Pain can be a difficult byproduct of many treatments, including treatments for 

Researchers from the New York University College of Dentistry and Queen’s University are soon planning to move forward with a new study testing a targeted opioid called NFEPP to treat the diseased tissues of IBD patients without having to effect the healthy tissues that could cause some of the painful side effects.

When treating chronic pain for IBD, opioids target opioid receptors, including the mu opioid receptor. However, when these treatments activate the mu opioid receptor in healthy tissues they can cause severe and potentially life-threatening side effects, including difficulty breathing, constipation, sedation, and addiction.

Senior study author Nigel Bunnett, PhD, professor and chair of the Department of Molecular Pathobiology at NYU College of Dentistry, explained in an interview with 

, how the treatment will target only the diseased tissues of patients in an effort to stave off pain.

Bunnett said initial research is promising for patients with ulcerative colitis and if proven safe and effective it should also be used to treat Crohn’s disease.

The next step will be to test human tissue samples before ultimately moving forward with human trials. Bunnett also said if successful the treatment could be an option for other pain states, including cancer.

Videos

Dr. Nigel Bunnett talks about future plans to test a new IBD treatment. 

Nigel Bunnett, PhD: Reducing Pain as a Side Effect of IBD Treatment

 are on the horizon, clinicians can still look to complementary treatments to help mitigate disease or medication-related symptoms.

, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, touted the utility of such integrative therapeutic options.

“I do think in atopic dermatitis there are a number of places where we can leverage an integrative approach,” he said. “And I stress that it’s integrative because I’m not trying to say don’t use any conventional medicine.”

In fact, he stressed, unconvetional therapies can be brought into a treatment regimen in order to fully optimize the patient treatment experience. Certain therapies can work to address side effects or augment the effects of a primary treatment course.

Some examples he mentioned were topical coconut oil as a potential antimicrobial agent, topical sunflower seed oil as an addition to moisturizers, and oral hempseed oil as a potential antiinflammation and skin barrier treatment.

“Another thing I do like as well is L-histadine,” Lio said. “There’s some data to show that, [when administered] in vitro and in vivo in patients, [...] their filaggrin production goes up. And we know that many patients with atopic dermatitis are filaggrin deficient, and so this may be able to bolster it.”

A dermatologist discusses alternative and complementary options for the treatment of atopic dermatitis.


Peter Lio, MD: Atopic Dermatitis and Integrative Therapies

, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, 

spoke on the treatment landscape of atopic dermatitis

, including the important considerations between adult and pediatric populations.

“The overall approach [to treatment] is very similar between children and adults,” said Lio. “We can approach it the same way and have the same general principles, but there are many specifics that really rise to the fore, especially in children.”

For example, he stressed the importance of evaluating safety in younger populations.

“Everything is multiplied,” he said. Adverse events of concern to adults should be especially monitored in children; further, clinicians should be particularly attuned to developmental issues.

Lio also stressed familial decision making and consent of all parties, as well as considerations of treatment tolerability.

And finally, children may be more inclined to refuse injectable treatments—such a dupilumab. Thus, as Lio noted, this warrants the need for more oral medications and increased therapeutic options and modalities.

As new and existing agents are becoming available to children

, dermatologists must continue to evaluate and reevaluate their approaches to ensuring that patients of all age group receive the most effective, safe, and comfortable treatment options for them.

A dermatologist gives a broad overview of key considerations when determining a treatment course for pediatric patients.

Peter Lio, MD: Atopic Dermatitis Treatment Considerations in Children

A new analysis of a model of the US population showed medicated-assisted treatment of 

 in combination with overdose education and distribution of naloxone was linked to cost-saving reductions in morbidity and mortality due to OUD.

The findings, from a team of Stanford University and Veterans Affairs investigators, suggest a combination of therapy and education access could provide up to 16.9% reduction in deaths and up to $105,000 in lifetime clinical care costs saved.

The research is particularly pressing into the second year of the COVID-19 pandemic, a time which the same investigators predict susceptibility to OUD is likely peaking.

 regarding the findings, study author Douglas K. Owens, MS, MD, of Stanford Health Policy at the Centers for Health Policy and Primary Care and Outcomes Research, discussed the continually proven benefit of OUD agents including buprenorphine, methadone, naltrexone, and psychotherapy—treatments which need to become more available.

“We know many people aren’t being treated with these very good therapies, and that’s a major issue,” Owens said. “Our work and many others’ suggest that the access to opioid use treatment should be expanded.”

