Craig Lammert, MD, is an associate professor of medicine at Indiana University School of Medicine and executive director for the Autoimmune Hepatitis Association. 

Advancing Autoimmune Hepatitis Treatment and Research, with Craig Lammert, MD

 treatment landscape has remained stagnant, relying on the same standard therapies with little innovation.

AIH is a rare chronic disease, with little known about its etiology and pathophysiology. Additionally, epidemiological data on AIH is scarce and likely unreported and underrecognized.

“The standard of care that we've been using for almost 70 years really has not evolved,” Craig Lammert, MD, an associate professor of medicine at Indiana University School of Medicine and executive director for the Autoimmune Hepatitis Association, explained to 

. “We have very much used azathioprine, or Imuran, as a hammer and the patients as a nail.”

He notes that recent studies have sought to widen the standard of care, specifically referencing the CAMARO trial comparing azathioprine and mycophenolate mofetil, both in combination with prednisolone, for the induction of biochemical remission in treatment-naive patients with AIH. Results showed mycophenolate mofetil with prednisolone led to a significantly higher rate of biochemical remission at 24 weeks with fewer adverse events compared to azathioprine combined with prednisolone.

Still, Lammert points out a significant proportion of patients fail to achieve biochemical response with currently available therapies and face long-term corticosteroid dependence.

“Anything we can do to herald in a new wave of clinical trials, and how we design those trials to not suffer from what we've seen in the PBC space, but also to identify agents and test them in a way to get full approval, would be tremendously impactful for autoimmune hepatitis patient populations,” he said.

In the meantime, Lammert describes efforts to optimize current standard of care and assess tools for long-term disease monitoring, including FibroScan.

“More to come on this area, and again, an exciting area, but we need so much more collaboration and patient-level data,” he said. “I think this will help guide us into the future, and hopefully, autoimmune hepatitis will catch up with all the other autoimmune diseases in terms of treatment and more individualized level of care.”

Editors’ note: Lammert has relevant disclosures with Eli Lilly, Kezar Life Sciences, and the Autoimmune Hepatitis Association.

Linzay CD, Sharma B, Pandit S. Autoimmune Hepatitis. StatPearls. August 14, 2023. Accessed March 25, 2025. 

https://www.ncbi.nlm.nih.gov/books/NBK459186/

Snijders RJALM, Stoelinga AEC, Gevers TJG, et al. An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis. 

Lammert describes the lack of developments in autoimmune hepatitis care over the past several decades and points to what might be next in disease management.

Craig Lammert, MD

 We can’t forget about insulin therapy. Insulin is a very effective tool. I talk about insulin as though it’s 1 thing, but there are many types of insulin being developed. One area that has seen a tremendous amount of evolution in recent years is the development of artificial pancreas systems. We have devices available that include both an insulin delivery component and a glucose sensor, or CGM [continuous glucose monitoring], component that are at least partially linked. The insulin delivery in at least some respect is directly affected by the ambient glucose level that the sensor detects.

We have a couple of devices that alter basal insulin delivery based on what the glucose level is, and that represents an exciting step forward. A true artificial pancreas—there are many such systems in development—would be completely hands-free or at least come very close. There are also a number of systems in development that include an algorithm or very sophisticated algorithms that alter insulin adjustment—not just for basal insulin delivery but for correction insulin or, to some extent, mealtime insulin in response to the individual’s activity and blood glucose level that will come a little closer. None of those hands-free systems are in development, but they’re getting closer.

We’ve seen published data, particularly in the pediatrics population, that look incredibly promising. Consistently, almost all the trials I’ve reviewed suggest that these kinds of systems reduce the risk of hypoglycemia compared with the traditionally available semi-integrated systems. The challenges we’ll see moving forward will be how these systems can be designed to account for meal intake, how to customize or appropriately deliver insulin in response to what the person is eating, and how the system reacts to hypoglycemia, should it occur.

Some of these systems are dual-hormonal systems that infuse not just insulin but also glucagon. Although none of these appear extremely close to becoming available, within the next 5 years, we’ll probably have multiple systems on the market that I hope will make life much easier for individuals who require these sophisticated insulin delivery systems. They’re not just for people with type 1 diabetes. These systems hold great potential for people with type 2 diabetes who need this intensive and complex treatment as well.

