PVRoundup Podcast

This episode reviews new evidence on online GLP-1 prescribing practices, aspirin-only thromboprophylaxis after hip and knee arthroplasty, unexpected protection against gonorrhea from meningococcal B vaccination, and a cannabinoid formulation for agitation in advanced dementia. The studies highlight evolving approaches to obesity care, postoperative management, infectious disease prevention, and palliative dementia treatment with important implications for clinical practice.

Drs. Martinez and Montesi discuss how treatment for ILD, IPF, and PPF has shifted from “nothing we can do” to a complex, rapidly expanding toolbox that now includes multiple antifibrotic options and emerging combination strategies. They stress that these drugs slow progression but don't cure disease, so real-world decisions hinge on side effects, quality of life considerations, patient goals, and the often frustrating realities of insurance coverage and cost.

Randomized evidence suggests that routinely used mucoactive therapies may no longer have a role in mechanically ventilated ICU patients, while a large comparative effectiveness study indicates GLP-1 receptor agonists may offer superior cardiovascular and atrial fibrillation outcomes compared with SGLT2 inhibitors in patients with both AF and type 2 diabetes. We also highlight a promising blood-based RNA biomarker panel that may predict Alzheimer's symptom onset several years before cognitive decline, potentially improving patient selection for emerging disease-modifying therapies.

Drs. Shahriari and Bunick discuss the emerging promise of bi- and tri-specific biologics for atopic dermatitis, aiming to bridge the gap between highly targeted biologics and broad JAK inhibitors by more comprehensively blocking key cytokine pathways. They highlight early data, such as with galvokimig, suggesting potentially higher efficacy and the possibility of improved safety and reduced paradoxical side effects, while emphasizing that final positioning in treatment will depend on forthcoming phase 2 and 3 trial results.

Drs. Witteles and Alexander discuss emerging data in transthyretin amyloid cardiomyopathy, highlighting durable survival benefits with long-term transthyretin-stabilizing therapy and the prognostic impact of atrial arrhythmias. They also review sex-related differences in phenotype that may contribute to under-recognition in women and emphasize earlier diagnosis with more nuanced, holistic management strategies.

This discussion between migraine specialists Dr. Bonakdar and Dr. Buse explores how evidence-based behavioral therapies, like CBT, biofeedback, mindfulness, and relaxation plus Complementary and Integrative Medicine approaches such as acupuncture, physical therapy, and key nutritional supplements, can meaningfully reduce migraine frequency and improve quality of life. They emphasize tailoring these options to patient preferences and medical profiles, and combining them with modern migraine medications for a personalized, comprehensive care plan.

Drs. Kalunian and McMahon explain how inflammation in areas of interstitial fibrosis and tubular atrophy (i-IFTA) in lupus nephritis is not inert scarring, but rather an active, prognostically powerful process that strongly predicts the decline of estimated glomerular filtration rate. They argue that recognizing and routinely scoring i-IFTA could transform clinical practice by shifting focus beyond glomerular lesions to the tubulointerstitial compartment, opening new avenues for risk stratification and potentially for targeted therapy.

Artificial intelligence may soon help clinicians prevent inpatient hypoglycemia before it occurs, while new decade-long follow-up data suggest CAR-T therapy may provide durable cures for selected patients with B-cell lymphoma. We also review a personalized statin muscle-risk calculator designed to improve shared decision-making and highlight new evidence supporting consistent resistance training as an important strategy for long-term type 2 diabetes prevention.

Drs. Newhall and Gupta discuss how biologic therapies are transforming care for patients with multiple allergic diseases—such as asthma, atopic dermatitis, nasal polyps, food allergy, and eosinophilic esophagitis—while also making treatment decisions more complex. They explain how they choose among biologics like dupilumab, omalizumab, IL‑5 blockers, and TSLP inhibitors by focusing on biomarkers, age, comorbidities, and which condition most affects the patient's quality of life.

This episode of the PeerDirect Medical News Podcast highlights three studies with potential implications for prevention, pulmonary medicine, and infectious disease management. Topics include the first national-level evidence that HPV vaccination prevents cervical cancer deaths, Phase III data showing tezepelumab can reduce chronic oral corticosteroid use in severe asthma while maintaining disease control, and new evidence supporting cefazolin as a safer treatment option for MSSA bacteremia with comparable survival outcomes and less nephrotoxicity.

