) is the third leading cause of cancer-related death despite only accounting for 3% of all new cancer diagnoses.

 Obesity is a well-known risk factor for multiple types of cancer, including PDAC. In fact, there exists a relative risk of PDAC of 1.10 for every 5-unit increment increase in body mass index (BMI).

 While bariatric surgery has been demonstrated to reduce overall cancer incidence and mortality, conflicting data exist regarding the effects of bariatric surgery on PDAC.

We performed a retrospective case-control study utilizing the National Inpatient Sample (NIS) database from October 2015 to December 2020. All adult subjects (age ≥18 years) with a BMI >40 kg/m2 or >35 kg/m2 with ≥1 metabolic comorbidity were identified and stratified into those with and without a history of bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy).

, Tenth Edition Clinical Modification (ICD-10-CM) codes were used to define variables of interest. Baseline characteristics and comorbidities among the 2 groups were compared using chi-squared and Wilcoxon rank-sum tests and logistic regression analysis was performed to assess the risk of PDAC after adjusting for multiple risk factors, including tobacco use, acute and chronic pancreatitis, diabetes mellitus and various stages of obesity.

Over 19 million subjects were included, 1,656,329 of whom had a history of bariatric surgery. Patients with a history of bariatric surgery were significantly younger, more frequently female (75% vs 58%), had higher rates of class 3 obesity (69% vs 52%) and lower prevalence of hypertension, hyperlipidemia, chronic kidney disease, Charlson Comorbidity Index (CCI) ≥3, tobacco use, acute and chronic pancreatitis and pancreatic cancer (0.1% vs 0.2%) while having a higher prevalence of OSA (

 <.001). Additionally, in-hospital mortality (0.5% vs 1.8%), total hospital charges and overall length of stay were lower in the bariatric surgery cohort compared to the nonsurgical cohort (

 <.001). After adjusting for multiple comorbidities and risk factors, history of bariatric surgery was demonstrated to significantly reduce the risk of PDAC on both univariable (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.44 - 0.56) and multivariable analysis (OR, 0.68; 95% CI, 0.61 - 0.77).

This is the largest analysis to date investigating the effects of bariatric surgery on pancreatic cancer risk reduction and serves to clarify previously inconclusive data. We have shown bariatric surgery to exhibit an independently protective effect against PDAC oncogenesis. It is reasonable to suggest that patients at increased risk of PDAC as well as other obesity-related malignancies may be recommended for surgically-assisted weight loss earlier and more frequently.

With advancements in minimally invasive bariatric procedures, expanding patient eligibility and indications for surgery, increasing utilization of bariatric surgery and endoscopic bariatric and metabolic therapies may help alleviate the growing burden of pancreatic cancer.

Surveillance, Epidemiology and End Result (SEER) Program. Surveillance Research Program, National Cancer Institute. 2023 Apr 25. https://seer.cancer.gov.

Aune D, Greenwood DC, Chan DS, et al. Body mass index, abdominal fatness and pancreatic cancer risk: a systematic review and non-linear dose-response meta-analysis of prospective studies. Ann Oncol. Apr 2012;23(4):843-52. doi:10.1093/annonc/mdr398

Schauer DP, Feigelson HS, Koebnick C, et al. Bariatric Surgery and the Risk of Cancer in a Large Multisite Cohort. Ann Surg. Jan 2019;269(1):95-101. doi:10.1097/SLA.0000000000002525

Adams TD, Stroup AM, Gress RE, et al. Cancer incidence and mortality after gastric bypass surgery. Obesity (Silver Spring). Apr 2009;17(4):796-802. doi:10.1038/oby.2008.610

Sjöström L, Gummesson A, Sjöström CD, et al. Effects of bariatric surgery on cancer incidence in obese patients in Sweden (Swedish Obese Subjects Study): a prospective, controlled intervention trial. Lancet Oncol. Jul 2009;10(7):653-62. doi:10.1016/S1470-2045(09)70159-7

Tee MC, Cao Y, Warnock GL, Hu FB, Chavarro JE. Effect of bariatric surgery on oncologic outcomes: a systematic review and meta-analysis. Surg Endosc. Dec 2013;27(12):4449-56. doi:10.1007/s00464-013-3127-9

Bulsei J, Chierici A, Alifano M, et al. Bariatric surgery reduces the risk of pancreatic cancer in individuals with obesity before the age of 50 years: A nationwide administrative data study in France. Eur J Surg Oncol. Apr 2023;49(4):788-793. doi:10.1016/j.ejso.2022.11.013

Fan H, Mao Q, Zhang W, Fang Q, Zou Q, Gong J. The Impact of Bariatric Surgery on Pancreatic Cancer Risk: a Systematic Review and Meta-Analysis. Obes Surg. Apr 05 2023;doi:10.1007/s11695-023-06570-x

Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci. Mar 24 2023;24(7)doi:10.3390/ijms24076192

A history of bariatric surgery was associated with up to 50% reduced risk of PDAC among a national cohort.

