Panelists discuss how patient history, vaccination status, and risk of infection influence the decision to administer complement inhibitors, with some expressing caution in high-risk cases, particularly in pediatric populations with prior infections or low immunoglobulin levels.

Balancing Complement Inhibition and Infection Risk in C3G Treatment

Video content above is prompted by the following: 

Summary for Physicians on Use of Complement Inhibitors in High-Risk Patients:

Patients with nephrotic syndrome who experience significant protein loss, leading to very low IgG levels, are at an increased risk for infections. These patients may not be ideal candidates for complement inhibitors due to concerns about their ability to fight bacterial infections, particularly encapsulated organisms.

Early trial data, particularly from studies like 

, suggest that while complement inhibitors are used in posttransplant patients on immunosuppressive therapy, they did not significantly increase the risk of infections, especially when vaccinated and managed with prophylactic antibiotics.

Vaccination and prophylactic antibiotics (e.g., penicillin or macrolides) are essential to reduce infection risks when using complement inhibitors. It’s important to assess local infection resistance patterns (e.g., penicillin resistance rates) before initiating therapy.

Clinical trials, such as the APEX trial, excluded patients with a history of recurrent invasive infections caused by encapsulated organisms. However, in clinical practice, the timing of infections, vaccination status, and use of prophylactic antibiotics are important factors to consider.

A patient who has had a meningococcal infection but was not vaccinated may still be a candidate for complement inhibitor therapy if vaccinations are administered and prophylactic antibiotics are used.

In real-world settings, physicians may proceed with complement inhibitors in high-risk patients, provided that adequate precautions are taken, including vaccination, use of prophylactic antibiotics, and consultation with infectious disease specialists when necessary. This approach has been successful in managing patients safely over extended periods.

It’s crucial to address concerns from parents or caregivers, particularly in pediatric populations. Parents need reassurance regarding the safety of long-term use of complement inhibitors, especially in the context of infection risks.

Andrew S. Bomback, MD, MPH

Dr. Dennis Marcus discusses how the PDS with ranibizumab fits into the treatment landscape and explores other sustained delivery mechanisms currently in development for neovascular AMD.

Positioning PDS Within the Therapeutic Landscape

Video content above is prompted by the following:

How does the PDS with ranibizumab fit into the treatment landscape that also includes highly durable agents such as faricimab and high-dose aflibercept?

What other sustained delivery mechanisms are currently in development for neovascular AMD?

Dennis M. Marcus, MD

Protecting Cardiorenal Function in Diabetic Kidney Disease

1:27 Diabetes, kidney disease, and CV risk interrelationship

3:54 Expanding indications for SGLT2 inhibitors for CV risk reduction

5:40 CV benefits of SGLT2 inhibitors in clinical trials

9:20 Using stage and severity of CKD to guide treatment choice

14:00 Benefits of combining finerenone with SGLT2 inhibitors

16:30 Potential use of GLP 1 agonists for CKD

19:20 Considerations for incorporating therapies for CKD

23:00 Key takeaways on using new treatments for CKD

Dhiren Patel, PharmD, and Bob Busch, MD, interview Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine specialist, to examine the cardiovascular (CV) impact of obesity and delve into the potential benefits of newer weight loss medications in mitigating CV risk and heart failure.

Protecting Cardiorenal Function In Diabetic Kidney Disease

Dhiren Patel, PharmD, CECES, BC-ADM

Jo A. Hughes, DMSc, PA-C, CAQ-Psychiatry, is a managing partner/founder of Piedmont Partners for Mental Health, PLLC, and a clinical preceptor for PA students at High Point University.

As a mental health clinician and the mother of a professional baseball player, I've spent a lot of time thinking about what sports can teach us about stability, structure, and support. Over the years, I’ve also had the opportunity to work with athletes managing serious 

. Through those experiences, I’ve come to believe that mental health care, like athletics, demands coordination, discipline, and mutual support. It works best when it’s treated like a team sport: everyone—patients, providers, care partners, and community members—has a role to play, and no one wins alone.

BD-I is marked by alternating episodes of depression and mania, each with distinct disruptions to mood, energy, and behavior. These fluctuations can impair daily functioning if not properly managed.

While antipsychotics remain the standard of care in managing BD-I, psychosocial support is also critical to long-term wellness. One of the most effective non-pharmacologic strategies to mitigate mood episodes associated with BD-I is the establishment of consistent daily routines, including regular physical activity.