Drs. Cohen and Chang review how CLL and its treatments weaken the immune system and lead to poorer responses to vaccines. Even though vaccine protection is often reduced, the experts emphasize that vaccination remains a key strategy for infection prevention, alongside careful timing around therapy and proactive counseling for patients and their families.

Drs. Waks and Sammons discuss how new long-term data and key updates in the NCCN Guidelines® are reshaping treatment strategies for HER2+ breast cancer in both early-stage and metastatic settings. They highlight the growing role of T-DXd, including its benefits, risks, and optimal patient selection, alongside how to sequence it with other HER2-directed therapies like pertuzumab and T-DM1.

Drs. Yiu and Emami wrap-up their discussion of the 49th Annual Macula Society Meeting, focusing on new and emerging treatments for retinal diseases—such as gene therapies and longer‑acting eye injections—and reflect on both their promise and current limitations. They note that while these advances, along with tools like AI and multi-omics, are exciting, they are only beginning to influence everyday clinical practice and patient counseling.

This episode of the PeerDirect Medical News Podcast highlights three major developments shaping diabetes and hematologic oncology care. First, the FDA expanded approval of teplizumab for selected children and adolescents with newly diagnosed Stage 3 type 1 diabetes, making it the first therapy to modify disease progression after diagnosis by preserving beta-cell function. Additional stories review evidence supporting continuous glucose monitoring in basal insulin-treated type 2 diabetes and promising Phase III data showing talquetamab-based bispecific antibody regimens improve outcomes in relapsed or refractory multiple myeloma.

Drs. Gupta and Newhall discuss how the traditional idea of the atopic march—eczema progressing to food allergy, asthma, and allergic rhinitis—may be too simplistic and does not always match what they see in the clinic, given what is now known about shared type 2 inflammation, cytokine pathways, and barrier dysfunction across organs. They note that these allergic conditions often arise in parallel rather than in sequence. They suggest using the atopic march as a way to talk about risk, while focusing on early skin protection, timely food allergen introduction, and emerging biologic treatments like dupilumab to potentially reshape a child's long-term allergic trajectory.

This episode of the PeerDirect Medical News Podcast reviews three developments with potential implications across nephrology, oncology, and public health. Highlights include the FIND-CKD trial showing finerenone may slow disease progression in chronic kidney disease patients without diabetes, seven-year CROWN trial data demonstrating durable long-term disease control with lorlatinib in advanced ALK-positive lung cancer, and a JAMA Network Open study linking measles-related vitamin A misinformation to increased toxic exposures. Together, these findings underscore evolving treatment paradigms and the growing impact of health communication on patient outcomes.

Drs. Dasgupta and Sarswat review how ATTR cardiomyopathy remains under-recognized despite its prevalence in older patients with heart failure, emphasizing clinical red flags across cardiac and systemic manifestations. They outline a practical diagnostic pathway that prioritizes early identification using light-chain evaluation, bone scintigraphy, and genetic testing to distinguish transthyretin subtypes and initiate timely, disease-modifying therapy.

Drs. Saver and Sanossian discuss ISC 2026 data highlighting neurologists' frequent inaction on markedly uncontrolled hypertension in high‑risk stroke patients and the need for specialists to “own” blood pressure management at every visit. They also review refinements in patent foramen ovale (PFO) risk stratification, including Pascal algorithm-defined “possible” PFO cases, and explore how a “clinical trial effect” may lower stroke risk through greater patient engagement.

Drs. McMahon and Kalunian discuss how patients with lupus nephritis face a markedly higher risk of cardiovascular disease and how traditional risk calculators fail to capture the added danger from chronic inflammation, steroids, and disease-specific factors. They call for a paradigm shift toward aggressive, early, and continuous cardiovascular protection—including tighter blood pressure targets, earlier statin use, lifelong hydroxychloroquine when possible, and close multidisciplinary management from the time of diagnosis.

This episode of the PeerDirect Medical News Podcast examines the rapidly expanding Ebola outbreak in Congo and concerns over weakening global public health infrastructure, reviews new Phase III obesity data showing substantial weight loss with Lilly's triple-agonist retatrutide, and highlights promising ASCO 2026 lung cancer data for a TROP2-directed ADC combined with pembrolizumab in frontline NSCLC.

