Video Series

Almandoz described his interpretation of the SYNCHRONIZE-1 findings, noting that while substantial and statistically significant weight reduction was observed, what captured his attention most was the nature and distribution of that weight loss, with the MRI sub-study demonstrating meaningful reductions in visceral and liver fat alongside relative preservation of lean mass, collectively pointing to a quality of weight loss that is biologically distinct from generalized weight loss.

Major depressive disorder (MDD) is a heterogeneous disorder with many unique symptom combinations.

Hepatitis B and hepatitis C behave nothing alike once treatment succeeds. This episode explains why hepatitis B's genomic integration makes true virologic cure fundamentally more complex than hepatitis C clearance.

Welcome back to another AJMC Peer Exchange series. In this episode titled, "The Burden of Major Depressive Disorder: Setting the Stage for Managed Care."

Guideline inconsistency and treatment thresholds continue to create gaps in chronic hepatitis B care, particularly in primary care settings. This episode also examines what functional cure means for cancer risk and long-term antiviral safety.

Different inclusion criteria, different primary endpoints, different eras of the pandemic: Dr. Rosmarin unpacks why the pivotal topical and oral vitiligo trials resist direct comparison, and where a meta-analysis might still help.

A payer's view of competing JAK mechanisms centers less on selectivity data and more on price. Jason explains why a wide cost gap between topical and oral therapies will likely keep the topical option as first-line policy.

Learn how doctors spot mild cognitive impairment early using MoCA, Mini-Cog, caregiver insights, and blood biomarkers to guide MRI/PET treatment.

Clinicians unpack Alzheimer’s rising risk, why early detection and lifestyle prevention matter, and how delaying onset could cut costs dramatically.

Jaime Almandoz characterized the historical management of metabolic disease as paradoxically siloed given how biologically integrated these conditions are, noting that a patient may have their obesity managed by one clinician, their diabetes by another, their cardiovascular disease by a third, and their liver disease, if addressed at all, evaluated in yet another separate setting, while the patient is experiencing all of these as one interconnected metabolic condition, creating fragmentation that delays diagnosis, duplicates effort, and leaves critical windows for intervention unaddressed.

Quantitative hepatitis B surface antigen testing is emerging as a critical tool for identifying which patients may respond best to next-generation therapies. This episode reviews new guideline recommendations and finite-duration therapy conversations.

Unlike hepatitis C, chronic hepatitis B does not always progress through classic fibrosis, making liver cancer possible without significant liver damage. This episode reviews how genomic integration drives that risk and how monitoring should adapt.

JAK inhibitors mark a genuine shift in vitiligo care, offering stabilization before repigmentation and color that matches native skin tone. Dr. Desai and Dr. Lal weigh their promise against the patience and compliance they demand.

From corticosteroids and calcineurin inhibitors to phototherapy, oral supplements, and emerging JAK inhibitors, Dr. Rosmarin walks through a treatment landscape defined by combination therapy rather than any single modality working alone.

Almandoz framed obesity, type 2 diabetes, cardiovascular disease, and MASH not as separate conditions but as different manifestations of the same underlying metabolic dysfunction, making MASH not merely a liver problem but a signal of broader cardiometabolic burden that demands comprehensive attention.

Noureddin drew on the prior Phase 2 survodutide data published in the New England Journal of Medicine, which demonstrated improvements in steatohepatitis histology and significant fibrosis reduction to contextualize the SYNCHRONIZE-1 findings, noting that MRI-based proton density fat fraction reduction has been shown to correlate with histologic improvement in steatohepatitis and fibrosis, suggesting the magnitude of liver fat reduction observed in SYNCHRONIZE-1 is a predictive surrogate for the histologic endpoints being evaluated in the ongoing Phase 3 LIVERAGE and LIVERAGE Cirrhosis trials.

Chronic hepatitis B remains highly prevalent yet chronically underdiagnosed in the United States. This episode reviews global and domestic epidemiology, new universal screening guidance, and a health-system model built to close the gap.

Chronic hepatitis B is often framed purely as a viral disease, but immune suppression from surface antigen excess is central to how it behaves. This episode examines why targeting that immune dimension is essential to curing it.

A recent JAMA Dermatology analysis refines mild-moderate-severe cutoffs for vitiligo, but Dr. Desai and Dr. Lal argue that psychosocial burden, anatomic site, and cultural context can make even limited disease profoundly severe for patients.

Halting progression early is more achievable than reversing it. Dr. Rosmarin details how oral steroids control active disease while payer barriers persist for later-line options, and Jason explains how benefit design and step therapy shape access.

The SYNCHRONIZE-1 trial was a Phase III double-blind study in which patients with elevated BMI were randomized in a one-to-one-to-one ratio to placebo, 3.6 mg, or 6.6 mg of survodutide alongside lifestyle counseling, with the primary endpoint of at least 5% weight loss at week 76.

Noureddin framed the emergence of dual GLP-1/glucagon receptor agonism as a significant development, placing it alongside artificial intelligence as a transformative force in medicine, noting that while GLP-1 receptor agonists have already improved the management of metabolic syndrome and generated robust data across obesity and cardiovascular outcomes, the bar has now moved higher, with tolerability, injection frequency, oral versus injectable delivery, and liver-specific activity all emerging as key differentiators among the next generation of incretin-based therapies.

Noureddin acknowledged the extraordinary challenge facing primary care physicians who are tasked with managing a patient holistically across rapidly evolving fields and expressed genuine appreciation for the breadth of responsibility they carry.

Body surface area offers a simple starting point for gauging vitiligo severity, but the panel argues that phenotype markers, anatomic location, and disease activity carry more weight in shaping treatment urgency than surface area alone.

Noureddin outlined the striking epidemiological burden of MASLD and MASH in patients with obesity, with prevalence climbing dramatically with increasing BMI, reaching up to 90% in patients with a BMI of 40 or higher, and affecting approximately 60% of individuals with type 2 diabetes.

Angela Lamb discussed the switching data from the LEVEL UP trial, noting that patients who had not met treatment goals on dupilumab and switched to upadacitinib were able to achieve meaningful improvements, reinforcing the message to patients that failure on one biologic does not preclude success with another.

Vitiligo's clinical course splits into segmental and non-segmental presentations, each carrying a distinct prognosis. Dr. Rosmarin explains how disease activity, not just extent, determines whether a patient needs urgent intervention or watchful monitoring.

Noureddin framed MASH as one that should not be viewed in isolation by hepatologists or any other specialist, but rather understood as part of a broader cardio-liver-renal metabolic syndrome that demands comprehensive, multidisciplinary management, noting that even lean individuals with elevated visceral fat and insulin resistance can develop MASLD, and that the risk increases substantially with higher BMI and the presence of type 2 diabetes, which is strongly associated with both higher MASLD prevalence and greater rates of advanced fibrosis and cirrhosis.