American Academy Of Dermatology (AAD)

Almost 5,000 medical personnel attended AAD this year, and there was plenty of news for them to learn. Here is an update on: acne, aesthetics, alopecia, atopic dermatitis, hidradenitis suppurativa (HS), hyperhidrosis, pruritus, psoriasis, and urticaria.

American Academy Of Pain Medicine (AAPM)

This meeting was relatively small, with few posters, and almost no new data. Choice of spinal cord stimulation devices at AAPM pretty much appeared mirrored usage trends seen at the North American Neuromodulation Society (NANS) meeting in January 2019, with Nevro and Abbott leading, Medtronic losing the most, and little interest in Nuvectra. Avanos Medical’s Coolief was described as too expensive, and that is limiting use for knee and hip pain. Pacira Pharmaceuticals’ Exparel (liposomal bupivacaine) also is considered expensive. Surgeons are using it, at least in limited ways, but they are looking for less expensive alternatives. Pain doctors didn’t know much about Heron Therapeutics’ HTX-011 (bupivacaine + meloxicam), but they predicted it will be used if it gets FDA approval, especially if it is labeled as opioid-sparing, though cost will be an issue. Several investigational agents look promising, including Neumentum Pharmaceuticals’ NTM-001, a low-dose IV Toradol, and sodium ion channel blockers (e.g., Biogen’s BIIB-074 and Vertex Pharmaceuticals’ VX-150). Pain doctors are not particularly worried about rapidly progressive osteoarthritis with Pfizer and Lilly’s tanezumab, an NGF inhibitor.

American College Of Cardiology (ACC)

ACC Scientific Sessions packed a lot of news into just three days, and a lot of it was practice changing particularly for devices. This included positive data from two trials of TAVR for low-risk patients, great results with a new LVAD, substudies confirming the value of Abbott’s MitraClip for mitral valve repair, and more. For drugs, there was a positive study of fish oil, an oral cholesterol-lowering drug, and a reversal agent for an antiplatelet drug. There was also a lot of research on new biomarkers, especially for heart failure.

Cardiovascular Research Technologies (CRT)

Is paclitaxel safe in drug-coated balloons and drug-eluting stents used for peripheral artery disease? The experts still don’t know. A panel at CRT on this issued agreed that there is a signal for an increased risk of mortality with paclitaxel-eluting DCBs and DES, but they aren’t sure if it is a real finding or not. They just can’t find the “smoking gun” or a mechanistic explanation. So, they called for more analysis and investigation – and for doctors to inform patients before procedures. Meanwhile, the issue is slowing down use of these devices.

North American Neuromodulation Society (NANS)

The outlook is for spinal cord stimulation implants to increase an average of 9% over the next year. Most use is on-label, but there is growing interest in expanding use for a variety of conditions beyond lower back pain. Among doctors at the meeting, devices from Boston Scientific and Nevro were most commonly used, with a smaller but significant role for Abbott devices. Other than their installed base, Medtronic and Nuvectra seemed to be the losers. Doctors generally agreed the explant rate with Nevro’s Senza is a non-issue. Saluda Medical’s closed-loop system was generating interest, but doctors were reserving their opinion until they see longer term data.

Society Of Critical Care Medicine (SCCM)

The meeting was a good opportunity to gauge the uptake of two new drugs as well as the use of high-flow non-invasive ventilation (HF-NIV), particularly for bronchiolitis. La Jolla Pharmaceutical’s Giapreza is a useful addition to treating distributive shock, but the price is holding back adoption, which should increase as hospitals establish protocols for use. Portola Pharmaceuticals’ Andexxa is also slowly getting on formularies. Again, price is the issue, and restrictive protocols are being established. More availability but not frequent use is expected. Vapotherm and Fisher & Paykel Healthcare are duking it out in the high-flow oxygenation/ventilation area. Both devices are a big improvement over BiPAP, and doctors and patients really like them, but generally they are viewed as interchangeable. Use is mainly in the ICU and should increase.

American Academy Of Cosmetic Surgery (AACS)

Business is booming for most cosmetic surgeons right now, and all procedures appear to be benefiting. As a California doctor explained, “Overall, business is up 13% across the board. There was a good economy last year, and a good economy floats all boats.” However, a Tennessee doctor said their volume is down year-over-year “because of nervousness over the stock market. Politicians are being ridiculous, so patients are reluctant to pay for elective procedures.”

Bulletin: Implications Of The FDA Warning About Mortality With Abiomed's Impella

The FDA issued a safety alert letter to healthcare providers, warning them that the interim results of a postmarketing study of Abiomed’s Impella RP, a temporary, percutaneously-placed right ventricular assist device, showed an increased rate of mortality. Here we look at what that means for use of the device.

Inflammatory Skin Disease Summit (ISDS): Atopic Dermatitis

Early data on three topical agents to treat mild-to-moderate eczema (atopic dermatitis) were presented at the meeting, each with a different method of action. It’s too early to compare them, but any agent that works would be appealing to patients.

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