 New port delivery system & faricimab talking points


American Society of Retina Specialists (ASRS) 2021 Scientific Meeting

, generally a summer-based event, moved its schedule to early October in light of the COVID-19 pandemic.

The move, fittingly, lined up the annual 

 meeting to within a few weeks of other hugely pertinent discussions and developments in ophthalmic care; to name a couple, the American Academy of Ophthalmology (AAO) meeting will occur later this month, and the US Food and Drug Administration’s (FDA’s) PDUFA date for ranibizumab via port delivery system (PDS) is due in weeks.

The convergence of landmark regulatory decisions and developing data for promising therapies in retina care made ASRS 2021 a perfectly-timed meeting for discussion of where ophthalmology is—and where it is headed.

In a special episode of DocTalk, Joshua Mali, MD, of The Eye Associates, joins to discuss some of the key conversations and data presentations highlighting ASRS 2021.

Among Mali’s most anticipated discussions are that of ranbizumab PDS, continued observations of faricimab for age-related macular degeneration (AMD), gene therapy progression and expansion, and the continued pursuit of the first regulated agent for patients with dry AMD.

Podcasts

Josh Mali, MD, of The Eyes Associates, joins HCPLive to review the key news and developments coming out of the American Society of Retina Specialists 2021 Scientific Meeting.

Ranibizumab PDS, Faricimab, Gene Therapy and Top ASRS 2021 Headlines

With US influenza vaccine rollout in effect and the population working toward 60% fully-vaccinated protection against 

, the discussion of immunization may not be more substantial than it is today.

However, although COVID-19 and flu outbreak risk are the leading preventable threats of focus today, they are only the very beginning of discussion around what’s still needed in respiratory virus protection.

In this episode of Lungcast, American Lung Association (ALA) Chief Medical Officer Albert Rizzo, MD, examines the status and future of respiratory virus immunization with a duo of industry leaders well-versed in the subject.

Michael Greenberg, MD, MPH, Medical Head of Sanofi Pasteur North America, and Rick Nettles, MD, Vice President ofUS Medical Affairs at Janssen Infectious Diseases and Vaccines, weigh in on the most pressing subjects of respiratory virus vaccination—from pediatric COVID-19 studies, to improving adult Tdap vaccine rates and projecting this year’s burden of flu.

Prior to their discussion, Rizzo reviews the history of medical vaccination—a concept first considered in China centuries ago.

Lungcast is a monthly respiratory health podcast series from the ALA, produced by 

Subscribe or listen to Lungcast on your favorite platforms:

https://open.spotify.com/show/1F3u1hKrwxi9snSQ0q3nti

https://podcasts.apple.com/us/podcast/lungcast/id1524712350

Michael Greenberg, MD, MPH, and Rick Nettles, MD, join Lungcast to discuss COVID-19 vaccine development, the 2021-22 flu season, RSV outbreaks, and more respiratory viruses.

Vaccination Roundtable with Experts from Sanofi & Janssen

 (ADHD) can be misunderstood, under-diagnosed, and misrepresented.

For many, ADHD represents the thoughts of a hyperactive child in school. And while hyperactivity can be a symptom (that often wanes as the patient ages), inattentiveness is also a major symptom associated with the disease.

For ADHD patients who exhibit more of the inattentive symptoms, they often do not ever seek help and receive an official diagnosis.

And while gaps certainly exist in ADHD care, telemedicine and increased awareness of the disease could pay dividends and make a huge difference for patients with the disease, particularly children.

, Yamalis Diaz, PhD, clinical assistant professor of child and adolescent psychiatry at the NYU School of Medicine, gives an overview on the current state of ADHD care and what needs to change in order to help more patients with ADHD.

Diaz said one area where there can be an increased understanding is how the disease manifests differently in different patients. This is often based on age, but not always.

However, Diaz also said some of these gaps can be closed by the advent of telemedicine, giving many who live in rural and remote locations the ability to seek help from doctors in bigger population areas.

Dr. Yamalis Diaz said ADHD is often under-diagnosed.