Drs. Humphries and Swigris describe how AI-driven CT analysis can detect subtle imaging features of ILD and UIP, outperforming visual reads for risk stratification and prognosis. They highlight how these tools may enable earlier identification of patients at high risk for fibrosis progression while also stressing current limitations, including opacity of algorithms, data dependence, and the need to adapt imaging hardware and clinical workflows.

Drs. McMahon and Kalunian discuss how the latest lupus nephritis guidelines from the American College of Rheumatology and European Alliance of Associations for Rheumatology are shifting care from short-term, reactive treatment to longer-term, continuous maintenance—often 3 to 5 years or more—to better prevent kidney flares and preserve renal function. They highlight emerging data on biologic-based triple therapy (including belimumab); the importance of biomarkers and repeat biopsies; and the growing push toward personalized, sometimes indefinite, therapy for high‑risk patients.

Drs. Chandwani and Kuruvilla explain that migraine and facial pain often share trigeminal system mechanisms, leading to frequent misdiagnosis as dental, musculoskeletal, or sinus problems, possibly resulting in unnecessary procedures. The speakers emphasize CGRP-targeted therapies, careful mechanism-based diagnosis, and multidisciplinary collaboration across neurology, orofacial pain, physical therapy, and behavioral health to improve outcomes for patients with complex facial pain and migraine presentations.

Drs. Wierda and O'Brien discuss new combination treatments for CLL that achieve exceptionally high rates of undetectable disease, especially with triplet regimens. They also show that venetoclax-based retreatment works very well, supporting a move away from chemoimmunotherapy.

Drs. Yiu and Emami continue their wrap-up of the highlights from the 49th Annual Macula Society Meeting, focusing on new developments in imaging technologies, AI, and drug delivery for retinal diseases. They also touch on emerging basic science topics like the gut microbiome and metabolomics, and how these may support more personalized, systems-level approaches to eye disease.

Drs. Mantia and Berg continue their discussion of ESMO 2025 data on HER2‑directed antibody–drug conjugates in urothelial cancer and the importance of routine HER2 testing. They highlight the promising efficacy and manageable toxicity of these agents across disease stages and raise future questions about how best to sequence them.

This episode of the PeerDirect Medical News Podcast explores promising new data on the oral pan-RAS inhibitor daraxonrasib in KRAS-mutated pancreatic cancer, a randomized stroke trial evaluating adjunctive tirofiban after tenecteplase, and AI-driven breast cancer risk prediction models that may outperform breast density alone. Together, these studies highlight emerging advances in targeted oncology, acute stroke management, and precision screening technologies that could influence future clinical practice.

Drs. Sarswat and Dasgupta discuss contemporary decision-making in treating transthyretin amyloidosis, comparing oral stabilizers with subcutaneous silencers and emphasizing earlier diagnosis, phenotype-driven therapy, and individual patient preferences. They highlight how neuropathy and autonomic dysfunction influence choice of mechanism, review practical considerations such as side-effect profiles, dosing logistics, and drug–drug interactions, and briefly touch on emerging approaches like amyloid-removing and gene-targeted therapies.

Drs. Wierda and O'Brien discuss how fixed-duration venetoclax-based therapy can match continuous BTK inhibitor treatment in CLL while offering deep remissions and time off therapy. They also explore promising real-world CAR T-cell (liso-cel) results and stress the growing importance of vaccination and cancer screening as CLL patients live longer.

Drs. Sanossian and Saver highlight emerging evidence that routine dental care and oral hygiene may function as actionable, modifiable contributors to stroke prevention beyond traditional vascular risk factors. They also review CREST-2 data showing that carotid revascularization in asymptomatic high-grade carotid stenosis reduces stroke risk, but does not appear to confer additional cognitive benefit over intensive medical therapy alone.

Drs. Swigris and Humphries discuss how data-driven texture analysis (DTA) on HRCT enables precise, objective quantification of fibrotic burden in ILD, overcoming the limitations of semi-quantitative visual scoring and blunt physiologic measures. They further describe a complementary AI-based classifier that predicts histologic usual interstitial pneumonia (UIP) patterns from CT, enhancing prognostication and potentially reducing the need for surgical lung biopsy.

