Eapen discussed her research into analyzing the cord blood methylome for markers that predict atopic dermatitis risk at the AAAAI/WAO Joint Congress.

Investigating Markers of Early-Onset Atopic Dermatitis, with Amy Eapen, MD

A study led by Amy Eapen, MD, an allergist-immunologist at Henry Ford Health System, has found distinct cord-blood DNA methylation (DNAm) patterns are associated with a risk of early-onset atopic dermatitis by 2 years old. Eapen presented the findings in a late-breaking abstract at the 

2025 American Academy of Allergy, Asthma, & Immunology (AAAAI)

 annual meeting in San Diego from February 28 – March 3.

Eapen and colleagues analyzed DNA from the umbilical cord blood of 302 using the Asthma & Allergy array tool and identified 16 differentially methylated regions linked to early-onset atopic dermatitis. In the 16 regions, 180 CpG sites were the most important for predicting early-onset atopic dermatitis and these sites had poly-CpG scores with high predictability of early-onset atopic dermatitis (area under the receiver operator characteristic curve, 93.7%; sensitivity, 84.9%; specificity, 86.3%).

spoke with Eapen to learn more about her investigations into the cord blood methylome and how the findings could potentially impact clinical care for early-onset atopic dermatitis. She shared how cord methylome screening could potentially fit into newborn screens and may help to prevent other atopic disease such as food allergy. She also mused that future studies could look at predicting responses to targeted therapies with DNA methylation markers. Lastly, she stressed the importance of continuing population birth cohort research for advances in early-onset atopic dermatitis and other diseases.

“Especially for early-onset atopic dermatitis, the biggest leaps that we've been able to make in science are from population birth cohorts, which have been funded by the NIH and NIAID. So, continuing this work will be super important for our diverse populations across the country, and also in identifying ways to prevent these diseases, because that is the goal,” Eapen said.

Eapen A, Loveless I, Pan M, et al. The Impact of the Cord Blood Methylome on Early-Onset Atopic Dermatitis. Presented at: AAAAI/WAO Joint Congress, San Diego; 2/28-3/3. Abstract L17

Amy Eapen, MD

Welcome to Kidney Compass: Navigating Clinical Trials!

Kidney Compass: Hierarchical Composite Endpoints in Nephrology, with Dustin Little, MD, and Niels Jongs, PhD

Welcome to the first installment of a 4-part series on 

 exploring the use of hierarchical composite endpoints (HCEs) in kidney disease clinical trials.

In this installment, hosts Brendon Neuen, MBBS, PhD, and Shikha Wadhwani, MD, MS, begin by introducing their guests Dustin Little, MD, Global Clinical Lead at AstraZeneca, and Niels Jongs, PhD, a statistician at the University of Groningen.

The discussion starts with an overview of traditional composite endpoints commonly used in nephrology trials, such as cardiovascular death, kidney failure, and sustained eGFR decline. Little explains key limitations of these traditional endpoints, including their reliance on first-event analysis and the disproportionate influence of rapid progressors on overall trial results. He emphasizes the need for more efficient trial designs that account for the entire study population rather than just those who reach predefined endpoints.

Jongs and Little both go on to explain how HCEs aim to address these shortcomings by structuring outcomes in a prioritized hierarchy, ensuring every patient contributes meaningfully to efficacy assessments. They discuss the addition of eGFR slope as a component of HCEs, allowing for a more comprehensive evaluation of treatment effects, especially in trials where only a small subset of participants progress to major clinical events.

Jongs expands on these concerns by highlighting statistical limitations, including how composite endpoints weigh events equally despite differences in clinical significance. The conversation then shifts toward the structure of HCEs, which build upon traditional endpoints by incorporating eGFR slope to ensure that all patients contribute to efficacy assessments. By structuring events hierarchically, HCEs aim to better reflect disease progression and provide a more comprehensive assessment of treatment effects.

For ease of viewing, we've divided this episode into 4 sections and highlighted them below.

Kidney Compass: Hierarchical Composite Endpoints in Nephrology

Part 1: Introductions, HCEs in Nephrology

Part 2: HCEs in Nephrology Clinical Trials

Part 3: Addressing HCE Skepticism, Potential Limitations

Part 4: Applying HCEs in Kidney Disease Trials

 include AstraZeneca, Bayer, Boehringer and Ingelheim, Janssen, and others. Relevant disclosures for 

 include the National Institute of Diabetes and Digestive and Kidney Diseases, GSK, Calliditas, and Travere Therapeutics. Relevant disclosures for 

In part 1 of 4 from this episode, the discussion focuses on traditional composite endpoints in nephrology trials and the use of HCEs.