Yamalis Diaz, PhD: The Current State of ADHD Care

With Asthma Peak Week rapidly approaching, conversations are once again being held by clinicians and patients alike on what the appropriate measures for asthma management are.

Patients with severe asthma and type 2 inflammation are of particular concern, especially as exposure rates begin to climb in the coming season.

Luckily, treatments for these patient groups exist.

In the September 2021 episode of Lungcast, Al Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA), discusses 

 biologic therapy with Mario Castro, MD, MPH.

Castro is the Chief of Pulmonary, Critical Care and Sleep Medicine; Vice-Chair for Clinical and Translational Research; and Director of Rainbow Clinical and Translational Science Unit, Frontiers at the University of Kansas School of Medicine.

“When we talk about patients with severe asthma, we use a combination of having an underlying diagnosis of asthma together with a patient that is either on high dose therapy with corticosteroids with a lone acting controller, and requires that treatment to retain their control, or despite that are not achieving control,” Castro said.

He added that patients with severe asthma represent 5%-10% of the population of people with asthma, and that clinicians have been able to advance therapies for these patients by understanding the phenotype or characteristics that lead to their underlying disease.

Castro and his colleagues have proposed 4 phenotypes of asthma: T2 driven disease or non-T2 driven disease.

“This T2 phenotype has really helped us advance targeted therapy for severe asthma,” Castro said. “So, we can now target those particularly T2 cytokines and we can abdicate that inflammation and lead to improved control in biologic therapy.”

Rizzo and Castro discussed several biomarkers that are used to treat inflammation in patients with severe asthma, including IgE levels, blood eosinophils, and exhaled nitric oxide.

For patients with elevations in their T2 levels, IgE are used to characterize a patients’ allergic status, and exhaled nitric oxide, commonly found in allergy and pulmonary offices, has been used to manage airway epiphyllum.

However, the most prominent biomarker are blood eosinophils.

“Blood eosinophils have really helped us advance our understanding of eosinophilic asthma, which is a subset of T2 inflammation,” Castro said.

Blood eosinophils have been considered a prognostic biomarker and a biomarker for therapy response predictor, and patients with high blood eosinophil have an increased risk of downstream events, like exacerbation and reduction in lung function. They have been known to respond better to corticosteroids.

Videos

Dr. Castro defines type 2 inflammation and the complications surrounding severe asthma, as well as several biomarkers including IgE levels, blood eosinophils, and exhaled nitric oxide.

Mario Castro, MD, MPH: Defining Severe Asthma Biomarkers

 Is empagliflozin an “expensive diuretic?”


 Applying renal outcomes from EMPEROR-Preserved


 The future of HFpEF devices and therapies


 research, therapies, and guidance coming from some of the greatest minds in medicine on a regular basis.

What’s more, the cross-sections of heart, metabolic, and renal disease have fully converged on these topics; today’s ever-changing discussion of modern cardiovascular care implicates numerous clinicians all at once.

It helps to have an expert at the center of it, available to help steer peers toward what research matters most in cardiology.

Introducing Heart Beats with Manesh Patel, MD, a new monthly podcast series from HCPLive. Patel is the Chief of the Divisions of Clinical Pharmacology and Cardiology, as well as the Richard Sean Stack, MD Distinguished Professor at the Duke University School of Medicine.

Every month, Patel and a featured guest will be breaking down relevant cardiovascular research—whether it be new or old—that can be applied to practice today. In this first episode, he and his Duke colleague, Marat Fudim, MD, Assistant Professor of Medicine, explore heart failure with preserved ejection fraction (HFpEF).

Their topics include new empagliflozin data reported in EMPEROR-Preserved, the new GUIDE-HF findings, their strategies for HFpEF screening, and the future of heart failure treatment.

You can subscribe to Heart Beats on your favorite podcast channels:

https://open.spotify.com/show/0jaV80DhfsbReg4nZShRG0

Manesh Patel, MD, kicks off his first podcast by discussing HFpEF findings in EMPEROR-Preserved, the GUIDE-HF trial and more with his Duke colleague.