Bariatric Surgery is Associated with Reduced Risk of Pancreatic Cancer: Analysis of a US National Database

Bailey Flora, MS, RD, ND

 Let’s shift to the other stuff coming in the future. There are other mechanisms being investigated in therapeutics in atopic dermatitis. I’ll start with topicals.

There’s a new topical JAK inhibitor that has been studied in ages 12 and older. It’s probably as strong or a little stronger than triamcinolone 0.1% as a steroid, but it’s a nonsteroid. There’s no atrophy. It may have more potency than our other nonsteroidals without a lot of irritancy, burning, or stinging at all. We’re really excited about that.

Tapinarof is a drug in a totally different class of medicines. It’s an aryl hydrocarbon receptor modulator. This is being developed both for psoriasis and atopic dermatitis. 

Another PDE4 inhibitor is under study as well. Another topical JAK inhibitor, delgocitinib, is being studied in both chronic hand eczema and atopic dermatitis. They’re not ready to be written yet, but these are other medicines that will give us different topical options.

Peter, do you want to talk about biologics?

Absolutely. We have some new biologic agents that are in development. In particular, we have 2 new IL-13 inhibitors that are in late-stage development, so that’s going to be exciting. It seems they’ll be similar to dupilumab but a different molecule. It may be for patients who have had an adverse event with dupilumab or if it didn’t work fully. This may be another option. This is going to be nice. It seems like they’re going to have a similar safety profile and lack of lab monitoring. That’s exciting.

We have an IL-31 inhibitor that’s also in development. That’s interesting because some people call IL-31 the master itch cytokine. That would be neat because that could answer our question we asked at the beginning. Is this the itch that rashes? If so, how much? Of course, nothing is quite that pure. IL-31 is doing other things too, but the early data seem very promising, so that’s exciting to me as well.

 There are some oral JAK inhibitors coming down the pike as well. They are well along the way. Baricitinib and upadacitinib have been approved for other indications and are being studied in phase 3 trials for atopic dermatitis. There’s also a new molecule, abrocitinib. These will be different. They’ll be oral. There are some more issues with monitoring blood work, but that will give another potential approach to some of our patients. Two of the 3 JAKs have been studied in ages 12 and older, and the other is being studied in adults but going younger. There’s lots of new stuff happening. 

This has been an incredible discussion and very practical, reflecting on all the changes that are happening in the field. Let’s get final thoughts from each of our participants. Jeffrey? 

I’ll go back to education. Educate the pediatrician and make sure the pediatrician educates the family and takes the time. This is not an easy process. This is not an easy disease state. If we do a good job outlining to the families what they need to do, we can see much better outcomes. That goes without saying for everything that primary care doctors do. This forum is going to be great for people to take a look and hear what’s coming on and where we should be.

We all have to work together in a therapeutic alliance. We need to get the patients on board. We need all of the specialists and primary care practitioners to work together because we’re all together for the same concept. We want the patient and their family to be better. When we bring all our forces together, it’s so much more powerful. There’s great synergy.

These are exciting times in the world of atopic dermatitis. The world is going to be a better place with all these new therapies on the way and with the advent of Dupixent 4 years ago. It’s a good time to have atopic dermatitis. We can do many more things to help.

Thank you. Great contributions from everyone today. Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box. Thank you.

Lawrence F. Eichenfield, MD; Jeffrey M. Bienstock, MD, FAAP; Peter A. Lio, MD; and Elizabeth A. Swanson, MD, review additional mechanisms being investigated in the pipeline for the treatment of atopic dermatitis. 

