Ryan Haumschild, PharmD, MS, MBA

Panelists discuss how neurofibromatosis type 1 (NF1) is typically diagnosed in early childhood using National Institutes of Health (NIH) clinical criteria, with genetic testing supporting unclear cases, and highlight the global prevalence of NF1 and the high incidence of plexiform neurofibromas, which affect up to 50% of patients regardless of racial or geographic background.

Panelists discuss how mutations in the NF1 gene lead to loss of neurofibromin function, resulting in hyperactivation of the RAS/MAPK and PI3K/AKT/mTOR pathways, and how this molecular dysregulation drives abnormal cell proliferation and tumor development in NF1.

Panelists discuss how the management of uncomplicated urinary tract infections (UTIs) is evolving, with promising new therapies that address antibiotic resistance concerns, while emphasizing the continued importance of antimicrobial stewardship, personalized treatment approaches, preventive strategies, and comprehensive patient education to reduce recurrence rates and improve outcomes in this common but burdensome condition.

Panelists discuss how recurrent urinary tract infections (UTIs) treated with older antibiotics generate 2 to 3 times higher total costs than initial savings, warranting cost-effectiveness analyses in treatment decisions, whereas payers create barriers to newer therapies through restrictive authorizations, high co-pays, step therapy mandates, and limited formulary inclusion that providers can navigate via detailed documentation, pharmacy benefit manager engagement, patient assistance programs, and advocacy for evidence-based coverage policies.

Panelists discuss how newer urinary tract infection (UTI) therapies such as pivmecillinam, sulopenem etzadroxil/probenecid, and gepotidacin demonstrate significantly lower resistance rates (below 5%) compared with traditional first-line antibiotics (10%-30% for trimethoprim/sulfamethoxazole), with improved clinical and microbiological cure rates particularly for resistant pathogens, anticipating their integration into treatment algorithms as second-line options after nitrofurantoin and fosfomycin for patients with risk factors for resistance, prior treatment failures, recurrent infections, or confirmed resistant pathogens, although limited by higher costs and need for antimicrobial stewardship until more real-world effectiveness data become available.

Panelists discuss how sulopenem etzadroxil/probenecid, approved in October 2024, functions as an oral β-lactam/β-lactamase inhibitor effective against extended-spectrum β-lactamase producers per SURE 1 and REASSURE trial findings whereas gepotidacin works through a novel mechanism as a triazaacenaphthylene bacterial topoisomerase inhibitor targeting resistant pathogens via unique DNA gyrase and topoisomerase IV binding sites, with EAGLE trial findings demonstrating noninferiority to nitrofurantoin with approximately 90% cure rates.

Panelists discuss how American Urological Association (AUA) guidelines for recurrent uncomplicated urinary tract infections (UTIs) in women recommend culture-confirmed diagnosis, prophylactic antibiotics, nonantibiotic prevention, self-initiated treatment, and behavioral modifications while noting pivmecillinam’s recent FDA approval. Pivmecillinam features a penicillin-binding protein 2 inhibition mechanism with 85% to 95% efficacy against gram-negative uropathogens, including extended-spectrum β-lactamase producers; minimal intestinal flora disruption; low resistance rates; and primarily mild gastrointestinal adverse effects.

Panelists discuss how treatment failure in uncomplicated urinary tract infections (UTIs) creates substantial economic burden through direct costs of additional health care visits, repeated diagnostic tests, and rescue medications alongside indirect costs from productivity losses, with implications including progression to complicated infections such as pyelonephritis, increased emergency department use, antimicrobial resistance development threatening broader public health, psychological impacts on patients, and strain on health care resources that could be mitigated through more effective initial treatment strategies.

Panelists discuss how significant gaps in current uncomplicated urinary tract infection (UTI) therapies include insufficient nonantibiotic preventive strategies, limited options for multidrug-resistant pathogens, inadequate personalized treatment approaches, minimal focus on biofilm disruption, lack of rapid point-of-care diagnostics to guide targeted therapy, poor understanding of the urinary microbiome’s role in infection susceptibility, and insufficient research into immunomodulatory interventions that could address the underlying mechanisms of recurrence and resistance development.

Panelists discuss how fluoroquinolones are generally reserved for uncomplicated urinary tract infections (UTIs) only when first-line options are contraindicated or pathogen resistance is confirmed, with treatment duration ranging from single-dose fosfomycin to 3 to 5 days for most antibiotics and 7 to 10 days for nitrofurantoin, noting shorter regimens typically achieve 85% to 95% adherence rates compared with 60% to 75% for longer courses, significantly affecting treatment success, particularly when patient factors such as adverse effects, dosing complexity, and lifestyle disruptions are considered.

Panelists discuss how standard-of-care antibiotics for uncomplicated urinary tract infections (UTIs) show varying efficacy, with nitrofurantoin and fosfomycin demonstrating superior response rates (85%-95%) compared with trimethoprim/sulfamethoxazole (70%-80% due to increasing resistance) and first-generation cephalosporins (80%-90%), and how cost-effectiveness depends on local resistance patterns, patient adherence to dosing schedules, medication costs and insurance coverage, treatment duration, recurrence rates, comorbidities, and potential adverse effects requiring additional interventions.

