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Society Of Critical Care Medicine (SCCM)

Shock – mostly septic shock but also cardiac shock – was a big topic at the meeting. Although in-hospital mortality from shock – distributive (septic) and cardiac – has declined, it is still alarmingly high. The first new drug in many years was recently approved for distributive shock, La Jolla’s Giapreza. However, critical care doctors are taking a cautious approach to this new agent. In cardiac shock a key message was the need to get more of these patients to the cardiac cath lab – and get them there fast. The meeting was also an opportunity to see if or how CAR T therapy for cancer patients is impacting intensive care units (ICUs).

Angiogenesis, Exudation, And Degeneration 2018

Retinal diseases are an active area of research, not just to find and test new drugs and gene therapies but also to develop new imaging approaches and to better understand the underlying pathology. n Wet AMD: It was disappointing that the Phase II data for Novartis’ brolucizumab, a longer-acting anti-VEGF, were expected but not presented. Does it really last longer? n Geographic atrophy: Apellis Pharmaceuticals’ APL-2, a Complement 3 inhibitor, and Stealth BioTherapeutics’ elamipretide both looked interesting. n Dry AMD: Hemera Biosciences’ HMR59, a gene therapy, had positive early data. n Diabetic macular edema (DME): The star of the day was Roche’s RG-7716 in diabetic macular edema, which showed efficacy better than Roche/Genentech’s Lucentis.

International Symposium On Endovascular Therapy (ISET)

This appeared to be a smaller, quieter ISET than last year. There was little controversy at ISET this year, but lots of interesting data. Among the key findings: Embolic filters are a must for carotid stenting, and there are a number that work well; the benefit of drug-coated balloons appears to fade over time; EVAR and TEVAR continue to gain popularity; there is real interest in using thrombectomy for pulmonary embolisms, but more data are needed; and while small bore vascular closure devices are underutilized, large bore VCDs are in strong demand because of the growth of procedures like TAVR.

American Academy Of Dermatology (AAD)

More than 18,000 people attended AAD this year. While the news was mostly in medical dermatology, cosmetic dermatology was alive and well, and this was one medical conference where there was not a shortage of doctors on the exhibit floor. It’s an exciting time in medical dermatology, with new drugs looking promising for acne, atopic dermatitis, hidradenitis suppurativa, hyperhidrosis, and psoriasis. There are also drugs in development for pemphigus vulgaris, but it is too early to say if they are promising. In cosmetic dermatology Allergan’s Kybella for submental fat has not taken off strongly, but device therapy looks more promising, particularly with Cynosure’s SculpSure. New toxins appear to offer both longer duration than Allergan’s Botox and short duration for new uses. Vaginal therapy is becoming mainstream, though not targeted for dermatologists. And there are some notes on onychomycosis and melanoma.

FDA Advisory Committee Rejects Expanded Approval For Pacira's Exparel

An FDA Advisory Committee rejected an expansion of the label for Pacira Pharmaceuticals’ Exparel to include nerve blocks. The panel wasn’t convinced of the efficacy because the trials had mixed results and did not use an active comparator. And the panel was worried about the safety, particularly deaths and falls. Despite a strong presentation by the company and some compelling endorsements by the public speakers, the panel said new trials are needed.

Society Of Thoracic Surgeons (STS)

Despite all the hoopla over transcatheter procedures, cardiac surgery is alive and well. Surgeons continue to be active partners in the Heart Team, and their devices and procedures continue to improve. Among the trends: Surgeons are increasingly ablating patients with atrial fibrillation during open cardiac procedures; robotic cardiac surgery is growing, with several new robots on the horizon; for temporary hemodynamic support, Abiomed’s Impella 5.5 looks promising; use of mechanical aortic valves is decreasing; TAVR volume has surpassed SAVR; and mitral repair is preferable to replacement.

North American Neuromodulation Society (NANS)

Spinal cord stimulation (SCS)use market has been growing by double digits, and that is expected to continue in 2018. That growth is driven by new data, device improvements, and marketing more than a move away from opioids for pain, though the expectation is opioid restrictions will spur future use of SCS. All vendors are likely to benefit, and there is interest in using the devices for new indications, but not until there is FDA approval and payor reimbursement.

Digital Therapeutics

Software and mobile apps for treating diseases by monitoring and modifying patient behavior, known as digital therapeutics, are still in their infancy, but a number of companies are actively trying to develop and market products. FDA approval and oversight is evolving, and the Agency has launched a Pre-Cert pilot program.