Adam Sturts, DO, is an internal medicine resident at Penn State Hershey Medical Center with an interest in cardiovascular health and endocrinology. Sturts is a graduate of the Rowan University School of Osteopathic Medicine and a type 1 diabetic.

Adam Sturts, DO

David T. Ahn, MD

For what it’s worth, I interview a lot of doctors. I’ve done a lot of panels. What struck me about you folks—the folks who deal with diabetics every day, or people with diabetes—I’m informed that diabetics is not the best term.

Not good—so, people with diabetes, people dealing with this disease. What I noticed is that you listen. Every 1 of you talks about listening to people. Doctors are bad at that, as a group, but not you. Did you select this because you like listening, or did you learn to listen because that’s what you do? I don’t know. It was just an observation. Call it a hunch. Look, we have come to the end of this discussion, but I don’t want to leave without giving each of you an opportunity to say something that you feel we may have omitted or something that you want to leave our audience with. Why don’t we go around, and each of you can take about 30 seconds and give us some final thoughts. Why don’t we start with you, Elaine?

 I’m just thinking back on the patients that I saw today. One of the biggest challenges of diabetes, and dealing with highs or lows, is that you could do everything perfectly Monday to Monday. With other things like saving money, or training for a marathon, you have something to build on. Maybe on the eighth day you can take a day off. That’s not the case with diabetes. You’ve got to start all over again that eighth day and do it all over again, and it may be the worst day of the eight. It’s such a marathon to run, and you don’t have an end line, or point, to look forward to. As a provider, you have to place yourself in that reality. You have to see through the patient’s eyes every day, and if you don’t do that, then you won’t understand their struggles and you miss the boat. That’s what I strive to do every day for them.

Wow, that was well said. Thank you. We really need to understand that, as Elaine has said, diabetes never gives the patient a break; it’s 24-7. Hypoglycemia is incredibly scary and really does limit so much of what the patient can and can’t do if we aren’t careful with educating our patients, assisting with quality of life, and making sure patients have a good understanding of their medications. We need to provide good education on prevention and treatment, and the use of continuous glucose monitoring [CGM] to try and help patients prevent hypoglycemia. We all need to take it seriously and make sure that we ask the right questions every time we touch the patient, so that hopefully we can have a better outcome for them.

I’m going to say something completely different, but I agree with what Elaine and Davida said. I want a system in which the pharmacist tells the patient and me every 2 years when their glucagon is going to expire, so I know to write a new prescription. Because what makes me crazy is when I’ve forgotten and the patient has forgotten to ask, and then they have a bad low and they don’t have their glucagon. Why can’t the pharmacists do this? I get bugged all the time about everything. Why can’t the pharmacist just say, “Patient X needs a prescription for glucagon”? That’s no skin off my back. They should probably just do it without a prescription. Why does this even have to require a prescription? That’s another issue. We need a system so patients and providers are reminded to do the refills. I don’t know why it doesn’t exist, so we need to create that solution.

Could that be built into the EMR [electronic medical record]?

When you click the prescription, it should pop up in 2 years.

 It should just say, “This is due.” Why not?

Jay Shubrook, DO, FACOFP, FAAFP, BC-ADM: 

Hypoglycemia is certainly something that’s very important to our patients, and most providers underestimate the frequency of it. Please ask your patient and the family at every visit about hypoglycemia. There’s no better time than today because we have plenty of tools to identify hypoglycemia, such as CGM, or continuous glucose sensors. We have ways that we can help patients have less hypoglycemia—particularly patients with type 2 diabetes—with novel therapies, and we have very effective treatments that can abort a hypoglycemic episode. Making sure you use the right treatment at the right time really is going to empower your patients not to be paralyzed by hypoglycemia but to be an informed and active crusader to prevent it and treat it earlier.

I want to thank all of you for being with us. This has been eye-opening for me because I don’t treat diabetes on a daily basis. I always thought, “It’s about sugar, for sure; usually it’s about hyperglycemia.” This hypoglycemic problem is real, significant, and tricky. These new therapies that I’ve learned about from you are strikingly interesting. Thank you all for being here.

I want to thank all of you at home for watching this 

. If you enjoyed the content, I want you to subscribe to our e-newsletter to receive upcoming Peer Exchanges and other great content right in your in-box.

Thought leaders in diabetes provide closing remarks about the importance of continuous awareness of glycemic control in patients as well as the need for effective communication between patients and providers. 

