Peer Exchange

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.

Panelists discuss how to effectively diagnose and manage chronic spontaneous urticaria, highlighting the importance of personalized treatment approaches and the exploration of emerging therapies to improve patient outcomes.

Panelists discuss how advancements in understanding IgA nephropathy (IgAN) and emerging therapies aim to address unmet treatment needs while improving patient outcomes through targeted approaches to disease management.

Panelists discuss how evolving treatment strategies and improved diagnostic approaches can enhance the management of Cchronic Sspontaneous Uurticaria (CSU), ultimately aiming to improve patient outcomes and quality of life.

Panelists discuss how early diagnosis and the utilization of systemic Janus kinase inhibitors are crucial in the effective management of alopecia areata, highlighting the impact of disease severity and patient experiences on treatment strategies.

Raj Chovatiya, MD, PhD, MSCI; George Han, MD; Elizabeth (Lisa) Swanson, MD; and Peter Lio, MD, explore the latest advances in oral systemic treatments for atopic dermatitis, including the use and long-term safety of oral JAK inhibitors, strategies for switching therapies, and navigating treatment breaks.

Medical experts discuss hypercortisolism in the diabetes landscape.

A panel of experts on atopic dermatitis review clinical trial data and discuss how treatment advances are improving patient-reported outcomes and elevating the standard of care.

A panel of experts on iron deficiency anemia has a comprehensive discussion on the clinical utilization of intravenous iron, highlighting available products and clinical practices on administration and monitoring.