 Technology has certainly taken off. We have penny-size sensors for continuous glucose monitoring. We have subcutaneously implanted sensors. We get a lot of questions from patients who might not necessarily benefit from sensors. They may be cardiovascular patients or any patient with diabetes who says, “I’m on 2 medications. I’m on metformin, and my hemoglobin A1C [glycated hemoglobin] is 6.8%. Should I wear a sensor?” That’s probably not helpful. These are meant more for patients on complex insulin regimens or multiple daily injections, combined with insulin pumps and an algorithm used to semiautomate—at least for now—the basal rates.

If you look at the requirements from the FDA for diabetes medications, they’re very stringent on outcome trials. For durable medical equipment, we’ve never had an outcome trial, other than looking at time in euglycemia or hemoglobin A1C. We don’t know well whether using a pump vs multiple daily injections would reduce microvascular or macrovascular complications. I alway s thought that would be a very interesting area to explore. But much of this has to do with quality of life in addition to quality of care. More time spent in euglycemia, safer insulin use, shut-off algorithms—basal insulin in the middle of the night—etc. These are the main advantages of pumps and continuous glucose monitoring. It’s available with phone data, so it becomes much more user friendly. If you look at pictures of how the first pump, the backpack pump, was developed to now automated algorithms, it’s really taken off. Diabetes care will become much easier, much safer, and outcomes will become much better in the future.

Some of the most encouraging data for us endocrinologists and cardiologists have been from a large Swedish cohort that looked at mortality data in patients with diabetes, emphasizing the comprehensive care model. I keep citing the Steno-2 trial in every presentation because it sends the message of comprehensive care, where if patients are treated with their hemoglobin A1C and albuminuria protected, and smoking, LDL cholesterol, and blood pressure all under control—all 5 of those factors were under control in this large Swedish cohort—there was no significant excess mortality across every age group. This is really encouraging. We have all the tools available to do that. The challenge will be to bring this to the wider population and to fill a lot of the gaps that we’re dealing with.

 I completely agree. I briefly mentioned the GRADE study. We have just a few moments left, but some of the information that trial will ultimately provide will be a bit of insight into personal phenotypes and drug choices that may be particularly effective and tolerable for individual patients. I’m interested to hear more from that study about personal phenotypes, individual predictors of accomplishment of good glycemic control, and even benefits from a microvascular or macrovascular perspective within the various classes of drugs that were studied in that trial.

Thank you, Dr Bruemmer. I’d like to thank everyone for watching this 

®. If you enjoyed the content, please subscribe to the e-newsletters to receive upcoming 

® and other great content right in your in-box. Thank you very much.

Expert clinicians discuss insulin therapy for treating type 2 diabetes and comment on what to look forward to in the future of diabetes care.

Insulin Therapy and the Future of Type 2 Diabetes Care

Dennis Bruemmer, MD, PhD

emerging treatment options for gout and share tips for monitoring and managing gout in patients with comorbid conditions.

Emerging Agents in the Treatment of Gout

14:00 Mechanisms to improve uric acid excretion

15:40 Options for treatment resistant gout

25:50 Challenges in monitoring patients with gout

29:50 Management of gout in patients with comorbid conditions

In this discussion, experts focus on emerging treatment options for gout and share tips for monitoring and managing gout in patients with comorbid conditions.

Emerging Agents in The Treatment of Gout

Gordan Lam, MD

COVID-19 has disrupted healthcare practices and challenged Primary Care Providers (PCPs) to rapidly innovate to deliver care. It has also upended patients’ lives and forced many to skip preventive care checkups and screenings, as well as highlighted gaps in chronic diseases and disparities in outcomes. In the last two years, cancer screening rates have plummeted in nearly all age groups

despite a rising incidence of colorectal cancer (CRC) in younger adults.

 Colorectal cancer is the second leading cause of cancer deaths in the United States;

 however, when caught in early stages, it is treatable in ~90% of people.

Regular screening can help catch cancer early.

