Peter Friedmann, MD, MPH, is a professor of quantitative health sciences at UMass Chan Medical School.

Bringing Hepatitis C Care to Rural Communities Through Mobile Telemedicine

New research is shedding light on the potential utility of a mobile telemedicine-based intervention for hepatitis C virus (HCV) infection among rural persons who inject drugs.

Findings from the randomized clinical trial showed telemedicine integrated with syringe services on a mobile van was associated with improved access to HCV treatment initiation and cure for people with a history of drug injection in rural communities where HCV treatment services are scarce.

High rates of HCV infection among people who inject drugs are well described in urban settings, but far less is known about how to effectively reach affected individuals in rural communities. Additionally, previous work has demonstrated the benefits of embedding infectious disease screening within inpatient substance use disorder programs, highlighting increases in testing uptake and low-barrier delivery of preventive and therapeutic treatment among this vulnerable and difficult-to-reach patient population.

In discussing his team’s work, Peter Friedmann, MD, MPH, a professor of quantitative health sciences at UMass Chan Medical School, explained how a 2-phase research project in northern New England sought to both define the problem and test a potential solution.

“This was in 2019 prior to the pandemic, so telemedicine was considered novel at the time, " Friedmann told 

. “We were interested in whether you could deliver telemedicine from a van, and have the van go out to areas where there was high prevalence of injection use, since injection behavior and hep C sort of go together.”

Previously reported findings from the first phase of the research highlighted high hepatitis C seropositivity rates and prevalence of risky injection behaviors, underscoring the urgent need to improve access to sterile injection supplies, hepatitis C testing, and curative treatment in rural settings.

Friedmann further explained that the first phase revealed significant structural barriers to care, including limited access to phlebotomy and clinicians experienced in hepatitis C management. These gaps directly informed the design of the project’s second phase.

For that phase, he described how the mobile van traveled to areas with high rates of injection drug use, offering harm reduction services alongside telemedicine visits for hepatitis C evaluation and treatment. Participants were randomized either to this intervention or to what he termed “enhanced usual care,” which involved referral to local providers with care navigation support.

Results showed treatment initiation rates were higher in the mobile telemedicine group, with corresponding improvements in cure rates. Friedmann noted that while cure rates were similar among participants who attended their first appointment in either group, the key difference was getting patients started on therapy. Of note, his hypothesis that hepatitis C treatment would reduce syringe-sharing behaviors was not supported.

Friedmann additionally stressed that the success of the mobile model depended on more than the van itself. In his view, having a well-trained, nonjudgmental team experienced in working with this population was critical to supporting treatment initiation and completion in this high-risk, underserved group.

“There are a lot of treatment interruptions in this population, and this population really does require a lot of support in order to initiate and complete treatment,” he said. “Having workers, people are working on the van or working in the setting who are really familiar and comfortable and able to work in sort of a non-stigmatizing, non judgmental way with this population is really critical.”

Editors’ Note: Friedmann reports relevant disclosures with the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH) and Indivior.

Friedmann PD, Wilson D, de Gijsel D, et al. Mobile Telemedicine for Treating Chronic Hepatitis C Among Rural People Who Inject Drugs: A Randomized Clinical Trial. 

 2026;9(1):e2555125. doi:10.1001/jamanetworkopen.2025.55125

Brooks A. Infectious Disease Screening in Substance Use Treatment Programs Effective, Study Finds. HCPLive. August 7, 2025. Accessed February 9, 2026. https://www.hcplive.com/view/infectious-disease-screening-in-substance-use-treatment-programs-effective-study-finds

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Friedmann describes his research exploring the benefits of mobile telemedicine for HCV infection among persons who inject drugs in rural areas.

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Bringing Hepatitis C Care to Rural Communities Through Mobile Telemedicine, With Peter Friedmann, MD, MPH

Vlado Perkovic is Dean and Scientia Professor of Medicine at UNSW Sydney. He is also a Professorial Fellow at The George Institute and a Staff Specialist in Nephrology at the Royal North Shore Hospital in Sydney.

