Adam Friedman, MD, FAAD, is professor and chair of 

 at George Washington University School of Medicine & Health Sciences in Washington, DC. At 

, he built his table discussion around a skill he says rarely factors into clinical training: saying no.¹ LEADderm was founded to address what organizers call dermatology's missing curriculum, covering skills such as mentorship, negotiation, and practice management.¹

Friedman used his own struggle with overcommitment as the starting point for a broader conversation about protecting limited time. Dermatology remains one of medicine's most selective specialties.² Friedman says competitive pressure trains applicants to say yes to nearly everything long before residency even begins, and the habit persists into academic and practice leadership roles.

Friedman's table centers on practical tactics: delaying an answer, and weighing whether an opportunity serves a career goal or personal energy. He also invites the requester into a shared decision about feasibility, an approach modeled on shared decision-making in patient care. He is also delivering an unrehearsed product theater at the meeting, delegating slides in real time with a co-presenter he had not previously met.

Friedman spoke in this Q&A discussion with 

 on-site at LEADderm 2026 in Newport Beach, California, about managing competing career demands.

: Can you walk us through the theme of your table here at LEADderm 2026?

When I was asked to come up with a discussion point around the table I am positioned at with attendees of LEADderm 2026, the first thing that came to mind was the power of yes, and even more so, the power of saying no, which, full disclosure, I am absolutely terrible at. Part of this is not just educating those sitting with me, but also an opportunity to self-reflect on how I manage my time and consider when I say yes and when I say no.

I'm a firm believer that early in your career, you should say yes to literally everything. You have no idea what door will open from saying yes to something that seems seemingly simple and how it can propel your career forward very quickly. The problem is you get very used to saying yes, and as you ascend the ranks, whether in academia or in practice, there is only a finite amount of time. So what you end up doing is not multitasking, which is not a real thing; you end up diluting your efforts. If you say yes to everything, you are giving less time to each thing and not doing anything with your full attention, and that's when you start dropping balls and undermining your reputation.

I think the biggest issue for any of us full-on yes responders is we're afraid if we say no, the opportunities disappear. I can tell you that is absolutely not true, unless you say no in the wrong way, which is also very possible. So I'll provide some tips I've learned over the years for how to say no in a way that doesn't disenfranchise others from inviting you again.

First, when you're asked to do something, do not shoot from the hip. You do not need an answer that second. You can say, let me circle back, let me look at my schedule, let me see what I can do. What that allows you to do is step back and ask: do I need to do this? Do I need to do this right now, for career gain, for personal gain, for personal life? And even if I don't need to do it, is it something I enjoy that will fill my cup so it invigorates me to take on the other soul-crushing things in my career?

The other thing I've started doing recently is applying shared decision-making, the same concept we use in patient care, to yes-or-no requests. You can go back to someone and say, I would really love to do this, but here are the things on my plate right now. What do you think? How do you think I can do this? Now you've passed it back to the person asking, and they may say, you're right, your plate is too full, you probably shouldn't be doing this. And now you didn't have to say the negative word, no. No doesn't have to be negative, but it's often perceived that way.

Taking time to make the decision, and including the person who asked you, takes the pressure and anxiety off of you. Now you've shared that load, and the perception will be that you thought about it critically, that you do want to do it, but you also want to give it your all. You'll be better respected for it.

: What do you feel is the biggest contributor to dermatologists taking on too much?

 I think it actually starts before our training, given dermatology is one of the most competitive fields. Not to scare anyone watching this, but last year's match rate was 46%. When I went into dermatology, it was roughly around 60%. I think because of that competitive nature, we are pushed to say yes to everything because we have to. If we want to get to the promised land, we have to do as many things as possible.

Even during residency, even though we have our MD and training licenses and are seeing patients, we still have this mindset that you've got to say yes to be part of the club, and it's really hard to learn how to turn that off. Even where I am in my career, sometimes I still think of myself in that position of trying to get into that cool club, so to speak, and it gives you that little bit of anxiety that pushes you to say yes even when you probably shouldn't.

So I think taking a step back to evaluate whether what you're being asked to do is really important right now is something we've never really done, because we've always said say yes, say yes, say yes. Now you actually can say not right now, or I'd love to but I'm just not available. I don't think anyone has talked about that along the pathway. It's always been, if you want this, you've got to suck it up and just say yes. As you go through your career that changes, but no one has given us the green flag for when that can happen.

: Are there other key points you highlight in your LEADderm presentation?

 One of the things I get to do at LEADderm 2026 is a product theater, which is no different from any conference. What's unique here is I'm doing it with a fellow faculty member I've never met before, and to keep it a little spicy, we didn't prep whatsoever. The LEADderm twist is we are going to delegate slides to each other in real time, just like you would in the real world, with some negotiation around whether my partner wants to take a slide or not, and vice versa.

That kind of unique spin on something we see at every conference really makes you think critically about how to deliver a presentation in partnership with someone else, because that mirrors what we do in negotiation regardless of where we are in our careers. We might negotiate in real time with a medical assistant, a practice manager, a resident, a fellow attending, or even the C-suite. There isn't all this prep time before a conference; it has to happen often in real time, and that's why I'm excited to present in that manner. Who knows what's going to happen? It'll be a huge success, of course, but we'll see. TBD.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Friedman had no relevant disclosures of note.