Brendon Neuen, MBBS, PhD

Anti-VEGF for RVO: The Gold Standard

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John W Kitchens, MD, bookends the discussion by highlighting the landscape of branch vein occlusion (BRVO) treatment options. 

Anti-VEGF for RVO: The Gold Standard 

Dante J. Pieramici, MD

Kris Kowdley, MD, FACP, FACG, AGAF, FAASLD: 

We’re comingto the end of this discussion, but I want to talk about unmet needs in PBC [primary biliary cholangitis]. What are some unmet needs? I’m going to have everyone comment, but I’m going to start with you, David.

This was a lead-in to say that transplantation for patients with PBC is an unmet need. They’re not well served by our current allocation system, and I’ve implored some of our UNOS [United Network for Organ Sharing] colleagues to consider itching in the malignant, life-altering aspect of pruritis to be something that we incentivize for transplant. Transplant is supposed to make your life longer and better, and many of these patients with recalcitrant pruritus from PBC deserve quality therapy. That’s where I see the biggest unmet need. I don’t think we do great in our transplant world. That’s a bigger question to answer. I’m hopeful that these new therapies and some of the emerging therapies may be able to treat some of our patients who aren’t candidates for obeticholic acid or second-line therapy as we try to prevent them from progressing to such a stage.

That’s a good point. There’s concern about patients who have decompensated liver disease. Obviously, they can’t receive obeticholic acid. With fibrates, there are some concerns and warnings about liver or kidney toxicity. Clearly, that’s the population where there’s a big need. I’ve had 3 patients in my career who I was able to get either prior to MELD [model for end-stage liver disease] and requiring exception points or during MELD with exception points for refractory life-threatening pruritis, 2 of whom were considering suicide. Those patients would not be eligible for exception points in this era. It’s uncommon, but it’s a huge unmet need. Ed, what do you think are the unmet needs in this disease?

Something we looked at in our clinic is ethnic disparities in PBC. We found that our Latino population who had PBC came at a much later stage of disease. Most of them have cirrhosis. David, you mentioned patients with PBC languishing in clinics. Increasing awareness of PBC and screening using the antimitochondrial antibody in certain ethnic groups or communities would be of value.

Like many things in liver disease, Kris, they’re all out of unmet needs. First, there’s an unmet need regarding the education of practitioners in how to diagnose this early. There’s an unmet need in terms of having more effective primary therapy in the first place for patients with PBC. There’s an unmet need for the treatment of the profound fatigue that some patients have with this disease. Even if they don’t have cirrhosis, it’s a major quality-of-life issue for them. There’s an unmet medical need for the pruritis. The pruritis doesn’t always correlate with the advance, with the stage of the disease. That’s also a misunderstanding. Patients can have moderate pruritis, which does affect their quality of life, but it’s not enough to need a transplant, and their liver disease isn’t so advanced. We know we could do better with therapy. So, there are a lot of unmet needs in PBC.

I agree, and your point about pruritis and symptoms not being correlated with disease severity is important to recognize. Some patients, as they start having more symptoms, are petrified, and their fatigue is getting worse. They think they need to get on a liver transplant list.

For patients with PBC, 1 of the extrahepatic manifestations is they can have very profound and aggressive osteoporosis. The guidance documents are clear that patients should have periodic bone densitometry when they have PBC. This, too, doesn’t correlate necessarily with the stage of their liver disease, and you can’t wait until patients are having spontaneous pathological fractures to identify this. The audience should also know in a patient with PBC that they are or should be recommending periodic bone densitometry to look for osteoporosis or even osteopenia.

At a minimum, your patient with PBC who comes into the office every 6 months or 1 year should have a vitamin D test with their standard labs. That’s a guidance, but it’s often not done. We added it to our standard order set for patients with cholestatic liver disease, so other providers would do it. That’s the best and easiest screening tool to identify higher-risk patients.

That’s an excellent point. Fractal vitamin deficiency isn’t necessarily seen only in patients with jaundice, so we do that routinely when we first see the patient. Sonal, you get the last word on unmet needs for education and for patients or clinicians.

