Peer Exchange

Panel of experts will discuss the persistent cardiovascular risk among patients with a history of ASCVD events and the importance of LDL-lowering in secondary prevention. Experts also evaluate current and emerging PCSK9-targeting therapies and share practical strategies for integrating PCSK9 inhibition into post-event lipid management to achieve optimal LDL-C control and improve long-term outcomes.

This series brings together experts to discuss advances in the early recognition, diagnosis, and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM). The panel highlights evolving evidence on TTR stabilizers and gene-silencing therapies, as well as emerging clinical data that are shaping future approaches to improving outcomes and quality of life for patients with ATTR-CM.

This series brings together expert clinicians to examine evolving strategies in psoriatic disease management. Through discussions on early systemic intervention, the role of IL-17 inhibitors, shared inflammatory pathways, and preventive treatment approaches, the program highlights a proactive, multidisciplinary model focused on achieving sustained remission, improving quality of life, and reducing the risk of psoriatic arthritis progression.

In this HCPLive Peer Exchange, Linda Stein Gold, MD, moderates a dynamic discussion with Jennifer Soung, MD, and David Cotter, MD, exploring how recent advances in psoriasis and psoriatic arthritis research are transforming patient management. The panel examines persistent treatment gaps, evolving patient preferences favoring oral options, and new guideline updates redefining “topical failure.” They highlight pivotal data from EADV 2025, including the ICONIC-ADVANCE and ICONIC-LEAD trials of icotrokinra (ICO)—a first-in-class oral IL-23 receptor antagonist—and the APEX study of guselkumab in psoriatic arthritis, which demonstrated significant inhibition of radiographic progression. The discussion emphasizes patient-centered, mechanism-driven approaches to psoriasis and PsA care, underscoring how emerging oral and biologic therapies are reshaping treatment paradigms

Panelists discuss how optimizing topical therapeutic strategies across all severities of pediatric atopic dermatitis can improve symptom control, family quality of life, and long-term skin health through individualized, evidence-based, and family-centered care.

Four panelist discusses how advancing diagnostic precision, integrating novel MRAs like finerenone, and addressing real-world barriers in access and adherence are transforming HFpEF care and improving patient outcomes.

Panelists discuss how IL-17 inhibitors have emerged as first-line treatment options for moderate to severe hidradenitis suppurativa, with long-term data demonstrating sustained efficacy over 2 years, manageable cutaneous adverse effects, and the potential for combination with surgery and other systemic therapies to optimize patient outcomes.

Experts discuss the clinical implications of early and irreversible structural damage in psoriatic arthritis, comparing mechanisms of action and radiographic outcomes of IL-23 and IL-17 inhibitors, interpreting emerging trial data, and exploring how safety, onset speed, and domain coverage shape treatment decisions and therapeutic strategies.

Evan Dellon, MD, MPH; Glenn Furuta, MD; Bryan Sauer, MD, MSc, and Joy Chang, MD, MS, discuss how eosinophilic esophagitis (EoE) presents with dysphagia and adaptive eating behaviors in adults and children and requires endoscopic diagnosis with biopsies showing 15 or more eosinophils per high-power field. It can be effectively managed through shared decision-making between first-line therapies including proton pump inhibitors; topical swallowed steroids such as budesonide oral suspension; and elimination diets, with step-up options such as dupilumab for refractory cases and esophageal dilation for fibrostenotic complications.

Jared Butler, MD, MPH, MBA; Vivian Fonseca, MD; Lance Sloan, MD; and Michael J. Bloch, MD, discuss how to effectively manage resistant hypertension through a comprehensive approach that includes differentiating true resistance from pseudoresistance; implementing lifestyle modifications and optimal medical therapy with ACE inhibitors/ARBs, calcium channel blockers, and diuretics; and incorporating emerging treatments like endothelin receptor antagonists such as aprocitentan, which demonstrated significant blood pressure reduction in the PRECISION trial across diverse patient populations, including those with chronic kidney disease.

Panelists discuss the significance of elevated eosinophils as a biomarker in COPD—highlighting challenges in its measurement and its role in guiding personalized treatment—while navigating current management strategies for eosinophilic COPD, exploring the overlap with asthma through type 2 inflammation and its therapeutic implications, and emphasizing the critical importance of timely care escalation to prevent symptom worsening and improve long-term outcomes.

Richard Pratley, MD; Vivian Fonseca, MD, FRCP; Ralph DeFronzo, MD; Richard Auchus, MD, PhD; and Natalie Bellini, DNP, FNP, BC-ADM, CDCES, discuss how the groundbreaking CATALYST trial results revealed that approximately 25% of patients with difficult-to-control diabetes despite optimal medical management have hypercortisolism, representing a treatable cause of treatment-resistant diabetes that can be identified through simple dexamethasone suppression testing and managed with targeted therapies such as mifepristone or surgical intervention for adrenal adenomas.

Sayna Norouzi, MD; Jonathan Barratt, MBChB, PhD, FRCP; Andrew S. Bomback, MD, MPH; Bradley Dixon, MD; and Brendon Neuen, MD, discuss how the diagnostic challenges of C3 glomerulopathy (C3G) are addressed, current treatment strategies are explored, and emerging therapies, including insights from the VALIANT trial, may impact clinical practice.

Panelists discuss how the evolving treatment strategies for ATTR-CM highlight the importance of early diagnosis and intervention, focusing on diagnostic tools to expedite diagnosis and recently approved therapies that can impact clinical practice.