 So, as we consider patient care in light of the ongoing pandemic, how can we encourage eligible adults to get screened when they’re due? We have an opportunity to redesign our approach – action is needed across the healthcare spectrum to ensure health systems, community centers, and PCPs partner to prioritize health literacy and ensure patients have the necessary support and resources to make informed decisions.

Increasing health literacy is critical to combatting colorectal cancer. With the recommended colorectal cancer screening age starting at 45 for average-risk Americans

, there should be a sense of urgency in finding new ways to engage with patients around preventive care measures.

New data from The Harris Poll** highlighted a lack of awareness about the risk*** of colorectal cancer. Many of those surveyed perceived themselves to be at minimal risk. In fact, 73% of respondents aged 45-49 believed they are at low risk for colorectal cancer. This demonstrates a critical and concerning gap in health literacy. We have a responsibility to ensure screening-eligible Americans, particularly adults aged 45-49 and those in vulnerable communities, have the resources and information they need to understand why screening should be a priority.

So, what steps can we take to drive progress? While I would love to see sweeping public health changes on initiatives for self-management of preventive care, where colon cancer screenings could be as accessible and convenient as a home-delivered rapid COVID antigen test, taken after using a validated screening calculator to self-assess their risk level for colorectal cancer, I believe that there are a few simple actions that can make a large impact now. 

We could reframe how we engage in cancer screening conversations. It is easy to lead with, “Now you’re 45, it’s time for your colonoscopy.” But perhaps start with, “Do you ever think about getting cancer?” It might be a surprising question to hear, even alarming, but it could give you some insights on your patient’s fears or willingness to screen for the recommended cancers or only specific types and why. Primary care providers are a trusted resource and can start the conversation about personal risk and share the best screening options to meet patients where they are.

Another option is to offer a choice in colon cancer screening options to patients first, before waiting to hear if there is any hesitancy about colonoscopy. While a colonoscopy is considered the primary screening option for colorectal cancer, offering a choice in screening can encourage those who have hesitancy to get scoped.

 Many respondents to the Harris Poll noted that their discomfort – physical or stigma-related – with colorectal cancer screening has prevented them from staying up to date, indicating an opportunity for more screening options. In fact, among those who have ever skipped a colorectal cancer screening after a referral, 38% of those surveyed cite having done so due to discomfort with the idea of invasive procedure. Additionally, 74% of adults surveyed agreed that they would get screened for colorectal cancer if it were a non-invasive procedure, while 72% of respondents said that they would be more willing to get screened if they could use an at-home test instead of going to a doctor's office.

Despite these results, only 4 in 10 respondents (40%) were familiar with at-home DNA based stool tests. Each type of screening test has its strengths and shortcomings when comparing effectiveness, accessibility, and ease of use, but the best screening is the one that gets done. When considering health disparities in populations where paid sick time is not available, or patients are primary caregivers to children or elders and unable to take time away for the colonoscopy prep and procedure, providing resources that clearly delineate various screening options is critical.

At-home screening options such as Cologuard® can provide a non-invasive, effective, and convenient screening option for adults 45 and older, who are at average risk for colorectal cancer. In the effort to improve health literacy, it is important to discuss with patients what makes them eligible and ineligible for Cologuard. Small practices and solo PCPs with limited resources have found it helpful that Cologuard also has a built-in, 24/7 patient support team to follow-up on and encourage test completion in over 240 languages which can help make the process more convenient and contact free, particularly as screening rates have dropped amidst COVID-19.

As we navigate this complex healthcare landscape, action is needed to ensure health systems, community centers, and PCPs partner to prioritize health literacy and engage patients with the meaningful resources and necessary support to make informed decisions. To do so, we must reframe our approach as we face increasingly challenging areas of care. With colorectal cancer incidence rates on the rise in younger populations,

 screenings remain the most important tool to detect preventable fatalities. Meeting patients where they are with solutions that fit their specific needs is critical to catching up on missed screenings and encouraging future screenings.

Indication and Important Risk Information


Cologuard is intended to screen adults 45 years of age and older who are at average risk for colorectal cancer by detecting certain DNA markers and blood in the stool. Do not use if you have had adenomas, have inflammatory bowel disease and certain hereditary syndromes, or a personal or family history of colorectal cancer. Cologuard is not a replacement for colonoscopy in high-risk patients. Cologuard performance in adults ages 45-49 is estimated based on a large clinical study of patients 50 and older.