Final Thoughts: Awareness and Communication in Diabetes 

Elaine Apperson, MD, University of South Carolina School of Medicine  

Thoughts on the Current State of PBC Management

Video content above is prompted by the following:

Please share your concluding thoughts about management of PBC.

Primary biliary cholangitis (PBC) is an autoimmune liver disease characterized by the progressive destruction of small and medium-sized bile ducts within the liver. This destruction is primarily mediated by autoreactive T lymphocytes targeting the epithelial cells of the bile ducts. The ensuing cholestasis leads to the accumulation of toxic bile acids, causing hepatocellular damage and inflammation. Over time, this chronic inflammatory process results in fibrosis and eventually cirrhosis. The pathophysiology of PBC is influenced by genetic predispositions and environmental factors, contributing to its complex etiology and progression.

The panel of experts offers expert insights and concluding thoughts on the management of primary biliary cholangitis (PBC), emphasizing the importance of personalized treatment strategies, monitoring, and the evolving role of new therapies in improving patient outcomes.

Ira Jacobson, MD

Jack Arnold, MBBS, is a clinical research fellow working within Dr. Edward Vital's lupus team at the Leeds Centre of Rheumatic and Musculoskeletal Medicine. He graduated Distinction in Clinical Sciences from University College London in 2015 and has previously worked as a clinical tutor for Harris Manchester College Oxford. His work primarily focuses on systemic lupus erythematosus (SLE), antineutrophil cytoplasm antibodies (ANCA)-associated vasculitis and new approaches to the classification of autoimmune connective tissue diseases.

Anxiety and depression are 2 of the most common conditions encountered by budding physicians irrespective of their primary specialty. Within rheumatology, these conditions can negatively impact the patient experience at several junctures. They can limit engagement with healthcare or treatment leading to later diagnosis, poor treatment adherence, and resultant poor disease control with associated negative sequelae. The clinical presentation of anxiety and depression can also overlap with features of active rheumatic disease, exacerbating the symptom burden experienced by patients.

 Within the paradigm of systemic lupus erythematosus (SLE), fatigue symptoms can be more prominent and can worsen with a coexistent diagnosis of depression.

 Furthermore, poorly treated depression and anxiety features can become a significant confounder when assessing outcome measures such as the Visual Analogue Scales (VAS), Short Form 36, FACIT-Fatigue, and other patient reported outcome scores.

A recent Chinese observational single center cross-sectional study assessed the impact of SLE disease activity on the prevalence of anxiety or depressive features.

 This study enrolled 325 patients over the age of 18 with SLE as defined by the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Key exclusion criteria were a previous diagnosis of anxiety/depression or other psychiatric illness, major organ pathology, and those with a history of substance abuse. Depressive features were assessed using the Patient Health Questionnaire 9 (PHQ-9) and anxiety features were assessed using the 7 item General Anxiety Disorders Scale (GAD-7). SLE disease activity was assessed using the SLE Disease Activity Index (SLEDAI).

Within the 325 patients enrolled to the study, 61.5% had a PHQ-9 score compatible with significant depression and 54.4% had a GAD-7 score compatible with significant anxiety. Patients with significant depressive/anxiety features had significantly higher SLEDAI scores than their counterparts (p=0.001) and had significantly higher rates of musculoskeletal and neuropsychiatric involvement. This is concordant with previous work which has shown musculoskeletal features to be key drivers of the patient experience in SLE.

Key confounders were mostly similar between the anxiety/depression and non-anxiety/depression groups except for household income. Those with a low household income defined as >50,000 Renminbi (RMB) had higher rates of depression than those with a higher income (p=0.005).

The authors used receiver operating characteristic (ROC) curve analysis to assess the utility of SLEDAI as a predictor of depression or anxiety in SLE patients. The optimal cut-off of SLEDAI >8.5 demonstrated a sensitivity of 50.5% and specificity of 78.4% in predicting depression (AUC 0.660, p <0.001). This cut-off had a sensitivity of 54.2% and specificity of 78.4% in predicting significant anxiety (AUC 0.684, p <0.001).

There are several limitations to this study; the authors identify the lack of longitudinal data as a key factor. The lack of ethnic diversity within the cohort is another important consideration. As with most SLE research, the chosen disease activity score has several additional limitations. SLEDAI scores features such as arthritis, rash, and oral ulceration based on the presence or absence of these features. Therefore, a patient with a severe rash encompassing >50% of their body surface area scores the same as one with a mild malar rash. Additionally, a patient with 2 synovitic joints scores the same as one with 12 synovitic joints, despite their very different clinical presentation. Therefore, the use of an alternative measurement such as the British Isles Lupus Assessment Group (BILAG-2004) score might allow for greater fidelity when describing a patient’s individual symptom burden.

