Fadi Fakhouri, MD, PhD, is a professor of nephrology at CHUV Lausanne, Switzerland.

Counting down the biggest news from major medical meetings, it's the HCPLive Five!

HCPLive Five at European Renal Association (ERA) Congress 2025

European Renal Association (ERA) Congress

 is a medical conference bringing together world-renowned experts, researchers, and practitioners in nephrology. 2025’s meeting was hosted in Vienna, Austria, and saw more than 10,000 participants from around the world with a record 2835 abstract submissions from 91 countries. This year’s conference was centered around the theme “Game Changers in Nephrology” with the slogan “Beyond Nephrology,” boasting a comprehensive and innovative program exploring the latest advancements and transformative ideas in nephrology.

As part of HCPLive’s on-site coverage, the editorial team conducted expert interviews and reported on timely topics across therapeutic advances, pipeline updates, new renal clinical trial data, and more. In this edition of the HCPLive Five, the team highlights key conversations on pegcetacoplan in 

 and idiopathic immune-complex membranoproliferative glomerulonephritis (IC-MPGN), a trio of 

 drugs in clinical development, and the potential benefits of simultaneous initiation of finerenone (Kerendia) and empagliflozin (Jardiance) in patients with 

Pegcetacoplan Sustains Proteinuria Reductions in C3G, IC-MPGN at 52 Weeks

Extended data from the phase 3 VALIANT trial were presented at ERA 2025 and support the sustained efficacy and safety of pegcetacoplan (Empaveli) in patients with C3G or IC-MPGN, including adolescents and adults with native or transplanted kidneys. The 52-week results show continued proteinuria reduction and eGFR stabilization in both treatment-naïve and crossover groups, reinforcing 26-week data presented at the American Society of Nephrology’s 2024 Scientific Sessions.

In this on-site interview at the meeting, Fadi Fakhouri, MD, PhD, co-lead principal investigator for the VALIANT study and a professor of nephrology at CHUV Lausanne, Switzerland, describes pegcetacoplan’s long-term potential in C3G and IC-MPGN and how the data presented at ERA could shift treatment strategies.

Understanding Zigakibart's Potential in IgA Nephropathy, with Jonathan Barratt, MD, PhD

100-week data from the phase 1/2 ADU-CL-19 trial presented at ERA suggest zigakibart, an APRIL inhibitor under development by Novartis, offers durable reductions in proteinuria and maintains a favorable safety profile in patients with IgAN. In the study, patients experienced a mean 60% reduction in proteinuria from baseline, with 55% achieving proteinuria below 500 mg and 31% below 300 mg, as described by Jonathan Barratt, MD, PhD, the Mayer Professor of Renal Medicine at the University of Leicester, in this interview. Additionally, serum IgA and pathogenic Gd-IgA1 levels dropped by 74%, building on earlier 52-week data showing reductions in IgA, IgM, and IgG of 67%, 78%, and 35%, respectively.

Kidney Compass: CONFIDENCE Trial at ERA 2025, with Rajiv Agarwal, MD, MS

Simultaneous initiation of finerenone (Kerendia) and empagliflozin (Jardiance) in patients with CKD and type 2 diabetes was well-tolerated and resulted in significantly greater reductions in urinary albumin-to-creatinine ratio (UACR) than either agent alone, according to results from the CONFIDENCE trial. During ERA, Kidney Compass host Brendon Neuen, MBBS, PhD, a senior research fellow with the George Institute for Global Health and the director of the Kidney Trials Unit with Royal North Shore Hospital, held a discussion with trial investigators Rajiv Agarwal, MD, Professor Emeritus at Indiana University School of Medicine, about the study results and what they mean for CKD management landscape in real-world settings.

Phase 3 ORIGIN Sets Stage for Atacicept in IgA Nephropathy, with Richard Lafayette, MD

Just days before the ERA 2025, the nephrology community welcomed and celebrated new positive data for atacicept in IgAN in the form of topline results from the phase 3 ORIGIN trial. Announced by Vera Therapeutics on June 02, 2025, the data indicate the trial met its primary endpoint of reduction in proteinuria at week 36, with the atacicept group achieving a 46% reduction from baseline and a statistically significant 42% reduction compared to placebo at week 36.

’s coverage of ERA, we sat down with Lafayette to discuss how this latest data adds to our understanding of atacicept and its potential role in the management of IgAN if it were to receive FDA approval.

Kidney Compass: Sibeprenlimab and the VISIONARY Trial, with Vlado Perkovic, MBBS, PhD, at ERA 2025

, hosts Brendon Neuen, MBBS, PHD, and Shikha Wadhwani, MD, MS, are joined by Vlado Perkovic, MBBS, PhD, dean and scientia professor of Medicine at UNSW Sydney, as he dives into one of the meeting’s most anticipated releases—

. Less than 2 weeks prior to the presentation, Otsuka Pharmaceutical Co. announced the US Food and Drug Administration had granted priority review for their BLA and the application has been given a target action date of November 28, 2025.

These 5 represent only some of the data the 

 team covered at this year's meeting! Check out more KOL insight and our full conference coverage on our 

From new data for potential IgAN treatments to the use of combination initiation therapy for type 2 diabetes and CKD, here are 5 key updates from the annual meeting.