The Cologuard test result should be interpreted with caution. A positive test result does not confirm the presence of cancer. Patients with a positive test result should be referred for diagnostic colonoscopy. A negative test result does not confirm the absence of cancer. Patients with a negative test result should discuss with their doctor when they need to be tested again. False positives and false negative results can occur. In a clinical study, 13% of people without cancer received a positive result (false positive) and 8% of people with cancer received a negative result (false negative). Rx only.

** Data is according to a national survey of 5,021 U.S. adults aged 45-75 conducted by The Harris Poll on behalf of Exact Sciences between March 25 and April 15, 2021.

*** Average risk in this survey was defined as those who do not have a personal history of: colorectal cancer, Inflammatory Bowel Disease, adenomas, a positive result from a colorectal cancer screening within the last 6 months, a family history of: colorectal cancer, Familial adenomatous polyposis (FAP, Hereditary non-polyposis colorectal cancer syndrome (HNPCCC or Lynch Syndrome), Peutz-Jeghers Syndrome, MYH-Associated Polyposis (MAP), Gardner’s Syndrome, Turcot’s (or Crail’s) syndrome, Cowden’s syndrome, Juvenile Polyposis, Cronkhite-Canada syndrome, or Neurofibromatosis, and are not experiencing rectal bleeding.

Chen RC, Haynes K, Du S, Barron J, Katz AJ. Association of Cancer Screening Deficit in the United States With the COVID-19 Pandemic. JAMA Oncol. 2021;7(6):878–884. doi:10.1001/jamaoncol.2021.0884

Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for average‐risk adults: 2018 guidelines update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250‐281. doi:10.3322/caac.21457.

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71:7-33. doi:10.3322/caac/21654.

National Cancer Institute. Cancer stat facts: colorectal cancer. Accessed November 10, 2021. https://seer.cancer.gov/statfacts/html/colorect.html.

Davidson KW, Barry MJ, Mangione CM, et al. Screening for colorectal cancer - US Preventive Services Task Force recommendation statement. JAMA. 2021;325(19):1965-1977. doi:10.1001/jama.2021.6238

Redesigning our Approach to Combating the Rising Incidence of CRC in Young Adults

Jenny Chiang, MD, FAAFP, Medical Director, MetroWest Healthcare Alliance, Wellforce

Joseph Anderson, MD, is an associate professor of medicine at Geisel School of Medicine at Dartmouth.

Colonoscopy’s Role in CRC Screening, The Importance of Adequate Bowel Preparation

 is the second leading cause of cancer-related death in the United States, a stark reality that underscores the need for effective screening and prevention.

Each March, Colorectal Cancer Awareness Month serves as a reminder of the importance of early detection to reduce colorectal cancer’s significant impact. Colonoscopy remains the gold-standard screening tool, but its effectiveness relies heavily on adequate bowel preparation. Inadequate preparation can lead to missed lesions, prolonged procedures, and the need for repeat exams, diminishing its preventive power.

New guidance from the US Multi-Society Task Force on Colorectal Cancer (USMSTF), which represents the American College of Gastroenterology, the American Gastroenterological Association, and the American Society for Gastrointestinal Endoscopy, provides clinical recommendations to address challenges related to bowel preparation for colonoscopy, focusing specifically on outpatients at low risk for inadequate bowel preparation.

In the first segment of this 6-part HCPLive RX Review, Brian Jacobson, MD, MPH, and Joseph Anderson, MD, discuss their work as co-authors on the recent USMSTF consensus statements and explain why adequate bowel preparation is so important in the context of colonoscopy.

Anderson begins by emphasizing the continued importance of colonoscopy as a cornerstone of colorectal cancer screening and prevention, particularly in the context of evolving noninvasive screening modalities. He highlights the comprehensive nature of colonoscopy, noting its dual role in both detecting and preventing colorectal cancer through polypectomy. While acknowledging the utility of noninvasive tests, both experts agree that colonoscopy remains the gold standard, acknowledging that even with noninvasive testing, a colonoscopy will still be required following a positive result.