Inflammation Emerges as Promising CKD Treatment Target, With Vlado Perkovic, MBBS, PhD

Recent trials, including FLOW and SELECT, have reinforced the suggested link between inflammation and chronic kidney disease (CKD) progression.1

Although FLOW was not designed to isolate an inflammatory mechanism, the parallel improvements in C‑reactive protein (CRP), kidney outcomes, and cardiovascular events reinforce inflammation as a plausible, and potentially targetable, facet of CKD management.

“We now know that GLP‑1 receptors are expressed in the kidney, often on immune cells, and in FLOW we saw a roughly 40% reduction in CRP,” explained Vlado Perkovic, MBBS, PhD, provost at the University of New South Wales, in an interview with 

. Taken together, these findings suggest that GLP‑1 receptor agonists have an important anti‑inflammatory effect that may be at least partly independent of their impact on weight loss, which itself would be expected to reduce inflammation. Inflammation clearly appears to be an important part of the story, and newer studies such as the REMODEL trial will help us understand this axis in more detail.”

Since the 1990s, investigators have recognized the central role inflammation plays in the pathogenesis and progression of CKD. Early work focused on monocyte‑derived interleukin‑1 (IL‑1), with investigators proposing IL‑1 release as a key initiating event underlying major complications and increased mortality in patients undergoing dialysis.

Subsequent research has shown an association of persistent low‑grade inflammation with worsened clinical outcomes in CKD, including faster eGFR decline, higher cardiovascular risk, and increased all‑cause mortality. Multiple factors contribute to the inflammatory burden in CKD, including pro‑inflammatory cytokines, oxidative stress and metabolic acidosis, chronic or recurrent infections, altered adipose tissue metabolism, and gut microbiota dysbiosis.

Collectively, these findings, together with the historical burden of inflammation in patients with CKD, have highlighted the reduction of inflammatory markers, such as CRP, as a potential clinical strategy to protect kidney function.

Semaglutide, a GLP-1 receptor agonist, has been associated with reductions in CRP and other inflammatory markers independent of glycemic effects. Potentially supporting this concept, the FLOW study, which evaluated patients with type 2 diabetes and CKD, demonstrated that semaglutide reduced the risk of clinically important kidney outcomes and death from cardiovascular causes. Over a median follow‑up of 3.4 years, investigators randomized 3533 participants to receive either semaglutide (n = 1767) or placebo (n = 1766).

Upon analysis, investigators observed a 24% reduction in the risk of the primary outcome in the semaglutide group compared with placebo (hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.88; 

= .0003). Similar benefits were seen for a composite of the kidney‑specific components of the primary outcome (hazard ratio [HR], 0.79; 95% CI, 0.66 to 0.94) and for death from cardiovascular causes (HR, 0.71; 95% CI, 0.56 to 0.89).

The results for all confirmatory secondary outcomes favored semaglutide: the mean annual eGFR slope was less steep (indicating a slower decline) by 1.16 ml per minute per 1.73 m² in the semaglutide group (

< .001); the risk of major cardiovascular events was 18% lower (HR, 0.82; 95% CI, 0.68 to 0.98; 

 = .029); and the risk of death from any cause was 20% lower (HR, 0.80; 95% CI, 0.67 to 0.95; 

 = 0.01). Serious adverse events occurred in a lower percentage of participants in the semaglutide group than in the placebo group (49.6% vs 53.8%).

“Ongoing trials of other anti‑inflammatory agents, such as interleukin‑6 (IL‑6) receptor antagonists, may also help clarify whether inflammation reduction alone can protect kidney function,” said Perkovic. “Those data could shed light on how much the CRP reductions seen in FLOW contributed to the observed kidney benefits. For now, what we can say is that the mechanism is likely multifactorial and still not fully understood.”

