How do you address patient concerns regarding the necessity of REMS monitoring when prescribing sparsentan?  

This is a hard one and very patient-dependent. I do have patients who do not want to have labs every month, and then we have a discussion: if the first 3 months are stable, then every 8 weeks, and if they cannot do it, then I tell them to stop the medication. The harder one is urine pregnancy tests ...

I point out to patients that sparsentan itself did not have an increased incidence of liver function abnormalities in trials, and that this REMS monitoring is required out of an abundance of caution because of liver function abnormalities seen with other anti-endothelin drugs like bosentan. Of cours...