Panelists discuss how uncomplicated urinary tract infections (UTIs) are typically managed with empiric short-course antibiotics based on local resistance patterns while identifying significant gaps in the outdated 2010 Infectious Diseases Society of America (IDSA) guidelines, including insufficient guidance on emerging resistance trends, limited recommendations for alternative therapies, inadequate consideration of patient-specific factors, absence of antimicrobial stewardship protocols, and minimal direction on prevention strategies for recurrent infections.

Panelists discuss how clinicians are addressing antimicrobial stewardship in urinary tract infection (UTI) management through implementation of evidence-based guidelines, delayed prescribing strategies, shorter treatment durations, targeted narrow-spectrum antibiotics based on local resistance patterns, increased use of culture-guided therapy, nonantibiotic preventive approaches, and enhanced patient education about appropriate antibiotic use.

Panelists discuss how patients with recurrent urinary tract infections (UTIs) describe significant burdens including constant anxiety about symptom onset, disruption to work and social life, financial strain from frequent office visits and medications, frustration with treatment-resistant infections, embarrassment discussing symptoms, sexual dysfunction, relationship difficulties, and substantial mental health impacts such as depression and diminished quality of life.

Panelists discuss how comprehensive patient education about proper hygiene practices, adequate hydration, voiding habits, and early symptom recognition significantly reduces urinary tract infection (UTI) incidence and recurrence rates, suggesting enhancement through personalized multimedia resources, telehealth follow-ups, community health programs, and improved provider-patient communication regarding preventive strategies.

Panelists discuss how uncomplicated urinary tract infection (UTI) recurrence affects 20% to 30% of female patients within 6 months of initial infection, with contributing factors including anatomical variances, hormonal changes, genetic predisposition, insufficient treatment duration, resistant pathogens, and biofilm formation that persists despite proper adherence to standard antibiotic protocols.

Panelists discuss how social determinants of health significantly influence uncomplicated urinary tract infection (UTI) prevalence and outcomes, with patients with lower income, those from rural areas, and those lacking consistent health care access experiencing higher infection rates, delayed treatment, increased complications, and poorer overall treatment success.

Panelists discuss how their practices have observed an increasing trend in uncomplicated urinary tract infections (UTIs), particularly among younger adult women and those with recurrent infections, noting potential contributing factors such as antibiotic resistance patterns and delayed care-seeking behaviors.

Panelists discuss how alopecia areata (AA) is a chronic autoimmune disease characterized by inflammation that attacks hair follicles, leading to hair loss and varying disease progression.

Panelists discuss how the landscape of small cell lung cancer (SCLC) treatment is rapidly evolving, highlighting key advances in immunotherapy, targeted treatments like tarlatamab, and ongoing research efforts, while emphasizing the importance of early diagnosis, appropriate staging, and personalized treatment approaches to improve patient outcomes and quality of life.

Panelists discuss how health care providers and payers can collaborate more effectively to optimize lupus nephritis care.

Panelists discuss how treatment options for small cell lung cancer (SCLC) extend beyond first-line therapies and the recently approved tarlatamab, exploring existing treatments in the second-line and beyond while also highlighting promising ongoing clinical trials and emerging therapies that show potential for improving outcomes in SCLC patients.

Panelists discuss how to determine the optimal timing for initiating immunotherapy in patients with small cell lung cancer (SCLC), considering the pros and cons of inpatient vs outpatient administration, while also addressing the unique barriers to diagnosing and treating SCLC compared with non–small cell lung cancer and exploring strategies to overcome these challenges.

Panelists discuss the challenges patients face in accessing lupus nephritis treatment and the resources available to support timely access, including how payers are facilitating care.

Panelists discuss the differences in efficacy and safety profiles between belimumab and voclosporin for lupus nephritis (LN) and how payers are evaluating their value, including considerations of cost-effectiveness in LN management.

Panelists discuss how to effectively collaborate with payers to ensure access to necessary medications for patients with small cell lung cancer (SCLC), while also exploring best practices for patient education and identifying valuable resources to share with those diagnosed with SCLC.

Panelists discuss how biomarker testing is currently utilized in the management of patients with small cell lung cancer (SCLC), including its timing within the treatment journey, while also exploring the existing unmet needs in biomarker testing for SCLC and potential strategies to address and overcome these challenges in the future.

Panelists discuss the considerations guiding treatment choices for lupus nephritis, such as drug interactions, patient characteristics, and steroid use, and how treatment approaches might differ between nephrologists and rheumatologists.

Panelists discuss the differences in efficacy and safety profiles between belimumab and voclosporin for lupus nephritis (LN) and how payers are evaluating their value, including considerations of cost-effectiveness in LN management.

Panelists discuss how the ADRIATIC trial investigating durvalumab in limited-stage small cell lung cancer (SCLC) has shown promising results, potentially addressing unmet needs in this patient population, and consider its potential impact on treatment algorithms and its possible emergence as a new standard of care if approved for this indication.