I’ll piggyback on what Steve said. As physicians, we focus on normalization of the alkalis or goals of preventing and disease prevention, which are understandable and obviously important. But from a patient perspective, what affects their day to day is their quality of life. If we can improve that, in combination with these new therapies, that will prevent disease progression. That will be huge.

That’s great. That hour and a half went by fast. I appreciate the chance to share thoughts and clinical experience. Thanks to all of you for this rich and informative discussion. Before we conclude, I’d like to get some final thoughts. Everybody gets 30 seconds. Let’s start with you, Steve.

The practitioners in the audience should understand that although this is an uncommon disease, it’s not so uncommon that you won’t see it. You will, and you need to know how to diagnose it and be comfortable about the diagnosis. Be aggressive in your therapy, even in patients who are asymptomatic. Follow their fibrosis scores, and don’t forget these extrahepatic manifestations, which are more prominent than any of the others in liver disease: osteoporosis, hyperlipidemia, pruritis. Become comfortable with it, understand it, and follow the patients aggressively because you’ll help them.

Steve summed it up well. Disease awareness is a big deal in PBC. Although this is a rare disease, it’s not something you’ll see once in your lifetime or never see. It’s important for practitioners to be aware that this disease exists and recognize that it’s an exciting time for patients with PBC. We have good therapies already in existence but even more exciting therapies in development.

I agree with what everyone said. But let’s not let these patients languish in our clinics. Let’s follow that alkaline phosphatase, and let’s get that alkaline phosphatase to normal.

Having the last name Victor puts me at the end of this. Our panelists have hit on all the issues. To the providers and practitioners watching this, go through your clinic and make sure you’ve optimized the patients you have to make sure they don’t see me for transplant.

That’s very well summed up. Thank you again. To our viewing audience, I hope this 

 discussion was useful and informative. If you enjoyed the content, please subscribe to our e-newsletters to receive 

Experts in hepatology review the unmet needs in primary biliary cholangitis, commenting on liver transplant, ethnic disparities, management of pruritis, as well as other symptoms.

Unmet Needs in the Treatment of PBC

David Victor III, MD

Jennifer B. Green, MD: Implementation of Evidence-Based Therapies for T2D

22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC)

, Jennifer B. Green, MD, an endocrinologist and a clinical trialist at Duke University Medical Center, provided updated insight into the implementation of evidence-based therapies for high-risk patients with 

Green highlighted the success of the COORDINATE-Diabetes trial, which aimed to improve the adoption of essential therapies—high-intensity statins, ACE/ARB inhibitors, and sodium-glucose co-transporter 2 (SGLT2) inhibitors or glucagon-like peptide-1 (GLP-1) receptor agonists—in cardiology clinics for patients with T2D and established atherosclerotic cardiovascular disease (ASCVD). The trial showed significant improvements in treatment adherence, addressing a critical gap where only 3-4% of patients were initially receiving all recommended therapies. Green also emphasized the importance of continuing medical education, noting that conferences like these help clinicians stay updated on evolving management strategies, particularly for managing cardio-renal complications in diabetes.

Reflecting on advancements in 2024, Green pointed to the expanding benefits of therapies like GLP-1 receptor agonists and SGLT2 inhibitors, which, beyond managing glucose and weight, are now shown to provide substantial cardiovascular and kidney-related outcomes. She expressed satisfaction in knowing that her prescribing practices are delivering broader benefits than initially expected, reinforcing the importance of implementing the latest evidence to improve patient outcomes.

Disclosures: Relevant disclosures for Green include Bayer, Boehringer Ingelheim, Eli Lilly, Merck, and others.

Green JB. From Research to Guidelines to Implementing Good Clinical Practice in the Management of Diabetes. Presented at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC). Los Angeles, California. December 12-14, 2024.

Dr. Jennifer B. Green discussed the implementation of evidence-based therapies for high-risk type 2 diabetes patients at the WCIRDC. She highlighted the COORDINATE-Diabetes trial's success in improving adherence to essential therapies in cardiology clinics, addressing a significant treatment gap. Green emphasized the role of continuing medical education in updating clinicians on management strategies, particularly for cardio-renal complications. She noted the expanding benefits of GLP-1 receptor agonists and SGLT2 inhibitors, which now show substantial cardiovascular and kidney-related outcomes, underscoring the importance of applying the latest evidence in practice.