 Exclusion of those with a pre-existing diagnosis of anxiety/depression in this study is understandable but given the widespread prevalence of these diagnoses, it may limit the generalizability of these findings in the rheumatology clinic.

This study does provide welcome data on an underappreciated and often poorly addressed feature of long term SLE management. The association between high disease activity and worsening depressive/anxiety features would seem obvious; however, this paper provides welcome quantitative evidence to the fact. Holistic care in SLE is critical and the mental health sequelae of high disease activity require addressing in a similar manner to the musculoskeletal or mucocutaneous features.

1. Arnaud L, Mertz P, Amoura Z, Voll RE, Schwarting A, Maurier F, et al. Patterns of fatigue and association with disease activity and clinical manifestations in systemic lupus erythematosus. Rheumatology [Internet]. 2021 Jun 18 [cited 2021 Jul 7];60(6):2672–7. Available from: https://pubmed.ncbi.nlm.nih.gov/33175957/

2. Figueiredo-Braga M, Cornaby C, Cortez A, Bernardes M, Terroso G, Figueiredo M, et al. Depression and anxiety in systemic lupus erythematosus: The crosstalk between immunological, clinical, and psychosocial factors. Medicine (Baltimore) [Internet]. 2018 Jul 1 [cited 2023 Jan 17];97(28). Available from: /pmc/articles/PMC6076116/

3. Meacock R, Dale N, Harrison MJ. The humanistic and economic burden of systemic lupus erythematosus: A systematic review [Internet]. Vol. 31, PharmacoEconomics. Springer; 2013 [cited 2021 Jul 2]. p. 49–61. Available from: https://link.springer.com/article/10.1007/s40273-012-0007-4

4. Liao J, Kang J, Li F, Li Q, Wang J, Tang Q, et al. A cross-sectional study on the association of anxiety and depression with the disease activity of systemic lupus erythematosus. BMC Psychiatry [Internet]. 2022 Dec 1 [cited 2022 Oct 6];22(1):591. Available from: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-022-04236-z

5. Chaigne B, Chizzolini C, Perneger T, Trendelenburg M, Huynh-Do U, Dayer E, et al. Impact of disease activity on health-related quality of life in systemic lupus erythematosus - a cross-sectional analysis of the Swiss Systemic Lupus Erythematosus Cohort Study (SSCS). BMC Immunol [Internet]. 2017 Mar 28 [cited 2022 Mar 18];18(1). Available from: https://pubmed.ncbi.nlm.nih.gov/28351341/

6. Carter LM, Gordon C, Yee CS, Bruce I, Isenberg D, Skeoch S, et al. Easy-BILAG: a new tool for simplified recording of SLE disease activity using BILAG-2004 index. Rheumatology (Oxford) [Internet]. 2022 Oct 6 [cited 2023 Jan 17];61(10):4006. Available from: /pmc/articles/PMC9536795/

Anxiety and depression can limit engagement with healthcare or treatment leading to later diagnosis, poor treatment adherence, and poor disease control with associated negative sequelae. 

Quantifying the Association Between Anxiety and Depressive Features and High Disease Activity Scores in SLE 

Jack Arnold, MBBS, MRCP

Jeff McIntyre is the vice president of Liver Health Programs at the Global Liver Institute.

Reflecting on Resmetirom’s Historic FDA Approval for MASH

On March 14, 2024, the US Food and Drug Administration (FDA) made history when it granted accelerated approval to Madrigal Pharmaceuticals’ resmetirom (Rezdiffra), making it the first and only treatment for noncirrhotic nonalcoholic steatohepatitis (NASH), now known as 

metabolic dysfunction-associated steatohepatitis (MASH)

One year later, resmetirom’s impact on clinical practice and patient care continues to evolve. In recognition of the anniversary of the landmark decision, the latest 

 spotlights a conversation between a trio of subject matter experts reflecting on the past year of having resmetirom as a treatment option for patients, remaining unmet needs in MASH management, and the evolving therapeutic pipeline poised to further transform care.

Estimated to affect more than 30% of the global population, MASLD is the most common chronic liver disease around the world. MASH represents an advanced stage of MASLD and has historically lacked treatment options beyond lifestyle changes with diet and exercise. In the absence of pharmacologic therapies, weight loss served as the cornerstone of disease management.