LEADderm. About LEADderm: a new kind of dermatology conference. leadderm.org. Accessed September 13, 2026. 

Articles

Adam Friedman framed leadership development around the under-taught competency of declining requests without damaging relationships. Early-career reflexive “yes” behaviors, reinforced by dermatology’s hypercompetitive pipeline, can become maladaptive as responsibilities scale and time becomes the limiting reagent. He emphasized avoiding impulsive commitments, pausing to assess strategic fit, bandwidth, and intrinsic reward, and using a shared decision-making style to externalize constraints with the requester. A live, unprepped co-presented product theater illustrated real-time delegation and negotiation dynamics.

Adam Friedman, MD, breaks down how to say no strategically in dermatology, from delaying an answer to sharing the decision with the requester.

Q&A: Why Saying 'No' is a Career Skill as a Clinician, with Adam Friedman, MD

Ragweed, mold, and lingering warm temperatures are driving this year's 

 season, and clinicians fielding a fresh wave of nasal symptom complaints now have an updated evidence base to prescribe against.

 The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, in collaboration with the European Academy of Allergy and Clinical Immunology (EAACI), published its 2024-2025 revision of the ARIA guidelines across 2 manuscripts in the journal Allergy earlier this year, with part 1 on intranasal treatments appearing in April 2026 and part 2 on oral and ocular treatments following in June 2026.

The writing group, led by Bernardo Sousa-Pinto, MD, PhD (University of Porto), and Jean Bousquet, MD, PhD (Institute of Allergology, Charité—Universitätsmedizin Berlin), developed the update using GRADE methodology, marking the first substantive revision to ARIA's pharmacologic recommendations since 2016 and the most significant shift in first-line intranasal therapy since the original 2010 update.

 For clinicians prescribing this season, whether starting fresh or revisiting regimens for patients whose fall symptoms outlast a single-agent spray, the update changes which therapy tops the treatment ladder.

The guideline reflects a broader move toward combination intranasal therapy over monotherapy. It also introduces individual agent-level preferences within drug classes for the first time, rather than stopping at class-level recommendations, and it reverses a prior recommendation on intranasal decongestants, a category patients often reach for on their own as fall congestion sets in.

Q: What is new about this guideline compared with ARIA 2010/2016?

Four questions were evaluated for the first time in this revision:

Should a fixed combination of an intranasal antihistamine and intranasal corticosteroid (INAH+INCS) be used over no treatment at all? 

Should a particular intranasal corticosteroid be preferred over others? 

(conditional recommendation favoring fluticasone furoate/propionate)

Should one fixed combination be preferred over another?

 (conditional recommendation favoring azelastine-fluticasone)

Should an intranasal corticosteroid be combined with a decongestant or used alone? 

(conditional recommendation against adding the decongestant)

Additionally, 3 existing recommendations changed in strength or directionality:

(now a strong recommendation toward INAH)

Intranasal decongestant vs. no treatment 

(flipped from conditional-for to conditional-against for long-term use)

 (shifted from "either is fine" to conditional preference for the combination)

The key shift: fixed INAH+INCS combinations move from an equal alternative to INCS monotherapy to the preferred option when monotherapy is unlikely to control symptoms.

Q: What is the key recommendation on combination intranasal therapy?

 In patients with allergic rhinitis in whom monotherapy is unlikely to lead to significant symptom improvement, the guideline recommends using a fixed INAH+INCS combination over no treatment, a strong recommendation based on moderate certainty of evidence for seasonal allergic rhinitis and very low certainty of evidence for perennial allergic rhinitis.

Q: Which individual agents does the guideline prefer within each class?

 For INCS monotherapy, the guideline suggests fluticasone furoate or fluticasone propionate over beclomethasone, budesonide, ciclesonide, mometasone, and triamcinolone, a conditional recommendation based on low to very low certainty of evidence drawn from network meta-analysis.

For fixed combination therapy, it suggests azelastine-fluticasone over olopatadine-mometasone, a conditional recommendation based on moderate certainty of evidence in seasonal allergic rhinitis. The guideline notes that both combinations share a similar safety profile and that olopatadine-mometasone may be preferred in patients who find azelastine-fluticasone's taste profile intolerable.

Q: What changed regarding intranasal decongestants?

 The guideline now recommends against adding an intranasal decongestant to an INCS, a reversal from the 2010/2016 guidelines. The current recommendation is conditional and based on very low certainty of evidence.

Q: What does part 2 recommend for oral and ocular treatment?

 The panel now conditionally recommends against adding a leukotriene receptor antagonist (LTRA) to an oral antihistamine.

For eye symptoms, oral antihistamines are conditionally preferred over ocular antihistamines except when very fast relief is needed. Ocular antihistamines are conditionally preferred over ocular mast cell stabilizers.

On choosing among individual oral antihistamines, the guideline stops short of naming a winner: cetirizine, bilastine, rupatadine, loratadine, and others each have tradeoffs in sedation, onset, and affordability, so the recommendation is to match agent to patient preference rather than default to one drug.

(changed from conditional to strong recommendation for OAH)

 (upgraded to a strong recommendation for INCS)

 (reversed to a conditional recommendation against LTRA in both seasonal and perennial disease, reflecting rare but serious neuropsychiatric safety signals)

 (now conditional against starting OcAH in seasonal disease (except brief or as-needed use) but conditional for OcAH in perennial disease)

Q: Are there population-specific caveats clinicians should know?