The conversation then shifts to the critical role of bowel preparation in ensuring effective and complete exams. Anderson notes that inadequate preparation can result in missed lesions, increased healthcare costs, and the need for repeat procedures, undermining the value of the screening itself. He emphasizes that proper bowel preparation safeguards the efficacy of colonoscopy and protects patients from potential morbidity associated with incomplete exams.

: Brian Jacobson, MD, MPH, an associate professor of medicine at Harvard Medical School and director of program development for gastroenterology at Massachusetts General Hospital

: Joseph Anderson, MD, a professor of medicine at Geisel School of Medicine at Dartmouth and a gastroenterologist at White River Junction VAMC

Editors’ note: Jacobson has relevant disclosures with Curis and Guardant Health. Anderson has no relevant disclosures.

Jacobson BC, Anderson JC, Burke CA, et al. Optimizing Bowel Preparation Quality for Colonoscopy: Consensus Recommendations by the US Multi-Society Task Force on Colorectal Cancer. 

The American Journal of Gastroenterology.

Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. 

In the opening segment of this 6-part RX Review, experts discuss new USMSTF guidance on bowel preparation for colonoscopy.

Joseph Anderson, MD

To watch the video series component of this episode, click here.

1:35 Importance of early diagnosis of Alzheimer’s disease

05:48 The pathophysiology of Alzheimer’s disease

09:32 Screening for Alzheimer’s disease

21:37 Utility and practicality of PET scans

In this episode of MEDcast, expert geriatric psychiatrists explore the urgent need for effective diagnostic methods that can detect Alzheimer’s disease at an early stage. We will discuss blood-based biomarkers and other advancements that can help screen Alzheimer’s disease non-invasively and early in the disease course.

Screening for Alzheimer’s Disease: Facilitating an Early Diagnosis for Prompt Intervention

Marc Agronin, MD

Mark Warren, MD, FACE is an endocrinologist and clinical associate professor at Campbell University School of Osteopathic Medicine.

 is a rare endocrine disease with consequences across multiple organ systems, which makes it challenging to diagnose and manage. Conventional therapy for HypoPTH focuses on normalizing serum calcium levels and not treating the source, which is a lack of the parathyroid (PTH) hormone. HypoPTH results from insufficient levels of PTH and patients with this disease must be managed holistically, similar to how patients with other hormone deficiencies, such as diabetes, are treated. Just as people with diabetes are more than their HbA1c level, people living with chronic HypoPTH are more than their calcium levels.

HypoPTH is a rare endocrine disease that results from the absence or deficiency of PTH, which is crucial for regulating calcium and phosphate levels in the body. While HypoPTH is frequently underdiagnosed, it is estimated that approximately 77,000 people are living with the disease in the United States. HypoPTH may result from surgery that damages the parathyroid glands, autoimmune/genetic causes, or may not have a known origin, such as idiopathic HypoPTH.

Insufficient parathyroid hormone leads to low levels of calcium and high levels of phosphate, which have significant effects on multiple organ systems. These effects may manifest as clinical symptoms (tingling/numbness, muscle cramps, seizures, wheezing, and irregular heartbeat), adverse health outcomes (kidney stones, kidney damage resulting in chronic kidney disease, cataracts, and basal ganglia calcifications), and decreased quality of life (due to fatigue, cognitive dysfunction, “brain fog,” and the challenge of managing symptoms and disease-related health issues).

Patients with HypoPTH experience the feeling that their symptoms and quality-of-life concerns are not being seen or heard by their healthcare providers when they address only the results of their blood tests and not the broader, negative impacts their hormone deficiency has on many aspects of daily living. These patients’ feelings are validated by several disturbing statistics from 

, a recent patient survey conducted by the HypoPARAthyroidism Association.

Two-thirds of respondents reported having at least one disease-related hospitalization before being diagnosed with HypoPTH, and most patients lived with symptoms of their disease for at least 6 months and, in some cases, more than 20 years before an accurate diagnosis. Even once diagnosed, only 25% of respondents strongly agreed that their physician fully understood their condition, and only 10% were happy with their treatment option.