Fadi Fakhouri, MD, PhD

 editorial team, JiaDe (Jeff) Yu, MD, MS, spoke about the most notable takeaways from his talk at the 

2025 Revolutionizing Atopic Dermatitis (RAD) Conference

 regarding chronic hand eczema, its impacts, and potential treatments in the pipeline.

Yu is known for his role as a board-certified dermatologist and fellowship-trained pediatric dermatologist specializing in allergic contact dermatitis and occupational dermatitis in adults and children at Massachusetts General Hospital. Yu spoke with in a Q&A interview about his talk and some of the specifics regarding chronic hand eczema.

Would you share some specifics highlighted in your session on chronic hand eczema?

I think chronic hand eczema is a slightly tangential but very much related area to atopic dermatitis. A lot of people think chronic hand eczema is just another form of atopic dermatitis. But the more we understand chronic hand eczema, we understand it to be a kind of mishmash of various types of different types of barrier-disruptive dermatoses, whether that's going to include irritant contact dermatitis, allergic contact dermatitis, atopic dermatitis, or other forms of dermatitis that can oftentimes present on the hand.

I think we tend to lump all of that together into what we call chronic hand eczema. The treatment for chronic hand eczema really depends on what we are trying to treat. If it's atopic dermatitis, I think a lot of the present atopic dermatitis therapies are very effective for it, especially the ones that are targeting particular pathways. However, if we're not treating atopic dermatitis in chronic hand eczema and a lot of chronic hand is not atopic dermatitis, we may actually be failing the patient. And that's where some of these newer therapies really come in handy.

So during my session today, I want to talk a lot about the burden of atopic dermatitis, about chronic hand eczema, why we care about it, what is the occupational impact of the condition, and how it affects patients. We think about it as hand eczema, but probably it's the most critical part of your body when you're trying to interact with the community, whether it is with work, whether it's with a loved one, whether it's with your child, hand eczema really affects all of us.

We would also like to ask you about delgocitinib cream, its potential upcoming approval by the US Food and Drug Administration (FDA) and what clinicians need to know about it?

I think delgocitinib is a really exciting therapy that is about to hit the market either later this year or early next year. I do think that with this therapy, it is the first type of therapy we have in the United States that is going to be geared towards chronic hand eczema. Currently, there are no FDA-approved therapies for chronic hand eczema. We, as dermatologists, tend to treat it just like we do other types of examined dermatoses with topical steroids and some of the non-steroidal topicals that are currently available on the market, but none of them have really been shown to be as effective as delgocitinib has shown to be in the literature so far.

In one of the comparative trials that they've done between delgocitinib and alitretinoin, which is one of the very few approved therapies for eczema, though it's not available in the US and it's only available in Canada and Europe, it showed that it was comparable to this oral retinoid that has been the standard of treatment for severe and eczema. So I think this topical therapy is very safe, very effective, and stands to maybe change the way that we treat hand eczema here in the United States.

Outside of atopic dermatitis and chronic hand eczema, are there any other areas of dermatology in which you are looking forward to research?

 Part of my time I spend clinically is working with patients who have allergic contact dermatitis. To date, there are absolutely no treatments available for allergic contact dermatitis other than avoidance of the allergen, which can be challenging for a lot of patients. Either we don't have a great way of identifying the allergen through patch testing, or we don't identify the allergen, or patients are not able to avoid the allergen, whether it's because of the type of work that they do or the type of things that they have to use on their day to day.

Sometimes, we just aren't able to really adequately control the dermatitis due to an allergen contact. So I am hoping to see if we can potentially partner up with some of our industry partners to potentially come up with a therapy to treat allergic contact dermatitis in patients who are otherwise not able to avoid it. I think that would make a huge amount of difference in about 20% of our patients' lives.

What is the value of a meeting like RAD 2025?

 I think Revolutionizing Atopic Dermatitis is just such an amazing conference, because it brings together all the clinicians and experts and industry partners in here and internationally that really care about atopic dermatitis. We're all here for the same mission, which is to improve our patients' lives with atopic dermatitis.

We're here to talk about advances. We're here to talk about current management practices. We're here to teach people who may be less familiar with atopic dermatitis all that we know about atopic dermatitis. I really think these disease-specific conferences, you come in knowing some, you walk out knowing a lot. I think it's one of them, probably the most valuable educational experiences that I can think of.

For further information on the topics presented by Yu as well as other data in the atopic dermatitis space, view the 

The quotes used in this Q&A interview summary were edited for the purposes of clarity.

Chronic hand eczema, often conflated with atopic dermatitis, encompasses various barrier-disruptive dermatoses, including irritant and allergic contact dermatitis. Effective treatment hinges on accurate diagnosis, as therapies for atopic dermatitis may not address other forms. Delgocitinib cream, pending FDA approval, promises a novel, effective treatment for chronic hand eczema, outperforming current options. Additionally, the need for therapies targeting allergic contact dermatitis remains unmet. Conferences like RAD 2025 are pivotal for advancing knowledge and collaboration among dermatology professionals, ultimately enhancing patient care in atopic dermatitis.