 Yes. The INCS agent-level preference was not extended to children and adolescents due to insufficient evidence for that population. For the combination-agent comparison, the guideline suggests either azelastine-fluticasone or olopatadine-mometasone in children and adolescents rather than favoring one. The writing group also notes that in low- and middle-income countries, availability and affordability, including WHO Essential Medicines List status for budesonide, may reasonably outweigh the efficacy-based preference for fluticasone formulations.

Why Are You Getting Allergies in the Fall? Cleveland Clinic. Published September 9, 2026. Accessed September 11, 2026. 

https://health.clevelandclinic.org/fall-allergies

Sousa-Pinto B, Bousquet J, Vieira RJ, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI guidelines-2024-2025 revision: part I-guidelines on intranasal treatments. Allergy. 2026;81(4):954-976. 

Vieira RJ, Sousa-Pinto B, Bousquet J, et al. Allergic Rhinitis and Its Impact on Asthma (ARIA)-EAACI guidelines-2024-2025 revision: part II-guidelines on oral and ocular treatments. Allergy. 2026;81:1947-1970. 

Brożek JL, Bousquet J, Agache I, Agarwal A, Bachert C, Bosnic-Anticevich S, Brignardello-Petersen R, Canonica GW, Casale T, Chavannes NH, Correia de Sousa J, Cruz AA, Cuello-Garcia CA, Demoly P, Dykewicz M, Etxeandia-Ikobaltzeta I, Florez ID, Fokkens W, Fonseca J, Hellings PW, Klimek L, Kowalski S, Kuna P, Laisaar KT, Larenas-Linnemann DE, Lødrup Carlsen KC, Manning PJ, Meltzer E, Mullol J, Muraro A, O'Hehir R, Ohta K, Panzner P, Papadopoulos N, Park HS, Passalacqua G, Pawankar R, Price D, Riva JJ, Roldán Y, Ryan D, Sadeghirad B, Samolinski B, Schmid-Grendelmeier P, Sheikh A, Togias A, Valero A, Valiulis A, Valovirta E, Ventresca M, Wallace D, Waserman S, Wickman M, Wiercioch W, Yepes-Nuñez JJ, Zhang L, Zhang Y, Zidarn M, Zuberbier T, Schünemann HJ. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines-2016 revision. J Allergy Clin Immunol. 2017 Oct;140(4):950-958. 

doi: 10.1016/j.jaci.2017.03.050. Epub 2017 Jun 8. PMID: 28602936

ARIA–EAACI’s 2024–2025 revision (GRADE-based) meaningfully reshapes pharmacologic management of allergic rhinitis, representing the first major update since 2016 and a pivotal change in intranasal first-line strategy. Fixed intranasal antihistamine plus intranasal corticosteroid combinations are elevated over corticosteroid monotherapy when monotherapy is unlikely to control symptoms. For intranasal corticosteroids, fluticasone furoate/propionate are conditionally favored. Guidance also reverses prior support for long-term intranasal decongestant add-on use and updates oral/ocular recommendations, including a more restrictive stance on LTRAs.

As ragweed and mold drive this year's fall symptom surge, updated GRADE recommendations shift first-line therapy toward combination intranasal treatment.

FAQ: Treating Fall Allergic Rhinitis Under The 2026 ARIA-EAACI Update

Welcome to The HCPFive, your go-to roundup for the latest healthcare news and breakthroughs, curated specifically for busy healthcare professionals. Each week, we highlight 5 key developments or headlines from healthcare that you need to know — whether it's a cutting-edge treatment, regulatory updates, or innovations shaping the future of medicine.

This week's top stories include the US Food and Drug Administration (FDA) approval of Abbott's TactiFlex Duo Ablation Catheter, Sensor Enabled, for patients with 

, the acceptance of Intellia Therapeutics’ Biologics License Application (BLA) for lonvoguran ziclumeran (lonvo-z) for 

, Breakthrough Therapy designation for DT120 (lysergide) orally disintegrating tablet for 

, positive 12-week induction results from Part A of the phase 2 SKYLINE trial evaluating SPY003 for 

, and positive topline results from the phase 3 CHAPTER-3 study of deucrictibant extended-release (XR) tablet for HAE.

With The HCPFive, you'll get the essential takeaways to stay informed and ahead of the curve. Here's your quick dive into the top stories for the week of September 06, 2026 — let's jump in!

TactiFlex Duo Ablation Catheter Receives FDA Approval for AFib

On September 8, 2026, the FDA approved Abbott's TactiFlex Duo Ablation Catheter, Sensor Enabled, for treating patients with atrial fibrillation, including complex cases. The approval rests on 12-month results from the FlexPulse investigational device exemption (IDE) study, presented as late-breaking data at the European Society of Cardiology (ESC) Congress 2026 and published simultaneously in EP Europace.

Lonvo-z BLA Accepted by FDA With Priority Review for HAE

On September 8, 2026, the FDA accepted Intellia Therapeutics’ BLA for lonvoguran ziclumeran (lonvo-z) and granted it priority review for HAE in patients aged ≥ 16 years, setting a Prescription Drug User Fee Act (PDUFA) target action date of March 10, 2027. If approved, lonvo-z would become the first in vivo CRISPR-based therapy to reach the HAE market and the only one-time treatment option available to patients who currently manage the disease with chronic intravenous or subcutaneous prophylaxis.