Additionally, 87% of respondents had developed HypoPTH following head or neck surgery (the most common cause of the disease), yet only 11% fully understood that this was a potential risk before they consented to surgery.

 This underscores the importance of hearing our patients and communicating with them more effectively, especially when a newly FDA-approved treatment option may help patients feel better and live more satisfying lives.

Conventional therapy for HypoPTH typically involves the use of calcium supplements and vitamin D to raise serum calcium levels into the normal reference range. Some patients may also be given magnesium supplements and phosphate binders based on laboratory assessments of serum phosphate and magnesium levels. While these supplements can help to normalize blood chemistry, they are not entirely benign. When administered at the high doses needed in patients with HypoPTH, calcium supplementation can cause gastrointestinal side effects. When used long-term, they can also lead to chronic kidney disease and the development of calcifications in the kidneys, brain, and other organs.

In 2024, the US Food and Drug Administration (FDA) approved a new PTH hormone analog for the treatment of HypoPTH called palopegteriparatide (

). It is administered daily by subcutaneous injection.

 In an 82-patient randomized, double-blind, placebo-controlled Phase 3 clinical study, 79% of patients in the palopegteriparatide group met a 5-part efficacy assessment endpoint compared with 5% of patients in the placebo group.

 The 5-point efficacy assessment required that patients meet all of the following criteria at Week 263:

• Normalization of albumin-corrected serum calcium

• Independence from conventional therapy since Week 22 (that is, no active vitamin D and 

• No increase in palopegteriparatide dose since Week 22

• No missing active vitamin D and calcium data since Week 22

• Palopegteriparatide dose of 30 mcg or less once daily during the 26-week treatment period

A collaborative approach to optimizing outcomes for patients with HypoPTH

Normalizing calcium is necessary but not sufficient to achieve optimal patient outcomes. Comprehensive and compassionate care of patients with HypoPTH must include consideration of physical, psychological, and quality-of-life factors in addition to calcium and phosphate levels. Achieving this holistic approach requires that HCPs work collaboratively with patients to understand the spectrum of symptoms they experience and how these symptoms impact their daily lives.

In my practice, I routinely ask specific questions to elucidate this rather than assuming that patients will recognize that what they are experiencing is related to their disease. In each interaction with one of my HypoPTH patients, I ask questions about:

• Physiologic aspects of the disease, including tingling/numbness, muscle cramps, seizures, wheezing, etc.

• Quality of life issues, including fatigue and brain fog.

• How they feel today compared with how they felt before disease onset.

• Anything they want to change about how their disease impacts their life.

Once I am fully informed about how each patient is experiencing HypoPTH, I can have a productive discussion about treatment options, including PTH hormone therapy, which allows the patient to make an informed decision about how they want to manage their disease.

One particular patient exemplifies how finding the right treatment can transform care. She is a 42-year-old woman who was very active and enjoyed surfing, running, and other activities as part of her daily routine. She developed HypoPTH after thyroid surgery, which significantly limited her ability to engage in these activities and other aspects of daily living. She required 4200 mg of calcium and 1 mcg of calcitriol daily to keep calcium between 8 and 8.5. Her calcium levels fluctuated with activity and illness, resulting in recurrent symptomatic hypocalcemia. She was no longer able to participate in any of her previous sports activities due to muscle cramping, fatigue and decreased sense of well-being.

She entered a clinical trial evaluating palopegteriparatide prior to its FDA approval and had a rapid and very positive response — so much so that she told me that she had “gotten her life back” and had been able to resume her previous activities.

Other patients have shared with me that they didn’t realize how poorly they had been feeling until they tried PTH replacement therapy. These patient stories are a compelling reminder that HCPs must remain up to date on the latest developments in HypoPTH diagnosis and treatment and empower patients to confidently advocate for the highest quality of care, fostering better health outcomes.

Now that we can address parathyroid deficiency rather than just calcium levels, treating our patients with HypoPTH will prove to be gratifying to both the provider and the patient. For me, being told that I helped someone “get their life back" never gets old.