New Heart Failure Data from ESC 2021 with Marat Fudim, MD

Diet might be just as important a treatment for gastrointestinal disorders like 

And until recently the advice on diet was a little unclear as there were very few studies proved the value in diet and specifics in diet for this patient population.

But recently there has been more evidence-based research proving the value in diet in not only preventing gastrointestinal disorders, but also aiding patients who have been diagnosed with diseases like IBS.

An example of a diet that has value in this target population is the FODMAP (

This diet values whole grains, fruits, vegetables, and lean proteins like chicken and fish, while eliminating the processed sugars and sweeteners that are prevalent in many diets today.

One of the biggest advocates for this diet for patients with gastrointestinal disorders is William Chey, MD, professor of gastroenterology and nutrition sciences at Michigan Medicine at the University of Michigan.

 to discuss how diets like FODMAP can be beneficial for IBS patients and how should patients view food trends to avoid falling for faulty information.

He also explained how the COVID-19 pandemic may have been good for some diets, while bad for others.

The FODMAP diet is considered a preferable option for patients with irritable bowel syndrome. 

William Chey, MD: Treating Gastrointestinal Diseases With Diet

Vitiligo, much like other inflammatory skin disorders such as alopecia areata and atopic dermatitis, is a complex condition with various physical and psychological burdens, affecting 1% to 2% of the global population.

For roughly 15 years, John E. Harris, MD, PhD, Professor and Chair, Department of Dermatology, Founding Director, Vitiligo Clinic and Research Center, has been intensely studying the pathogenesis of vitiligo, as well as potential treatments.

Harris initially studied type 1 diabetes when he was a student, but an encounter with a patient with vitiligo inspired him to become a dermatologist. In time, he became one of the most prominent vitiligo experts, whose skills are used daily at the University of Massachusetts Medical School (UMMS) in Worcester, MA.

In this interview with Dr. Brad Glick, Harris provided insight into his decades of research on inflammatory skin disorder including vitiligo and alopecia areata. He also offered an in-depth analysis on the most recent data surrounding the conditions, and promising new therapies involving topical steroids, JAK inhibitors and more.

In this episode of Derm Discussions, vitiligo expert John Harris, MD, PhD, discusses new tactics and therapeutic options in treating inflammatory skin disorders like vitiligo, alopecia areata, and atopic dermatitis.

John E. Harris, MD, PhD: The Current State of Vitiligo and Alopecia Areata Research

 Biologics: the emerging severe asthma treatment field

 Defining type 2 inflammation and severe asthma

The evolving field of biologic therapy may have come to the public forefront for their formidable role in combating COVID-19 in recent years, but to investigators and prescribers, they have been a mainstay in another respiratory field for decades now.

In the September 2021 episode of Lungcast, Al Rizzo, MD, Chief Medical Officer of the American Lung Association (ALA), discusses 

 biologic therapy with Mario Castro, MD, MPH.

Rizzo and Castro delve into the growing fields of severe asthma biomarkers and treatment-targeting pathways, and the field’s most promising agents such as dupilumab, omalizumab, and tezepelumab. As Castro explains, the potential for these agents may be still untapped.

“These biologic therapies…are achieving control, they’re improving lung function, and we think they may have a chance of disease modification,” Castro said.

Prior to their discussion, Rizzo is joined by Cindy Trubisky, National Senior Director of Health Promotion for Asthma at the ALA, for insight on September’s “Asthma Peak Week.”

Dr. Castro and Dr. Rizzo discuss the evolving world of monoclonal antibodies for severe asthma. Plus, the ALA team discusses September's annual Asthma Peak Week, and what it means for reopening schools.

Biologic Breakthroughs for Severe Asthma with Dr. Mario Castro

The disease refers to a group of disorders: Type A, B, C1, and C2.

Type A is the most severe form; Type C is the most common. 

Lipids may accumulate in the brain, spleen, liver, lungs, and bone marrow.