DT120 ODT Receives Second FDA Breakthrough Therapy Designation in MDD

On September 8, 2026, Definium Therapeutics received a second Breakthrough Therapy designation from the FDA for DT120 (lysergide) orally disintegrating tablet, this time for major depressive disorder. The designation follows an initial Breakthrough Therapy designation for DT120 in generalized anxiety disorder, positioning the ergoline-derived 5-HT2A partial agonist across 2 psychiatric indications with FDA-recognized potential for substantial improvement over available therapy.

SPY003 Meets Primary Endpoint in Phase 2 Trial for Ulcerative Colitis

On September 8, 2026, Spyre Therapeutics reported positive 12-week induction results from Part A of the phase 2 SKYLINE trial evaluating SPY003, an investigational anti-IL-23 antibody, in patients with moderately-to-severely active UC. According to the Company, this readout completes proof-of-concept for all 3 components of Spyre's inflammatory bowel disease (IBD) combination pipeline, following earlier positive Part A results for SPY001 (anti-α4β7) and SPY002 (anti-TL1A).

Deucrictibant XR Meets Primary Endpoint in HAE Prophylaxis

On September 8, 2026, Pharvaris reported positive topline results from the phase 3 CHAPTER-3 study of deucrictibant extended-release (XR) tablet, showing an 83% reduction in mean monthly HAE attack rate versus placebo (P <.0001) across all 3 HAE types in adolescents and adults. The study is the first and only prophylaxis phase 3 program to evaluate all 3 HAE types, including HAE with normal C1 inhibitor, a population without a dedicated oral prophylactic option in this analysis.

Regulatory and clinical milestones spanned electrophysiology, rare disease, psychiatry, and IBD. FDA cleared Abbott’s TactiFlex Duo sensor-enabled ablation catheter for atrial fibrillation based on 12‑month FlexPulse IDE outcomes. Intellia’s lonvoguran ziclumeran BLA for hereditary angioedema received priority review, targeting a March 2027 action date and offering a potential one-time in vivo CRISPR option. Definium’s DT120 lysergide ODT earned a second Breakthrough Therapy designation for MDD. Spyre’s SPY003 met phase 2 UC induction endpoints. Pharvaris’ deucrictibant XR reduced HAE attacks 83% in phase 3.

Stay updated with the latest healthcare breakthroughs, including a new ablation catheter for AFib and progress in the hereditary angioedema pipeline.

The HCPFive: Top News for Healthcare Providers from the Week of 09/06

Evolocumab substantially improves survival in high-risk patients without a prior 

, according to a new subanalysis of VESALIUS-CV.

Evolocumab Improves Survival in Patients Without Prior MI or Stroke

European Society of Cardiology (ESC) Congress 2026

 in Munich, Germany, by Robert Giugliano, MD, professor of medicine at Harvard Medical School and a physician at Brigham & Women’s Hospital.

“If you start a cholesterol-lowering medicine today, you’re not going to prevent a death tomorrow, or in a week, or in a month, or even in a year. It takes a while. You’re affecting the underlying pathology,” Giugliano told 

in an exclusive interview. “You’re changing the plaque, but it takes a while for that to translate into a reduction in death. So, we have to treat patients for a lifetime.”

The original VESALIUS-CV trial was an international, double-blind, randomized, placebo-controlled trial across 774 sites in 33 countries. Patients were eligible for inclusion if they were 50-79 years of age in men or 55-79 years of age in women and had an LDL-C level of ≥90 mg/dL, a non-HDL-C level of ≥120 mg/dL, or an apolipoprotein B level ≥80 mg/dL. Additionally, patients were required to be on stable, optimized lipid-lowering therapy for ≥2 weeks.

Patients were assigned in a 1:1 ratio to either evolocumab 140 mg every 2 weeks or matching placebo. The 2 primary efficacy endpoints were a composite of death from coronary heart disease, MI, or ischemic stroke (3-point major adverse cardiovascular event [MACE]) and a composite of 3-point MACE and ischemia-driven arterial revascularization. Secondary endpoints included each individual component and composites of pairs of each component.

A total of 12,257 patients were assigned to receive either evolocumab (n = 6129) or placebo (n = 6128), with a median age of 66 years and 43% women. After a median follow-up of 4.6 years, 3-point MACE events occurred in 336 patients in the evolocumab group and 443 in the placebo group (HR, 0.75; 95% CI, 0.65-0.86; 

 <.001), and 4-point MACE events occurred in 747 patients in the evolocumab group versus 907 in the placebo group (HR, 0.81; 95% CI, 0.73-0.89; 

The present study was a prespecified secondary analysis of the VESALIUS-CV trial, incorporating all 12,257 patients from the original trial. Giugliano and colleagues evaluated the effects of evolocumab for all-cause mortality and cause-specific death, including cardiovascular disease, non-cardiovascular disease, and deaths of undetermined etiology. Cardiovascular death was further subcategorized as acute MI, sudden cardiac death, heart failure, cardiovascular hemorrhage, cardiovascular procedures, or other cardiovascular causes.