YORVIPATH Prescribing Information. Available at: 

https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/216490s000lbl.pdf

Khan AA, et al. Efficacy and Safety of Parathyroid Hormone Replacement With TransCon PTH in Hypoparathyroidism: 26-Week Results From the Phase 3 PaTHway Trial. 

. 2023 Jan;38(1):14-25. doi:10.1002/jbmr.4726

Chronic hypoparathyroidism (HypoPTH) is a rare endocrine disorder characterized by insufficient parathyroid hormone (PTH), leading to low calcium and high phosphate levels, affecting multiple organ systems. Traditional treatments focus on normalizing calcium levels but do not address the underlying hormone deficiency. A new PTH analog, palopegteriparatide, has shown promising results in clinical trials, offering a more comprehensive treatment approach. Effective management requires a holistic, patient-centered approach, considering both physiological and quality-of-life factors, to improve patient outcomes and satisfaction.

Chronic hypoparathyroidism requires holistic management addressing more than just calcium normalization to achieve optimal patient outcomes.

Beyond Calcium: A Holistic Approach to Optimizing Outcomes for Patients with Hypoparathyroidism

Mark Warren, MD

Benralizumab Reduces Severe Asthma Exacerbations in Older Adults, with Muhammad Adrish, MD

ZEPHYR-5, a real-world evidence study, showed that older adults with severe 

 experienced meaningful reductions in the rate of asthma exacerbations on benralizumab.

“This particular study was aimed to actually see what happens with this drug when it's given to patients who are old,” lead investigator Muhammad Adrish, MD, from Baylor College of Medicine, told 

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

Adrish and colleagues sought to assess the change in asthma exacerbations following the initiation of benralizumab among older adults. Older adults are often underrepresented in asthma clinical trials, with the focus on younger individuals.

“Asthma is relatively considered a disease of young patients,” Adrish explained. “As the overall median age in [the] US is increasing…we expect to see more and more older patients with asthma.”

ZEPHYR-5 included 5611 patients with a mean age of 69.3±10.9 years. Participants were included if they had a prescription for benralizumab and ≥ 1 refill within 90 days, 12 months of enrollment with Medicare Fee-for-Service or Medicare Advantage with benefits lasting before and after the index date, ≥ 1 inpatient or ≥ 2 outpatient claims with a diagnosis code for asthma, and ≥ 2 asthma exacerbations. Most participants were females (69.1%) and Medicare fee-for-free beneficiaries (91.4%).

Investigators evaluated for exacerbations during the baseline and follow-up periods, which were defined as either an asthma-related hospitalization, a mechanical ventilation claim, or an outpatient or emergency department visit with an asthma diagnosis and a claim for systemic corticosteroids within 7 days. The team also assessed the percent change in annual asthma exacerbation rate from baseline to follow-up.

Benralizumab led to a 43.5% reduction in the annual asthma exacerbation rate from baseline to follow-up in older adults (3.8±2.0 to 2.2±2.2 exacerbations per year; 

 < .001). Moreover, the proportion of patients with ≥ 4 exacerbations were reduced by 50.5%.

“It was very important for me to know that in this particular age group, this drug is also very effective,” Adrish said. “No matter how many exacerbations they had to begin with, whether they had 2 exacerbations, 3 exacerbations, or 4 exacerbations… the beneficial effect of [the] drug was seen across the spectrum.”

A relevant disclosure for Adrish includes Astrazeneca Pharmaceuticals.

Adrish, M. Reduction in Asthma Exacerbations Following Initiation of Benralizumab Among Medicare Beneficiaries: Results from the ZEPHYR-5 Study Adrish. Abstract 938. Presented at AAAAI 2025 on March 3 at 1:10 pm

A real-world study shows benralizumab significantly reduced severe asthma exacerbations in older adults, with a 43.5% decrease in annual rates.

Muhammad Adrish, MD

Assistant Professor of Medicine, Harvard Medical School, and Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center

Bendapudi gave an overview of 2 studies presented at ASH 2024 from his Harvard lab.

Pavan K. (Tem) Bendapudi, MD: Large-Scale Analyses Elucidate Genetic Risk of Thrombosis

New large-scale database analyses of hemostasis-related genes have elucidated relationships between genes such as protein S (PROS1) and factor 12 (FXII) and thrombosis.