This changed in March 2024, when resmetirom became the first and only FDA-approved MASH therapeutic, earning accelerated approval for the treatment of noncirrhotic MASH with moderate to advanced fibrosis. Although lifestyle interventions continue to play a pivotal role in MASH care, as the thyroid hormone receptor-beta selective agonist is indicated in conjunction with diet and exercise, they are no longer the only tools available for disease management.

 on the 1-year anniversary of resmetirom’s FDA approval and the evolving landscape of MASH management, moderator Jeff McIntyre asks Mazen Noureddin, MD, MHSc, and Juan Pablo Arab, MD, about the clinical impact resmetirom has had since being approved and whether it lived up to the expectations set for it as the first-ever MASH therapeutic.

Noureddin begins by highlighting resmetirom’s “game-changing” impact, citing strong clinical results, guideline updates, and the shift toward noninvasive testing. He notes that patients are seeing benefits and that long-term data continues to support the drug’s efficacy.

Arab expresses agreement, emphasizing that resmetirom has not only improved patient outcomes but also changed how clinicians approach MASH. Previously, primary care providers and endocrinologists were reluctant to screen for at-risk MASH due to a lack of treatment options. Now, with an FDA-approved therapy, he says there is greater urgency in identifying and managing these patients.

Discussing challenges, Arab points to the need for broader screening, improved access to noninvasive tests, and overcoming reimbursement hurdles, additionally stressing that implementing a new treatment requires systemic change across healthcare.

Noureddin adds that while hepatology clinics were well-prepared for resmetirom’s arrival, uptake in gastroenterology practices has been mixed. He sees a need for more education on noninvasive tests and fibrosis staging but says that overall, awareness and access are improving. He remains optimistic about the drug’s future and the potential for combination therapies to further transform MASH treatment.



Mazen Noureddin, MD, MHSc, is a professor of medicine and a transplant hepatologist at Houston Methodist and director of the Houston Research Institute.

Juan Pablo Arab, MD, is an associate professor of medicine in the division of gastroenterology, hepatology, and nutrition at Virginia Commonwealth University School of Medicine.

Noureddin has relevant disclosures with Altimmune, Madrigal Pharmaceuticals, Merck, Takeda, Terns, and others. Arab and McIntyre have no relevant disclosures.

US Food and Drug Administration. FDA Approves First Treatment for Patients with Liver Scarring Due to Fatty Liver Disease. March 14, 2024. Accessed March 13, 2025. 

https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-patients-liver-scarring-due-fatty-liver-disease

Brooks, A. Stephen Harrison, MD: Promising Phase 3 Data for Resmetirom in NASH, Fibrosis. HCPLive. February 7, 2024. Accessed March 13, 2025. 

https://www.hcplive.com/view/stephen-harrison-md-promising-phase-3-data-resmetirom-nash-fibrosis

In the opening segment of this 6-part HCPLive RX Review, experts reflect on resmetirom’s FDA approval for MASH and clinical challenges to implementing it.

Jeff McIntyre

Assistant Director of Interventional Psychiatry

Ryan J. Wakim, MD, DFAPA, explores the causes and diagnostic criteria for treatment resistant depression. He also discusses the importance of comprehensive assessment and personalized approaches to care.

The Burden of Treatment Resistant Depression

Paul Ruberg, PA-C

A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change.

Generational Trends and Innovations in Retinal Disease Care

1:00 Evolving trends
5:50 Key Advances
8:20 Targeting Ang/Tie pathway
13:12 Role of steroids
15:00 Biosimilars
18:44 Therapies in the pipeline

A panel of ophthalmologists discuss how retinal disease management has evolved in the past decade and continues to change with advancements in diagnostics and therapies.

Generational Trends and Innovations in Retinal Disease Treatment

Peter Kaiser, MD

Vitiligo is a chronic autoimmune condition resulting in depigmented lesions of skin that can appear on any part of the body. The condition, which has been diagnosed in approximately 1.5 million people in the United States

, occurs with similar frequency in all ethnic groups and can occur at any age, although initial symptoms often appear before the age of 30

Given the visual nature of the disease, vitiligo is sometimes viewed as a cosmetic issue rather than as an autoimmune condition

. Because of this misconception, the severity and impact of vitiligo – both physical and emotional – can often be downplayed or overlooked. In addition, the limited treatment options currently available for vitiligo can lead people living with this condition to believe they have little to no choices

More than cosmetic: The role of the immune system in vitiligo

Research suggests vitiligo develops in genetically-susceptible individuals when environmental triggers – e.g., sun exposure, chemical exposure, physical skin trauma or psychological strain – induce stress responses in the skin

