Insights

This AJMC Insights series explores the evolving treatment landscape for retinal vascular diseases, including neovascular age-related macular degeneration (AMD), diabetic macular edema (DME), and retinal vein occlusion (RVO), with a focus on next-generation anti-VEGF therapies. Throughout the discussion, expert faculty review the clinical burden associated with these chronic retinal vascular diseases, emphasizing the impact of vision loss, treatment burden, patient adherence, and long-term disease management. The panel also examines emerging clinical trial and real-world evidence evaluating newer anti-VEGF therapies, including aflibercept 8 mg and faricimab, with discussions centered on durability, dosing intervals, safety, fluid control, and treatment persistence. In addition, the series highlights important economic and access considerations in retinal vascular disease management, including treatment burden, utilization management strategies, physician choice, and the role of durable therapies in improving real-world patient outcomes.

Dr. Jaideep Behari highlighted the systemic financial and clinical consequences of delayed MASH detection, emphasizing that the liver plays a central role in cardiorenal metabolic (CKM) syndrome — which he proposed reframing as CKLM syndrome to reflect the liver's contribution — and that progressive liver fibrosis is strongly associated with the development of type 2 diabetes, chronic kidney disease (CKD), and cardiovascular disease, with end-stage disease potentially requiring liver transplantation.

Welcome back to another AJMC Insights series. In this episode titled, ‘Bridging the Disconnect: From Diagnosis to Treatment in Cardio-Renal-Metabolic Syndrome’, Ian Neeland led the conversation about the following questions: In people with type 2 diabetes, CKD prevalence is high (~40.7%), yet over half may lack a documented CKD diagnosis, underlining detection gaps. What strategies can bridge the disconnect between diagnosis and treatment initiation? Obesity (BMI ≥30) affects over 30% of U.S. adults and is a major driver of insulin resistance, type 2 diabetes, CKD progression, and MASLD. How do access barriers, including coverage and awareness, contribute to delays in treatment in patients with obesity?

This AJMC Insights interview series features Brandi Jones, who shares her lifelong experience with alopecia areata, including early diagnosis challenges, limited access to care, and the emotional and social impact of the disease. It highlights her decades-long treatment journey—from ineffective and painful therapies to the transformative success of JAK inhibitors—which significantly improved her condition and quality of life. The series also emphasizes ongoing barriers such as insurance restrictions, misclassification of alopecia as cosmetic, and the need for earlier intervention, better access to treatment, and greater awareness of the disease’s psychosocial burden.

The KDIGO 2025 guidelines for IgA nephropathy broaden diagnostic and treatment strategies by promoting earlier kidney biopsy consideration and setting stricter proteinuria targets while advocating a dual-focused therapeutic approach that simultaneously limits pathogenic IgA immune complex formation and addresses nephron loss with both traditional supportive care and newer agents such as targeted-release budesonide, sparsentan, and SGLT2 inhibitors.

Panelists discuss how prescription digital therapeutics (PDTs) can serve as adjunctive treatments to traditional medications for addressing the often-overlooked negative symptoms of schizophrenia, such as social withdrawal and cognitive deficits, by providing personalized, smartphone-based interventions that improve treatment adherence and help patients develop social skills and cognitive rehabilitation in a more accessible format than traditional therapy.

Ryan Haumschild, PharmD, MS, MBA, CPEL; Patricia K. Coyle, MD, and Kavita V. Nair, PhD, FAAN discuss how progression independent of relapse activity (PIRA) represents a critical driver of disability in multiple sclerosis that requires new therapeutic approaches, biomarkers for early identification, and treatment strategies that address both the relapsing inflammatory component and the underlying smoldering neurodegeneration that manifests clinically around midlife.

Catherine M. Broome, MD, discusses how immune thrombocytopenia (ITP) is diagnosed, classified, and managed, including bleeding risk assessment, quality of life impacts, personalized treatment approaches, and future directions for addressing this heterogeneous autoimmune disorder that causes low platelet counts.

Bradley J. Monk, MD, FACS, FACOG; Kathleen Moore, MD, MS, and Floortje J. Backes, MD discuss how comprehensive molecular testing in ovarian cancer has evolved to include BRCA, folate receptor alpha, and emerging biomarkers like HER2 and CCNE1 while addressing challenges in education, reimbursement, and tumor heterogeneity that impact widespread adoption.