This Q&A interview features Jeff Yu, MD, in a discussion regarding his presentation on chronic hand eczema at the 2025 RAD Conference.

Discussing Chronic Hand Eczema and Delgocitinib’s Potential Approval, with Jeff Yu, MD

JiaDe (Jeff) Yu, MD

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

Skin of Color Savvy: Diversity in Dermatology Within the Modern Landscape, with Crystal Aguh, MD, and John Harris, MD, PhD

, Crystal Aguh, MD, associate professor of dermatology and director of the Ethnic Skin Program at the Johns Hopkins School of Medicine, and John Harris, MD, the founding Director of the Vitiligo Clinic and Research Center, founding director of the Autoimmune Therapeutics Institute and professor and chair of the Department of Dermatology at UMass Chan Medical School in Worcester, together explored the importance of mentorship, visibility, and leadership among dermatologists and dermatology trainees of different backgrounds.

Hosted by Skin of Color Society (SOCS) leaders, this podcast episode continues to delve into the latest research, clinical insights, and culturally intelligent and responsive care practices in the field of dermatology. Together, Aguh and Harris spoke on a variety of subjects in this area.

Aguh and Harris discussed the importance of diversity in clinical trials and research, emphasizing the need for diverse principal investigators and teams. Harris highlighted his experiences moderating a panel on incorporating diversity into clinical research, noting the challenges and benefits. They discussed the impact of federal regulations on National Institutes of Health (NIH) grants and the necessity of addressing questions about the importance of diversity.

Harris pointed out the challenges of addressing conversations regarding diversity among clinicians and in clinical research within the present political climate, highlighting that some have questioned whether to bring up the conversation at all. Both expressed optimism about the growth and impact of SOCS in advancing research and treatment for patients of color.

As the episode closed, the conversation reinforced the power of mentorship, the importance of role models, and the responsibility of current leaders to cultivate a more equitable future in dermatology. For both those in medical school and those who are current health care providers, the episode offers a compelling look at how connection, advocacy, and shared purpose can drive lasting change within the specialty.

To learn more about SOCS’s mentorship programs and initiatives, visit 

Editor's note: This interview was summarized with the aid of artificial intelligence.

This episode of the SOCS podcast features an in-depth discussion between Crystal Aguh, MD, and John Harris, MD, PhD.

John E. Harris, MD, PhD

Thank you to all 3 of you for participating in this rich discussion. I’d like to give you one last opportunity for any pearl that you might have that you want to share with your colleagues about taking care of patients with atopic dermatitis now, and then what we are going to be doing over the next year or two, as we learn more and continue to add to our therapeutic options. Do you have anything you would like to add?

My advice to my colleagues is for those who aren’t participating locally in journal clubs and meetings, do it because by doing so, you’ll meet incredible providers who share the same passion you do by improving the lives of patients. You’ll find other providers who speak your same language who you get along with and you’ll enjoy collaborating with on care for patients. The second thing is for patients to hang in there. We’re in this together. This is a journey. This isn’t a 1-gene condition. This is complicated, but we’re in it together, and we’re going to find the answers and stick with it until we find the answer that will make our patients become their best selves. I joke that my patients are my Prozac all day long because they give me such a high when they come in and they’re happy. You can see when they’re not happy, but it’s so empowering on my side and it’s a real honor to be in a position to ask them questions that nobody else can ask and to walk side by side with our patients in this journey.

Susan, do you have any words to your colleagues or to your patients or their families?

 It is a partnership, laying out the options treatment wise and weighing the risks and benefits, and all the other extraneous things, costs, and other things that influence the family. It’s also being the empathetic providers that we all are and that the patient knows you’re listening. That’s a huge aspect of any chronic disease, that patients need to feel heard and they need to know that you are listening and that it matters what they’re going through. We know statistically and scientifically all of the things about the diseases, but everybody’s different and not everyone fits into that mold. We need to be able to pull those idiosyncrasies out from the patient, knowing what has failed and helped, and you are there as their provider to get success for their disease and their quality of life and to be able to move forward.

If you have a patient who is not doing well on what we have available, you might want to go to clinicaltrials.gov and look at sites all over the country where children, adolescents, and adults with different types or different levels of atopic dermatitis might be able to participate in a clinical trial to help get the data needed to move forward. 

 The National Eczema Association [NEA] may have information about clinical trials across the country, so they may be a good resource for that as well.

 I encourage my patients to start their own local chapter of the NEA. Patients need to collaborate with each other and relate so they can help each other by sharing stories and know they’re not the only one. It’s insane to me how I’ll go in and see a patient, and they’ll feel so alone, but there are so many people out there suffering from this. They should never feel alone.

They’re going to seek answers through social media or through other online sources. They’re going to be seeking answers, and you can either direct them and give them the proper information, or they’re going to find it on their own, so we have to realize that and try to direct them to places that matter. Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your inbox. Thanks to all 3 of you, and we’ll see you again soon.

Clinical pearls regarding the management of patients with atopic dermatitis with newer treatment approaches as the field continues to evolve. 