.This causes a localized autoimmune response in which melanocytes are targeted and destroyed by CD8+ T-cells

An environmental trigger combined with genetic factors leads to melanocyte stress, causing an inflammatory response

Innate immune cells activate CD8+ T-cells that target melanocytes and release IFN-γ

JAK-STAT activation and inflammatory cycle triggering: 

IFN-γ activates the JAK-STAT pathway (by binding to JAK 1 and 2) to induce production of immune mediators (CXCL9/10) by keratinocytes. More autoreactive T-cells are attracted to the site, where they continue the inflammatory cycle by producing more IFN-γ in a positive feedback loop

The T-cell attack creates a hostile environment resulting in melanocyte death, which leads to depigmentation

People living with vitiligo would benefit from additional options to consider with their health care team.

Vitiligo has a significant burden of disease

The social stigma around vitiligo, and the idea that it is a cosmetic issue rather than an autoimmune condition, can significantly impact people with vitiligo. Findings from the global 

ernational Communities (VALIANT) study underscore the profound impact vitiligo has on people’s lives. This was an observational, cross-sectional evaluation of the burden of vitiligo from the perspective of patients aged 18 years and older with vitiligo and health care professionals who treat patients with vitiligo

Of the more than 3,500 adults with vitiligo surveyed, nearly 60% said they had been diagnosed with mental health conditions, including anxiety (28.8%) and depression (24.5% )

49% said having vitiligo made them feel less confident and more self-conscious

Some of those surveyed also said they experience sleep disturbance and approximately half said the progression of their disease worries them

Additionally, a patient-focused meeting held by the U.S. Food and Drug Administration (FDA) in March 2021 explored the health effects and daily impact of vitiligo as well as management goals

. Among the key findings was that vitiligo can lead to feelings of loss of identity, particularly among African Americans

. Some participants expressed that others are unable to see past their condition, making it hard to establish successful friendships or secure employment

As such, it is critical for health care providers to approach discussions about vitiligo with their patients as an autoimmune condition and to consider the full impact that vitiligo can have on a person’s daily life. By educating people with vitiligo about the science behind their condition and forming a doctor-patient relationship based on trust, an individualized management plan tailored to a patient’s specific needs and goals can be established.

Supporting patients and managing vitiligo

As a result of their disease, people with vitiligo may feel frustrated, misunderstood and unheard, and their health care teams may have a challenging time supporting their needs. It is essential that dermatologists and other health care providers who diagnose and manage vitiligo discuss the science behind the condition and the impact it may have with their patients. Approaches to engage in these conversations can include:

Explain the autoimmune nature of vitiligo

Establish a regular cadence of appointments to ensure appropriate follow up

It is important that dermatologists take the time to understand how the condition impacts their patients’ quality of life and emotional well-being. Management of vitiligo is a process, and expectations need to be set based on each patients’ individualized management plan. We need to form open lines of communication with patients early on and provide easily understood information about the science behind the condition. We can thereby help people living with vitiligo see it as an autoimmune rather than cosmetic issue and support informed decisions about their health and the overall management of their disease.

Note: Dr. Batra has been compensated for her time.

Bowcock AM, Fernandez-Vina M. Targeting skin: vitiligo and autoimmunity. 

. https://www.sciencedirect.com/science/article/pii/S0022202X1535452X. Accessed June 23, 2022.

National Library of Medicine. Medline Plus. Vitiligo. 

https://medlineplus.gov/genetics/condition/vitiligo/

Frisoli M, Essien K, Harris JE, et al. Vitiligo: mechanisms of pathogenesis and treatment. 

U.S. Food and Drug Administration. The voice of the patient: A series of reports from the U.S. Food and Drug Administration’s (FDA’s) patient-focused drug development initiative. https://www.fda.gov/media/155068/download. Accessed May 4, 2022.

Manga P, Elbuluk N, Orlow SJ. Recent advances in understanding vitiligo. 

Rodrigues M, Ezzedine K, Hamzavi I, Pandya AG, Harris JE; Vitiligo Working Group. New discoveries in the pathogenesis and classification of vitiligo. 

Strassner JP, Harris JE. Understanding mechanisms of autoimmunity through translational research in vitiligo. 

Damsky W, King BA. JAK inhibitors in dermatology: the promise of a new drug class. 

Howell MD, Kuo FI, Smith PA. Targeting the Janus kinase family in autoimmune skin diseases. 