Emerging Agents for the Treatment of Atopic Dermatitis 

Elizabeth A. Swanson, St. Luke’s Children’s Hospital 

I think we've gone through a litany of different ideas about the drugs and how we use them. One of the concerns that many people have when anything new comes out is, is it reliable? I know, certainly, when drugs come out, is it effective, is it safe, and then can my patients get it? We ask the same questions with laboratory tests. Is it effective? Is it reliable? Can my patients get it for free or covered through insurance? With that, I think I'd like to get the last part. I'm going to hear from both of you. What advice do you have for your colleagues treating rheumatoid arthritis in the community setting? Joy?

I think we've come a long way. I think rheumatologists need to commend themselves. First of all, rheumatologists are still the subspecialty that still listens to patients. We still examine our patients. We use all of our clinical tools, we don't rely just on testing alone. However, we are probably the group of subspecialists that question and ask those questions on how this test is going to benefit our patients. And so I think that we do look at science, and the fact that we are getting these studies that are showing us consistently that looking at the signaling and whether a patient is going to have a response or not have a response to certain medications, and as we get into more precision medicine, and we see that these tools are going to help us to get our patients into low disease activity quicker and get to that treat to target quicker, I think we're going to rely on them more. Like Bob has said, it's going to take us a few years. There's going to be our early adopters that are going to look at this and look at that science and study it and say, ‘This is a tool in my toolbox, I’m going to use it with my clinical exam. I’m going to use it with all my laboratory testing, and I’m going to move into that direction quicker, and I’m going to see the response probably in my patients a little bit quicker.’ Then there are going to be the early adopters. There are going to be our colleagues that are going to take a little bit more time. But I think over the next few years you're going to see a big change in how we approach our patients. We're going to be commended for how quickly we take care of the patient journey and get these patients in low disease activity, and maybe at some point, rheumatoid arthritis will not have the stigma that it has had over the last several years, at least in my career, that this is a "crippling" disease process. Thank you.

Joy said it very nicely, and I would like to add that this technology has great potential. We're only scratching the surface based on the data on looking at the signal of nonresponse to TNFs [tumor necrosis factor], and hopefully getting more patients involved and more data collected will strengthen the argument that this is a reliable piece of information that will really help us guide therapy. Second, I look forward to the day that the adoption by CMS [Centers for Medicare & Medicaid Services] and adoption by the commercial insurance carriers will help us guide therapy and allow us to have this be an affordable option for us to use and not have the worry of large out-of-pocket expenses and concerns about that. Then, I just think that this really has the opportunity to help guide our patients to get to those treat to target goals, low disease activity, remission. That would ultimately lead to getting our patients to our goals as providers, as doctors, and also to the patient goals of improving those quality-of-life and patient-reported outcome things that we measure.

I think both of you hit the nail right on the head. We need more tools. We need more information. We need more accessibility to these tools because although we've had a tremendous explosion of therapeutic options, we haven't had any real guidance. To have a test that may guide our hand in therapy, even for just the first decision or even beyond that, because as we both and all know here, the therapy selection right now comes down to what are we most comfortable with? What came first? Maybe comorbid conditions, but mainly insurance mandates. Use this, then that, then this because that's our formulary. That's our sequence. I think many of us are feeling choked by this because as scientists, as rheumatologists, we are data-driven. We know better, and we know that as this science evolves in the 21st century, precision medicine is the way we can learn from our oncology colleagues. With that, I'd like to give a thanks to all of you for this rich and informative discussion. Before we conclude, I'd like to get final thoughts from each of you. Joy?

I wholeheartedly agree with everything that has been said here today. We're in a very rich environment that we have a lot of potential, a lot of hope, down the line by having a good collaboration with the science, with the testing, to give our patients that precision medicine that we want to achieve and to get these patients into the remittive state that they should be able to get into. By using good science and showing insurance companies that we are scientists, that we use evidence-based medicine to make some of our decisions. I hope through the work of the CRSO [Clinical Research Support Office], Bob, and my other colleagues, and I know myself I've tried to work in that area as well, that we'll be able to convince our insurance payers that this is the way to go for our patients and to get them into low disease activity in remission as quickly as possible.

I'm going to throw one out there. I'll put on my advocacy hat for a minute and just say that we've been really trying to improve formulary construction based on efficacy and safety. That flies in the face of the payers and the PBMs [pharmacy benefit managers] who basically construct formularies based on what's most profitable to them and not at all what's related to safety or effectiveness. I see this being a real tool that we can use from the advocacy standpoint in fighting the PBMs, in other words, being a PBM buster. That it could blow up their whole paradigm. I'm doubly excited, not only based on the science and how patient outcomes can be affected by utilizing this, but also utilizing it as maybe a cajole against the payers and against the PBMs who are unfortunately in control of what we prescribe and getting in the way of the doctor-patient relationship.