Experts discuss actionable insights on leveraging early PCSK9 inhibitor intervention to help improve outcomes and prevent recurrent cardiovascular events in patients post ACS events.

Melodie Young, MSN, AGNP-C, FSDNP, DCNP; TJ Chao, MPAS, PA-C; Leigh Ann Pansch, MSN, FNP-BC, DCNP; and Douglas DiRuggiero, DMSc, MHS, PA-C, discuss how the transformative landscape of atopic dermatitis management now incorporates comprehensive severity assessment, personalized treatment goals, and strategic biologic selection based on mechanism of action, patient characteristics, and response patterns—with dupilumab, lebrikizumab, tralokinumab, and nemolizumab offering targeted approaches that demonstrate both rapid relief and long-term efficacy when optimally monitored and supported with appropriate adherence strategies.

Jason Hawkes, MD, MS; Saakshi Khattri, MD; James Song, MD; and Fabrizio Galimberti, MD, PhD, discuss how comprehensive psoriasis management requires integrating multiple severity assessment tools; considering disease impact beyond body surface area; addressing undertreatment especially in patients with high-impact locations and diverse skin types; recognizing the value of biologics as demonstrated in studies like SPECTREM; and embracing future directions that prioritize personalized approaches, earlier intervention, and quality-of-life outcomes.

Experts discuss the impact of hypercortisolism, its clinical presentation, the relationship with comorbidities like hypertension and type 2 diabetes, and the 3 screening tests used in clinical practice to diagnose the condition.

Experts discuss the mechanism of action of oral Janus kinase (JAK) inhibitors, the impact of selectivity on efficacy and safety, the long-term safety and efficacy of JAK inhibitors in atopic dermatitis (AD) treatment compared with other disease states, and the latest data for the 2 oral JAK inhibitors approved for AD and their implications for treatment.

Panelists discuss novel approaches to diagnosing and treating generalized pustular psoriasis, highlighting emerging therapies, advances in early detection, and personalized treatment strategies to improve patient outcomes.

Brad P. Glick, DO, MPH, FAAD; Zed Zha, MD, FAAFP; Charles Vega, MD, FAAFP; Mona Shahriari, MD, FAAD, and Michael R. Nazareth, MD, PhD, FAAD, discuss reviewing strategies for diagnosing atopic dermatitis and determining disease severity in adult patients, exploring the latest data for the use of systemic therapies for adults with atopic dermatitis, and using practical approaches and strategies for comanagement of adult patients with atopic dermatitis between primary care practitioners and dermatologists.

Giselle Mosnaim, MD, MS; Shyam Joshi, MD; Mark Lebwohl, MD; and Jason Hawkes, MD, MS, discuss how chronic spontaneous urticaria, driven by both IgE and IgG pathways, may soon be treated with selective Bruton tyrosine kinase inhibitors that show promising efficacy and safety in targeting both mechanisms, potentially filling an important gap between antihistamines and biologics in the treatment landscape.

M. Bradley Drummond, MD, MHS; MeiLan K. Han, MD, MS; Emily Wan, MD, MPH; and Ravi Kalhan, MD, MS, discuss updates and additions in the recently released 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Report. We will review the clinical and economic burden of chronic obstructive lung disease (COPD) and unmet needs in its treatment. We will summarize key changes in the recent GOLD Report and highlight the clinical evidence for 2 new agents, dupilumab and ensifentrine, in treating stable COPD. Finally, we will discuss current GOLD recommendations for using these agents and their expected role in clinical practice.

Panelists discuss multidisciplinary approaches to the management of pediatric atopic dermatitis (AD), including the pathophysiology of AD, the role of type 2 inflammation, and the importance of early diagnosis and referral. They explore the atopic march and its potential links to other allergic diseases, review current treatment options and recent guidelines, and highlight advances in systemic therapies for moderate to severe AD, while addressing challenges related to treatment resistance and evolving strategies to manage pediatric patients.

Panelists discuss how IL-13 targeting biologics, including dupilumab, tralokinumab, and lebrikizumab, are advancing the treatment of atopic dermatitis, improving efficacy, safety, and patient outcomes, while addressing key challenges in diagnosis and treatment selection.

Manesh R. Patel, MD; Payal Kohli, MD, FACC; John M. Flack, MD, MPH, FAHA, FASH, MACP, CHS, and C. Michael Gibson, MS, MD, explore the challenges and evolving management strategies for resistant hypertension, including medication adherence, comorbidities like CKD, traditional and novel drug mechanisms like aprocitentan, and the importance of accurate blood pressure measurement, while emphasizing the critical role of the endothelin pathway and comprehensive treatment approaches.

Panelists discuss how a multidisciplinary approach, early diagnosis, and emerging therapies are essential in managing Familial Chylomicronemia Syndrome (FCS)to prevent acute pancreatitis and mitigate long-term cardiovascular risks.

Panelists discuss how comprehensive cardiovascular disease management requires integrating screening protocols, risk assessment, and targeted interventions across the lifespan, from pediatric lipid testing through adult treatment strategies, while addressing barriers to care and leveraging both established and emerging therapeutic options.

Panelists discuss how addressing the gaps in screening, diagnosis, and treatment can significantly improve outcomes for patients with chronic kidney disease (CKD) in the context of type 2 diabetes.

This discussion provides an in-depth overview of Primary Biliary Cholangitis (PBC), covering pathophysiology, clinical presentation, diagnostic approaches, disease progression, management strategies—including first- and second-line therapies—and recent advances in PPAR agonist treatments to guide optimal care for patients.