During the 4.6-year follow-up, 973 patients died. Patients who died were more likely to be older at baseline with a higher prevalence of high-risk diabetes and kidney dysfunction. Of the 973 deaths, 351 (36%) were adjudicated as attributable to cardiovascular causes, 497 (51%) were non-cardiovascular, and 125 (13%) were of undetermined cause. The most frequent causes of cardiovascular death were sudden cardiac death (n = 174), heart failure (n = 58), acute MI (n = 44), and stroke (n = 39), representing 50%, 17%, 13%, and 11% of all cardiovascular deaths, respectively.

Evolocumab nominally reduced the rate of all-cause mortality by 20% - among the evolocumab group, 434 patients died (5-year Kaplan-Meier rate, 7.9%), compared to 539 deaths in the placebo arm (9.7%) (HR, 0.8; 95% CI, 0.7-0.91; 

 = .0005). There was no reduction in mortality endpoints in the first 1.5 years (HR, 0.99; 95% CI, 0.78-1.25), according to landmark analyses; this was followed by a 27% reduction thereafter (HR, 0.73; 95% CI, 0.63-0.85).

Giugliano and colleagues ultimately concluded that these data support the use of evolocumab to improve survival in patients without prior MI or stroke, particularly among those with high-risk diabetes without qualifying atherosclerosis. However, the implementation of this treatment, Giugliano acknowledges, will likely face the same limitations as other lipid-lowering therapies.

“A large gap in background treatment of hyperlipidemias persists even in patients at high risk, patients who have known, diagnosed coronary disease, or cerebrovascular disease, or peripheral arterial disease, or high-risk diabetes,” Giugliano said. “We need to do a better job at reducing LDLs across the board, particularly in those patients at high risk.”

Editors’ Note: Giugliano reports disclosures from Amgen, Daiichi-Sankyo, Inventiva Pharma, Novartis, Pfizer, Sanofi, and others.

Giugliano RP, Bohula EA, Bellavia A, et al. Effects of evolocumab on mortality outcomes in patients without previous myocardial infarction or stroke: A prespecified analysis of the VESALIUS-CV randomized clinical trial. Circulation. Published online August 31, 2026. 

Bohula EA, Marston NA, Bhatia AK, et al. Evolocumab in patients without a previous myocardial infarction or stroke. New England Journal of Medicine. 2026;394(2):117-127. 

Videos

Robert Giugliano, MD, breaks down his prespecified subanalysis of the VESALIUS-CV trial, evaluating evolocumab’s effect on cardiovascular mortality.

Verekitug, an investigational monoclonal antibody that targets the thymic stromal lymphopoietin (TSLP) receptor, met its primary endpoint in the phase 2 VALIANT trial, reducing annualized 

 exacerbation rates by as much as 56% overall and 87% in patients with elevated eosinophil counts. The results, from Upstream Bio's ongoing development program in severe asthma, were presented at the 

European Respiratory Society (ERS) Congress 2026

"Even low concentrations of verekitug are sufficient to saturate the TSLP receptors, and therefore abrogate some of the TSLP signaling, and this allows for longer dosing intervals," Michael Wechsler, MD, MMSc, professor of medicine and director of the Cohen Family Asthma Institute at National Jewish Health, said in an interview with HCPLive.

Verekitug Reduces Asthma Exacerbations Up to 87%, With Michael Wechsler, MD

TSLP is an upstream epithelial alarmin that drives activation of interleukin-4, interleukin-5, and interleukin-13 through T helper 2 cells and ILC2 cells, playing a central role in the type 2 inflammatory pathways implicated in asthma and chronic sinusitis with nasal polyps (CRSwNP). While other therapies, including tezepelumab, target TSLP itself, verekitug is the only agent in development that targets the TSLP receptor directly. Wechsler noted that the added benefit is an extended half-life alongside a robust efficacy signal, building on what he described as an already well-validated pathway.

VALIANT was a multicenter, randomized, placebo-controlled phase 2 trial that enrolled 478 adults with poorly controlled asthma, defined by an Asthma Control Questionnaire (ACQ) score >1.5, along with either 2 exacerbations or 1 emergency department visit with inpatient care in the prior year, or 1 exacerbation plus an exhaled nitric oxide level >50. All participants required a medium to high dose inhaled corticosteroid for at least 3 months prior to enrollment. Patients were randomized to 1 of 3 verekitug doses, 100 mg every 12 weeks, 400 mg every 24 weeks, or 100 mg every 24 weeks, or to placebo. The primary outcome was the annualized asthma exacerbation rate through week 60, with a minimum of 24 weeks of drug exposure required; median exposure across the trial was approximately 37 weeks.

Baseline ACQ-6 scores ranged from 2.5 to 2.7, with eosinophil counts between 250 and 290 cells/microliter and lung function near 60%. The placebo arm had an annualized exacerbation rate of approximately 1.52, while all 3 verekitug doses produced statistically significant and clinically meaningful reductions, ranging from 39% to 56%, independent of phenotype. The effect was more pronounced among patients with eosinophil counts ≥300 cells/microliter.

