C3G patients with a treatment specifically designed to address the root cause of their disease, but it also opens the door for further advancements in complement-targeted therapies. With a new tool in their arsenal, clinicians can now offer patients a chance to slow or even stop disease progression—something that was once out of reach.

For additional insight into the significance of the approval and its impact on C3G care, the editorial team of 

 spoke with Gerald Appel, MD, a professor of clinical medicine, director of clinical nephrology, and director of the Glomerular Disease Center at Columbia University; Andrew Bomback, MD, an assistant professor of medicine at Columbia University Medical Center; and Jared Hassler, MD, a pathologist at the Temple University Hospital.

Expert Perspectives: Iptacopan FDA Approval for C3 Glomerulopathy

Relevant disclosures for Appel include Aurinia, Bristol Myers Squibb, Genentech, Genzyme-Sanofi, Eli Lilly, Merck, Pfizer, Mallinckrodt, Achillion, Alexion, Reata, Travere Therapeutics, GlaxoSmithKline, Vertex Therapeutics, Novartis, Apellis, Chinook, Arrowhead, Calliditas, and Vera. Relevant disclosures for Bomback include Amgen, Novartis, Kezar, Silence Therapeutics, Genentech, Visterra, Catalyst, Q32, and Apellis. Relevant disclosures for Hassler include Travere Therapeutics, Omeros, and Novartis.

Campbell P. FDA Approves Oral Iptacopan (Fabhalta) as First C3 Glomerulopathy Therapy. HCPLive. March 20, 2025. Accessed March 21, 2025. 

https://www.hcplive.com/view/fda-approves-oral-iptacopan-fabhalta-as-first-c3-glomerulopathy-therapy

A trio of nephrology experts discuss the significance of iptacopan’s FDA approval as the first treatment for C3G.

Andrew Bomback, MD, MPH

Associate Director Science and Medicine, Yale University


The promise of genome editing to help understand human diseases and create new therapies is vast, but technological limitations have limited advancement of the field. While existing editing technologies can alter or delete single base pairs within the human genome’s 3 billion base pairs, they are limited in their ability to alter multiple locations simultaneously — and can sometimes incorrectly alter neighboring DNA bases.

A new Yale study, however, advances the ability of scientists to edit multiple DNA sites by threefold and helps prevent unwanted mutations in nearby genetic sites.

The findings are published in the journal 

“We were able to increase the number of edits in a single cell while also enhancing the precision of these edits,” said Farren Isaacs, PhD, professor of molecular, cellular and developmental biology at Yale’s Faculty of Arts and Sciences and senior author of the study. Isaacs is also affiliated with the Systems Biology Institute at Yale West Campus and the Department of Biomedical Engineering at the Yale School of Engineering & Applied Science.

Advances in genome engineering have allowed researchers to more efficiently modify single genetic sequences that help improve the understanding of their biological roles. However, most human diseases, including cancer, arise from multiple genetic mutations.

“Many phenotypes arise from multiple genetic mutations but most gene editing has been focused on a single site, which has limited technology advancements in the field,” said first author Anabel Schweitzer, who is a student in Yale’s Graduate School of Arts and Sciences and a member of Isaacs’ lab.

Human genome editing historically has allowed for precise alterations of single base pairs by excising or inserting new sequences at a single location along the DNA strand. However, conventional gene editing technologies — such as CRISPR Cas9 — have been limited by the generation of double-strand breaks in DNA that introduce unwanted modifications in the genome. While the development of base editors has enabled direct chemical modification of target DNA nucleotides, enabling researchers to avoid DNA double-strand breaks, base editing technology has been constrained by the number and precision of single base edits that can be achieved.

If DNA is viewed as a massive 3 billion-character manuscript, the new engineering technology essentially allows researchers to make multiple changes in different chapters simultaneously, not just edit single words or sentences on one page. However, the improvements in genome engineering also have drawbacks. Sometimes edits are made at unintended locations which makes assessing the effects of the changes difficult.

