For the past 17 years, the Cleveland Clinic has predicted what the top 10 medical disruptors will be for the following year.
The list of technologies, cultivated by a panel of physicians and scientists at the clinic, was led by Dr. Michael Roizen, emeritus chief wellness officer.
“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,” Roizen said.
The Cleveland Clinic announced this year’s top 10 list at its annual Innovation Summit Oct. 21-23 in Cleveland. From drugs for heart failure with preserved ejection fraction to expanded use of minimally invasive mitral valve surgery, here are the institute’s predictions for medical technologies that will prove disruptive in 2019.
10. Drugs for heart failure with preserved ejection fraction
Diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF), occurs when the ventricular heart muscles contract normally, but don’t relax. Because of a preserved ejection fraction, the heart doesn’t properly fill with blood and leaves less blood to be pumped and distributed throughout the body.
Treatment for the syndrome is limited to accompanying conditions and symptom relief. Doctors at the Cleveland Clinic suggest that SGLT2 inhibitors, medications designed to treat Type 2 diabetes, could be used to treat HFpEF.
“We need to remember that this form of heart failure doesn’t have a definitive treatment today,” Dr. Nancy Albert, associate chief nursing officer of research and innovation at the Cleveland Clinic, said at the annual Cleveland Clinic Innovation Summit. “It’s promising to think that a drug that affects glucose metabolism might be beneficial to people who suffer from heart failure with preserved ejection fraction.”
9. PARP inhibitors for maintenance therapy in ovarian cancer
Poly-ADP ribose polymerase (PARP) inhibitors block damaged DNA repair in tumor cells, which can increase cell death in tumors that have deficient repair mechanisms.
Recent advances in ovarian cancer treatment have shown that PARP inhibitors have improved progression-free survival and are being approved for first-line maintenance therapy in advanced-stage disease, according to the Cleveland Clinic.
“We have a tough time managing ovarian cancer. It takes up a lot of our time,” Dr. Chad Michener, a staff member in the OB/GYN department at the Cleveland Clinic said. “We expect a recurrence, so anything we can do to reduce that is great.”
There are large-scale trials currently underway using PARP inhibitors that are slated to improve outcomes in cancer therapy. Outcomes have shown 12-16 months of delayed recurrence. Side effects of the therapy include nausea, bone marrow toxicity and fatigue, but for the most part they’re “pretty tolerable” Michener said.
8. Bempedoic acid for cholesterol-lowering in statin-intolerant patients
High cholesterol can lead to serious health problems such as heart attack and stroke. It is typically managed with statins, but some people experience unacceptable muscle pain with those drugs and become intolerant.
Bempedoic acid could offer an alternative approach to lowering the LDL-cholesterol without the side effects.
“This problem is one of the most vexing problems we face in cardiology,” Dr. Steve Nissen, a staff member in cardiovascular medicine at the Cleveland Clinic, said.
The drug is a prodrug that isn’t activated until it enters the liver. It has shown to lower c-reactive proteins more than statins, according to Nissen. It is slated for FDA approval in February.
7. Antibiotic envelope for cardiac implantable device infection prevention
Cardiac electronic devices are implanted in 1.5 million patients per year, according to the Cleveland Clinic. Infection is a risk when receiving the implant, which could lead to life-threatening complications.
Antibiotic-embedded envelopes are designed to encase the cardiac device and prevent infection.
“It’s not one-time risk. It’s a lifetime risk,” Dr. Khaldoun Tarakji, a staff member in cardiovascular medicine at the Cleveland Clinic, said. “Patients are outliving their devices.”
6. Biologics in orthopedic repair
Patients can take months or years to recover from orthopedic surgeries. Doctors at the Cleveland Clinic suggest that biologics – cells, blood components, growth factors and other natural substances – could replace or use the body’s own power to promote healing post-surgery.
Dr. Paul Saluan, a staff member in orthopedic surgery at the Cleveland Clinic, said doctors want to use biologics appropriately to change immediate outcomes and long term outcomes.
The repair can be done at the point of surgery. It’s provided as a sponge device at the time of surgery, Saluan said.