"In the patients who had high eosinophil counts, there was an 87% reduction in exacerbations. This is really exciting. It's best in class as far as I'm concerned, for demonstrating a reduction in exacerbations," Wechsler said. Patients with eosinophil counts <150 cells/microliter, who represent roughly 20% of the severe asthma population, did not show a significant reduction. Verekitug also improved forced expiratory volume in 1 second (FEV1), with 100 to 157 mL gains at 6 months, along with improvements in ACQ scores and exhaled nitric oxide levels.

Verekitug's Quarterly Dosing Cuts Asthma Burden, With Michael Wechsler, MD

Editor’s Note: Wechsler reports relevant disclosures with Upstream Bio and is principal investigator on the VALIANT trial.

Upstream Bio Reports Positive Top-line Results from the Phase 2 VALIANT Trial of Verekitug for the Treatment of Severe Asthma. GlobeNewswire. February 11, 2026. 

https://www.globenewswire.com/news-release/2026/02/11/3236073/0/en/Upstream-Bio-Reports-Positive-Top-line-Results-from-the-Phase-2-VALIANT-Trial-of-Verekitug-for-the-Treatment-of-Severe-Asthma.html

Upstream Bio Presents Results from the Phase 2 VALIANT Trial of Verekitug for the Treatment of Severe Asthma in Oral Presentation at ERS Congress 2026. GlobeNewswire. September 8, 2026. 

https://www.globenewswire.com/news-release/2026/09/08/3357341/0/en/upstream-bio-presents-results-from-the-phase-2-valiant-trial-of-verekitug-for-the-treatment-of-severe-asthma-in-oral-presentation-at-ers-congress-2026.html

Phase 2 VALIANT data show the anti-TSLP receptor antibody sharply reduced exacerbations in patients with high eosinophil counts.

Dermatologists increasingly step into administrative and health system leadership roles despite limited formal leadership training during residency or fellowship.

LEADderm, founded and chaired by Jennifer Soung, MD, was built to close this gap, prioritizing skills such as mentorship, negotiation, and practice building over traditional clinical programming.¹ The 2026 meeting convened dermatologists, physician associates, and nurse practitioners in Newport Beach, California, for 2 days of leadership-focused sessions.¹

Kristina Duffin, MD, MS, is professor of dermatology and dean of the Spencer Fox Eccles School of Medicine at the University of Utah. She built her session, "Lessons in Leadership: Elements & Experiments," around the framework from the book Total Leadership.² She examined what qualities and behaviors leaders bring to four areas of life: work, home, spiritual or personal life, and community.

She described physician leaders taking on new roles beyond clinical care, including chief problem solver, chief vision setter, and chief cultural attaché. Duffin outlined a three-question framework for delegation: whether a task belongs only to the leader, whether someone else would benefit from solving it as sponsorship or mentorship, or whether it falls outside the leader's role.

She pointed to professional coaching and leadership courses, including programs from the American Academy of Dermatology and Intermountain Health, as ways to build these relational skills. "You cannot do CPR and run the code at the same time," said Duffin, describing how leaders must learn which problems are truly theirs to solve.

In the following Q&A discussion, Duffin sat down with 

 at LEADderm 2026 in Newport Beach, California, to discuss the elements and experiments behind her leadership journey:

: Why did you choose ‘Lessons in Leadership: Elements and Experiments’ as your LEADderm topic?

 I wanted to share a little of my story about my journey to leadership, because I think there are misconceptions about how people become leaders. Sometimes it's not that intentional, and you have to learn a lot about your own skills and strengths as you move into it. I wanted to knit together some of the elements I found valuable in leadership, as well as the experiments that resulted from that.

: What were the main takeaways from your session?

 A lot of what we've been talking about today at LEADderm has been about personal resilience, well-being, building community, and how to speak in a way that commands a room, many different individual skills. What I felt I needed to start with was what qualities, traits, or elements are necessary for my own thriving in leadership. I've read many books about leadership, and one of my favorites is called Total Leadership, which asks what qualities, traits, or behaviors you should bring to all four aspects of your life: work life, home life, spiritual or self life, and community. That's an exploration for every leader to have. From there, I looked at how to deploy those things in being a leader: being the chief problem solver, the chief vision setter, and the chief cultural attaché.

: What's one tip from the talk that's most worthwhile for clinicians to take away?

 Health care providers are leaders in their own right. They're leading their teams, and they're leading their patients toward better health decisions, so leaders are always made in health care. As you move up, whether you become a vice chair, a chair, or a dean, you're going to be asked to solve problems, and the most important thing you can do at that point is ask: is this my problem to solve? Define that as carefully as you can. The slogan I brought was a quote from a colleague of mine from many years ago: you cannot do CPR and run the code at the same time. As a leader, the things you were doing before change. You might not see as many patients, or you might do supervision and education to help people become better physicians.

: Is knowing when to take charge versus delegate key for budding leaders in dermatology?

 Absolutely. There are three questions to ask: Is this something only I can do in my current role? If so, that's your job. Or is this something someone else would be better at solving? Maybe they're becoming a leader themselves, and giving them that problem helps them; that's sponsorship. Or you help them solve it; that's mentorship. The last option is that it's not your job at all. The risk of doing someone else's job is that you're taking time you shouldn't be devoting to it anymore, and you might damage the relationship. People generally don't want you to do their job for them.

: What tips do you have for clinicians who want to step into leadership roles but aren't there yet?