Perkovic also highlighted the SELECT trial, which evaluated semaglutide in patients with obesity but without diabetes. Investigators in SELECT reported improvements in several kidney parameters, including reductions in albuminuria and slower kidney function decline, findings that were broadly consistent with the renal effects observed in FLOW. However, SELECT was not designed to formally test kidney outcomes, he noted.

“This is an important and exciting area for future research. With SGLT2 inhibitors, we saw kidney benefits that were just as robust in people without diabetes as in those with diabetes, suggesting glucose‑independent mechanisms. I suspect we will see something similar with GLP‑1 receptor agonists,” said Perkovic. “Ideally, future trials will demonstrate kidney protection in non‑diabetic chronic kidney disease as well, allowing us to expand the therapeutic toolbox for those patients.”

Perkovic V. Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes. 

New England journal of medicine/The New England journal of medicine

Stenvinkel P, Chertow GM, Devarajan P, et al. Chronic Inflammation in Chronic Kidney Disease Progression: Role of Nrf2. 

https://doi.org/10.1016/j.ekir.2021.04.023

Mihai S, Codrici E, Popescu ID, et al. Inflammation-Related Mechanisms in Chronic Kidney Disease Prediction, Progression, and Outcome. 

Habib Yaribeygi, Maleki M, Tannaz Jamialahmadi, Amirhossein Sahebkar. Anti-inflammatory benefits of semaglutide: State of the art. 

Journal of clinical & translational endocrinology

https://doi.org/10.1016/j.jcte.2024.100340

FLOW/SELECT suggest. GLP-1 receptor agonists may protect kidneys beyond glucose control

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Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

Positive and statistically significant topline results have been released from a phase 3 clinical study evaluating Ameluz photodynamic therapy (Ameluz PDT) for 

, with the treatment meeting its primary endpoint and showing highly statistically significant superiority versus vehicle gel.

These data were announced on February 9 by Biofrontera Inc. These findings specifically highlight the effectiveness of Ameluz-PDT used alongside the red-light LED RhodoLED platform in the treatment of mild to moderate actinic keratoses (AKs) on the extremities, neck, and trunk.

“Ameluz® PDT is already a valuable treatment option for actinic keratoses on the face and scalp,” Nathalie Zeitouni, MD, professor of dermatology at the University of Arizona College of Medicine and coordinating investigator of this study, said in a statement.

 “Many patients present with lesions on other areas of the body, and these data support the potential for Ameluz® PDT to expand treatment options for physicians and their patients.”

Actinic keratosis is among the most frequently encountered conditions in dermatology, representing a benign intraepidermal proliferation of lesions considered a precancerous and classified as squamous cell carcinoma in situ.

 Around 25% of adults are affected by AK, with prevalence increasing with age.

Ameluz-PDT, a photodynamic therapy option, is currently being evaluated by the US Food and Drug Administration (FDA) following Biofrontera’s submission of a supplemental New Drug Application (sNDA) for superficial basal cell carcinoma (sBCC). The treatment was assessed in a multi-center, randomized, double-blind, vehicle-controlled phase 3 trial, designed to look at both the efficacy and tolerability of field-directed Ameluz PDT compared with vehicle PDT in patients who present with AKs impacting the extremities, neck, and trunk.

There were 172 patients recruited for the analysis, with Zeitouni and coauthors randomizing participants in a 4:1 ratio to be either treated with Ameluz gel or vehicle gel. In their study protocol, the team allowed for treatment of progressively larger field areas, with 1, 2, or 3 tubes of Ameluz applied to regions of approximately 80, 160, or 240 cm², administered either continuously or in discrete patches.

PDT was performed, after application, via either a RhodoLED XL or BF-RhodoLED lamp. All of those assessed were given a single PDT session, with a second treatment provided at the 12-week mark provided residual AK lesions were visible. Those evaluated are still being followed for roughly a year following their final PDT session. The investigators’ main efficacy outcome was the subjects’ complete clearance rate, defined as the proportion of individuals attaining complete clearance of all treated AK lesions 12 weeks post-final PDT treatment.