Optimizing Therapy for Patients With Atopic Dermatitis 

Keri Holyoak, PA-C, MPH, Dermatology Center of Salt Lake 

Mohd Salman, MD, is a specialist in gastroenterology. He obtained his medical degree from ERA Medical College in Lucknow. His clinical and research interests focus on inflammatory bowel disease, advanced endoscopic techniques, and emerging therapies in gastroenterology.

 grows, driven by lifestyle changes, dietary habits, and diagnostic capabilities, clinicians are increasingly challenged to manage not just the disease’s inflammatory component but also its broader systemic implications. Among these, the heightened risk of vaccine-preventable infections (VPIs) due to immunosuppressive therapy stands out as a major concern.

Despite well-established global guidelines, vaccination remains underutilized in developing and underdeveloped countries in adult IBD care. In this article, we explore the scientific rationale, timing, and strategy behind vaccinations for IBD, focusing on the Indian clinical context.

The Hidden Risk: Immunosuppressants and Infection Vulnerability

IBD treatment often involves a continuum of immunosuppressive agents, such as corticosteroids, thiopurines, methotrexate, biologics, and Janus kinase (JAK) inhibitors. These agents are crucial for disease control but elevate the risk of both common and opportunistic infections. For instance, reactivation of hepatitis B virus (HBV) is a documented risk in patients receiving anti-TNF therapy, while herpes zoster reactivation is more common with tofacitinib, a JAK inhibitor.

This risk is compounded when multiple immunosuppressants are used in combination. A meta-analysis led by Murat Toruner, MD, reported that combination therapy was associated with a significantly higher incidence of serious infections compared to monotherapy.

 Therefore, pre-emptive vaccination emerges as a cornerstone in the preventive management of patients with IBD, particularly those on long-term or high-level immunosuppression.

Vaccine Types and Timing: A Strategy Rooted in Immunological Logic

Vaccines in IBD are broadly classified into 2 types: live-attenuated and inactivated. The former — including vaccines like MMR (measles, mumps, rubella), varicella, and live herpes zoster (Zostavax) — pose a risk of causing disease in immunocompromised hosts and are therefore contraindicated during high-level immunosuppressive therapy. In contrast, inactivated vaccines, such as those for influenza, pneumococcus, HBV, and the recombinant herpes zoster vaccine (Shingrix), are considered safe across all levels of immunosuppression, albeit with potentially reduced immunogenicity.

The ideal window for vaccination is either at the time of IBD diagnosis or before the initiation of immunosuppressive therapy.

 When necessary, live vaccines should be administered at least 4 weeks before immunosuppression begins or delayed until 1 to 3 months after therapy has ceased. This timeline allows sufficient time for the host immune system to mount an adequate response while minimizing adverse events.

Vaccine Recommendations: Evidence-Based Guidance

The influenza vaccine should be administered annually via intramuscular injection. The live intranasal formulation is contraindicated in immunosuppressed patients. Studies suggest that high-dose influenza vaccines offer improved seroprotection in patients receiving biologics, underscoring the importance of optimizing formulation choice based on therapy status.

Pneumococcal vaccination involves a 2-step regimen: PCV13 followed by PPSV23 at least 8 weeks later, with a PPSV23 booster at 5 years and again after age 65. Notably, combination immunosuppressive therapy has been shown to reduce vaccine efficacy, further emphasizing the need for early administration.

Hepatitis A and B vaccines are critically important in regions like India, where intermediate endemicity persists. For HBV, serological screening for HBsAg, anti-HBc, and anti-HBs is essential before vaccination. Immunosuppressed patients may require double-dose or accelerated regimens, and post-vaccination titers should be rechecked within 1 - 2 months to confirm seroconversion.

Human papillomavirus (HPV) vaccination is recommended for all individuals up to age 26 and optionally until age 45.

 The quadrivalent vaccine, covering HPV types 6, 11, 16, and 18, has been demonstrated to be both safe and effective in immunosuppressed individuals. Cervical cancer screening remains essential for women with IBD, irrespective of vaccination status.

Other vaccines, such as Tdap (tetanus, diphtheria, pertussis), meningococcal, and Shingrix (recombinant herpes zoster), are also indicated based on individual risk profiles. Notably, the availability of Shingrix in India remains limited, though it offers > 90% efficacy in preventing herpes zoster even in immunocompromised populations.

Special Populations: Children, Pregnant Women, and Household Contacts

Children with IBD should be vaccinated in accordance with pediatric guidelines, with additional caution around timing relative to immunosuppressive therapies. Pregnant women can safely receive inactivated vaccines such as influenza, Tdap, and HBV, but all live vaccines should be strictly avoided. Household contacts of IBD patients on immunosuppressants may receive all standard vaccines, including live ones, provided they do not develop vaccine-derived infections, such as a post-varicella rash.

Adult vaccination is largely neglected in developing countries, with national efforts primarily focused on pediatric immunization. Barriers include lack of patient awareness, vaccine cost, limited policy support, and insufficient physician initiative. In a 2022 Indian cohort study, less than 30% of adult IBD patients had received recommended vaccines, an alarming statistic considering their heightened infection risk.

Despite well-established global guidelines, vaccination remains underutilized in IBD care, especially among adult patients. For clinicians seeking ongoing updates on immunization guidelines and infectious disease trends, a trusted 

 platform can be instrumental in maintaining best practices.