 The most critical activity I did early on, when I was moving toward leadership, was coaching. Having a professional coach who's good at pointing out your blind spots helps you understand how to be individualistic and yet still be part of a community and a team. Those skills aren't necessarily things you're born with; they can be learned, taught, and absorbed. I recommend individual coaches, or leadership courses like this one at LEADderm, as well as courses offered by the American Academy of Dermatology and other organizations. Intermountain Health, for example, offers one focused on exploring the personal qualities and traits of leadership rather than how to balance a spreadsheet or understand health care economics. It's about relational leadership traits, and those are very valuable.

Editor's Note: This transcript has been edited for grammar and clarity using artificial intelligence tools. Duffin had no relevant financial disclosures of note.

Smith T. Conference Preview: 2026 LEADderm Conference in Newport Beach, CA. HCPLive. Published August 27, 2026. Accessed September 11, 2026. 

https://www.hcplive.com/view/conference-preview-2026-leadderm-conference-newport-beach-ca

University of Utah Health. Kristina Callis Duffin, MD, MS, Named Dean of the Spencer Fox Eccles School of Medicine at the University of Utah. Published April 1, 2026. Accessed September 11, 2026. 

https://healthcare.utah.edu/press-releases/2026/04/kristina-callis-duffin-md-ms-named-dean-of-spencer-fox-eccles-school-of

Dermatology clinicians are increasingly expected to lead teams and health systems, yet formal leadership training remains uncommon. LEADderm was created to fill this gap with programming centered on mentorship, negotiation, practice development, and relational skills. Kristina Duffin applied the Total Leadership framework to align leadership behaviors across work, home, self/spiritual life, and community, framing senior roles as chief problem solver, vision setter, and cultural attaché. She emphasized disciplined delegation, recognizing which problems belong to the leader, and using coaching and structured courses to uncover blind spots.

Kristina Duffin, MD, dean of the Spencer Fox Eccles School of Medicine, discusses leadership, delegation, and coaching at LEADderm 2026.

Q&A: Lessons in Leadership from LEADderm 2026, With Kristina Duffin, MD

A significantly greater proportion of patients with 

severe chronic rhinosinusitis with nasal polyps (CRSwNP)

 achieved composite asthma clinical remission at week 24 with dupilumab (Dupixent) than with omalizumab (Xolair), according to an analysis of the phase 4 EVEREST trial presented at the 

European Respiratory Society (ERS) 2026 Congress

EVEREST is the first head-to-head trial comparing 2 approved biologics in this overlapping upper and lower airway population.

 Topline efficacy results were published in 

 in December 2025, and the new analysis extends those findings by evaluating a composite asthma remission endpoint incorporating exacerbations, oral corticosteroid (OCS) use, lung function stability, and symptom control.

Guy Brusselle, MD, PhD, of Ghent University Hospital in Belgium, discussed the trial design and findings with 

“Although the active comparator is not [a] placebo but an active treatment, omalizumab, the dupilumab-treated group has a more profound benefit, and the difference between these 2 active treatments is above the MCID, the minimal clinically important difference,” Brusselle said. “So, [these are] very intriguing results.”

Dupilumab Outperforms Omalizumab for Asthma Remission in phase 4 EVEREST

Dupilumab Outperforms Omalizumab for Asthma Remission in Phase 4 EVEREST

Dupilumab Achieves Greater Asthma Clinical Remission Rates in EVEREST

EVEREST randomized 360 adults with severe CRSwNP and coexisting asthma of any severity 1:1 to subcutaneous dupilumab 300 mg every 2 weeks (n = 181) or weight- and IgE-tiered omalizumab 75-600 mg every 2 or 4 weeks (n = 179) for 24 weeks, on a background of inhaled corticosteroids, intranasal corticosteroids, and a second asthma controller.

 Patients were stratified by type 2 inflammatory status, defined as baseline eosinophils of ≥ 150 cells/µL or fractional exhaled nitric oxide of ≥ 25 ppb. Mean age was 52 years, with a mean 13-year duration of CRSwNP and adult-onset asthma beginning around age 35 years, Bruselle said.

In the prespecified remission analysis, patients were classified by whether they met a composite asthma clinical remission endpoint at week 24, defined as absence of asthma-related exacerbations, no OCS use, stable or improved FEV1 (≤ 5% decline from baseline), and an Asthma Control Questionnaire-5 (ACQ-5) score of ≤ 1.5.

 A significantly greater percentage of dupilumab-treated patients met all 4 criteria compared with omalizumab, at 64% (112 of 175) versus 40.5% (70 of 173) (

Nasal Polyp Score, Smell, and Lung Function Outcomes in EVEREST


EVEREST is a phase 4, head-to-head trial comparing dupilumab and omalizumab in adults with severe CRSwNP and coexisting asthma over 24 weeks, including a composite asthma clinical remission endpoint at week 24.

How did dupilumab compare with omalizumab for asthma clinical remission?


In the week 24 analysis, 64.0% of dupilumab-treated patients met composite asthma clinical remission criteria versus 40.5% of omalizumab-treated patients (

Did nasal polyp and smell outcomes differ by remission status?