For the new study, the Yale team used a CRISPR-associated protein Cas12 — which is similar to Cas9, a protein that can act as a sort of “molecular scissor” that can precisely cut or modify portions of DNA — and so-called guide RNAs (gRNAs). When fused to an enzyme, Cas9 and Cas12 can make targeted chemical changes to DNA at locations determined by the gRNA sequence. The team chose Cas12 because of its innate ability to process an RNA array containing many gRNAs. To improve the precision of editing, the team engineered the gRNAs by shortening the gRNA sequence or modifying the RNA bases.

They then used the new system to successfully alter gene sequences with greater precision at 15 different sites in human cells — three times as many locations as had been previously engineered.

The improvement will not only help assess the roots of complex genetic diseases, such as cancer, but will also guide the development of new designer drugs enabled by synthetic genomes developed in the Isaacs lab.

“Overcoming these key obstacles of mammalian genome engineering technologies will be critical for their use in studying single nucleotide variant-associated diseases and engineering synthetic mammalian genomes,” the authors say.

The research was primarily funded by Yale University and the National Institutes of Health.

Other Yale authors include Etowah Adams, Michael Nguyen, and Monkol Lek.

A recent study from Yale has significantly advanced genome editing by tripling the number of DNA sites that can be edited simultaneously, while reducing unwanted mutations. This breakthrough, achieved using CRISPR-associated protein Cas12 and engineered guide RNAs, enhances the precision of genetic modifications. The technology allows for multiple simultaneous edits, crucial for understanding complex diseases like cancer, which often involve multiple genetic mutations. This advancement not only aids in disease research but also paves the way for developing new therapies and synthetic genomes.

A new Yale study advances the ability of genome engineers to edit multiple DNA sites by threefold, and helps prevent unwanted mutations in the process.



Yale Genome Engineers Expand the Reach and Precision of Human Gene Editing

Bill Hathaway

Schultz discussed the SCtalk trial and its findings at ASH 2024.

Corinna L. Schultz, MD: Improving Sickle Cell Trait Documentation in Infancy

Sickle cell trait (SCT) documentation should be improved and can be by implementing simple strategies in the SCtalk toolkit for primary care providers (PCPs), including an electronic health record (EHR) prompt, a 20-minute educational video, and reference materials.

Findings from a randomized trial of the toolkit rollout were presented by Corinna L. Schultz, MD, hematology/oncology, Nemours Childrens’ Health, at the

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

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

“[People] could be very well intentioned in meaning to talk about it later, but unless it gets written down, often that information gets lost and forgotten over time. And so our goal was to ensure that every child who has SCT that's found on newborn screen has it written down in the EHR, so that it provides a little bit of insurance that maybe it could get talked about again over time, but also that it's discussed not just in infancy, but also as that child grows up,” Schultz told 

Schultz and colleagues found that the 3 implementation strategies were acceptable to PCPs, feasible for use, and increased self-reported practices of documentation and disclosure of SCT within infancy, although PCP levels of confidence to discuss SCT with family or adolescents or to discuss inheritance or reproductive options did not significantly increase, prompting a need for further research.

In this clip, Schultz discussed the importance of documenting SCT, information on which is often forgotten by the time children grow up. She discussed the SCtalk study, its findings, and further research and implementation of the toolkit she would like to see.

Schultz CL, Higgins K, Pinto AT, et al. Sctalk: A Pilot Trial Using Implementation Science to Improve Documentation and Disclosure of Sickle Cell Trait during Infancy. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 5008

Corinna L. Schultz, MD

Numerous advanced therapies have been introduced in recent years for the management of 

, and it has been suggested that these novel therapies are contributing to a decreased need for colectomy among this patient population.

 However, many individuals with UC still do not respond to medical management and require surgical intervention, most commonly in the form of a colectomy followed by the creation of an ileal pouch-anal anastomosis (IPAA) to restore intestinal continuity and prevent the need for an ileostomy.

