The panelists examined aripiprazole's pivotal trial design, which used an antidepressant lead-in phase followed by randomization to placebo or active drug among non-responders, with Thase detailing how dose-finding evolved toward lower 5 mg and 10 mg doses to minimize akathisia, the primary dose-limiting side effect, while preserving antidepressant benefit at doses lower than those used for antipsychotic indications.
The Be Well trials narrowed eligibility to a specific surface antigen window, a design choice with real implications for which patients could benefit first. This episode reviews that rationale and its practice impact.
Repigmentation unfolds over months, not weeks, and Dr. Desai argues that managing expectations from the first visit matters as much as the medication itself. Dr. Lal adds that clinical-trial consistency rarely mirrors real-world adherence.
Without a head-to-head trial, comparing JAK inhibitors requires care. Dr. Rosmarin urges matching time points before drawing conclusions, while Jason explains how payers weigh incomplete data, member churn, and documentation when building coverage exceptions.
Bepirovirsen's antisense mechanism raises a genuinely unsettled question: how much of its effect comes from direct antiviral activity versus an unexpected immune response. This episode unpacks that debate.
An all-oral, bedaquiline-containing regimen offers a potential salvage option for refractory MAC, reducing reliance on aminoglycoside therapy while requiring continued QT monitoring.
Led by the moderator, the expert neurology and primary care panelists examined the realities of delivering Alzheimer's disease care where specialists are scarce.
Led by the moderator, the panelists discussed how their practices use structured screening tools, electronic health record order sets, and attention to subtle behavioral symptoms to catch Alzheimer's disease earlier, and how targeted continuing medical education, a "see one, do one, teach one" mentoring approach, and e-consult safety nets are building primary care physicians' confidence to diagnose despite a shrinking pool of behavioral neurologists and geriatricians.
The ENCORE trial challenges the practice of reserving inhaled amikacin liposome therapy for refractory disease, showing improved culture conversion when it is introduced earlier in newly diagnosed, non-cavitary MAC.
Led by the moderator, the expert mental health experts examined how tolerability shapes agent selection, with Wilkinson highlighting metabolic side effects and akathisia — most pronounced with aripiprazole — as key counseling points, alongside the value of anticipatory guidance in building patient trust and preventing premature discontinuation.
Dr. Chung welcomes Dr. Robert Gish to the program, who introduces himself as medical director of the Hepatitis B Foundation, an academic appointee at UCSD, Loma Linda, and the University of Nevada, Las Vegas, and a clinician who sees patients with hepatitis B across five active clinic sites, where the disease makes up roughly 10% of his practice.
Led by the moderator, the panelists discussed persistent efficacy, tolerability, and adherence gaps in antidepressant treatment, noting that only about 60% of patients with MDD receive treatment and roughly 30% develop treatment resistance, with early adverse effects often undermining adherence before benefits take hold.
Combination regimens, monoclonal antibodies, and gene therapy aimed at de-integrating viral DNA are reshaping what a hepatitis B cure could look like. This episode looks ahead to the next five to ten years
Age shapes more than pill-swallowing ability in pediatric vitiligo care. Dr. Lal explains how activity level, motivation, and comorbidities guide the choice between topical and oral therapy in younger patients, more than any single BSA threshold.
Trial enrollment ranges become policy boundaries in practice. Dr. Desai explains how broader BSA inclusion supports patients with widespread disease, while Jason describes how narrower criteria let payers manage the bulk of cases through topical therapy first.
New multi-center registry data confirm MAC as the dominant cause of NTM pulmonary disease, while culture conversion with standard therapy still fails in nearly half of patients.
Better risk stratification, more tolerable regimens, and outcome measures beyond culture conversion top the list of unmet needs Dr. Losier identifies for MAC and NTM pulmonary disease heading into ATS 2026.
Almandoz challenged one of the most persistent misconceptions in metabolic disease management, that obesity treatment is primarily about weight loss, arguing instead that obesity is a systemic driver of healthcare utilization across multiple high-cost disease states including type 2 diabetes, cardiovascular disease, osteoarthritis, chronic kidney disease, and MASH, and that by the time a patient develops liver cirrhosis, heart failure, or end-stage kidney disease, the financial and human costs have already become enormous and largely preventable with earlier intervention.
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.
Almandoz explained that while GLP-1 receptor agonism alone delivers meaningful benefits in appetite regulation, satiety, glycemic control, and cardiorenal and liver outcomes, the addition of glucagon receptor agonism introduces a distinct and complementary layer of biology that goes beyond weight loss alone to address the metabolic drivers most closely linked to insulin resistance, cardiometabolic risk, and MASH progression.
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.