Jennifer B. Green, MD highlights the successful implementation of evidence-based therapies for high-risk patients with type 2 diabetes.

Jennifer B. Green, MD

HCPLive Five – Allergy Updates at AAAAI 2025

 2025 Academy of Allergy, Asthma, & Immunology (AAAAI) 

annual meeting in San Diego to connect with colleagues, explore late-breaking data, and attend hundreds of sessions.

 Allergy Team reported live from San Diego, conducting dozens of interviews and covering late-breaking research. In this iteration of the HCPLive Five, the team highlighted standout video interviews, covering topics such as insect allergy testing, chronic rhinosinusitis, omalizumab for food allergies, oral immunotherapy with autoclaved peanuts, and the WAYPOINT phase 3 trial assessing tezepelumab for nasal polyp management.

When to Test for Insect Sting Allergies, with David Golden, MD

David Golden, MD, from Johns Hopkins University, discussed the pitfalls of over-testing for insect sting allergies. He emphasized that a positive test does not confirm an allergy, as many people with positive results experience no reaction to stings.

Testing should be reserved for patients with anaphylactic reactions, as unnecessary testing can lead to undue worry and even disqualify individuals from opportunities like military service. Unlike peanut allergies, insect allergy tests do not predict reaction severity, making it crucial for clinicians to avoid misinterpreting strong test results as indicators of severe allergy risk.

When an Allergist Should Refer Endoscopic Sinus Surgery for Chronic Rhinosinusitis, with Kent Lam, MD

Kent Lam, MD, from Eastern Virginia Medical School at Old Dominion University, discussed when allergists should refer patients with chronic rhinosinusitis for endoscopic sinus surgery; surgery is recommended when symptoms persist despite treatment with topical steroids, saline irrigation, or antibiotics.

The procedure aims to improve sinus drainage and ventilation rather than remove tissue. Lam emphasized setting patient expectations regarding risks such as bleeding, scarring, and symptom persistence.

Omalizumab Performs Better Than Oral Immunotherapy for Food Allergy, with Robert Wood, MD

Robert Wood, MD, from Johns Hopkins Medicine, discussed the OUtMATCH trial comparing omalizumab and oral immunotherapy (OIT) for food allergies. The study found omalizumab superior in the intent-to-treat analysis (36% vs 19%;

 = .031), but per-protocol analysis—excluding dropouts—showed similar effectiveness (

OIT had a high dropout rate due to side effects, while omalizumab was well tolerated. Wood emphasized the need for individualized treatment, as OIT may offer long-term immune changes, but omalizumab provides a safer alternative with fewer side effects.

Patients Tolerate Oral Immunotherapy Better with Autoclaved vs Blanched Peanuts, with Casey Cohen, PhD

A study found that peanut-allergic patients tolerated oral immunotherapy better with autoclaved peanuts than with blanched peanuts. Casey Cohen, PhD, from McGill University, explained that autoclaving—using high temperature and pressure—reduces peanut-specific immunoglobulin binding, resulting in fewer severe reactions.

In a double-blind trial of 10 participants, the median tolerated dose was significantly higher for autoclaved peanuts (300 mg vs. 9 mg). No participants required epinephrine for autoclaved peanuts, whereas all were for blanched peanuts.

Tezepelumab Lowers Nasal Polyp Severity in CRSwNP During Phase 3 WAYPOINT, with Joseph Han, MD

The phase 3 WAYPOINT trial demonstrated that tezepelumab significantly reduced nasal polyp severity in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP), lowering the need for surgery by 92%. Tezepelumab significantly improved nasal congestion, sense of smell, and overall symptom scores at 52 weeks.

Investigator Joseph Han, MD, from Eastern Virginia Medical School, highlighted the near elimination of surgery in the treatment group. These findings support tezepelumab as a promising treatment option for CRSwNP, reducing reliance on systemic steroids and surgical intervention.

GlaxoSmithKline, Regeneron Pharmaceuticals, and AstraZeneca Pharmaceuticals for Lam, Genentech USA for Wood, none for Cohen, and GlaxoSmithKline, Genzyme Corporation, Regeneron Healthcare Solutions, Medtronic, Merck Sharp & Dohme, Optinose, AstraZeneca Pharmaceuticals, Aerin Medical, and PFIZER for Han.