 In this approach, surgeons may elect to perform a stapled anastomosis without mucosectomy, which leaves a rectal remnant (cuff) and has been shown to improve functional outcomes.

Although most patients with an IPAA report positive pouch health, inflammation of the pouch (pouchitis) and rectal cuff (cuffitis) are common and present with symptoms of increased frequency of bowel movements, urgency, and rectal bleeding.

 In addition to these symptoms, rectal cuff inflammation has been shown to increase the risk of pouch failure (pouch explant, pouch re-do, or diversion ileostomy), but it remains unknown by which specific mechanisms and clinical sequelae that this condition may be associated with poor long-term pouch outcomes.

To address this gap in knowledge, Powers et al. conducted a retrospective cohort study of adult patients with 

 who underwent IPAA between January 2010 and December 2021. These patients were divided into cohorts based on whether they had demonstrated inflammation of the rectal cuff on one or more endoscopic evaluations (pouchoscopies) at any time following surgical completion. Outcomes of this study included the development of fistulas and strictures of the ileal pouch while excluding anastomotic and peri-anal disease. These diagnoses were recorded through review of imaging, endoscopic, and clinical visit data from electronic health records.

In total, this study identified 402 patients who met inclusion and exclusion criteria, with 182 (45%) patients in the endoscopic cuff inflammation cohort and 220 (55%) patients in the control cohort. Most patients included in this study were male (56.7%) and had been diagnosed with UC (93.8%). The overall median follow-up time was 3.2 (Interquartile range [IQR], 1.4-5.2) years after surgical completion, with the cuff inflammation cohort demonstrating a slightly longer follow-up (4.0 years; IQR, 2.3-6.2) compared to the control group (2.6 years; IQR, 1.2-4.5).

In total, 41 patients developed non-anastomotic strictures and 25 patients developed fistulas during the follow-up period. On univariable analysis, the development of non-anastomotic strictures and fistulas were both more frequent in the cohort with cuff inflammation (

 = .032, respectively). Multivariable logistic regression models were fit to assess this relationship while controlling for potential confounders including pan-colitis disease distribution, duration of disease before colectomy, and history of extraintestinal (skin, eye, and joint) manifestations of IBD.

Controlling for these potential confounders, the endoscopic cuff inflammation cohort again demonstrated significantly higher odds of non-anastomotic strictures compared to individuals without cuff inflammation (Adjusted odds ratio [aOR], 3.47; 95% CI, 1.71 - 7.52; 

 <.001). For the development of fistulas, individuals with cuff inflammation had odds 2.57 times those of the cohort without cuff inflammation (aOR, 2.57; 95% CI, 1.11-6.47; 

 = .034). Additionally, a prior history of extraintestinal manifestations was significantly associated with fistula development (aOR, 2.82; 95% CI, 1.21-7.09; 

From these results, this study suggests that endoscopic inflammation of the rectal cuff is associated with structural pathologies of the pouch, which may contribute to a higher risk of pouch failure. Patients undergoing pouchoscopy who are found to have cuff inflammation should therefore be monitored and treated for these specific structural conditions to limit the risk of long-term complications. Furthermore, this study suggests that extraintestinal manifestations may also predict structural pouch disease and should thus be considered when evaluating a patient’s risk for future pouch health.

Future directions from this study include performing time-to-event analyses given the varying follow-up times and considering whether more distal disease (anastomotic strictures, perianal fistulas) demonstrates the same trends noted in this study.

Ghoz H, Kesler A, Hoogenboom SA, et al. Decreasing Colectomy Rates in Ulcerative Colitis in the Past Decade: Improved Disease Control? 

. 2020;24(2):270-277. doi:10.1007/S11605-019-04474-9

Garcia-Planella E, Mañosa M, van Domselaar M, et al. Long-term outcome of ulcerative colitis in patients who achieve clinical remission with a first course of corticosteroids. 

. 2012;44(3):206-210. doi:10.1016/J.DLD.2011.10.004

Ng KS, Gonsalves SJ, Sagar PM. Ileal-anal pouches: A review of its history, indications, and complications. 