Well, Bob and Joy, thanks to you and our audience for this rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchanges and other great content right in your inbox.

Nehad Soloman, MD; Joy Schechtman, DO; and Robert Levin, MD, share final thoughts and takeaways on the treatment of rheumatoid arthritis in the community setting.

Clinical Pearls for RA Management

Joy Schechtman, DO

Mehrdad Ghoreishi, MD, is a board-certified cardiothoracic surgeon; he is the co-director of aortic surgery and medical director of cardiac surgery research at Baptist Health Miami Cardiac & Vascular Institute.

Transformations in Aortic Disease Management with Mehrdad Ghoreishi, MD

, Mehrdad Ghoreishi, MD, the co-director of aortic surgery and medical director of cardiac surgery research at 

Baptist Health Miami Cardiac & Vascular Institute

 treatment, highlighting the advantages of minimally invasive endovascular techniques compared with traditional open-heart surgery.

Ghoreishi recently presented a session entitled “The Next Frontier: Ascending Aorta and Aortic Valve Therapy” at the International Symposium on Endovascular Therapy (iSET) 2025 in Hollywood, Florida.

While open surgery remains the gold standard for aortic root, ascending aorta, and aortic arch diseases, endovascular approaches offer viable alternatives for patients unable to tolerate major surgery. Ghoreishi detailed the current availability of US Food and Drug Administration (FDA)-approved devices for the descending thoracic and abdominal aorta and the ongoing trials for ascending aorta and aortic arch interventions.

Ghoreishi also underscored the importance of multidisciplinary collaboration in aortic care, emphasizing the role of cardiac surgeons, vascular specialists, interventional radiologists, and cardiologists in optimizing treatment strategies. This team-based approach not only improves surgical planning but also ensures comprehensive follow-up care, enhancing patient outcomes.

Looking ahead, Ghoreishi shared excitement for upcoming advancements in both open and endovascular procedures, including novel stent graft technologies for the aortic arch and ascending aorta. He highlighted the potential of endovascular solutions for high-risk patients, particularly in the context of Type A aortic dissections, where minimally invasive techniques could serve as a bridge to definitive treatment. As the field progresses, he expressed anticipation for significant innovations over the next five years that will expand the scope of endovascular therapy, ultimately transforming the management of complex aortic disease.

Disclosures: Ghoreishi reports no relevant disclosures.

Ghoreishi M. The Next Frontier: Ascending Aorta and Aortic Valve Therapy. Presented at the International Symposium on Endovascular Therapy (iSET) 2025. Hollywood, Florida. February 2–5, 2025.

Mehrdad Ghoreishi, MD explores the latest advances in aortic disease treatment and the role of minimally invasive techniques.









Mehrdad Ghoreishi, MD

Andrea Nguyen, PA, shares her clinical pearls on taking care of patients with AD.

Clinical Pearls on AD Management

This is a video synopsis/summary of a panel discussion involving Melodie Young, NP, and Andrea Nguyen, PA.

In this segment, the discussion centers on providing advice and encouragement for healthcare professionals, particularly those entering the field or adjusting their approach to adhere to newer guidelines for managing atopic dermatitis (AD). The speakers acknowledge the increasing prevalence of AD, emphasizing the substantial number of patients with significant body involvement who may require more than just topical therapies.

The advice includes a systematic approach to learning about the various therapeutic categories, such as monoclonal antibodies, biologics, oral Jack inhibitors, and topicals. The recommendation is to start with a focused exploration of one category to build confidence before expanding knowledge across all therapy options. Anticipating continuous development in the next 5 to 10 years, there is emphasis on creating an efficient workflow and clinic template to streamline the prescription process for these complex therapies.

The conversation concludes with the suggestion of possible future discussions on using telemedicine for AD management, highlighting its effectiveness in treating chronic diseases like AD.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Clinical Pearls on AD Management 

Melodie Young, NP

The panel discusses the mechanism of treatment-emergent hypophosphatemia that occurs following the administration of certain intravenous iron formulations.

