Top 10 medical innovations

Want to know what treatments and technologies are going to change patient care next year? To find out, a panel of nearly 100 clinicians and researchers at Cleveland Clinic, Cleveland, OH, reviewed more than 150 novel medical innovations to  rank for the top 2020 .

The nominated technologies meet certain criteria. They should have significant clinical impact and significant patient benefit with current methods. They must have clinical trials and be available on the market sometime in the coming year. And they must have significant human interest and human impact on their application or benefits.

After a discussion and debate, the panel decided on the top 10 up-and-coming technologies in medicine.

"Healthcare is ever changing and we anticipate these innovations will transform the medical field and improve care for patients in the Cleveland Clinic and throughout the world," said Michael Roizen, MD, Emeritus Chief Wellness Officer at Cleveland Clinic, who led the panel.

Top 20 Medical Innovations for 2020

1. Dual-acting osteoporosis drug

Approved by the FDA in April, romosozumab is the first drug for osteoporosis that has a dual effect on both increased bone formation and reduced bone resorption. In the  New England Journal of Medicine , women with postmenopausal osteoporosis who received romosozumab had a 50% reduced risk of spine fracture and a 38% reduced risk of hip fracture compared with those who received standard anti-resorption therapy (alendronate ).

“Patients are getting back to work without risk. The treatment is not only strength, but in spirit, ”according to the Cleveland Clinic.

2. Expanded use of minimally invasive mitral valve surgery

Minimally invasive surgery for mitral valve repair was initiated in 2013. The procedure is an innovative transcatheter device that is FDA approved to repair the mitral valve in individuals with primary mitral regurgitation (MR).

But, in March, the  FDA broadened the device's approval  to include patients with MR as a result of an enlarged left ventricle, known as secondary MR. These are patients whose optimal medical therapy failed to relieve their symptoms.

Noted the Cleveland Clinic: "This expanded use of the minimally invasive method is to relieve more patients by some risk, fear, and inconvenience associated with cardiac surgery."

3. Transthyretin amyloid cardiomyopathy for first-ever treatment

Transthyretin amyloid cardiomyopathy is a progressive and fatal disease in which amyloid fibrils, composed of misfolded transthyretin protein, deposit the walls of the heart's left ventricle. These deposits stiffen the muscle, which eventually leads to heart failure.

But a newly developed compound, tafamidis, binds to transthyretin to prevent misfolding of the deposited protein. In a  high-profile clinical trial , patients with tafamidis had a 30% lower all-cause mortality compared with cardiovascular-related hospitalizations compared with placebo on similar patients.

"Following Fast-Track and Breakthrough Designs in 2017 and 2018, marked by the  FDA approval of tafamidis , the first-ever medication for treatment of this recognized condition," The Cleveland Clinic stated.

4. Peanut allergies for immunotherapy

Peanut allergy can be a nightmare for children — and their parents. In September, an FDA expert panel recommended approval of a first-of-its-kind oral immunotherapy for children with a capsule with a minuscule amount of pharmaceutical-grade peanut protein. The immunotherapy's dose is peanuts to a tolerance of the child builds up over time. In a double-blind phase 3  clinical trial , more than 3 in 4 children (76.6%) reached a daily maintenance dose of 300 mg — the equivalent of one peanut.

"Though not a cure," The Cleveland Clinic noted, "the breakthrough treatment lessens the risk of accidental exposure, the ease of the mind of parents who live in constant fear."

5. Closed-loop spinal cord stimulation

Conventional spinal cord stimulation works by sending an electrical impulse along an implanted spinal cord stimulator, asking for pain signals that reach the brain. However, each patient is prescribed a fixed dose of stimulation, which does not take into account the individual's movement, limiting its effectiveness.

Now, researchers have developed  closed-loop  spinal cord stimulation, which receives feedback from the patient's own spinal cord. The closed-loop system uses a stimulator that is able to communicate in real time with spinal cord neurons and modulate the rate of stimulation. It's the first such system to measure the spinal cord's response to each pulse according to the patient's activity.