. 2019;25(31):4320. doi:10.3748/WJG.V25.I31.4320

Chambers WM, Mortensen NJMC. Should ileal pouch-anal anastomosis include mucosectomy? 

. 2007;9(5):384-392. doi:10.1111/J.1463-1318.2007.01211.X

Zezos P, Saibil F. Inflammatory pouch disease: The spectrum of pouchitis. 

WJG. 2015;21(29):8739. doi:10.3748/WJG.V21.I29.8739

Kayal M, Plietz M, Rizvi A, et al. Inflammatory Pouch Conditions Are Common After Ileal Pouch Anal Anastomosis in Ulcerative Colitis Patients. 

. 2020;26(7):1079-1086. doi:10.1093/IBD/IZZ227

Findings suggest cuffitis after ileal pouch-anal anastomosis is linked to long-term complications including strictures and fistulas, potentially contributing to a greater risk of pouch failure.

Cuff Inflammation Following Pouch Creation and Future Stricture, Fistula Development

Joseph Carter Powers

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 Lineup: Progress, Policy, and Barriers in Hepatitis C Elimination

Liver Lineup: Updates & Unfiltered Insights

, hosts Kimberly Brown, MD, a professor of Medicine at Michigan State University and Wayne State University, associate medical director of the Henry Ford Hospital Transplant Institute, and medical director of Transplant Outreach Services at Henry Ford Hospital, and Nancy Reau, MD, a professor of internal medicine, the Richard B. Capps Chair of Hepatology, associate director of solid organ transplantation, and the section chief of hepatology at Rush University Medical Center, discuss the progress and persistent challenges in eliminating 

With highly effective, short-course oral therapies now available, Brown and Reau emphasize that curing HCV is more achievable than ever. The discussion explores the major policy, clinical, and structural milestones enabling this effort—and the critical gaps in diagnosis, treatment access, and health policy that still impede progress.

Reau opens by emphasizing the revolutionary nature of curative HCV therapies, which not only improve individual health outcomes but also reduce transmission, presenting a rare opportunity for public health impact on a global scale. She and Brown discuss how national and international efforts, including World Health Organization goals and US legislation, have aligned to prioritize viral hepatitis elimination.

Specifically, the hosts discuss the role of the US Preventive Services Task Force and the Affordable Care Act in establishing HCV screening as a covered preventive service. Outlining the evolution from birth cohort screening to universal screening for adults 18 and over, Reau and Brown discuss a recent legal challenge to the Affordable Care Act’s preventive service mandate that threatened access to HCV screening. The Supreme Court’s 6–3 decision to uphold this provision was, in their view, a critical win for public health and HCV elimination.

Despite these advances, both experts acknowledge major challenges remain in the HCV care cascade. Many patients are lost between screening and cure, often due to provider restrictions, system fragmentation, and lack of prioritization. They emphasize the need for government-backed elimination efforts, drawing lessons from successful national programs in countries like Egypt and Georgia.

The conversation also underscores the role of grassroots advocacy, emphasizing the critical role clinicians and patients alike can play in supporting federal hepatitis elimination legislation. Most importantly, they encourage patients to share their stories with legislators—a strategy proven effective in other public health movements, including HIV.

Reau additionally calls upon listeners to write to their local senators to support bipartisan legislation from senators Bill Cassidy (R-LA) and Chris Van Hollen (D-MD) to eliminate hepatitis C using the following link: 

Ask Senators to Cosponsor the Cure Hepatitis C Act

Editors’ note: Relevant Disclosures for 

 include AbbVie, Gilead, Salix, Arbutus, and VIR. Relevant disclosures for 

 include Mallinckrodt Pharmaceuticals, Gilead, Salix, Intercept, Ipsen, and Madrigal.

Hosts Kimberly Brown and Nancy Reau discuss policy, clinical, and structural milestones enabling HCV elimination efforts and critical gaps impeding progress.