Circadian rhythm disturbances are common in BD-I. Adherence to structured schedules, including consistent sleep and activity patterns, can help regulate mood cycles and reduce the frequency or severity of manic or depressive episodes.

Sports offer a natural framework for this kind of structure. Within the context of sports, routine is inherent: practice sessions occur on set days, game schedules create predictability, and training programs instill discipline. For individuals with BD-I, participating in sports or adopting similar structured routines can provide a stabilizing force. In this way, the consistency that benefits athletes can also support patients by reinforcing daily rhythms and promoting mood stability. When patients, care partners, and clinicians work together to align on treatment plans, support routines, set expectations, and reinforce healthy habits, we create a framework that’s more likely to stick.

Exercise as an extension of clinical treatment

Exercise supports more than just physical health—it serves as a potent modulator of neurochemical activity. Physical activity triggers the release of endorphins, activates the dopaminergic system in the prefrontal cortex, and helps lower cortisol levels, reducing the impact of stress on the mind and body.

These changes do more than improve mood. They can support neuroplasticity, which may help the brain adapt more effectively to mood regulation challenges common in BD-I. They also enhance executive function skills, such as planning, focus, and emotional regulation, that are often impaired during both manic and depressive episodes.

Additionally, exercise can help lift the brain fog many patients report during depressive phases, improving clarity and day-to-day functioning. Regular movement, when integrated into a broader treatment plan, can serve as a valuable tool in restoring a sense of emotional balance and connection to self.

Beyond the brain, exercise delivers benefits throughout the body. People with BD-I are at higher risk of 

, obesity, and metabolic syndromes due to a combination of factors: physiological effects of the disorder, lifestyle patterns associated with mood episodes, and the side effects of some commonly prescribed medications to treat the condition. Regular physical activity can help address many of these, strengthening the connection between body and mind. As I often say to patients, “Physical well-being nurtures mental well-being."

The power of community and accountability

BD-I can be incredibly isolating. The enduring stigma surrounding serious mental illness often discourages patients from disclosing their diagnosis. And when people feel shame, they tend to retreat.

That’s where being part of a team, whether through an actual sports team or by viewing one’s care support network as a team, can be transformative. In both cases, the structure, shared goals, and sense of accountability can foster belonging. The sense of responsibility to others can spark movement even when personal motivation feels out of reach. Over time, that sense of responsibility can help foster connection, and connection can support confidence and engagement in their own care.

This dynamic of shared responsibility and mutual encouragement mirrors what successful mental health care should look like. Care partners, coaches, and players all play a vital role in reinforcing routines and detecting mood fluctuations that may warrant clinical attention.

Community organizations—whether a recreational league, yoga studio, or support group—can provide a sense of belonging that reinforces treatment goals. It’s this network of support that transforms care from a solitary effort into a collective one.

The integration of sports principles into mental health care, particularly for managing bipolar I disorder (BD-I), emphasizes the importance of routine, exercise, and community. Establishing consistent daily routines, akin to sports schedules, can stabilize mood cycles in BD-I patients. Exercise not only enhances physical health but also modulates neurochemical activity, supporting mood regulation and cognitive function. Community involvement, whether through sports teams or support networks, fosters accountability and reduces isolation, transforming mental health care into a collaborative effort that enhances treatment adherence and overall well-being.

Discover how structured routines and exercise enhance mental health for those with bipolar disorder, fostering stability, and community support.

Treating Bipolar Disorder Requires a Treatment Team, Not Just a Treatment Plan

Jo A. Hughes DMSc, PA-C

Joy Chang, MD, MS, is an assistant professor of medicine in the division of gastroenterology at the University of Michigan in Ann Arbor.

Recommended Biopsies in EoE and Assessing Severity

Current guidelines from the American College of Gastroenterology recommend obtaining at least 6 biopsies from 2 different levels of the esophagus due to EoE’s patchy distribution pattern. Research data demonstrate that diagnostic yield approaches 100% by the 5th or 6th biopsy specimen, emphasizing the importance of adequate sampling. Clinical practice typically involves using 2 separate specimen jars, with one targeting the proximal-mid esophagus and the other focusing on the distal esophagus. Many practitioners take 5 to 6 biopsy samples per jar, totaling 10 to 12 biopsies per procedure to maximize diagnostic accuracy for each esophageal region.

Targeted biopsies should focus on areas showing inflammatory features such as edema, exudates, and furrows, as these locations yield higher eosinophil concentrations. However, biopsies should be obtained even when the esophageal mucosa appears endoscopically normal, as microscopic changes may not be visible during endoscopy. This comprehensive approach ensures that EoE is not missed and helps rule out other conditions when eosinophilia is absent, preventing diagnostic delays and allowing for appropriate alternative diagnoses.