Ryan Haumschild, PharmD, MS, MBA, CPEL, and Casey Butrus, PharmD, discuss the challenges related to stakeholder adoption of biosimilars, such as perspectives from pharmacy benefit managers, regional payers, health systems, and private label agreements, and assess strategies to enhance market uptake.

Panelists discuss how emerging Bruton tyrosine kinase (BTK) inhibitors and combination regimens are addressing unmet needs in the treatment of chronic lymphocytic leukemia(CLL) and mantle cell lymphoma (MCL), with a focus on improving outcomes for treatment-naive patients and advancing current therapeutic strategies.

Hadar Lev-Tov, MD, discusses the challenges in patient identification and diagnosis of hidradenitis suppurativa (HS), with a focus on early warning signs. He evaluates the latest American Academy of Dermatology (AAD) guidelines for the treatment of HS and their evolution over time and discusses the multidisciplinary care approach within HS centers and the potential impact of establishing HS Centers of Excellence on patient outcomes.

Robert M. Rifkin, MD, FACP, discusses how real-world studies on teclistamab and talquetamab presented at ASH 2024 align with clinical trial data and reveal key differences, while panelists discuss how clinicians should prioritize patient characteristics and prior treatments when selecting the most appropriate bispecific therapy for relapsed/refractory multiple myeloma.

Panelists discuss how industry-provided patient support services can address the physical, emotional, and practical challenges faced by patients with diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL), from diagnosis through treatment and beyond.

A medical expert discusses the key aspects of Lambert-Eaton Myasthenic Syndrome (LEMS) in the context of small cell lung cancer (SCLC), including its differential diagnosis, long-term effects, economic burden, and how a multidisciplinary approach can optimize patient care and reduce health care

Paul Feuerstadt, MD, FACG, AGAF, discusses how antibiotics remain the initial treatment for Clostridioides difficile infections, but due to limited efficiency and recurrence rates, newer therapies including fecal microbiota transplantation (FMT), Rebyota (a purified live biotherapeutic), and Vowst (an oral microbiota therapeutic) have emerged as FDA-approved options that restore gut microbiome diversity and show promising efficiency in preventing recurrent infections, particularly in patients who have failed standard antibiotic therapy.

Reynold A. Panettieri Jr., MD, discusses the role of type 2 inflammation in COPD and asthma, emphasizing its potential to impair lung function.

Susan Perlman, MD, provides a comprehensive overview of Friedreich's ataxia management, encompassing current guidelines, FDA-approved therapies, assessment tools, and prospects for the treatment landscape.

Justin Oldham, MD, MS, provides clinical insights on the evolving treatment landscape in idiopathic pulmonary fibrosis.

Iltefat Hamzavi, MD, provides comprehensive insights on hidradenitis suppurativa (HS), highlighting disease characteristics, treatment practices, and the disease’s profound impact on patients and families.

Ronald Oudiz, MD, FACP, FACC, FCCP, provides clinical insights on the evolving treatment landscape for patients with pulmonary arterial hypertension, focusing onemerging therapies and integrating them into clinical practice.

Robert Gabbay, MD, PhD, discusses type 1 diabetes by addressing the distinct stages of the disease, risk factors, and current and emerging treatments.

Elizabeth Spencer, MD, discusses treatments for eosinophilic esophagitis (EoE), caregiver challenges, therapy struggles, insurance hurdles, and patient advocacy needs.

Expert perspective delves into nature of bronchiectasis and navigates its current treatment landscape across various patient populations.

Mirna Chehade, MD, MPH, describes the symptoms of eosinophilic esophagitis in pediatric patients, and discusses the importance of prompt diagnosis, tailored treatments, and shared decision-making for better patient outcomes.

Elizabeth Yeu, MD, highlights the current landscape of Demodex blepharitis and available treatment options.

Joseph M. Coney MD, FACS, discusses key factors needed to address disparities in care among patients with diabetic macular edema, including the significance of community involvement and the role of provider self-reflection in facilitating fair and unbiased medical care.

Experts discuss novel therapies, unmet needs, and supportive care measures for patients with metastatic non-small cell lung cancer (mNSCLC).