Gastroenterologists must lead the effort to integrate vaccination into routine IBD care. This includes reviewing immunization history during baseline evaluation, maintaining vaccine records, and using electronic health records (EHRs) to prompt timely vaccinations. Coordination with primary care and infectious disease specialists can further streamline implementation.

Vaccination represents one of the most effective, yet underutilized, interventions in IBD management. By assessing immunization history early, prioritizing inactivated vaccines, and timing live vaccines judiciously, clinicians can significantly reduce infection-related morbidity and mortality.

In countries where adult vaccination remains under-emphasized, a shift toward proactive immunization protocols is not just good practice—it is a clinical imperative.

Toruner M, Loftus EV Jr, Harmsen WS, et al. Risk factors for opportunistic infections in patients with inflammatory bowel disease. 

. 2008;134(4):929-936. doi:10.1053/j.gastro.2008.01.012

Farraye F. Reviewing recommendations for vaccines and health care maintenance in patients with inflammatory bowel disease. 

https://www.gastroenterologyandhepatology.net/archives/february-2024/reviewing-recommendations-for-vaccines-and-health-care-maintenance-in-patients-with-inflammatory-bowel-disease/

Yingyounyong S, Ngamjanyaporn P, Pisitkun P, Boonnak K, Suangtamai T, Thongpradit S, Rotjanapan P. A study of booster dose influenza vaccination responses compared to standard dose in lupus patients: an open-labeled, randomized controlled study. Clin Exp Med. 2025 Apr 9;25(1):109. doi: 10.1007/s10238-025-01639-6. PMID: 40205278; PMCID: PMC11982163.

Centers for Disease Control and Prevention. (2023). HPV vaccination recommendations.

https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html

Lal H, Cunningham AL, Godeaux O, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. 

. 2015;372(22):2087-2096. doi:10.1056/NEJMoa1501184

Shah BB, Goenka MK. A comprehensive review of vaccination in patients with inflammatory bowel diseases: an Indian perspective. Indian J Gastroenterol. 2020;39(4):321–330. doi:10.1007/s12664-020-01069-0


https://www.researchgate.net/publication/343889126_A_comprehensive_review_of_vaccination_in_patients_with_inflammatory_bowel_diseases_An_Indian_perspective

The increasing prevalence of inflammatory bowel disease (IBD) necessitates comprehensive management strategies, including addressing the risk of vaccine-preventable infections (VPIs) due to immunosuppressive therapies. Despite established guidelines, vaccination remains underutilized in adult IBD care, particularly in developing regions. Immunosuppressive treatments elevate infection risks, making pre-emptive vaccination crucial. Vaccines are categorized into live-attenuated and inactivated types, with timing critical to ensure efficacy and safety. Proactive vaccination protocols, especially in countries with limited adult immunization focus, are essential to reduce infection-related morbidity and mortality in IBD patients.

Immunization is underused in IBD care despite high infection risks from immunosuppressants—early, proactive vaccination is essential for prevention.

Strategic Immunization in IBD: A Clinical Priority Amidst Rising Infection Risks

Mohd Salman, MD

I want to focus in on topicals, given that clinical scenario I outlined. Let’s say you were going to stick with topicals for the in-between patient we talked about. Peter, is there general guidance in terms of body surface area when you’re thinking about topicals? A lot of this ties into earlier discussion on what’s practical for a patient, something they can follow through on. Is there a sweet spot where it works, beyond which it becomes impractical even if it’s mild or mild to moderate disease?

That’s another problem with the way we categorize disease. Frequently, if we’re doing something like an easy score, that takes body surface area heavily into account. But we have patients with very small body surface area, where it’s quite severe. Other times, patients are mild, but it’s overwhelming—like 90% body surface area. Part of the calculation is responsiveness to treatment and feasibility of treatment. For littler kids, you can get away with whole-body application of topicals. When they’re little, it’s easy because they’re portable; the parents can usually do it. But as the kids get older, adolescents in particular, it’s very tough. They get easy burnout and very fatigued about putting on a lot of topicals. For those patients, even small body surface areas might be an issue.

That’s the best way to approach it: on a person-to-person basis. But I always say that everybody’s got to try some topicals. Even when we’re on systemics, almost all our patients on the systemic agent are going to use some topicals; you’re never outside that. It depends on the response. Sometimes I’m confident that this is never going to work, and that when I talk to them next week, they’re going to say they’re worse. I think that they’re going to have to go on to a systemic agent. Then I call them, and they say, “No, it’s great. Pretty much everything is healed. I did most of the body for a few days, everything responded, and I’m focusing on my hands or my ankles. We made it.” Other times it’s small. I said, “Come on. Let’s push hard. We’ll do everything. We’ll do wet wraps.” Then in 2 weeks, they call me and say, “I’ve been using it like crazy, and my hands are still miserable and cracking and bleeding.” Then we have to go to systemics.

Oftentimes, when we’re making that move on the value of step-wise therapy for atopic dermatitis, we’re adding many of those therapies together. It’s not a straightforward discussion of trading in your topical for a systemic. There’s often concurrent use. Matt, when is combination therapy viable for patients? And when do you want to see if monotherapy does its thing? Is there a difference between the 2, or are you doing everything at once and peeling off? Take me through how this works in your practice.