Overall, the team noted Ameluz-PDT demonstrated superiority over vehicle PDT for the study’s primary endpoint.

 In the Full Analysis Set, complete clearance was shown to have been attained in 45.6% of individuals treated with Ameluz-PDT, compared with 16.7% of those on vehicle PDT, a difference described as highly statistically significant (

Results were consistent in the Per Protocol Set, where complete clearance took place in 53.2% of Ameluz-treated individuals versus 22.2% of vehicle-treated subjects (

 In their secondary analyses, Zeitouni et al further reinforced their data. Overall clearance rates of AK lesions at 12 weeks after the final PDT reached 73.1% in the Full Analysis Set and 80.3% in the Per Protocol Set. When assessed by anatomical site, subject complete clearance rates on the extremities were 38.5% in the Full Analysis Set and 46.5% in the Per Protocol Set, whereas clearance on the neck and trunk was higher, at 74.1% and 78.3%, respectively.

Outside of clinical efficacy, the use of Ameluz-PDT was linked with favorable cosmetic outcomes and strong patient-reported satisfaction in this analysis as well.

 The investigators looked at ratings of the post-therapy appearance of the skin as good or very good in 75.2% of those evaluated. They noted 70.9% of subjects reported comparable assessments. In line with these results, 86.3% of patients stated they would opt for PDT once more if future use was shown to be necessary.

On the basis of these new phase 3 results, Biofrontera has highlighted its plan to submit an sNDA to the FDA during the third quarter of 2026.

Biofrontera Announces Positive Results in Phase 3 Study of Ameluz® PDT for Actinic Keratoses on the Extremities, Neck, and Trunk, Meeting Primary Endpoint. Biofrontera, Inc. February 9, 2026. 

https://www.globenewswire.com/news-release/2026/02/09/3234622/0/en/Biofrontera-Announces-Positive-Results-in-Phase-3-Study-of-Ameluz-PDT-for-Actinic-Keratoses-on-the-Extremities-Neck-and-Trunk-Meeting-Primary-Endpoint.html

Ceryn J, Lesiak A, Narbutt J, et al. Actinic keratosis: comprehensive review of current treatments and emerging therapeutic innovations. Postepy Dermatol Alergol. 2025 Jan 31;42(3):221-231. 

Biofrontera Inc. Announces Filing of Supplemental New Drug Application (sNDA) for the Treatment of Superficial Basal Cell Carcinoma (sBCC) with Ameluz®-PDT. Biofrontera Inc. December 2, 2025. Accessed February 9, 2026. 

https://www.globenewswire.com/news-release/2025/12/02/3197970/0/en/Biofrontera-Inc-Announces-Filing-of-Supplemental-New-Drug-Application-sNDA-for-the-Treatment-of-Superficial-Basal-Cell-Carcinoma-sBCC-with-Ameluz-PDT.html

Articles

These positive results of Ameluz photodynamic therapy suggest the treatment is effective in actinic keratoses on the neck, trunk, and extremities.

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The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

New Phase 3 Findings Support Ameluz-PDT for Patients with Actinic Keratosis

Shakia Hardy, PhD, MPH, is an associate professor in the department of epidemiology at the University of North Carolina at Chapel Hill.

Shakia Hardy, PhD, MPH | Image Credit: UNC Gillings School of Global Public Health

 were not taking antihypertensive medication, despite having a systolic blood pressure (SBP) and diastolic blood pressure (DBP) within 10 mmHg of the 2025 American Heart Association/American College of Cardiology (AHA/ACC) goal, according to a recent study.

Investigators utilized data from the National Health and Nutrition Examination Survey (NHANES) 2021-2023 data. The team included patients aged ≥20 years with hypertension, defined as SBP ≥130 mmHg or DBP ≥80 mmHg, or self-reported use of antihypertensive medication. Uncontrolled blood pressure was defined as SBP ≥130 mmHg or DBP ≥80 mmHg.

