Drug therapies for cardiology, osteoporosis, and peanut allergies hold great potential.
When Cleveland Clinic prognosticators peered into their crystal ball to forecast the top 10 medical innovations for 2020, there must have been a healthy heart beating in the center of the orb. Four of the 10 predictions involve advancements in the field of cardiology.
Many of the innovations involve emerging drug therapies, with the number one innovation related to a new drug to treat osteoporosis, which possesses dual properties to increase bone formation and decrease bone resorption.
As the 2019 Cleveland Clinic Medical Innovation Summit came to a close on Wednesday, organizers released their annual list of the medical innovations that hold the greatest promise to impact healthcare in the coming year. The list of up-and-coming technologies was selected by a panel of Cleveland Clinic physicians and scientists, led by Michael Roizen, MD, emeritus chief wellness officer at Cleveland Clinic.
“Healthcare is ever-changing, and we anticipate that these innovations will significantly transform the medical field and improve care for patients at Cleveland Clinic and throughout the world,” says Dr. Roizen in a news release issued by the health system.
The top 10 medical innovations for 2020, in order of anticipated importance, are:
1. Romosozumab, a Dual-Acting Osteoporosis Drug
The team hailed a new dual-acting drug, romosozumab, recently approved by the FDA, as the top innovation for 2020. Romosozumab is a monoclonal antibody that binds to and inhibits sclerostin, increases bone formation, and decreases bone resorption, according to an article published on October 20, 2016 in the New England Journal of Medicine. The drug gives "patients with osteoporosis more control in preventing additional fractures," according to the panel. About 10 million Americans have osteoporosis costing patients, their families and the healthcare system $52 billion annually, according to the National Osteoporosis Foundation.
2. Expanded Use of Minimally Invasive Mitral Valve Surgery
Earlier this year the FDA expanded approval of a minimally invasive valve repair device to treat a population of patients who have failed to get symptom relief from other therapies. The team of physicians and scientists say this "provides an important new treatment option," for the condition. Normally, the mitral valve allows blood flow from the heart’s left atrium to the left ventricle; however, one in 10 individuals over the age of 75 have a defective valve, which causes the blood to flow backwards or "regurgitate." The device prevents this from occurring.
3. Inaugural Medication for Transthyretin Amyloid Cardiomyopathy
The cardiovascular disorder, ATTR-CM, "is a progressive, underdiagnosed, potentially fatal disease in which amyloid protein fibrils deposit in, and stiffen, the walls of the heart’s left ventricle," according to Cleveland Clinic. "A new agent to prevent misfolding of the deposited protein is showing a significantly reduced risk of death," the news release says. "Following fast-track and breakthrough designations in 2017 and 2018, 2019 marked the FDA approval of tafamidis, the first-ever medication for treatment of this increasingly recognized condition."
4. Therapy for Mitigation of Peanut Allergies
A new oral immunotherapy medication to gradually build tolerance to peanut exposure holds the opportunity to lend protection against attack. While not yet approved by the FDA, the drug made progress toward that goal when an advisory committee voted in support of the drug's safety and effectiveness. A full vote is expected in January. The American College of Allergy, Asthma and Immunology (ACAAI) suggests that peanut allergy in children has increased 21% between 2010 and 2017, and that nearly 2.5% of U.S. children may have an allergy to peanuts.
5. Closed-Loop Spinal Cord Stimulation Because current treatment for chronic pain involving spinal cord stimulation has "unsatisfactory outcomes due to subtherapeutic or overstimulation," says the panel, a treatment involving closed-loop stimulation looks promising. The latter treatment "allows for better communication between the device and the spinal cord, providing more optimal stimulation and relief of pain," according to the release. A study, involving researchers from multiple institutions, including one from Cleveland Clinic, is underway to compare the two methods. As reported in Neuromodulation on March 3, 2019, "This study represents the first randomized, double-blind, pivotal study in the field of neuromodulation to measure SC activation in ECAP-controlled closed-loop versus open-loop stimulation and is expected to yield important information regarding differences in safety, efficacy, and neurophysiological properties."
6. Biologics in Orthopaedic Repair
The use of biologics, which include cells, blood components, growth factors and other natural substances, "have the power to replace or harness the body's own power and promote healing," the panel says. Use of biologics in orthopaedic care may enhance the possibility of expedited improved outcomes, speeding the months and years it can take to recover from orthopaedic surgery. An article published January 15 in the Journal of American Academy of Orthopaedic Surgery presents consensus recommendations for use of these substances.
7. Antibiotic Envelope for Cardiac Implantable Device Infection Prevention
According to Cleveland Clinic, an estimated 1.5 million patients around the world who receive an implantable cardiac electronic device every year. There is added protection against infection through the use of antibiotic-embedded envelopes which encase these cardiac devices. Cleveland Clinic researchers participated in a study about this innovation published May 16 by the New England Journal of Medicine.
8. Bempedoic Acid for Cholesterol Lowering in Statin Intolerant Patients
High cholesterol is a major concern for nearly 40 percent of adults in the U.S., according to the Cleveland Clinic release. "Left untreated, the condition could lead to serious health problems like heart attack and stroke." Some individuals experience unacceptable muscle pain with statins, which are typically prescribed to treat this problem. "Bempedoic acid provides an alternative approach to lowering of LDL-cholesterol while avoiding these side effects," the panel says. An article published March 29 in the Journal of the American Heart Association concluded that "bempedoic acid offers a safe and effective oral therapeutic option for lipid lowering in patients who cannot tolerate statins.""
9. PARP Inhibitors for Maintenance Therapy in Ovarian Cancer
Ovarian cancer has a new foe with PARP—poly-ADP ribose polymerase—inhibitors that "block repair of damaged DNA in tumor cells which increases cell death, especially in tumors with deficient repair mechanisms," according to the release. Cleveland Clinic reports PARP therapy is "one of the most recent important advances ovarian cancer treatment. PARP inhibitors have improved progression-free survival and are now being approved for first-line maintenance therapy in advanced stage disease. Several additional large-scale trials are underway with PARP inhibitors set to make great strides in improving outcomes in cancer therapy," the panel reports. As reported by the American Journal of Managed Care, a presentation in March at the National Comprehensive Cancer Network Annual Conference in Orlando, Florida, outlined several key updates for treatment in ovarian cancer based on new studies and approvals for poly (ADP-ribose) polymerase (PARP) inhibitors and bevacizumab.
10. Drugs for Heart Failure with Preserved Ejection Fraction
A potential new treatment option is emerging for treatment of heart failure with preserved ejection fraction (HFpEF). The condition is also known as diastolic heart failure, in which the ventricular heart muscles contract normally, but do not relax as they should, the release explains. "With preserved ejection fraction, the heart is unable to properly fill with blood, leaving less available to be pumped out to the body. Currently, recommendations for this treatment are directed at accompanying conditions and mere symptom relief. But SGLT2 inhibitors, a class of medications used in the treatment of type 2 diabetes, is now being explored in HFpEF – alluding to a potential new treatment option." An article published online in February by JACC, the Journal of the American College of Cardiology presents the growing case for use of SGLT2i in heart failure.
The annual Medical Innovation Summit is organized by Cleveland Clinic Innovations, the development and commercialization arm of Cleveland Clinic. The Cleveland Clinic Newsroom offers additional information about the annual Top 10 Medical Innovations including descriptions, videos, and year-by-year comparisons.
Mandy Roth is the innovations editor at HealthLeaders.
Photo credit: Courtesy of Cleveland Clinic