“With this technology, patients are getting measurable pain relief, sleeping better, and taking less medication,” according to the Cleveland Clinic. " Pending approval , closed-loop stimulation could be a saving grace for chronic pain patients."

6. Biologics in orthopedic repair

People who’ve torn their anterior cruciate ligament (ACL) have a 20% chance of re-tearing it again. Now, researchers are looking for better long-term results using the patient's own biologics — cells, blood components, growth factors, and other natural substances — to promote better healing and lower inflammation.

In conventional ACL repair, the torn ligament is replaced with autologous tissue. The new technique — known as bridge-enhanced ACL repair (BEAR) —is a combination of biologic factors injected with a sponge. This acts as a scaffold to stimulate healing of the ACL, preserving the tissue instead of cutting it. A  multicenter, randomized clinical trial  using this procedure is now underway.

Other potential uses include orthopedic repair for its use in rotator cuff injuries and implant devices for anti-infective coating.

"Biologics hold the potential to provide every orthopedic patient with a more natural, more effective, faster recovery," the Cleveland Clinic predicted.

7. Cardiac implants with prevention of antibiotic envelope

Cardiac implant devices such as pacemakers and defibrillators come with a risk of infection. But encasing these devices in an antibiotic “envelope” —a mesh sleeve embedded with antibiotics — ensures the slow delivery of 2 antibiotics, rifampin and minocycline, for 7 days after implantation. The week-long release of antibiotics minimizes the risk of infection.

“The FDA clearance received in 2013, but healthcare professionals were awaiting results from a landmark worldwide randomized WRAP-IT [Worldwide Randomized Antibiotic EnveloPe Infection Prevention] trial,” according to the Cleveland Clinic. "For The  Findings Published: March-in,  to Show The sum of up to 40%, reduction-in, safer procedures pics of the device's major infections, making implantable cardiac patients."

8. Patients who cannot take bempedoic acid

About 5% to 10% of patients who take statins cause muscle pain. A new agent, bempedoic acid, provides an alternative approach to lowering LDL cholesterol while avoiding these side effects.

Like statins, bempedoic acid works by blocking a key enzyme used by the body to make cholesterol. But unlike statins, it cannot accumulate muscle, requiring the likelihood of muscle pain.

“In  clinical trials , patients who saw their LDL levels drop by an average of about 21%. If approved by the FDA, bempedoic acid could be another addition to the arsenal of cholesterol-lowering treatments available to patients, ”the Cleveland Clinic stated.

9. Ovarian cancer maintenance therapy for PARP inhibitors

One of the most important advances in ovarian cancer treatment recently, poly-ADP ribose polymerase (PARP) inhibitors have improved progression-free survival in patients, and are now approved by the FDA for first-line maintenance therapy in advanced stage disease.

Until now, maintenance therapy has been explored in ovarian cancer. In a  landmark study  published last year, investigators showed a 70% reduction in risk of disease progression or death in participants with a PARP inhibitor approved for 3 years.

The Cleveland Clinic predicted: "Several additional large-scale trials are underway, with PARP inhibitors set to produce great strides in cancer therapy."

10. Preservative ejection fraction with heart failure for Diabetes drugs

No treatment is still available for preserved ejection fraction (HFpEF) with heart failure. However, sodium glucose co-transporter 2 (SGLT2) inhibitors — currently used to treat low blood glucose in type 2 diabetes — are now being investigated for HFpEF.

Use of SGLT2 inhibitors for this purpose has been  reported  in patients with type 2 diabetes with reduced risk of cardiovascular death and cardiovascular hospitalization. Similar results were shown by SGLT2 inhibitors on diabetes without heart failure and reduced ejection fraction. For patients with HFpEF,  research is ongoing  but promising.

"With an FDA decision anticipated in 2020, these drugs, among others, are introducing potential new treatment options for patients with this heart failure subtype,"