A total of 3216 patients were included, of whom an estimated 79.1% (95% CI, 77.2-81.1%) had uncontrolled blood pressure. Of these, roughly 61.3% (95% CI, 58.8-63.9%) were not taking antihypertensive medication. Those not taking antihypertensive medication were younger (estimated mean age, 49.2 vs 62.4 years; 

 <.001) and were less likely to have health insurance (88.8% vs 95.1%; 

 <.001), a routine place for health care (83% vs 95.9%; 

Additionally, patients with uncontrolled blood pressure who were taking antihypertensive medication were substantially more likely to have SBP or DBP above goal by ≥10 mmHg (52.6% vs 34.6%; 

For further insight into these data, we spoke with Shakia T. Hardy, PhD, MPH, associate professor in the department of epidemiology at the University of North Carolina at Chapel Hill, in the following Q&A:

 Could you provide a brief overview of your study and its findings?

: We conducted a study that was somewhat motivated by the new 2025 AHA and ACC blood pressure guidelines, and we really wanted to see where the US population was in relation to the new thresholds. So, our study was partially motivated by that, but also by our desire to understand how close people were to that threshold. We often describe blood pressure control in terms of a proportion, but we don't really characterize how far away from that goal people are. So we found that 8 in 10 US adults who had hypertension had uncontrolled blood pressure, and the vast majority of those were not taking antihypertensive medication, and those that were not taking medication were closer to goal. So, we felt like they could easily achieve the treatment goal with the initiation of antihypertensive medication or lifestyle modifications. What I think was most unique about what we found that we didn't necessarily expect was that 80% of those who had blood pressure above goal that were uncontrolled had access to health care. They had health insurance, and they had a regular place to go for care, yet they weren't treated with antihypertensive medications.

 Do you view these findings as a failure of detection, treatment, initiation, intensification, or health system follow-through? Or is it really all of the above?

: I think it's really all of the above. We didn't look at awareness in this study, but oftentimes, once we do, we see that most people are aware. I don't know that it's necessarily a lack of awareness or access to care. I think it is more about the way people are managed within care systems. I think there should be a larger focus, from the clinician standpoint, on initiating medication earlier and titrating medication when people are not reaching blood pressure goals.

 Based on these data, younger adults with uncontrolled blood pressure were much less likely to be treated. How should clinicians rethink hypertension risk communication for patients in their 40s and 50s?

 I think we as a society have come to think of hypertension as a disease of older age, and more recent evidence suggests that hypertension is beginning as early as adolescence for a lot of people, and by middle age, when people are above the threshold. I think the common way of handling that has been to wait and see if blood pressure rises more, as opposed to managing it when it's around the threshold for treatment. From my perspective, I would hope that people were treated earlier, once their blood pressure is consistently above the threshold used for defining hypertension and qualifying people for anti-hypertensive medication.

: Among those already on therapy, a large portion were still ≥10 or ≥20 mmHg above goal. What does this tell us about the need for combination therapy and rapid titration?

 Recent evidence has suggested that a lot of people are still being initiated on monotherapy, even though there's strong evidence that suggests combination therapy is necessary for most people to achieve control. I would hope that titration, whether it's increasing dosage on the medication that people were initiated on or trying combination therapy, would happen earlier in the treatment process than it is currently happening.

 How much of this problem do you believe reflects clinical inertia versus patient-level barriers, such as cost concerns, side effects, or risk perception?

 I don't think it's a cost barrier; anti-protection medications are not that expensive. I do think it might be some patient hesitancy. I've talked to several clinicians who say that their patients are really familiar with the 140/90 threshold for blood pressure, and they're hesitant to bring their blood pressure lower than that. I think part of it might be patient awareness, education, and the desire for their blood pressure to be lower, but I also think part of it is clinical inertia.

 The study highlighted dementia risk as well as cardiovascular risk. Do you believe that framing blood pressure control as “brain protection” might change patient engagement?