For me—and we all practice this way—every patient who’s on a systemic is on combination therapy. Whenever I’m talking about drugs—let’s say I’m giving a promotional talk for a systemic—I tell the audience to ignore the monotherapy data, because they’re not clinically relevant. I tell them, “Those were data the FDA required, but they’re not clinically relevant.” The data we want to look at are the combination therapy along with topical corticosteroids. That’s what’s always done in the trials. When I put somebody on systemic therapy, I’m telling them, “Use your topical, but hopefully with the systemic that we have, you won’t need to use the topical anymore.” As you get better, you don’t need to keep using it.

That’s the case when I have people on combination therapy. If they need a little topical, I’m not worried about it. It’s not, “Let’s put you on a systemic. Once you’re better, we’ll stop the systemic and see if we can keep you on the topical.” No, it’s, “Let’s start you on a systemic. Assuming the systemic works good, you don’t need to use the topical anymore.” That’s the direction that I’m going in. Part of that is because it’s so hard from an insurance perspective to start and restart the systemics because patients stopped ordering it, or their authorization immediately is revoked.

The other part of it is the experience with the drugs that we have. If you stop the systemic, at some point the disease is going to come back. Peter has published—and I agree with him—that with the biologics, the data show you can give people a long-term remission. If they have done wonderfully and are clear, a lot of times, if they stop and you pick dupilumab, it might be 3 to 6 months or even longer before the disease comes back. But it’s going to come back. I always think in terms of infection risk in these patients. If we wait until the disease starts to flare, and before we restart therapy, they’ve already been through the high-risk period for getting a skin infection that can turn into something serious.

Dr Noor, you’re no stranger to getting many things on board to get someone under control. How does the idea of monotherapy and combination therapies play a role in what you’re doing, especially for someone who’s transitioned up the severity ladder? As Matt told us, combination therapy is the most indicative of what’s happening in the real world. Tell us about your practice.

One thing that’s very consistent with essentially every patient in my practice is that I look them in the face and say, “I’m going to get you better.” I can get you better because I have all these options, and these options are extensive. We have wonderful options, all the way down to cyclosporine and methotrexate, and the ability to combine different treatments. If we can appreciate the data, if we can appreciate the safety, then we can appreciate what to expect that this individual needs.

One thing that I always stand by, and it’s going to sound silly, is that I’m not a vending machine. I don’t do the same thing for each individual. It’s not like you come in, you punch in a button and say, “I have moderate atopic dermatitis,” and out comes your drug. That’s not how it works. Every patient is an individual, and I treat everybody individually to make sure I get the best possible outcome for that individual. Every patient knows that, in every room and in every scenario. If that means that they need to go on a biologic and a topical, like ruxolitinib; a biologic; or even an oral JAK inhibitor, then I’m going to take that situation individually and determine the best option for that patient.

Experts in dermatology share general guidance for use of topicals, switching from topical to systemic treatment, and when combination therapy is an option for patients with atopic dermatitis.

Guidance for Topical Treatment Use Based on BSA in AD

Omar Noor, MD

A pair of authors of a recent scientific statement and the president of the HFSA discuss cognitive impairment in heart failure. 

Role of Screening, Addressing Cognitive Impairment in Heart Failure Management

For some time, the heart failure community has warned of an impending storm brewing under the nose of public health despite their rallying cries and calls for a greater emphasis on management. With the aging US population as a backdrop, the prevalence of 

 is expected to grow in the coming years and, with heart failure fellowships going unfilled at an alarming rate, many in the field are concerned they are heading toward a perfect storm bent on wreaking havoc on public health.

The concern among filling fellowship slots aside, advanced heart failure and transplant specialists currently practicing have been confronting a growing concern associated with the aging population, but that could spell disaster for heart failure in particular: cognitive impairment. In their latest scientific statement, the Heart Failure Society of America has aimed at the issue and how it affects the management of heart failure.

Published on March 12, 2024, the 17-page document cites 142 references and is divided into 5 sections addressing the following subjects: risk factors for cognitive impairment, implications of cognitive impairment, management of cognitive impairment, integration of cognitive impairment into decision-making, and gaps in knowledge and challenges to implementation. In addition to calling attention to the prevalence of cognitive impairment in this patient population, the docuemnt also provides an overview of recommended screening tools and practices based on contemporary literature.

In this HCPLive peer-to-peer discussion, we spotlight perspectives on the subject from 3 subject matter experts in Eiran Gorodeski, MD, MPH, Parag Goyal, MD, MS, and James Fang, MD. In the conversation, Fang, who also serves as the president of the Heart Failure Society of America, acts as a moderator and guides Gorodeski and Goyal, who served as lead co-authors for the statement, through a discussion on the creation process, key takeaways, the complexities of heart failure management in patients with cognitive impairment, and the role of the Heart Failure Society of America and other professional organizations in aiding clinicians with incorporating changes and recommendations within these types of documents.

, director of the Advanced Heart Failure & Transplant Center at Harrington Heart & Vascular Institute in the University Hospitals Health System as well as section head of advanced heart failure in the Division of Cardiovascular Medicine and Professor of Medicine at Case Western Reserve University.