The manifestations are diverse; a host of neurological symptoms may occur. 

Patients may develop NP, especially NPC, any time in their life. However, the disease usually manifests early in life. 

The disease is panethnic but has a higher rate among populations with greater consanguinity. 

Historically, Niemann-Pick was discovered as a disease back in 1900 when a pediatrician noticed a child with an enlarged liver, enlarged spleen, and neurologic symptoms.

Most patients will unfortunately succumb to the disease before the age of 20. But for those who present with symptoms in their 20s, or sometimes up to 50 or 60 years old, those patients can live for decades with varying amounts of disability.

Diagnosis is becoming easier when clinicians suspect Niemann-Pick disease. [The process of sending for genetics to confirm Niemann-Pick] is becoming more common.

Patients tend to be treated symptomatically.

 is group of rare disorders affecting the proper storage of fats across organs. According to the United States National Institute of Neurologic Disorders and Stroke, the condition occurs when “harmful quantities of lipids accumulate in the brain, spleen, liver, lungs, and bone marrow.”

There are various types of disease, known as Niemann-Pick A, B, and C. Type C is further divided into C1, the most common type, and C2. 

What makes this disease more difficult to diagnose and treat is its extreme heterogeneity in symptoms and prognosis. While individuals with type A typically die in infancy, individuals with type B may live a longer lifespan requiring supportive care. The life expectancy of type C is more variable. Even more, the disease may not be diagnosed until adulthood.

, Sharon Hrynkow, PhD, Chief Scientific Officer and Senior VP for Medical Affairs at Cyclo Therapeutics, discussed the various manifestations of Niemann-Pick—with a particular focus on Niemann-Pick type C. She spoke in detail on the daily challenges faced by patients, highlighting in particular the neurological symptoms of the condition.

Hyrnkow further discussed the clinical trial program of a new agent developed by Cylco Therapeutics for Niemann-Pick C and expressed hope that new therapeutics may someday and finally be available for this underserved patient population.

Listen to The Rare Disease Report on your favorite podcast platforms, including 

Sharon Hrynkow, PhD, joins the Rare Disease Report to discuss the ultra rare and heterogenous lysosomal storage disorder. 

The Rare Disease Report Podcast: Niemann-Pick Disease

While these small molecule drugs have seen approvals in other domains—such as tofacitinib (Xeljanz) and upadacitinib (Rinvoq) for rheumatoid arthritis and ulcerative colitis—they have yet to make full headway into the dermatology space.

As of now, no drug has been approved for any single dermatologic condition. Currently, the US Food and Drug Administration (FDA) are reviewing applications for a variety JAK inhibitors—namely baricitinib, abrocitinib, upadacitinib, and ruxolitinib cream for the treatment of atopic dermatitis—but the agency has

While safety concerns should not be overlooked or taken lightly, the drug class has demonstrated promising efficacy in patients suffering from dermatologic conditions, including atopic dermatitis, psoriasis, alopecia areata, and vitiligo.

Even more, the safety profile of JAK inhibitors must be understood in the context of previous dermatology- and non-dermatology-related clinical trials—a fact that Brett King, MD, PhD, Associate Professor of Dermatology at Yale School of Medicine, stressed in this episode of 

King explained how JAK inhibitors work, emphasizing their potential place inside a dermatologist’s treatment arsenal.

He compared JAKs with biologic agents, like dupilumab, and speculated on the implications the addition of a drug class would have on diagnostic and prescribing strategies, particularly for atopic dermatitis. 

Both Glick and King expressed forward-looking, optimistic sentiments for the future while remaining grounded in the available evidence for a drug class that has the potential to revolutionize dermatologic care.

On the latest Derm Discussions, Brett King, MD, PhD, joins Brad Glick, DO, to discuss the potential of the JAK inhibitor class for dermatology. 

Brett King, MD, PhD: The Promise of Janus Kinase Inhibitors

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Best Practices in the Treatment and Management of Migraines

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, Rare Disease Report, and Heart Trials.