Nancy Reau, MD

 I’ve enjoyed the opportunity to talk with you because I’ve learned a ton. Your experience and acknowledge is outstanding. To wrap this up, what would be your take-home messages for health care providers treating opioid-induced constipation?

 One would be to open the conversation if you see it on their list. I find that being a PCP [primary care physician] these days is the hardest job. The patients are living longer and in and out of the hospital. With the amount of record review, interaction with the charts, and certain care measures, this may be 10th on the list. They may be doing well from a pain relief perspective. We ask that question, but it’s hard when they have a million other medical problems. But it’s a simple question.

Patients oftentimes don’t want to bring it up or talk about it. It’s embarrassing. But it can affect their quality of life. We’re happy to help. I’m happy to see patients and have the longer discussion with them, especially if we can initiate the appropriate-line therapies to start. It’s important to open that conversation and ask them the simple question: “I see you’re on opiates. How are your bowel habits?” If there’s an issue, then start to get them on the right track to treatment, because it’s very efficacious and safe, as we talked about. They don’t have to bear this burden. We can help fix it for them.

 Yes, the conversation or even the prompt to have that conversation is important. We transitioned to electronic intake forms, and we have smart responses, where if somebody is taking opioids, it starts to ask about all the things related to opioids, including feeling sleepy, being able to function at work, and driving. Constipation came up there, and we were surprised by the number of people who were responding to this. We had never thought to have that discussion. With the time that you have to be able to discuss this, it might be very low on the list. But if you’re able to screen and have the conversation based on that response, it cuts out a lot of time, and thankfully we have some great options to choose from that will make the conversation go quickly and smoothly.

 Excellent. Thank you once again for participating in 

Expert Perspectives in the Management of Opioid-Induced Constipation

A panel of experts discuss their key takeaways and the future of treating opioid-induced constipation. 

Future Directions in the Treatment of Opioid-Induced Constipation

Neel Mehta, MD

Switching to Aflibercept 8 mg in Treatment-Experienced Patients with Theodore Leng, MD, FACS

2025 Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting

, Theodore Leng, MD, Director of Clinical and Translational Research and Director of Ophthalmic Diagnostics at Stanford University School of Medicine, presented an analysis of using aflibercept 8 mg in eyes with 

neovascular age-related macular degeneration (nAMD

) upon switching from other anti-VEGF agents.

“I’m really excited about this study because it is a real-world data study which allows us an insight into how aflibercept 8 mg is being used in the AMD and DME population since it launched,” Leng told 

. “The other exciting part about this study is that we combined data from two separate real-world data sets. And from that, we had data from almost 40,000 aflibercept 8 mg patients to provide early insights into the effectiveness of this medication in everyday clinical practice.”

The study created multiple cohorts of previously treated eyes with nAMD from electronic records in Intelligent Research in Sight (IRIS) and Vestrum Health Retina Database (Vestrum). Eyes initiating aflibercept 8 mg from August 18, 2023 to June 30, 2024 (IRIS) and August 18, 2023, to July 30, 2024 (Vestrum) were followed from initiation until last visit, real-world treatment (tx) switch, or missing tx laterality information.

Mean dosing intervals were calculated during the pre-aflibercept 8 mg switch period (≥6 months up to 1 year); loading phase, defined as the first 3 injections or 90 days, whichever occurred first; and post-loading phase, defined as the end of follow-up. Dosing intervals were examined before and after switching in a subset of eyes that were consistently anti-VEGF-treated prior to switch with average dosing intervals before switching of 4-≤6 or 6-≤8 weeks. Consistency was defined as tx for ≥6 months and average dosing intervals of ≤8 weeks.

The trial collected a total of 25,846 and 9480 eyes initiating aflibercept 8 mg from IRIS and Vestrum, respectively. The mean age of these patients was 81 years; roughly 40% were men and 49% had bilateral nAMD. Approximately 71% switched from aflibercept 2 mg and 18% from faricimab.

