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.

PAINWeek

This was the 12th PAINWeek meeting, and it was an opportunity to hear about the opioid abuse situation from a physician standpoint, as well as hear about new migraine drugs. The bottom line: Opioid abuse is a problem, but clinicians at the meeting see fentanyl and heroin as the bigger problem today. It has become a dangerous environment for physicians prescribing opioids, which is discouraging prescribing. Development and use of abuse-deterrent opioids has been slow, but insurance coverage is starting to improve, which may encourage more use in the future. Treatment of opioid use disorder with medication-assisted treatment is increasing, but many of the doctors at the meeting refer these patients to addictionologists. When opioid-use disorder is treated, most commonly it is with buprenorphine, usually Indivior’s Suboxone. There is little use of naltrexone or methadone for medically-assisted treatment among these clinicians. New CGRP inhibitors for migraine prevention were getting a lot of attention, but it is early, and uptake is still almost non-existent among these clinicians.

Alzheimer's Association International Conference (AAIC)

From the busy schedule and the attendance at this meeting (a record >5,800, with more than half women), you might think there were major advances or treatment breakthroughs taking place in Alzheimer’s disease (AD). However, the news was mostly risk reduction approaches – i.e., lifestyle factors and changes (e.g., diet, pregnancy), better diagnostics, and non-cognitive symptoms of AD. There were no therapeutic breakthroughs reported at the meeting, with Biogen and Eisai’s BAN-2401 antibody the only somewhat exciting therapeutic with new data, though experts were skeptical of the data that were presented. However, there were updates on a number of other agents.

American Diabetes Association (ADA)

Insulin pumps and continuous glucose monitors are under-used, but increases are likely to be incremental. Dexcom’s G5 and G6 remain the favorite CGM of doctors, but patients really like the simplicity and lower cost of Abbott’s FreeStyle Libre, which doesn’t require fingersticks. Senseonics’ Eversense got attention at the meeting but is not expected to really catch on until fingersticks are eliminated. n A number of new closed-loop systems are being investigated that are more user-friendly. n On the drug front, AstraZeneca’s MEDI-0382 looked interesting but there wasn’t a lot of enthusiasm for it. Evidence is building that SGLT2 inhibitors can be used in combination with insulin in Type 1 diabetics, and an oral GLP-1 is on the horizon. n Doctors were reassured that the two new basal insulins – Sanofi’s Toujeo and Novo Nordisk’s Tresiba – looked very similar in the BRIGHT trial. n Islet cell transplants are still extremely limited, and cell therapy is considered far off.

American Academy Of Neurology (AAN)

The AAN meeting lasts longer than many major medical conferences, but it covers a broad array of neurological conditions. The key news this year was in migraine, Parkinson’s disease, and spinal muscular atrophy. In addition, this report covers developments in treatments for Alzheimer’s disease, Dravet and Lennox-Gastaut syndrome, Huntington’s disease, and multiple sclerosis. There are also some shorter notes at the end on Duchenne muscular dystrophy (DMD), dyskinesia, epileptic seizures, and myasthenia gravis (MG).

Bulletin: American Society Of Clinical Oncology (ASCO) – Preview

In a web and teleconference with reporters, ASCO highlighted six studies.ASCO abstracts – other than late breakers – are now off embargo, and these are the ones ASCO chose to present to the media.This is a brief write-up mostly to provide a sense of the tone and focus of those choices and the webcast.About 39,000 attendees are expected at ASCO in Chicago June 1-5, 2018, and there will be ~5,000 abstracts. The theme this year: Delivering, Discovering, and Expanding the Reach of Precision Medicine.

American Society Of Cataract And Refractive Surgery (ASCRS)

Cataract surgeons are increasingly interested in learning how to do minimally-invasive glaucoma surgery (MIGS), but the move to MIGS is still slow, and doctors agree that there is a steep learning curve when it comes for these techniques. Glaukos’ iStent is the overwhelming favorite, mostly because doctors have the most experience with it. Ophthalmologists are also interested in Glaukos’ next-generation iStent inject, which appears to be very easy to implant. There is great interest in Allergan’s Xen subconjunctival device. Novartis/Alcon’s CyPass is popular but has some side effects, and doctors said they will only use it in patients for whom they have to get even lower IOP. Reimbursement for MIGS is a continual and aggravating problem, and doctors don’t know what will be reimbursed from month to month. However, there is a feeling that as MIGS increases in popularity, insurance companies will have no choice but to cover it.

American Psychiatric Association (APA)

There was a lot of news about treatment and testing for depression at APA, and that is the main focus of this report – treatment-resistant depression, postpartum depression, and major depressive disorder – but there also was some medication news in bipolar disorder and schizophrenia.

World Federation Of Hemophilia (WFH)

For a rare disease, the explosion in new treatments is really remarkable. They offer better control, more normal control, easier administration, and less bone/joint damage. The newest extended half-life agent – Roche and Chugai’s Hemlibra (emicizumab) – is expected to be adopted widely and quickly, but there are a number of exciting agents in the pipeline, including Sanofi/Bioverativ’s BIVV-001. Gene therapy was the hottest topic at the meeting, and there are several gene therapies in development, but the data are still scant.

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