Severity assessment in EoE has historically been challenging due to the complex interplay between symptoms, endoscopic findings, and histological features. The American Gastroenterological Association recently developed an Index of Severity score that incorporates patient age, symptom frequency and severity, endoscopic mucosal findings, and histological characteristics to categorize patients into mild, moderate, or severe disease classifications. This standardized scoring system has demonstrated utility in both pediatric and adult populations and shows reliability for monitoring therapeutic responses. Severe disease typically presents in younger patients with complications such as strictures or food impactions, potentially warranting earlier, more aggressive treatment approaches. The goal of early intervention is preventing disease progression from inflammation to irreversible scarring and fibrosis, similar to severity-based treatment stratification used successfully in asthma management by allergy specialists.

Panelists discuss how proper eosinophilic esophagitis (EoE) diagnosis requires at least 6 biopsies from 2 esophageal levels due to the patchy nature of the disease, and how severity assessment using tools such as the AGA IC score incorporates symptoms, endoscopic findings, and histologic features to guide treatment decisions and potentially prevent progression to fibrosis and structuring through earlier intervention.

Joy Chang, MD, MS

Dr. Taub describes effective strategies in overcoming access barriers to novel lipid lowering therapies.

Overcoming Access Barriers to Novel Non Statin Therapies

The experts discuss barriers to initiate newer, more intensive lipid-lowering therapies after cardiovascular events and strategies to enhance access. A key challenge is overcoming inertia and reluctance to intensify therapy quickly. Even when attempts are made to accelerate treatment, new therapies are frequently denied by insurers.

For example, with the advent of PCSK9 inhibitor immunotherapy, the outstanding 60% LDL reductions seen in trials did not readily translate to clinical practice due to strict insurance approval criteria. However, eligibility criteria have eased over time, enhancing real-world access. Still, uniform approval standards are needed to facilitate broad access to novel therapies after events.

Strategies like shared decision-making boards between medical societies, clinicians, and payers can align guidelines with insurer expectations. One example is a one-page prior authorization checklist outlining required information like recent LDL levels, documentation of maximally tolerated statin therapy, and other key phrases payers look for. Incorporating such “buzzwords” into the medical record can accelerate approvals by addressing common reasons for denials.

In summary, overcoming clinical inertia as well as administrative burdens imposed by payers is critical to optimizing lipid management after cardiovascular events. A shared vision between stakeholders, clear documentation requirements, and streamlined approval processes for novel therapies can enhance real-world access and uptake.

Summary was AI-generated and edited for clarity. 

Dr Taub describes effective strategies in overcoming access barriers to novel lipid lowering therapies.

Manesh Patel, MD

Effects of AREDS Vitamins on Geographic Atrophy Lesions with Roger Goldberg, MD, MBA

2025 Association for Research in Vision and Ophthalmology (ARVO) annual meeting

, Roger Goldberg, MD, MBA, cofounder of Emmetrope Ophthalmics and a practicing vitreoretinal surgeon at Bay Area Retina Associates, presented the results from his post hoc analysis of the OAKS and DERBY phase 3 trials testing micronutrient supplements AREDS and AREDS2 in reducing nonsubfoveal (NSF) 

A previous post hoc analysis indicated AREDS and AREDS2 could potentially slow down GA lesion progression without affecting overall GA area growth. Goldberg and colleagues analyzed whether the OAKS and DERBY trial populations exhibited similar effects.

“We actually had quite a large population of patients with untreated geographic atrophy, of whom about half were on AREDS vitamins,” Goldberg told 

. “So we had a great comparison between patients on vitamins and patients not on vitamins.”

During the study, eyes were grouped by AREDS micronutrients use (AREDS, AREDS2, or no micronutrients); sham observed NSF GA eyes and fellow eyes with NSF GA that met study inclusion criteria from subjects in the modified intent-to-treat population were pooled and included in the analysis.

Changes in GA distance to foveal centerpoint from baseline and changes in square root transformed total GA lesion size, measured by reading center assessments on fundus autofluorescence (FAF) images over 24 months. For analyses of distance to foveal centerpoint, if it was reached or an event of exudative AMD occurred, the data from subsequent timepoints were excluded.