5. Closed-loop spinal cord stimulation
Prescription opioids are often used to treat chronic pain, but the epidemic surrounding the drugs has left doctors looking for alternatives to pain therapy. Spinal cord stimulation is a popular alternative for chronic pain.
Implantable devices can provide an electrical stimulus to the spinal cord, but the outcomes can sometimes be unsatisfactory with subtherapeutic or overstimulating results.
“Chronic pain is a major health-economic problem,” Dr. Nagy Mekhail, a staff member in pain management at the Cleveland Clinic, said. “We all agree that narcotics are not the solution.”
Closed-loop stimulation could allow for better communication between the device and the spinal cord for more optimal stimulation and relief of pain.
“This new development came from the fact that we need to monitor how much stimulation we are giving to someone and how they are responding,” said Mekhail. “This is the wave of the future that I call interactive stimulation.”
4. Therapy for mitigation of peanut allergies
Emergency epinephrine has reduced the severity and risk of accidental exposure to peanut allergic reactions. However, the innovation has not done enough to provide ease of mind to 2.5% of parents who worry their child might not be able to breathe due to an allergic reaction.
New oral immunotherapy medication has been developed that could allow children to gradually build a tolerance to peanut exposure to protect against allergic reactions, according to the Cleveland Clinic.
“Food allergies have doubled in the last decade,” said Dr. Sandra Hong, a staff member in the allergy and clinical immunology department at the Cleveland Clinic. “Treatment at this point has been complete avoidance.”
The drug is a purified protein with an exact amount, said Hong. On the first day of dosage, a patient receives multiple doses and they stay a 5-6 hours after dosage for monitoring. The dosage is increased every two weeks and continues on for six months. The person then stays on the drug indefinitely.
However, Hong said the drug is not for everyone. If they’re non-compliant, it’s not for them. They can’t exercise within two hours of taking the drug and there is a risk of anaphylaxis.
3. Inaugural medication for transthyretin amyloid cardiomyopathy
ATTR-CM is a cardiovascular disorder where amyloid protein fibrils deposit in the walls of the heart’s left ventricle and stiffen. The heart condition is underdiagnosed and potentially fatal, according to the Cleveland Clinic.
A new agent could prevent misfiling of deposited protein and has been shown to significantly reduce risk of death.
“The medication binds the protein and stabilizes so it doesn’t break apart in the heart,” Dr. Mazen Hanna, a staff member in cardiovascular medicine at the Cleveland Clinic, said. “It’s a huge breakthrough in the field for a very underdiagnosed disease.”
The medication received fast-track and breakthrough designations in 2017 and 2018 and the FDA approved tafamidis medication in 2019 to treat ATTR-CM.
2. Expanded use of minimally invasive mitral valve surgery
Mitral valve regurgitation happens to 10% of people over the age of 75. Minimally invasive valve repair devices are seeing expanded approval for patients who have failed to get symptom relief from other therapies.
“The beauty of this mitral clip device is it’s minimally invasive,” Dr. Samir Kapadia, chair of cardiovascular medicine at the Cleveland Clinic, said.
Kapadia said cardiac surgery won’t be all minimally invasive in the future because of mitral valve repair. The procedure is remedying the mitral valve, which is part of a bigger heart failure problem.
There are a number of companies currently in a race to commercialize some of the first mitral valve replacement devices.
1. Dual-acting osteoporosis drug
Osteoporosis occurs when bones become weak and brittle. Bone mass loss occurs silently and progressively without symptoms until the first fracture, according to the Cleveland Clinic. The condition also results in a greater risk of bones breaking.
Bone-strengthening medication in the form of a new dual-acting drug (romosozumab) could give patients with osteoporosis more control in preventing additional fractures.
“For every hip fracture patient, they have a 20% likelihood of dying in the next year,” Dr. Chad Deal, a staff member in rheumatic disease at the Cleveland Clinic said.
The drug has shown a 50% reduction in spine fractures and a 38% reduction in hip fractures.
“I think it will be first-line for high-risk patients [in the next three years],” Deal said.
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