, statement co-author, associate professor of Medicine, the Founding Director of the Heart Failure with Preserved Ejection Fraction Program, and the director of the Cardiac Amyloidosis Program at Weill Cornell Medicine.

 president of the Heart Failure Society of America, chief of Cardiovascular Medicine at the University of Utah School of Medicine, and director of the Cardiovascular Service Line at University of Utah Health Care.

Relevant disclosures for Gorodeski include Dynamed Plus. Relevant disclosures for Goyal include Agepha, Axon, and Sensorum Health. Relevant disclosures for Fang include Amgen, AstraZeneca, Boehringer Ingelheim, Novartis, and 

Bozkurt B, Ahmad T, Alexander KM, et al. Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America. 

. 2023;29(10):1412-1451. doi:10.1016/j.cardfail.2023.07.006

Goyal P, DiDomenico RJ, Pressler SJ, Allen LA, Gorodeski EZ. Cognitive Impairment in Heart Failure: A Heart Failure Society of America Scientific Statement. 

. Published online March 12, 2024. doi:10.1016/j.cardfail.2024.01.003

Eiran Gorodeski, MD, MPH, Parag Goyal, MD, MSc, and James Fang, MD, discuss the HFSA's recent scientific statement on the prevalence and impact of cognitive impairment on the management of heart failure. 

The Role of Screening, Addressing Cognitive Impairment in Heart Failure Management

Parag Goyal, MD, MSc

The first question is, what is treatment resistant depression? So, when depression fails to respond to conventional treatment, then we call that treatment resistant depression (TRD). And beyond that very basic definition, it's only natural to ask yourself: “Well, how much treatment does it have to fail before it counts as TRD?” Right. So, if you look for a more precise definition or for a more fleshed out definition, it turns out that the definitions vary. Every place you go to has a different definition of TRD. The point here is that there is no consensus for a specific definition, and there's no universally accepted definition for what TRD is. As you'll see with these examples, there's differences in how many treatment attempts have to fail before you call it treatment resistance. Also, there's differences in parts of the wording [as well]. The definitions really vary.

How common is TRD? We just got through talking about how we don't have a precise definition, so if we don't have a precise definition, we sure don't have a precise percentage. But a very good rule of thumb is that it's roughly one third of patients with major depressive disorder (MDD) have TRD. Different people who have, you know, created estimates in different ways all come in at around that number. So, one out of three is just a very good rule of thumb. So, about a third of the people with MMD have TRD. With that many people with TRD, you know that anyone who practices mental health is going to have lots and lots of patients who they see who have TRD. The situation we see is kind of like this: You know, we see TRD all the time, every day. And I think so often that we hardly notice it sometimes because we're just we're just so used to it. Sometimes this can be the patient who comes in and says, "Oh, I'm doing fine." But when they say "fine," what they really mean is that they're not nearly as suicidal anymore. They are able to get up and go to work even though they're miserable, etc. Sometimes "fine" can still mean very depressed. Some of these people, you can give them a Patient Health Questionnaire (PHQ-9) and find out they're pretty darned depressed. We see these patients all the time who, even if they’re getting excellent care and the patient’s compliant and doing everything they’re supposed to do, [but] they’re doing lousy anyway. Of course, we all see that. Here we see, a lot of my patients just stay depressed: “This is fine.” The reason that this meme is amusing is because it's not fine. It's horrible for every individual with TRD; they are suffering. So, what can we do about it?

If a patient fails conventional treatment, what else can you do? I think the reason that TRD has come into our vocabulary so much more in recent years is that there's more we can do about it. So, it's worth talking about more because we have other things we can do. I'm going to list some of those other things we can do for treatment resistant depression. It's not an exhaustive list by any means, but here's some of the things we can do. One thing we can do for TRD is Transcranial Magnetic Stimulation (TMS). [It is] very safe, very effective. Also, there is Electroconvulsive therapy (ECT). ECT has its advantages and disadvantages. It is certainly has still has a place in psychiatry and it's been around a long time. There's ECT also. And then there's ketamine and esketamine. That's been increasingly used and for good reason. Here I just show the molecules; there's two mirror image molecules. The ketamine is a mixture of those two, esketamine is the one on the left. We have ketamine and esketamine are also good options. There's a lot more things to do. I mean, there's these and then there's, "but wait, there's more." There are psychedelic agents, there's deep brain stimulation, vagal nerve stimulation, direct transcranial current magnetic seizure therapy, [and] probably other stuff too that I don't I didn't remember to put on the slide. There are other options, but the ones I list I think are the main ones. If you can remember one thing from what I'm talking about, it's this: if you have patients who have an inadequate response to what you're doing; you can be doing a great job and your patient can still be doing lousy. If you're in that situation, then what I recommend is this: let's do something different because we've got different stuff. We have other treatments that work very, very well. So as a health care provider, it's our duty to learn as much as we can about these other options so that we can do the very best we can for the patients who trust us with their care.

Transcript was AI-generated and edited for clarity.

Steve Harvey, MD, discusses the challenges of defining treatment resistant depression and provides and overview of treatment options.

Overview of Treatment Resistant Depression

Steve Harvey, MD

) is the third leading cause of cancer-related death despite only accounting for 3% of all new cancer diagnoses.