A total of 516 eyes with NSF GA were included – 226 of these were on micronutrients and 290 were not. Participants exhibited no meaningful difference in progression towards the fovea between the sham and fellow eyes between micronutrient supplementation compared to those not (13 µm faster growth, 

 = .5). There was also no meaningful difference in area-based GA progression between eyes on and not on oral supplementation (.07 mm more progression, 

Ultimately, Goldberg and colleagues noted that this analysis found no evidence that oral micronutrient supplements slow GA progression towards the fovea or overall GA growth. Goldberg also acknowledged the limited ability of post hoc analyses to fully guide clinical practice, justifying the study’s departure from previous findings.

“I think AREDS are safe, so if patients want to take them, I think that’s fine,” Goldberg said. “Do I think it’s a substitute for either considering one of the FDA approved medicines, or that it should impact or impede our development of new agents? No. But lots of therapies are in development across all stages, some still targeting a compliment cascade, some targeting totally new pathways. I’m excited and optimistic for what the next decade or two will bring.”

Goldberg reports the following disclosures: Regeneron, Alimera, EyePoint, Cognition, 4DMT, and others

Goldberg, R, Saperstein, D, Do, D, et al. Analysis of AREDS oral micronutrients supplementation on geographic atrophy growth: Insights from the OAKS and DERBY studies. Abstract presented at Association for Research in Vision and Ophthalmology in Salt Lake City, UT, from May 3 – May 8, 2025.

Goldberg’s post hoc analysis has indicated that AREDS and AREDS2 vitamins do not slow either GA progression to the fovea or overall GA growth.

Roger A. Goldberg, MD, MBA

An expert in the treatment of atopic dermatitis shares her perspectives on patient communication and treatment optimization practices.

Patient Communication and Utilization of JAK Inhibitors in Atopic Dermatitis

Video content above is prompted by the following questions:

How do you educate and counsel patients who want to consider or are currently using a JAK inhibitor?

How do you discuss treatment targets and manage patient expectations?

What suggestions do you have for patients and healthcare professionals to optimize treatment of AD with JAK inhibitors?


Ruth Ann Vleugels, MD, MPH, MBA

Before we transition out here, any thoughts on the future pipeline, phase 2 data, or phase 1 data, what’s the future here?

There are lots of potential options, more second-generation FMT [fecal microbiota transplantation] products that we can talk about, but we also have other narrow-spectrum antibiotics in the pipeline. The closest is ridinilazole, which is similar to fidaxomicin, and it’s going to target 

 and kill it very well, but also spare our commensal microbiota. The phase 2 data look great, it helped prevent recurrence among patients who received ridinilazole compared to oral vancomycin. That’s exciting to me.

There are 2 other microbiome-based therapies that have finished phase 2 clinical trials and 1 that has finished a phase 1 clinical trial. Going alphabetically, CP101 is a full-spectrum microbiome-based therapy that recently finished a phase 2 clinical trial and showed a 74.5% versus close to 60% success rates. This is going to go to a phase 3 clinical trial in the near future. There’s another one that is a room temperature stable or nonfrozen formulation of a capsule called RBX7455, and that one finished a phase 1 study with a 90% success rate, and a larger trial is being planned at this time. Then finally, moving on to what I call designer microbiome-based therapies, where the field is going to go, is VE303, which is from a donor-independent bacterial consortia. Recently in a press release, they had their phase 2 data presented, where the high-dose VE303 was statistically significant and clinically meaningfully different from the placebo in preventing recurrent 

 infection. There is lots of excitement going on in today’s world.

There’s one more. There’s a company now with a particular single strain of bacterium that thrives on a particular oligosaccharide that’s found in certain kinds of fibers where they’re hoping that this 1 strain, which would be a true probiotic, would be able to reduce the risk for recurrences of 

 We’ve really painted the entire spectrum of all the different therapeutic options. We start with full-spectrum stool, which is basically the entire biodiversity. We move toward another company that basically focuses on the different consortia, or the ecological niches, where defects in metabolism can then just be plugged right back in. Then we have these companies that are more designer that have found out that maybe we can pick this handful of species alone and give them back to our patients. And then companies that are probably more savvy have figured out that there may be some species that have multiple functions, and you may just need to give 1 species back. And of course, as we are scientists, we can figure out what we don’t need to give an organism back, we can just find the products that they produce or the proteins that are on their surface and use those. There’s a whole different spectrum of therapeutic options, which is great for our patients because at that point, we have options to choose what’s going to work best for patients in different scenarios.

So the future is bright. I would like to ask all of our participants to give us a final thought.