Owens also discussed the means of improving access and education relative to more robust screening—a necessary effort following addiction-driving burdens of the pandemic.

“One of the things we need to do is identify people who have OUD and other substance use disorders,” he said. “That’s not always easy, but it’s important work we do a physicians.”

Cost-effectiveness of Treatments for Opioid Use Disorder,

New data show reduced risk of mortality, and clinical savings upward of $100,000, are linked to sometimes inaccessible substance use disorder therapies.

The Cost Benefit of Treating Addiction

Amid the systemic rush to assure patient care would not be compromised by the COVID-19 pandemic last year, US healthcare may have discovered some measures of telemedicine that are more efficient, and even more beneficial, that previous in-person strategies.

One field that found successes in virtual care was 

 near the end of 2020 showed teledermatology was significantly more cost-effective than conventional care, and discussions with private practice leaders suggested there were particular streamlines to virtual screening and treatment for the field.

So what will a post-pandemic dermatology practice look like?

, Melissa Stenstrom, MD, assistant clinical professor at the University of Illinois College of Medicine Rockford, discussed her colleague’s experiences in telemedicine monitoring and care, and how her team dictates in-person versus virtual visits.

“There have been occasions where I’ll do a telemedicine visit, and then ask them to come in to the office so I can see a lesion more clearly,” she said. “It definitely has been helpful in some cases: pre-cancerous lesions, actinic keratoses, treating those with field therapy has been something we’ve done a lot through teledermatology.”

Stenstrom also discussed the benefit of virtual care for monitoring chronic skin conditions including acne, atopic dermatitis, and psoriasis—instances where treatment plan and disease state have been well-established previously with the patient.

“We’ve had the discussion in the office, and now they’re just on cruise control,” Stenstrom said. “For those patients, just checking in every 6-12 months has been a perfect addition to our practice, and probably one of the good things that has come out of the last year.”

The pandemic forced practices to consider more virtual screening and care. A dermatologist shares perspective on what's been working as telemedicine practice.

Teledermatology: What Happens After COVID-19?

 showed investigative therapy sotatercept was beneficial in improving pulmonary vascular resistance and six-minute walking test (6MWT) outcomes in patients with 

The findings from the PULSAR trial, led by David B. Badesch, MD, offer reasonable hope for the utility of sotatercept as an added agent in the treatment of the burdensome, sometimes fatal pulmonary disease—a concept currently being pursued in a phase 3 trial.

 this week, Badesch, of the Divisions of Pulmonary Sciences and Critical Care Medicine and Cardiology at the University of Colorado Anschutz Medical Campus, discussed the novel mechanisms and makeup of sotatercept, a drug originally developed for anemia-associated care.

The drug is comprised of the extracellular domain of human activin receptor type IIA, fused to the Fc domain of human immunoglobulin G1 (IgG1). It provides balance of the growth-promoting activin growth differentiation factor pathway, and the growth-inhibiting BMP pathway by serving as a ligand trap for the TGF-β superfamily.

“It offers a novel approach, it appears to be active in addition to background therapy—that’s up to triple-background therapy, with agents that impact each of the 3 pathways that have been previously utilized in therapy,” Badesch explained. “It’s in addition to those things it appears to be a benefit, so that’s exciting to us.”

Though the drug’s benefit is unique to the field, that may not be the case for long.

“Its mechanism of action is quite novel,” he said. “I would guess that there might be other agents coming along that would try to do something similar, with perhaps slightly different approaches.”

Badesch also discussed in the video above how sotatercept is being assessed in phase 3, the burdens of PAH, and the broader potential of the novel therapy.

An interview with a phase 2 investigator on the the novel drug's potential in a field it wasn't originally designed to treat.

What Experts Are Learning About Sotatercept for PAH

Understanding Sickle Cell Disease 

Prevalence and Burden of SCD 

Acute and Chronic Complications in SCD 

Anemia-Related SCD Manifestation: Monitoring and Screening  

 Impact of SCD on Quality of Life 

Hydroxyurea in Sickle Cell Disease 

Experts discuss challenges in sickle cell disease along with the available standard of care and newer FDA-approved agents used in the management of the disease. 

