Medical innovations for 2020

A list of up-and-coming technologies has been unveiled by the Cleveland Clinic, selected by a panel of Cleveland Clinic physicians and scientists led by Dr Michael Roizen. The Top Ten Medical Innovations for 2020 were presented at the 2019 Medical Innovation Summit.

1. Dual-acting osteoporosis drug

The recent FDA approval of the dual-acting drug romosozumab will give patients with osteoporosis more control in preventing additional fractures. Romosozumab works by binding and inhibiting the activity of the protein sclerostin and, as a result, has a dual effect on bone, both increasing bone formation and decreasing bone breakdown.

2. Expanded use of minimally invasive mitral valve surgery

The mitral valve allows blood to flow from the heart’s left atrium to the left ventricle, but in about one in 10 individuals over the age of 75 the mitral valve is defective, causing the action of regurgitation. Expanding the approval of a minimally invasive valve repair device to a population of patients failing to attain symptom relief from other therapies provides an important new treatment option.

3. Treatment for transthyretin amyloid cardiomyopathy

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive, underdiagnosed and potentially fatal disease in which amyloid protein fibrils deposit in, and stiffen, the walls of the heart’s left ventricle. A new agent to prevent misfolding of the deposited protein is showing a significantly reduced risk of death. It is reported that the FDA approval of tafamidis marks the first ever medication for the treatment of ATTR-CM.

4. Therapy for mitigation of peanut allergies

The development of a new oral immunotherapy to gradually build tolerance to peanut exposure holds the opportunity to lend protection against allergic reaction.

5. Closed-loop spinal cord stimulation

Spinal cord stimulation is a popular treatment for chronic pain, involving an implantable device that provides electrical stimulus to the spinal cord. But unsatisfactory outcomes due to subtherapeutic or overstimulation events are common. Closed-loop stimulation allows for better communication between the device and the spinal cord, thus improving stimulation and pain relief.

6. Biologics in orthopaedic repair

The body can take months or years to recover from orthopaedic surgery, but the use of biologics such as cells, blood components and growth factors can promote healing and may allow for expedited, improved outcomes.

7. Antibiotic envelope for cardiac implantable device infection prevention

Worldwide, around 1.5 million patients receive an implantable cardiac electronic device every year. Infection remains a major, potentially life-threatening complication in these patients. Antibiotic-embedded envelopes are now made to encase these cardiac devices, effectively preventing infection.

8. Bempedoic acid for cholesterol lowering in statin-intolerant patients

High cholesterol is a major concern for nearly 40% of adults in the US. Left untreated, the condition can lead to serious health problems like heart attack and stroke. Though typically managed with statins, some individuals experience unacceptable muscle pain when taking this medication. Bempedoic acid provides an alternative approach to lowering of LDL cholesterol while avoiding these side effects.

9. PARP inhibitors for maintenance therapy in ovarian cancer

PARP (or poly-ADP ribose polymerase) inhibitors block the repair of damaged DNA in tumour cells, which increases cell death, particularly in tumours with deficient repair mechanisms. PARP inhibitors are an important advance in ovarian cancer treatment, improving progression-free survival, and are now being approved for first-line maintenance therapy in advanced-stage disease. Several additional large-scale trials are underway that are set to make great strides in improving outcomes in cancer therapy.

10. Drugs for heart failure with preserved ejection fraction

Heart failure with preserved ejection fraction (HFpEF) — also known as diastolic heart failure — is a condition in which the ventricular heart muscles contract normally but do not relax as they should. 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 — are now being explored in HFpEF and may provide a potential new treatment option.

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