Counting down the most impactful news at major medical meetings, it’s the HCPLive Five! This episode focuses on 5 key allergy updates from the 2025 American Academy of Allergy, Asthma, and Immunology (AAAAI) annual meeting.


Kent Lam, MD

Panelists discuss how key nonpharmacological interventions include vaccinations to prevent infections, pulmonary rehabilitation to improve function, and lung cancer screening for high-risk patients to enable early detection.

Vaccination and Pulmonary Rehabilitation in COPD

Video content above is prompted by the following:

What nonpharmacological interventions should one consider for their patients, including vaccination, pulmonary rehabilitation, and lung cancer screening?

M. Bradley Drummond, MD, MHS

Margaret A Chang, MD, MS  

Steven Flamm, MD, FAASLD, FACG

It’s important for us to understand that we treat the whole patient, and we treat the whole patient in the circumstances that surround us. And the circumstance that surrounds us now is COVID-19. Sometimes, it brings families closer together because they’re sheltering in place, and that helps with their support group. But sometimes, it’s the opposite. Sometimes, an older parent can’t be around their kids because their kids are sick, or their kids have little kids who are sick. And they don’t have the support. It’s good to keep all those factors in mind when we’re prescribing things. Sometimes an infusion is better, and sometimes a self-injection, for instance, like a repository corticotropin injection, might be easier than coming in to get an infusion. And in some ways, it may be more effective. We have to take into account all the factors with our patients, their support systems, their ability to come in and get treatment, their ability to get the monitoring that they need. All those are important things. Any comments you want to make on that?

 I totally agree. I tell my patients if you want black and white, then this is not the specialty for you. We are many shades of gray, and our decisions are individualized and based on our best opinion.

: I like to say, that absence of evidence is not evidence of absence. Just because you’re paranoid, doesn’t mean that people are out to get you. My professor used to say, “I don’t know what he’s got, but he’s got something.” And sometimes what we have to do is use the information available and go with it. I had a patient who had a bad inflammatory myopathy, early in the pandemic. I wanted to get a muscle biopsy on her, and there were no elective procedures, so I couldn’t do it. I had to go ahead and treat her. And now, doing the muscle biopsy isn’t going to be that helpful because we’re pretty far along. I’m having some trouble tapering her off of her oral prednisone. And I’ve found that repository corticotropin is a good way to help taper because of its effect on melanocortin type 2 receptors in the adrenal cortex. It’s sort of helping the adrenal cortex to work, and to wake up and do its job, so you can give fewer oral steroids.

 It has both, like you mentioned, direct and indirect properties. The percentage of engagement with the adrenal cortex is minimal. That’s the other special sauce, as you might want to call it.

: Yes. Well, we’ve covered a lot of ground today about treatment options for systemic lupus erythematosus and idiopathic inflammatory myopathies. What advice would you have for community physicians treating rare systemic autoimmune rheumatic diseases?

 Don’t be afraid to say, “I don’t know.” These are rare conditions, and even we’re not seeing them every day. But a good physical history, there are some serologies that are available, that anyone can order, and try to connect the dots with other subspecialties. If it doesn’t make sense, and if they’re having multiple organs involved, and you can’t quite tie a diagnosis, rheumatologists might be the missing link.

: I like that, the rheumatologist might be the missing link. That sounds great. I say exactly the same thing, that we’re here to help. Please use us as a resource. And we want to work with you and help you to work with things that are rare. I completely agree that common things are common, and not much of what we do is. And certainly, since we don’t have necessarily a light switch that says on and off for our diseases, it takes a lot of clinical judgment, and it takes a lot of working with the patient, following the patient. And sometimes it evolves over time. We might think it’s one thing, and it turns out that it’s something else. I completely agree with everything you have to say. And I think that’s great advice for community physicians. Do you have any final comments before I make closing remarks?

 I look forward to the good old days, where we can all get together in person, and not have to socially distance ourselves and not worry about unvaccinated individuals. And I wish everyone health and the very best.

Well, this has been delightful, and I’ve really enjoyed talking with you. I hope we get to do this again sometime. I want to thank all those out there who are watching this 

. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming programs and other great content right in your inbox.

Closing out their discussion, experts highlight practical advice for caring for patients with SARDs in the current treatment landscape. 

Authors