Consistently anti-VEGF treated eyes with ≥1 post-loading phase injection (IRIS n = 7256; Vestrum n = 1814), the last post-loading dosing interval was on average (mean standard deviation [SD]) 16 (18) and 18 (17) days longer than last observed interval prior to switch, respectively. Consistently anti-VEGF-treated eyes with average pre-switch injection intervals of 4-≤6 weeks in IRIS (n = 3577) and Vestrum (n = 801), dosing intervals were extended by 19 (17) and 21 (15) days, respectively. Eyes with an average pre-switch injection interval of 6-≤8 weeks in IRIS (n = 3628) and Vestrum (n = 1013), mean interval extension was 12 (19) and 16 (18) days, respectively.

Leng and colleagues noted that these data suggest dosing intervals could be extended by 2 or more weeks among nAMD eyes that had received consistent anti-VEGF treatment prior to beginning aflibercept 8 mg.

“Typically, the most common reason for switching is a lack of efficacy or suboptimal treatment response, or the desire to have longer treatment intervals between the injections. And so, while we did see less extension in the patients that were not being dosed as frequently, it was still a significant time increase in treatment,” Leng said. “If your goal is to have fewer visits, that can come from either the patient side or from a clinical flow operational side, from the physician side. Then even patients who are only going to get a few more weeks might still be worth to consider switching.”

Leng reports the following disclosures: Astellas, Boehringer Ingelheim, Regeneron Pharmaceuticals, Inc., Roche/Genentech, Topcon, Virtual Field

Leng, T, Sherman, S, Murdock, D, et al. Early insights from real-world use of aflibercept 8 mg among eyes with neovascular age-related macular degeneration (nAMD) switching from other anti-VEGF agents. Abstract presented at Association for Research in Vision and Ophthalmology in Salt Lake City, UT, from May 3 – May 8, 2025.

An analysis of several datasets cataloguing the switch revealed that dosing can be extended up to 2 weeks for patients with nAMD who received prior anti-VEGF therapy.

Switching to Aflibercept 8 mg in Treatment-Experienced Patients with Ted Leng, MD

Theodore Leng, MD, FACS

Tim Smith joined the MJH Life Sciences team as an assistant editor for HCPLive in August 2022. He graduated from UC Berkeley with a degree in political science, working in multimedia journalism as a staff writer prior to joining MJH. In his spare time, he enjoys reading, watching TV, listening to podcasts, and rock climbing. You can contact him at 

Dual biologic therapy may be effective and generally well-tolerated in treating refractory inflammatory skin conditions such as 

, new findings suggest, although it carries a moderate risk of infection.

This finding and others were the conclusions that resulted from a recent systematic review on dual biologic therapy use in skin disease. These data were authored by such investigators as Eric McMullen, MD, of the University of Toronto Department of Medicine’s Division of Dermatology.

McMullen and his coauthors highlighted that dual biologic therapy, a process involving the concurrent use of biologic treatments, is an approach for refractory cases of 

 individuals living with comorbid inflammatory conditions who are in need of additional therapies.

“This systematic review aims to document, synthesize and critically appraise the current literature on dual biologic therapy in inflammatory skin diseases,” McMullen and colleagues wrote.

The trial investigators used 5 databases—including Embase, MEDLINE, CENTRAL, Scopus, and Web of Science—for their comprehensive literature search, conducted across these databases' inceptions through March 2024. The team used a search strategy that involved both subject headings and keywords related to various types of biologic agents, inflammatory dermatologic conditions, and combination (dual) biologic use.

The review adhered to PRISMA 2020 guidelines and was registered with PROSPERO.

 McMullen et al maintained a set of criteria for inclusion, looking only at studies assessing the safety and effectiveness of dual biologic therapy in skin diseases that were also written in English. 40 studies were found to have met these criteria, encompassing data from 106 total patients, 59.4% of whom were labeled as female.

Among these trial subjects, the investigators noted the mean age across the cohort as 47.1 years, with ages ranging from 10 - 79 years. Before initiating dual biologic therapy, patients assessed in these studies had failed an average of 1.3 topical drugs, 2.4 non-biologic systemic drugs, and 2.1 biologic monotherapies.

