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Bulletin: American Society Of Hematology (ASH) – Preview

In a web briefing for reporters in advance of the American Society of Hematology (ASH) meeting in San Diego CA December 1-4, 2018, ASH officials highlighted three themes this year – sickle cell disease, CAR T therapies, and big trials with big results – as well as the late-breaking studies they predicted would be most important – and practice-changing. The big focus this year is chronic lymphocytic leukemia (CLL).

Bulletin: Ash Guidelines for VTE

The American Society of Hematology (ASH) has issued new guidelines for venous thromboembolism (VTE). Nearly a million Americans each year develop a deep vein thrombosis (DVT) or pulmonary embolism (PE). The guideline include nearly 150 recommendations. This report summarizes what ASH considers some of the key points from the guidelines.

American College Of Emergency Physicians (ACEP)

Novel oral anticoagulants (NOACs) are increasingly being prescribed, but until a few months ago there wasn’t a specific reversal agent for Factor Xa inhibitors. ACEP was a good opportunity to gauge the enthusiasm for – and uptake of – Portola Pharmaceuticals’ Andexxa. Emergency department physicians said they would like to have Andexxa in their pharmacy, but they are concerned about the cost. On average, doctors predicted they would use Andexxa 2-3 times a month – if it were available. Two new technologies were getting attention at ACEP: Butterfly Network’s iPhone-connected ultrasound, and Genetesis’ CardioFlux, a non-invasive magnetic imaging device to evaluate coronary stenosis in the ED.

Plastic Surgery The Meeting

There wasn’t a lot of late-breaking news at the annual meeting of the American Society of Plastic Surgeons, but it was a good opportunity to get a snapshot of developments in breast implants as well as adoption of a therapy for hyperhidrosis, Sientra’s miraDry. Plastic surgeons said their breast implant volume over the last year has been flat to slightly up, and that trend is expected to continue over the next year. Johnson & Johnson/Mentor and Allergan remain the dominant implant providers, but Sientra is gradually regaining market share, and Ideal Implant is starting to get some attention. There is increasing concern about the safety of textured implants, which may make it difficult for Establishment Labs’ Motiva to get traction in the U.S.

North American Spine Society (NASS)

Robotics is catching on in spine, but slowly. Medtronic hopes to give that a push with the purchase of Mazor Robotics and some aggressive marketing. Stryker, Zimmer Biomet, and Johnson & Johnson also all have spine robots in development. Surface materials was a hot topic at NASS, and many companies offer a 3D-printed porous titanium implant, but there may be important differences. This was highlighted with reports of troublesome breakage with Stryker’s devices. Expandable cages are catching on but not taking over.

NYC Neuromodulation Conference and the North American Neuromodulation Society (NANS) Summer Series

The market for SCS is growing, raising all boats (manufacturers), and so is the number of players, but pricing is holding steady. With four established companies, it is hard for new entrants to gain traction. SCS explants are not a big concern, and reports of an excess of explants with Nevro are viewed as overblown or counter-marketing. What is a big concern is whether a device is MRI compatible. Neurostimulation is being explored in a long list of conditions – such a long list that it dilutes the messages. The hot area in treatment-resistant depression is TMS, which is dampening enthusiasm for invasive therapies like LivaNova’s VNS. Reimbursement for TMS is good, though the cost to insured patients is pretty hefty, and MagVenture’s MagVita, which is faster and cheaper, could lead to a cut in reimbursement overall. In VNS, there is growing interest in non-invasive systems (tVNS) for headache, particularly electroCore’s gammaCore.

Bulletin: SITC Guidelines for Lung Cancer Immunotherapy

The Society for Immunotherapy of Cancer (SITC) hosted a webcast on Cancer Immunotherapy Guidelines for Non-Small Cell Lung Cancer (NSCLC) on September 13, 2018, with at least 84 people participating. It was a torough review and timely given the number of checkpoint inhibitors that have been approved by the FDA since 2015.