One of the things that we sometimes neglect is how devastating this disease is to our patients. We talked about the diarrhea itself, we talked about the hospitalization, the epidemiology, the impact on hospitals, but at the same time, there are a number of patients who have their lives turned upside down because of the first infection or the recurrences. I’ve taken care of patients who have lost their jobs, I’ve taken care of patients who can’t be with their families, who ask me if they can see their grandchildren. I’ve seen patients who have developed this post-traumatic stress disorder from having 

 infections. If we think about the thousands and thousands of recurrences that we see each year, there are thousands and thousands of people who are not the same after this infection. I’d like to stress to everyone who’s watching to read these guidelines and look to see what is the appropriate way to treat these patients the first time because that gives them the best chance of success of beating this infection so that they can go back to their normal lives afterward.

That was beautifully said, Carl. This infection creates a huge burden on individual patients, but also on our health care system. I’d also like to mention that the microbiome field and microbiome therapeutics are burgeoning right now. We are learning new things every single day, and some of these microbiome-targeted therapies are ultimately going to be studied in other diseases too, so hopefully, we can make an impact elsewhere in addition to 

 infections. And the last thing I’ll say is, eat your fiber and close the toilet lid when you flush.

I’ll add 2 things. One thing to add to Carl’s point that is paramount is educating our patients on the impact of this illness. When you see a patient for the first time, don’t just hand out an antibiotic prescription and say, “You’ll be fine.” Patient education is paramount. There are resources that are available at the CDC’s [Centers for Disease Control] website, NIH [National Institutes of Health] has resources, and also the C Diff Foundation is a tremendous resource that I suggest to my patients. The other point that I would make is that as these microbiome-based therapies become mainstay, they’re going to move from tertiary care centers, from infectious disease and GI [gastrointestinal] doctors to empower primary care providers, family practice providers, nurse practitioners, physician assistants, who are the first touchpoints that our patients sometimes have with recurrent 

 They should start thinking that they should be and will be able to prescribe these therapies to our patients.

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Closing out their discussion on Clostridioides difficile infection, panelists share closing thoughts on novel pipeline therapies.

Looking Toward the Future of CDI Management

Sahil Khanna, MBBS, MS

Ironing Out Deficiency: Anemia Management in Hematology and Oncology 

This presentation discusses the management of iron deficiency in a general hematology practice, covering causes, diagnosis, treatment options, and patient education, particularly regarding iron infusions.

Common Causes of Iron Deficiency in Hematology Practice:


Iron deficiency often results from conditions such as menorrhagia (heavy menstrual bleeding), gastric bypass surgery, chronic kidney disease, and certain cancer treatments, which may require iron supplementation to manage the deficiency.


Diagnosis relies on a combination of patient history and lab results. Clinicians must differentiate between iron deficiency and anemia. It’s important to understand the body’s need for iron and consider treatment options, such as oral or IV iron, with a trial period before retesting for improvements.


Oral iron is often the first treatment choice for many patients. However, not all patients are suitable candidates for oral iron, particularly if they have gastrointestinal issues or other complicating factors. IV iron may be necessary for those who do not respond to oral supplementation.


IV iron treatment involves dosing strategies that aim to minimize the number of infusions, reducing patient burden. Fewer doses are preferable when managing iron deficiency through IV iron therapy.


Adverse reactions to IV iron are rare but can occur. Common symptoms include nausea, typically the next day. Test doses may not predict the development of these reactions. It’s important to be prepared to manage these rare adverse events effectively.


Patient education is crucial to addressing concerns about the risks and benefits of IV iron infusions. For pregnant patients, it’s important to emphasize the benefits of iron supplementation for both the patient and the fetus. Follow-up after IV infusion may be necessary, and some patients will require regular check-ins.


If iron deficiency is suspected to be related to gastrointestinal issues, such as those related to colon cancer, referring patients to a gastroenterologist is key. Understanding the criteria for referral helps ensure appropriate management of underlying conditions.

Future Directions in Iron Deficiency Management:


Looking ahead, there is an increasing focus on early screening for iron deficiency, including more rigorous iron and ferritin testing, particularly in childhood. The goal is to reduce iron deficiency-related deaths globally and improve management practices.

In summary, the management of iron deficiency in hematology requires a comprehensive approach involving accurate diagnosis, appropriate treatment choices, patient education, and collaboration with specialists when necessary. Ongoing advancements in treatment and screening hold promise for improving outcomes and reducing the global burden of iron deficiency.

Panelists discuss how accurately diagnosing iron deficiency, selecting appropriate treatments like oral or intravenous iron, educating patients, and collaborating with specialists are essential for effective management and improving outcomes in hematology practice.

Authors