No; dupilumab produced greater improvement in nasal polyp score and UPSIT scores than omalizumab regardless of whether patients met asthma clinical remission criteria at week 24.²

Regardless of whether patients met remission criteria, dupilumab produced greater improvement than omalizumab in objective upper airway measures. Bruselle said that nasal polyp score fell by nearly 3 points with dupilumab compared with roughly 1 point with omalizumab at week 24 (P <.0001) University of Pennsylvania Smell Identification Test scores improved to a significantly greater extent with dupilumab as well (

The pattern extended to lower airway outcomes. Dupilumab produced a more pronounced increase in pre-bronchodilator FEV1 than omalizumab, and SNOT-22 scores improved more with dupilumab as well. ACQ-7 scores declined by nearly 2 points with dupilumab versus approximately 1.5 points with omalizumab, with the treatment difference exceeding the minimal clinically important difference for the outcome, Bruselle said.

The full EVEREST dataset, including additional lung function parameters, was presented separately at the 2025 CHEST Annual Meeting, reinforcing dupilumab's comparative benefit across large and small airway outcomes in this population.³ Under the trial's protocol, clinical asthma remission is only confirmed once criteria are sustained through week 52, and longer-term follow-up is anticipated.

Brusselle G, Heffler E, Busse WW, et al. Clinical asthma remission and nasal polyp outcomes over 24 weeks with dupilumab versus omalizumab in patients with severe chronic rhinosinusitis with nasal polyps and uncontrolled asthma: results from EVEREST. Presented at: European Respiratory Society (ERS) Congress 2026; September 5-9, 2026; Barcelona, Spain.

De Corso E, Canonica GW, Heffler E, et al. Dupilumab versus omalizumab in patients with chronic rhinosinusitis with nasal polyps and coexisting asthma (EVEREST): a multicentre, randomised, double-blind, head-to-head phase 4 trial. 

Kunzmann K. Dupilumab Bests Omalizumab in Airway Improvement for Patients with CRSwNP and Asthma. HCPLive. 

https://www.hcplive.com/view/dupilumab-bests-omalizumab-airway-improvement-patients-crswnp-asthma

. Published October 22, 2025. Accessed September 11, 2026.

Guy Brusselle, MD, PhD, says that 64% of dupilumab-treated patients met composite asthma clinical remission criteria at week 24 versus 40.5% with omalizumab.

Artificial intelligence (AI) is a burgeoning technology, developing rapidly across a wide range of industries. Now that it is beginning to make itself known in 

 care, many clinicians have begun to shift their focus from how the technology is implemented to the question of equity and ethical usage.

Equitable and Ethical AI Use in Cardiology: Addressing Biases and Privacy Concerns

 in Munich, Germany, chaired by Sadiya Khan, MD, MSc, the Magerstadt Professor of Cardiovascular Epidemiology, associate professor of medicine, preventive medicine, and medical social sciences, and the director of the center for population science and aging at Northwestern University Feinberg School of Medicine, a series of presentations discussed the ethical and practical pathways for AI implementation in cardiovascular care – as well as addressing the potential roadblocks and pitfalls inherent in this new technology.

“One of the key things that came up in this session – in every single person’s presentation – was that AI has become such a buzzword, and we are all enamored by the opportunity,” Khan told 

 in an exclusive interview. “It is of course going to be used, and it is being used, and it should be better implemented because we want to maximize the impact we can have on patient outcomes. The challenge is how we do it, and whether or not it makes things better.”

Although cardiovascular disease accounts for roughly 50% of all mortality in the United States, access to care and advanced therapies are reduced for Black, Indigenous, rural, and lower-income individuals. Additionally, these groups tend to have a higher likelihood of heart failure, stroke, and hypertension. AI’s rapid expansion in recent years has presented the opportunity to bridge these gaps in care access.

However, AI in itself is also prone to disparities in access and potential inequity. Generative AI, such as the large language models (LLMs) that are increasingly used to collate and interpret medical data, can easily inherit biases and contextual issues from the data used to train them.

In a review from August 2026, investigators from the University of Pittsburgh and the Cohen Children’s Heart Center in New York analyzed these biases and developed a series of design principles for the creation of equitable generative AI. In particular, they highlighted representation bias, in which case the AI’s training data does not accurately reflect the target population, and deployment bias, when the AI is implemented in a different context from the one for which it was originally designed.

Additionally, the presence of AI in healthcare is an intrinsically thorny issue in terms of patient privacy. These models are trained on and work with substantial amounts of sensitive data, including imaging, genetic information, and patient history. Without proper security, these data could be vulnerable to unauthorized access or breaches. This issue was a key focus in several of the presentations in Khan’s session, and largely remains an open question for clinicians.

“Patient privacy is really one of the core things in medicine, and we hold it very dearly – AI threatens the ability of continuing to protect data,” Khan said. “If it is unleashed without guardrails, without clear stopgaps that need to be in place, it has the potential to do that. I think that’s probably one of the key things we need to figure out: who has governance over the data, and how can we maximize their impact in a way that doesn’t threaten patient privacy?”

Editors’ Note: Khan reports no relevant disclosures.

Kulkarni A, Visweswaran S. Achieving equity in generative artificial intelligence in cardiovascular medicine. JACC: Advances. 2026;5(8):102967. 

Sadiya Khan, MD, MSc, discusses the session she chaired at ESC 2026, which saw clinicians discuss the equitability of artificial intelligence in medicine.

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