The most frequently reported biologic pairing was found by the investigative team to be omalizumab alongside rituximab, which accounted for 25.7% of cases. This was mostly observed in those showing treatment-resistant bullous pemphigoid. The next most common biologic combination was omalizumab and secukinumab, among 16.5%, which is implemented for refractory chronic spontaneous urticaria (CSU) and psoriasis. 

All 106 of these individuals showed demonstrated clinical response to the dual biologic agent regimens. The most prevalent conditions treated among these subjects included bullous pemphigoid among 28.3%, CSU among 35.8%, psoriasis among 23.6%, and atopic dermatitis among 9.4%. It was noted that 30.2% of patients initiated dual therapy after being prompted by an inadequate response to single-agent biologic treatment, while others required combination biologics as a result of coexisting inflammatory diseases. These were both dermatologic (35.8%) and non-dermatologic (34.0%).

McMullen and coauthors noted that the mean follow-up period of 14.7 months saw 78.3% of patients report no adverse events. Among those who did, the most frequent were non-severe infections (10.4%). Loss of therapeutic response took place in 4 of the study subjects. Serious adverse outcomes included a single case of respiratory failure and 1 fatality in a patient with multiple comorbid conditions—acute lymphoblastic leukemia, bullous pemphigoid, renal failure, sepsis, and graft-versus-host disease. 9 patients had infections, with a notable link to therapies involving ustekinumab or TNF inhibitors being observed by the investigative team.

A notable therapeutic approach for resistant CSU and psoriasis involved co-administration of anti-IgE and anti-IL-17 agents. Such biologics act on separate yet potentially synergistic immunological pathways. IL-17A, a cytokine elevated in psoriasis, can promote IgE class switching and IgE-secreting cell differentiation when stimulated via anti-CD40 and anti-IL-4 pathways. Given that IL-17A may contribute both to psoriatic inflammation and to IgE-driven allergic responses, dual iIL-17A and IgE pathway inhibition could allow for enhanced clinical efficacy.

This systematic review underscores dual biologic therapy's potential in helping achieve clinical responses with an acceptable safety profile in individuals living with inflammatory diseases impacting the skin. However, a 10.4% infection rate was noted by the investigators as raising questions about increased susceptibility due to compounded immunosuppression and impaired immune surveillance.

“Distinct and complementary mechanisms such as IL-17 and anti-IgE in psoriasis and CSU highlight these promising findings, yet current evidence is limited by small sample sizes and likely publication bias,” they concluded.

 “Future studies should prioritize larger studies, extended follow-up periods and refined patient selection criteria to better assess the efficacy and safety of dual biologic therapy.”

McMullen E, Croitoru D, Piguet V, et al. Efficacy and safety of dual biologic therapy in inflammatory skin diseases: A systematic review. J Eur Acad Dermatol Venereol. 

Page MJ, McKenzie JE, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71.

Dual biologic therapy shows promise in treating refractory inflammatory skin conditions like psoriasis, with a generally acceptable safety profile, though it carries a moderate infection risk. A systematic review analyzed 40 studies involving 106 patients, revealing that dual biologic regimens, such as omalizumab with rituximab, effectively manage conditions like bullous pemphigoid and chronic spontaneous urticaria. Despite a 10.4% infection rate, the therapy's potential is highlighted, though further research with larger sample sizes and longer follow-up is needed to better understand its efficacy and safety.

This systematic review evaluated current research on dual biologic treatments in patients living with inflammatory skin conditions.

Review Highlights Benefits, Drawbacks of Dual Biologic Therapy in Dermatology

Tim Smith

Victoria Barbosa, MD, MPH, is an associate professor for the University of Chicago Section of Dermatology.