Bibeau K, Hamzavi IH, Ezzedine K, et al. Mental health and psychosocial burden among patients living with vitiligo: findings from the global VALIANT survey. Presented at Maui Derm for Dermatologists, January 2022.


More Than a Cosmetic Concern – Increasing Understanding of and Addressing Challenges and Care in Vitiligo, an Autoimmune Condition

R. Sonia Batra, MD, MSc, MPH, Board-Certified Dermatologist at Batra Dermatology

One of the issues has been that there does appear to be a therapeutic ceiling with all our agents. We’re seeing about 40% to 60% clinical remissions along those lines, depending on where these drugs are positioned. Both of us have been very aggressive about trying to get these drugs earlier in the course to prevent complications. If you look in the clinical trials with ustekinumab or vedolizumab, the average duration of Crohn disease is 10 years. Patients with 10 years of disease are already developing the problems that we’re trying to prevent. One of the things that I would like to focus on in the future is earlier intervention with these highly effective therapies that we’ve been discussing. What other unmet needs do you see in the pediatric and adult populations for IBD [inflammatory bowel disease]?

 I also have a very keen interest in preconception and fertility in the management of women’s reproductive health, which does tie in to everything we’re talking about. The message to all our female patients is that it’s all about safety and being able to have your disease under control. It is paramount that having anti-inflammatories onboard is what is most important. We know the risk benefit profiles associated with therapies and how to use these therapies in pregnancy, particularly the biologics. We need to be focused on teaching the right thing to our physician partners and patients, that it’s all about controlled inflammation. 

Chronic pelvic inflammation can never end well. That is something I’m vocal about within my preconception clinic, and I counsel women appropriately. But it does have to do with some of these small molecules. We’ll add a layer of complexity when we are looking at bringing these therapies to the clinic. With some therapies, such as the small molecules, we don’t have a lot of real-world experience on the impact in the first trimester because they cross the placenta. That is the question that we need to get more data on. For example, with ozanimod, it will be in the label to stop 3 months before conception. With JAKs you need to stop it. It does add a layer of complexity—we’ve become ob-gyns in terms of figuring out how to use these therapies. An unmet need is also understanding the safety of these therapies in women of reproductive age.

 Did that also apply to pediatric patients? Are there other unmet needs besides improving the efficacy and maintaining a good safety profile in kids?

Marla Dubinsky, MD: It’s a similar concept once you get beyond the VEO [very early onset] IBD. We have the same principles. Similar to what you talked about, whether those extraintestinal manifestations were activity linked or not, the same applies to growth. For all our therapies, just because you heal the intestine, does not equate to growth improvement. We don’t know. We need more data. Does gut-specific therapy have the same impact as systemic therapies? These are things that we need to see from our clinical trials.

There are a couple of unmet needs that you made me think about. I do believe, as I noted before, the future is combination therapy. It could be diet plus biologic. It could be small molecule plus biologic. It could be fecal restorative therapy. It doesn’t matter. The concept of combination means that 1 therapy alone is not going to be the answer. I was addressing your plateau. This is the way I’m thinking about it. Also, sequence will be a hugely important topic to address, meaning understanding the sequence over the long lifetime of a patient who has an evolving immune system based on the therapies we’re using.

I have to plug something that both you and I believe strongly. The plateau may also be the fact that we are not addressing the emotional or behavioral well-being of our patients in clinical trials or the real world, so we can understand how social determinants of behavior, mental health, and comorbidities impact outcomes. We may see a different percentage of remission at week 52. That is an important unmet need that we need to focus on.

I want to amplify your recognition of the social determinants. Certainly in 2021, we’ve seen social determinants of COVID-19 infections and increasingly recognize the disparities of health care in treating chronic illnesses such as ulcerative colitis, Crohn disease, inflammatory bowel disease. We really need to address these disparities and try to improve, whether it’s with psychology, social workers, diet, and education. All these combinations—as your group and our group have shown—really impact patients. They keep them out of the emergency department. Keep them out of the hospital. We need our systems to help us address these disparities. As practitioners, it’s challenging for us and our staff to address this full spectrum of the patients’ needs, from diet to psychological or behavioral support. Economically, 1 of the biggest issues we all have is access to these highly effective therapies. We’re dealing with different insurance programs that may not allow us to use these drugs in the most effective manner that we think we could.

Thank you for watching this HCPLive® Peers & Perspectives®. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers & Perspectives® and other great content right in your in-box. Thank you.

Current treatment limitations in inflammatory bowel disease and the rationale for earlier initiation and use of newer therapies to manage pediatric and adult patients.

Authors