Drs. Mantia and Berg discuss HER2 as a biomarker in genitourinary cancers, focusing on testing strategies, prevalence, and the clinical implications of HER2 expression and ERBB2 mutations for patient management. They also review new data from ESMO 2025, highlighting the DISTINCT-1 trial and a HER2-targeted approach for high-risk upper tract genitourinary carcinoma.

New cardiovascular data suggest pulsed field ablation may challenge antiarrhythmic drugs as first-line therapy for persistent atrial fibrillation, while real-world evidence positions apixaban as the preferred DOAC for younger patients with nonvalvular AF due to superior safety and effectiveness. Additional findings from the SENIOR-RITA trial indicate that routine invasive management may not benefit frail older adults with NSTEMI and could worsen outcomes in the most frail patients. Together, these studies highlight a growing shift toward more individualized cardiovascular treatment strategies.

Daraxonrasib, a first-in-class oral RAS inhibitor, nearly doubled overall survival versus chemotherapy in previously treated metastatic pancreatic cancer, representing a potentially landmark advance in a historically difficult-to-treat disease. The antibody-drug conjugate datopotamab deruxtecan significantly improved progression-free and overall survival over chemotherapy in first-line triple-negative breast cancer, particularly for patients ineligible for immunotherapy. A Cochrane review of nearly 20,000 patients found anti-amyloid Alzheimer's therapies offer minimal clinically meaningful cognitive benefit while carrying meaningful safety risks, complicating their real-world use.

Drs. Maron and Rowin review how treatment for symptomatic obstructive hypertrophic cardiomyopathy has evolved from mainly using beta blockers and invasive procedures to now including newer cardiac myosin inhibitor drugs. These newer medications more reliably reduce obstruction and improve patient symptoms and exercise capacity, but require careful safety monitoring with regular heart function checks.

Shingles vaccination in adults with established cardiovascular disease was associated with dramatic reductions in heart attack, stroke, and mortality in a large real-world analysis, supporting its role as a cardiovascular risk-reduction tool beyond infection prevention. The VESALIUS-CV trial found evolocumab significantly reduced major cardiovascular events in high-risk diabetic patients without known ASCVD, challenging the convention of reserving PCSK9 inhibitors for secondary prevention only. AI-analyzed smartwatch data predicted heart failure hospitalizations days to weeks in advance, signaling a shift toward continuous remote monitoring in heart failure management.

Drs. Yiu and Emami review key themes from the 49th Annual Macula Society Meeting, emphasizing a shift toward earlier diagnosis and intervention, longer-acting therapies, and increasing reliance on advanced imaging biomarkers and AI. They also look at new and existing data on a range of emerging treatment options for both neovascular and atrophic macular conditions.

Drs. Kuruvilla and Chandwani discuss migraine as a key women's health issue driven largely by estrogen fluctuations across a woman's lifespan, influencing CGRP, serotonin, sleep, and comorbid pain conditions from menstruation through perimenopause and menopause. These experts emphasize individualized, interdisciplinary care that combines CGRP-targeted preventives, hormonal strategies, integrative medicine (eg, acupuncture, supplements), and lifestyle and sleep optimization to improve quality of life.

A trial found that discontinuing beta-blockers in stable post-MI patients without heart failure was noninferior to continuing them, suggesting long-term use may be unnecessary. Second, the 2026 ACC/AHA lipid guideline promotes earlier, personalized intervention using the PREVENT risk calculator and expanded biomarkers to reduce lifetime cardiovascular risk. Finally, a JAMA study found thiazide diuretics carry meaningful hyponatremia risk, especially in older adults and women, urging careful patient selection

Drs. Swigris and Humphries discuss how AI-driven, quantitatively trained algorithms can standardize the interpretation of high-resolution computed tomography (HRCT) in ILD by reducing inter- and intra-reader variability and improving fibrosis extent assessment. They contrast traditional visually based radiology with supervised machine learning approaches, including models trained on biopsy-confirmed diagnoses and disease behavior, to potentially enhance prognostication and clinical decision-making.