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

SOCS Clinical Episode 3

, Victoria Barbosa, MD, MPH, MBA, associate professor of dermatology at the University of Chicago and president of the Skin of Color Society (SOCS), is joined by Janiene Luke, MD, clinical professor of dermatology at Loma Linda University. Together, they engage in a comprehensive discussion on hair care myths, patient habits, and the management of 

The conversation begins with a deep dive into common misconceptions about alopecia, highlighting how the term is often misunderstood by patients. Luke explains that alopecia is a broad term encompassing various forms of hair loss, each requiring distinct diagnostic and treatment approaches. They discuss the challenges of educating patients who self-diagnose and stress the importance of accurate clinical evaluation. Barbosa shares that many patients assume alopecia refers to a specific condition rather than a general term for hair loss, making clear communication critical.

The discussion then shifts to protective styling, an area where many patients unknowingly engage in damaging practices. Barbosa and Luke highlight how tight hairstyles, prolonged wear, and excessive tension can lead to conditions such as traction alopecia. They emphasize patient education on safer styling techniques and discuss the difficulty of balancing these conversations within the time constraints of clinical practice. Barbosa describes her structured approach, breaking hair loss visits into multiple sessions to ensure comprehensive evaluation, while Luke shares strategies for handling these time-consuming discussions in a busy clinic setting.

Both experts outline their structured approaches to diagnosing and managing hair loss. Luke shares insights into her clinic’s thorough patient evaluation, which includes taking detailed histories, utilizing dermoscopy, and selectively performing biopsies. They stress the importance of cultural humility and patient-centered care, particularly in addressing the emotional distress often associated with hair loss. Barbosa underscores the need for dermatologists to physically examine the scalp, noting that some patients report prior experiences where their hair loss was assessed from a distance.

The conversation also covers specific types of alopecia commonly seen in patients with skin of color, including central centrifugal cicatricial alopecia (CCCA), frontal fibrosing alopecia (FFA), and lichen planopilaris (LPP). They discuss how these conditions are often misdiagnosed as traction alopecia, underscoring the need for careful clinical examination, including checking for eyebrow loss and facial pigmentation. Luke shares how dermoscopy-guided biopsies have improved diagnostic accuracy in her practice.

In terms of treatment, they discuss the role of topical and oral therapies, including corticosteroids, doxycycline, minoxidil, and platelet-rich plasma (PRP). Luke shares her experience incorporating metformin into CCCA treatment and expresses excitement about ongoing research into JAK inhibitors. They also touch on hair transplant options for patients with traction alopecia, emphasizing the importance of selecting surgeons experienced with curly and textured hair. Barbosa details how she offers patients a choice between topical and oral minoxidil, framing treatment as a collaborative process to maintain patient autonomy and adherence.

The episode concludes with a discussion on best practices in hair care, product recommendations, and the importance of partnering with knowledgeable hairstylists to support patients. Barbosa and Luke emphasize that dermatologists can enhance patient outcomes by either learning about Black hair care or establishing connections with local hairstylists specializing in textured hair. They stress the importance of recommending water-based moisturizing products, sulfate-free shampoos, and proper conditioning practices to help patients maintain healthy hair.

This episode delivers expert perspectives on diagnosing and managing hair loss in patients with skin of color, combining scientific insights with practical clinical strategies to improve patient outcomes. By fostering culturally intelligent and responsive conversations, personalizing treatment approaches, and staying informed on the latest research, dermatologists can better serve their diverse patient populations.

Barbosa has the following disclosures: Pfizer, Eli Lilly, L'Oréal, Vichy, and Beiersdorf. Luke's disclosures include Eli Lilly, Sanofi/Regeneron, and Arcutis.

This summary was formulated with the assistance of artificial intelligence.

Hosted by Skin of Color Society and produced by HCPLive, 

 delves into the latest research, clinical insights, and culturally competent care practices in dermatology with leading experts. Whether it’s groundbreaking research, practice-changing insights, or highlights from the SOCS community, this twice-monthly program provides dermatologists and care providers with expert perspectives on treating patients with skin of color.

In this episode, Victoria Barbosa, MD, MPH, MBA, and Janiene Luke, MD, highlight insights and misconceptions about alopecia.