 I would hope so. Dementia is a very popular topic right now that people are aware of, and I think it is an outcome that a lot of us fear. I think the risk of dementia being increased with uncontrolled blood pressure might make people rethink whether they want their blood pressure to be lowered. People might be hesitant to take more medications to lower their blood pressure. I think if we emphasize the risk of dementia more, it might convince people that blood pressure lowering is a good thing.

 Which patient populations do you think are the most vulnerable to being left behind by guideline-based hypertension care, and how can future research address that?

 I think it's young adults. There's a lack of evidence for hypertension treatment among the young adult population. And I think because of that, clinicians are hesitant to start young adults on antihypertensives when we don't have the clinical trial data to support it. But then, to look at the long-term implications of that, I am most concerned about the young adult population. In our study, you can see that those who are not on medication were more likely to be younger. I'm most concerned about them being left behind in the long term, and what that means for their cardiovascular disease and dementia risk.

Editor’s Note: Hardy reports no relevant disclosures.

Hardy ST, Jaeger BC, Emanuel E, Muntner P. Blood pressure above goal among US adults with hypertension. JAMA. Published online February 2, 2026. 

Writing Committee Members*, Jones DW, Ferdinand KC, et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;152(11):e114-e218. 

NHANES 2021–2023 data indicate that hypertension control remains poor relative to 2025 AHA/ACC targets: ~79% of US adults with hypertension had SBP/DBP ≥130/80. Among those uncontrolled, ~61% were untreated and tended to be younger, less insured, and less connected to routine care, yet most still had healthcare access. Untreated individuals were often within 10 mmHg of goal, suggesting high leverage for early initiation and lifestyle intervention. Treated patients more frequently remained ≥10–30 mmHg above goal, implicating undertitration and insufficient combination therapy.

Hardy discussed the disparity between treatment access and usage, highlighting the fact that most patients are within 10 mmHg of guideline recommendations.

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Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

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The HCPLive hypertension page is a resource for medical news and expert insights on high blood pressure. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for hypertension, and more.

Most US Adults With Uncontrolled Blood Pressure Not Taking Medication, With Shakia Hardy, PhD, MPH

Ralph DeFronzo, MD is a Professor of Medicine and Chief, Diabetes Division at UT Health San Antonio.

In their closing remarks, Auchus and DeFronzo emphasize routine screening of high-risk patients, the persistent cardiovascular burden of hypercortisolism despite risk-factor treatment, and the necessity of targeting cortisol excess itself.

Final Takeaways: Screening, Cardiovascular Risk, and Treating Cortisol as the Root Cause

In the concluding segment, Ralph DeFronzo, MD, returns to a central message: hypercortisolism in difficult-to-control type 2 diabetes is substantially more common than many clinicians appreciate. He compares the evolution of thinking around primary aldosteronism—once deemed rare, now recognized as prevalent in resistant hypertension—to the growing recognition of cortisol excess in refractory diabetes. Just as guidelines now recommend screening for primary aldosteronism in resistant hypertension, Dr DeFronzo argues that clinicians should adopt a similar posture toward hypercortisolism in complex diabetic patients, particularly those on advanced therapies such as glucagon-like peptide-1 receptor agonists and tirzepatide who nonetheless remain poorly controlled.

Richard Auchus, MD, underscores that the overnight 1-mg dexamethasone suppression test is inexpensive, technically simple, and well suited to broad use. A single tablet at bedtime and one morning cortisol measurement can identify a meaningful subset of patients—on the order of 1 in 4 in enriched populations—who warrant further evaluation. Rather than viewing this as an additional burden, he frames it as an opportunity: when potent agents such as semaglutide, tirzepatide, and sodium-glucose cotransporter 2 inhibitors fail to normalize glycemia or blood pressure, uncovering hypercortisolism offers a clear, pathophysiologic explanation and a new therapeutic avenue.