Expert Perspectives on the Optimal Management of Sickle Cell Disease

Arena Pharmaceuticals is currently investigating etrasimod, a highly selective sphingosine 1-phosphate (S1P) receptor modulator, for 

 as well as for other indications, such as ulcerative colitis and Crohn’s disease.

 from the ADVISE trial reported that 2 mg of the investigative drug led to clear or almost clear skin in patients, as measured according to the validated Investigator Global Assessment (vIGA). This improvement was considered to be statistically significant.

Etrasimod was also associated with statistically significant improvements in Eczema Area and Severity Index (EASI), EASI-75 and pruritis at week 4. However, the trial did not meet the study primary endpoint of EASI change from baseline at week 12.

It was also considered well-tolerated with no serious adverse event across treatment groups.

As such, if approved by the US Food and Drug Administion (FDA), etrasimod will only expand the 

, Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, discussed the promise of this new drug as well as his concerns for it.

“It seems to have some real potential for inflammatory pathways,” he noted.

“My only hesitation is when we hear about something that works across multiple conditions, especially disparate conditions."

Nonetheless, Lio expressed cautious optimism and believed more data on its efficacy, accessibility, safety, and tolerability could help further elucidate its potential.

“I think the devil may be in the details, but I welcome it — we need all the options we can get,” he stressed.

An expert offers his perspective on the investigative SLP receptor modulator for atopic dermatitis.

Peter Lio, MD: Thoughts on Etrasimod for Atopic Dermatitis

Recent months have signaled a promising new era in the realm of 

. Biologics like dupilumab are already on the market for patients as young as 6 years of age, and Janise kinase (JAK) inhibitors promise to revolutionize the treatment landscape.

“It’s an incredibly exciting time for atopic dermatitis,” said Peter Lio, MD, Clinical Assistant Professor of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, in a recent interview with 

He expressed optimism for new drugs coming down the pipeline, some of which may receive a US Food and Drug Administration (FDA) approval within the next few months.

“This is after an incredibly long drought,” Lio noted, pointing to the far and few approvals, especially when compared with innovations in psoriasis. 

In 2016, topical crisaborole (Eucrisa) was approved for atopic dermatitis, followed by biologic dupilumab (Dupixent) in 2017. Of course, not all patients will experience relief or improvement with these agents.

Therefore, new and effective options are needed.

Soon, patients and providers may be able to add JAK inhibitors (such as abrocitinib, baricitinib, and upadacitnib), new biologics (lebrikizumab, tralokinumab, nemolizumab, etc.), and new/revolutionary topical agents (ruxolitinib, roflumilast, delgocitinib, tapinarof, etc.), to their official treatment toolbox.

“We’re going to have all these medicines to think about,” Lio said. “We’re trying to now sort them out and figure out which is going to be the best for which patient, how we’re going to use them, and really get a sense of them once they come out on the market.”

An expert discusses new and emerging therapies for atopic dermatitis.

Peter Lio, MD: The Atopic Dermatitis Treatment Landscape in 2021

The Prevalence of Disease, and Need for Screening

Understanding Insulin Resistance Associations

LDL-P: An Underused Metric for Risk

Seeking Out and Achieving Apolipoprotein-B Levels

Two Cases of Cardiometabolic Diseases Treated Post-Panel

Summary and Final Thoughts

Cardiometabolic disease, in manifestations including 

atherosclerotic cardiovascular disease (ASCVD)

, affects millions of Americans in evolved forms of the disease.

Whereas the traditional mean ASCVD patient decades ago was generally male, older aged, with a smoking habit and slight obesity—the contemporary ASCVD patient is a greater mix of females, significantly younger, less likely with a smoking habit and more likely with obesity. They are hyperinsulemic, and present with mixed dyslipidemia.

Particularly when considering that last point: how is the average patient now monitored and treated for cardiometabolic disease risk? With an evolution and growth of risks, there must be a modernization of treatment strategy.

, cardiologist Brett Nowlan, MD, FACC, explains the complexities of cardiometabolic risk evaluation, and how it influences care.

In his talk, Nowlan discusses the interpretation of cardiometabolic risk through 3 factors:

Throughout the presentation, Nowlan highlights the clinical interpretations and biochemistry roles of LDL-P and Apo-B among modern patients with mixed dyslipidemia.

Nowlan also highlights a pair of successful cases treated through a response from panel results, and provides guidance to prescribing clinicians on the utility and priority of panels.

An expert physician in cardiology and metabolic management walks through a presentation on identifying, addressing, and continually treating for heightened cardiometabolic risk.