Findings from the analyses were presented at the

 66th American Society of Hematology (ASH) Annual Meeting and Exposition

, held December 7-10, 2024, in San Diego, California, by members of the lab of Pavan K. (Tem) Bendapudi, MD, Assistant Professor of Medicine, Harvard Medical School, and Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center.

“[This work] really highlights the value of these extremely large population scale next generation sequencing data sets to answer long standing and kind of previously unapproachable questions in hemostasis and thrombosis. And I would just encourage people to stay tuned, because we have a lot of other ideas and a lot of other things we're interested in looking into, and I think we will have, finally, have the power to do that in a way we weren't able to before,” Bendapudi told 

Among the new findings were a stronger than previously though relationship between 

deficiency and thrombosis and a protective effect against venous thromboembolism (VTE) in people with inherited FXII deficiency. In this clip, Bendapudi discussed the research more in-depth and emphasized the potential of new technology, such as that employed in this research from the Broad Institute's Cardiovascular Disease Initiative, to enable these large-scale analyses.

Bendapudi's relevant disclosures include Takeda Pharmaceuticals, Verve Therapeutics, and Alexion Pharmaceutical.

Chaudhry SA, Haj AK, Ryu J, et al. Leveraging Population-Scale Multiomic Datasets to Elucidate the Risk of Thrombosis Associated with Protein S (PROS1) Deficiency. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 17

Haj AK, Paul D, Chaudhry SA, et al. Coagulation Factor XII (F12) Haploinsufficiency Is Protective Against Venous Thromboembolism. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 133.

Pavan K. (Tem) Bendapudi, MD

Smoking is the most preventable health hazard in the US, responsible for over 480,000 deaths annually. About 19% of US adults reported current use of a commercial tobacco product in 2020, of which cigarette smoking was the most prevalent.

 perspective, smoking is a risk factor for esophageal, pancreatic and colon cancer, and adversely affects peptic ulcer disease, pancreatitis and Crohn’s disease. Smoking cessation is strongly encouraged by the American College of Gastroenterology (ACG) guideline for Managing Crohn’s Disease in Adults. Despite key recommendations for the management of smoking in healthcare settings, the degree to which this is implemented in GI clinics is unknown.

In our study that was presented at the recent Digestive Disease Week (DDW) 2023 Annual Meeting’s GI Fellow-Directed Quality Improvement Projects session—and which won an American Gastroenterological Association (AGA) Fellow Abstract Award—we aimed to assess our providers’ practices regarding smoking cessation, identify perceived barriers for administering smoking cessation treatments, and address these barriers by implementing a novel Electronic Health Record (EHR)-assisted tobacco treatment model (ELEVATE) in our GI clinics.

ELEVATE is implemented by the medical assistant during the patient rooming process, and utilizes the “5 A’s” recommended by the US Public Health Service Clinical Practice Guideline Panel, as illustrated in 

A rate of 91% of GI physicians responded to our survey, and nearly half of them stated they always asked patients if they smoked. Although 75% of physicians stated they would assess their patients’ willingness to quit at the time of the visit, less than half consistently advised smokers to quit, and only 20% often assisted patients who smoke with counseling.

Lack of a systematic program to offer help to patients was reported by 80% of providers as an extremely/very important barrier limiting their smoking cessation practices. ELEVATE module training was implemented at the beginning of 2021 using Epic Systems EHR. The proportion of smokers receiving cessation treatment increased from pre-ELEVATE to post-ELEVATE (14.36% to 27.47%; RR, 1.90; 95% CI, 1.60 - 2.26, 

<.001). Post-ELEVATE, 14.4% (n = 38) of patients with treatment quit smoking, compared to 7.9% (n = 55) of patients without treatment (RR, 1.89; 95% CI 1.26 – 2.82, 

This study sheds light on an often under-recognized source of morbidity in our GI patients and identifies an efficient and scalable strategy to combat tobacco use and improve clinical outcomes in our patients. ELEVATE smoking module has been selected by Epic Systems for wide dissemination to other healthcare systems.

How an outpatient-based smoking cessation model may come to aid other health systems' gastroenterology patients.

Authors