Treatment-Emergent Hypophosphatemia Following Administration of Intravenous Iron

Video content above is prompted by the following:

Treatment-emergent hypophosphatemia is now widely recognized as a phenomenon that can occur following administration of certain IV iron formulations and within the first 2 weeks after administration. Can you discuss the mechanism of treatment-emergent hypophosphatemia?

Michael Auerbach, MD

 Karl, there’s a drug that was mentioned by Nate called daridorexant. It’s a new drug. Can you tell us a little bit about this and what’s new and different about it?

 As Nate mentioned, it’s a dual orexin receptor antagonist [DORA], and it seems to have a shorter half-life than the other DORAs. And it may, for that reason, have different clinical effects. But one of the interesting things about the clinical development of this medication is that it’s also been looked at for daytime functioning disturbances with insomniacs. It has been shown to have some improvement in some areas of daytime functioning, which I think is very interesting, since we’ve been speaking about daytime functioning as being a critical area for insomniacs. I think we need more studies like this. It would be very helpful in the future if we could also develop more objective ways of quantifying daytime dysfunction with insomniacs and see if these medications could be helpful. This medication was also studied in, I believe, a 3-month trial where there was a rapid discontinuation. Of course, that’s a clinical issue with many of our patients who discontinue sleep medications, stop taking them. In this particular case, there was no rebound insomnia, which was very interesting to find out.

 Yes, this is interesting. You mentioned having effects on daytime functioning. When you survey patients, you find that daytime functioning is the biggest complaint, and I think you mentioned that at the beginning of the program. The fact that this medication has shown some benefit, not only at night, but also during the daytime, I think is a good direction. Hopefully, we will have other medications for insomnia that will address this as well and look at various daytime consequences of insomnia, not just look at how it’s improving the nighttime.

 Another medication, Michael, I want to mention in the pipeline is something called IMB-115; it does not have an official name yet. It is a medication being developed for not only insomnia, but also for insomnia associated with alcohol cessation. It actually acts at the receptors that are important for both pain as well as for mood and other issues and those susceptive receptors. And interestingly, it may have some effects on drug addiction as well. Thus, it has been developed as a way of possibly treating alcohol cessation insomnia as well as insomnia, period.

 Yes, I think this is particularly interesting because it’s a whole new different mechanism of action for a hypnotic [medication]. As you said, it’s affecting these pain receptors, it’s a pain receptor agonist. This medication is under investigation at the present time. What’s yet to be seen is whether it will eventually get FDA approved, of course. But it’s nice to think that there are new receptor types that could be affected by medications to help people sleep and not just the traditional ones.

Expert panelists share their excitement for novel agents that may impact the insomnia treatment landscape.

Improving Insomnia Management: Novel Agents in the Pipeline 

Michael J. Thorpy, MD

Vice Chief of Education, Fellowship Program Director

Division of Gastroenterology and Hepatology at UNC Health Care

Experts discuss the recent use of biosimilars like inolimomab as treatment for ulcerative colitis (UC).

Biosimilar Treatment Options for Patients With UC

Millie Long, MD, MPH

The panel concludes the discussion with key takeaways on the evolving treatment landscape for COPD.

Key Takeaways on the Evolving COPD Treatment Landscape

Video content above is prompted by the following question:

What are your key takeaways on the evolving COPD treatment landscape?

Nicola Hanania, MD, MS

Dr Linda Stein Gold, Dr Mona Shahriari and Dr Seemal Desai share advice for improving psoriasis care for patients with skin of color.

Advice for Dermatologists in Treating Psoriasis in Patients With Skin of Color

This is a video synopsis/summary of a panel discussion involving Linda Stein Gold, MD; Mona Shahriari, MD, FAAD; and Seemal Desai, MD.

The discussion focuses on the implications of research findings for patients with skin of color in psoriasis treatment. The speakers emphasize the importance of utilizing data-driven approaches to guide treatment decisions and advocate for increased diversity in clinical trial participation to ensure representative study populations.

They discuss the significance of cultural sensitivity in patient interactions and highlight the need for continued investment in research and development to generate data that can inform clinical practice effectively. The transcript concludes with a call to action for dermatologists to play a critical role in improving outcomes for all patients with psoriasis, underscoring the value of sharing knowledge and fostering collaboration within the medical community.

Overall, the conversation emphasizes the importance of evidence-based approaches, cultural competence, and ongoing research efforts in addressing the needs of diverse patient populations with psoriasis.

Authors