 Obesity is a well-known risk factor for multiple types of cancer, including PDAC. In fact, there exists a relative risk of PDAC of 1.10 for every 5-unit increment increase in body mass index (BMI).

 While bariatric surgery has been demonstrated to reduce overall cancer incidence and mortality, conflicting data exist regarding the effects of bariatric surgery on PDAC.

We performed a retrospective case-control study utilizing the National Inpatient Sample (NIS) database from October 2015 to December 2020. All adult subjects (age ≥18 years) with a BMI >40 kg/m2 or >35 kg/m2 with ≥1 metabolic comorbidity were identified and stratified into those with and without a history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy).

, Tenth Edition Clinical Modification (ICD-10-CM) codes were used to define variables of interest. Baseline characteristics and comorbidities among the 2 groups were compared using chi-squared and Wilcoxon rank-sum tests and logistic regression analysis was performed to assess the risk of PDAC after adjusting for multiple risk factors, including tobacco use, acute and chronic pancreatitis, diabetes mellitus and various stages of obesity.

Over 19 million subjects were included, 1,656,329 of whom had a history of bariatric surgery. Patients with a history of bariatric surgery were significantly younger, more frequently female (75% vs 58%), had higher rates of class 3 obesity (69% vs 52%) and lower prevalence of hypertension, hyperlipidemia, chronic kidney disease, Charlson Comorbidity Index (CCI) ≥3, tobacco use, acute and chronic pancreatitis and pancreatic cancer (0.1% vs 0.2%) while having a higher prevalence of OSA (

 <.001). Additionally, in-hospital mortality (0.5% vs 1.8%), total hospital charges and overall length of stay were lower in the bariatric surgery cohort compared to the nonsurgical cohort (

 <.001). After adjusting for multiple comorbidities and risk factors, history of bariatric surgery was demonstrated to significantly reduce the risk of PDAC on both univariable (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.44 - 0.56) and multivariable analysis (OR, 0.68; 95% CI, 0.61 - 0.77).

This is the largest analysis to date investigating the effects of bariatric surgery on pancreatic cancer risk reduction and serves to clarify previously inconclusive data. We have shown bariatric surgery to exhibit an independently protective effect against PDAC oncogenesis. It is reasonable to suggest that patients at increased risk of PDAC as well as other obesity-related malignancies may be recommended for surgically-assisted weight loss earlier and more frequently.

With advancements in minimally invasive bariatric procedures, expanding patient eligibility and indications for surgery, increasing utilization of bariatric surgery and endoscopic bariatric and metabolic therapies may help alleviate the growing burden of pancreatic cancer.

Surveillance, Epidemiology and End Result (SEER) Program. Surveillance Research Program, National Cancer Institute. 2023 Apr 25. https://seer.cancer.gov.

Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. Apr 2012;23(4):843-52. doi:10.1093/annonc/mdr398

Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort. Ann Surg. Jan 2019;269(1):95-101. doi:10.1097/SLA.0000000000002525

Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). Apr 2009;17(4):796-802. doi:10.1038/oby.2008.610

Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. Jul 2009;10(7):653-62. doi:10.1016/S1470-2045(09)70159-7

Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc. Dec 2013;27(12):4449-56. doi:10.1007/s00464-013-3127-9

Bulsei J, Chierici A, Alifano M, et al. Bariatric surgery reduces the risk of pancreatic cancer in individuals with obesity before the age of 50 years: A nationwide administrative data study in France. Eur J Surg Oncol. Apr 2023;49(4):788-793. doi:10.1016/j.ejso.2022.11.013

Fan H, Mao Q, Zhang W, Fang Q, Zou Q, Gong J. The Impact of Bariatric Surgery on Pancreatic Cancer Risk: a Systematic Review and Meta-Analysis. Obes Surg. Apr 05 2023;doi:10.1007/s11695-023-06570-x

Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci. Mar 24 2023;24(7)doi:10.3390/ijms24076192

A history of bariatric surgery was associated with up to 50% reduced risk of PDAC among a national cohort.

Bariatric Surgery is Associated with Reduced Risk of Pancreatic Cancer: Analysis of a US National Database

Vibhu Chittajullu, MD

Role of PCPs in Proactively Discussing CRC Screening With Patients

How can primary care providers effectively communicate the importance of colorectal cancer screening and guide patients in selecting the most appropriate option?

What role do patient preferences and adherence play in choosing a colorectal cancer screening method?

What are future innovations in the colorectal cancer space?

Effective communication by primary care providers about colorectal cancer screening involves clear, empathetic discussions that emphasize the importance of early detection and personalized risk assessment. Providers should guide patients in selecting the most appropriate screening option by considering individual risk factors, preferences, and potential barriers to adherence. Patient preferences and adherence significantly influence the choice of screening method, as they impact the likelihood of completing the screening process. Future innovations in colorectal cancer screening may include advancements in non-invasive testing, improved risk stratification tools, and personalized screening schedules.

Vivek Kaul, MD, discusses how primary care providers can effectively communicate the importance of colorectal cancer screening and guide patients in selecting the most suitable option, and the significant role of patient preferences and adherence in this decision-making process, while also addressing future innovations in screening methods.

Authors