A randomized trial in the New England Journal of Medicine found prehospital whole blood transfusion did not improve 30-day mortality over standard component therapy in traumatic hemorrhage, supporting current transfusion protocols. A large population-based study showed patients with positive fecal occult blood tests who did not complete follow-up colonoscopy had significantly higher colorectal cancer incidence and more advanced-stage disease. Finally, a study in Nature Medicine of nearly 15,000 individuals found antibiotic exposure reduced gut microbial diversity for up to 4–8 years, with clindamycin and fluoroquinolones causing the most persistent disruption.

Drs. Sanossian and Saver review new evidence supporting intensified antithrombotic strategies to reduce recurrent ischemic stroke in high-risk, noncardioembolic patients without increasing intracranial hemorrhage. They place this within a comprehensive, multimodal secondary prevention framework that integrates pharmacologic therapy with aggressive risk factor modification (lipids, blood pressure, diabetes, and lifestyle).

Drs. O'Brien and Wierda discuss how fixed-duration venetoclax-based therapy can match continuous BTK inhibitor treatment in CLL while offering deep remissions and time off therapy. They also explore promising real-world CAR T-cell (liso-cel) results and stress the growing importance of vaccination and cancer screening as CLL patients live longer.

Drs. Dougherty and Ailani discuss the 2025 International Headache Society guidelines indicating that neuromodulation is an effective, non-invasive option for both acute and preventive migraine treatment. They stress that it works best as part of a personalized, multimodal plan alongside medications, behavioral therapies, and lifestyle changes.

Drs. Maron and Rowin provide an overview of hypertrophic cardiomyopathy, explaining how it is diagnosed by heart imaging and classified into obstructive and non-obstructive forms. They highlight that obstruction is a major cause of symptoms and stress the importance of carefully assessing patients' day-to-day limitations to guide treatment decisions.

Drs. Petri and Woolfson discuss a simple risk score using autoantibodies, complement, and demographics to predict which SLE patients are most likely to develop proteinuria and lupus nephritis. They also highlight evidence showing that earlier kidney biopsies at lower proteinuria levels, especially in patients with low complement, can detect serious disease sooner and improve outcomes.

This week's podcast covers three NEJM trials. First, apixaban showed over 50% less clinically relevant bleeding than rivaroxaban in acute venous thromboembolism patients, with similar efficacy. Second, romiplostim helped 84% of patients on oxaliplatin-based chemotherapy avoid dose modifications due to thrombocytopenia, versus 36% with placebo. Third, inhaled treprostinil slowed lung function decline in idiopathic pulmonary fibrosis patients over 52 weeks, though cough and discontinuation rates were higher.

Drs. Isaacs and Traina discuss DESTINY-Breast09, where first‑line T‑DXd + pertuzumab clearly outperforms the CLEOPATRA regimen in progression-free survival for metastatic HER2+ breast cancer. They focus on the dilemma of when to use T‑DXd: earlier, for maximal efficacy, or later, to protect quality of life and manage ILD and cardiac risks.

The WISDOM trial found risk-based breast cancer screening — using genetic and polygenic risk scores — is non-inferior to annual mammography, enabling more intensive surveillance for high-risk women while reducing unnecessary imaging for low-risk individuals. Among hypertensive adults, prediabetes combined with elevated cardiac biomarkers significantly increases heart failure risk, suggesting combined metabolic and biomarker screening could guide earlier prevention. RSV vaccination in older adults appears to reduce not only respiratory illness but also associated cardiovascular complications including heart attack and stroke.

Drs. Cytryn, Foote, and Thummalapalli review evolving HER2-targeted treatment strategies for upper GI, biliary, and colorectal cancers, emphasizing challenges with disease heterogeneity and treatment sequencing. They also highlight the importance of HER2 reassessment after progression and advancing diagnostic approaches.

Three studies highlight new findings: A phase 3 trial showed obinutuzumab significantly improved lupus responses versus placebo in active SLE patients on standard therapy. A trial of finerenone in type 1 diabetes with chronic kidney disease demonstrated meaningful reductions in albuminuria compared to placebo, suggesting a new renal-protective option. Finally, paired pediatric trials found that adding acetaminophen or hydromorphone to ibuprofen provided no additional pain relief for children's acute limb injuries, with opioids causing four times more adverse events. Ibuprofen alone remains the recommended first-line approach.