Both faculty members close by highlighting that hypercortisolism is not solely a glycemic or blood pressure issue; it is a major driver of atherosclerotic cardiovascular disease, atrial fibrillation, stroke, and myocardial infarction. Dr DeFronzo notes that even when traditional risk factors such as hypertension and dyslipidemia are well treated, cardiovascular risk remains elevated because cortisol exerts direct detrimental effects on the arterial wall, skeletal muscle, skin, and bone quality. Surgical removal of cortisol-producing adenomas or medical blockade of cortisol action is therefore essential to normalize risk. The discussion ends with a call for heightened awareness, systematic screening, and proactive cortisol-directed therapy to improve long-term outcomes in patients with complex metabolic disease.

Video Series

Special Reports

Auchus and DeFronzo survey the broader pharmacologic armamentarium for Cushing syndrome and hypercortisolism, including metyrapone, osilodrostat, ketoconazole, levoketoconazole, pasireotide, and investigational agents such as relacorilant and ACTH receptor antagonists.

Beyond Mifepristone: Enzyme Inhibitors, Pituitary-targeted Agents, and Emerging Therapies

DeFronzo and Auchus underscore the magnitude of metabolic benefit with mifepristone, the complexity of managing withdrawal and electrolyte issues, and the importance of specialist support and education for primary care physicians.

Practical Use of Mifepristone and the Need for Endocrinology–Primary Care Collaboration

Auchus and DeFronzo review mifepristone (RU-486) as a glucocorticoid receptor antagonist for Cushing syndrome and refractory hypercortisolism, detailing its effects on glycemic control, weight, and safety considerations from the SEISMIC and CATALYST trials.

Mifepristone in Hypercortisolism: Mechanism, Metabolic Benefits, and Management Challenges

Auchus and DeFronzo use the CATALYST trial to illustrate that both tumor-related and non-neoplastic hypercortisolism are common in refractory diabetes and respond to glucocorticoid receptor blockade, redefining “pseudo-Cushing” as a clinically important disease state.

Non-Neoplastic Hypercortisolism, CATALYST Data, and Expanding the Concept of Cushing Syndrome

Auchus and DeFronzo describe the underuse of hypercortisolism screening in primary care and outline a straightforward, clinically pragmatic approach to the overnight 1-mg dexamethasone suppression test and subsequent workup.

Screening in Primary Care: When and How to Use the Overnight Dexamethasone Suppression Test

In this introductory segment, Richard Auchus, MD, and Ralph DeFronzo, MD, frame hypercortisolism as an underrecognized driver of difficult-to-control type 2 diabetes, hypertension, and osteoporosis, challenging the traditional view of Cushing syndrome as a rare disorder.

Rethinking “Rare” Cushing Syndrome: Hypercortisolism in Difficult-to-Control Diabetes

Frances Lee, MD, is an assistant professor of medicine in the division of liver diseases at Mount Sinai.

Healthcare professionals discuss individualized approaches to second-line therapy for liver disease, considering patient age, fibrosis, and insurance challenges.

How Special Populations and Disease Risk Impact Treatment Assessment in PBC

Experts discuss first-line treatments for Primary Biliary Cholangitis, emphasizing the importance of monitoring and patient compliance for effective management.

Experts Review the First- and Second-Line Treatment Options for PBC

Examine adherence challenges, specialty pharmacy support, and emerging precision medicine approaches in pediatric atopic dermatitis and psoriasis.


Adherence, Specialty Pharmacies, and the Future of Precision Pediatric Care

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

An audio recap of the top 5 stories in healthcare news from the week of 02/01-02/07.

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Latest News

Bringing Hepatitis C Care to Rural Communities Through Mobile Telemedicine, With Peter Friedmann, MD, MPH

Inflammation Emerges as Promising CKD Treatment Target, With Vlado Perkovic, MBBS, PhD

New Phase 3 Findings Support Ameluz-PDT for Patients with Actinic Keratosis

Most US Adults With Uncontrolled Blood Pressure Not Taking Medication, With Shakia Hardy, PhD, MPH

Final Takeaways: Screening, Cardiovascular Risk, and Treating Cortisol as the Root Cause