2020 will be known as the year when the world — including thousands of research labs — came to a screeching halt. Many labs picked back up, some pivoted to COVID-19 studies, and clinical research continued. Here are five non-COVID DynaMed® topics with the most research summaries added in 2020 including a short description of some notable findings.
Atopic dermatitis (also known as eczema) is a chronic, relapsing, inflammatory skin disease affecting 10-20 percent of the population worldwide. It often presents during childhood and can present or persist into adulthood. While conservative management including use of moisturizers and avoiding irritants is the recommended first-line approach, research in this area is primarily focused on medications to improve severe symptoms and prevent flares. Topical anti-inflammatory therapy with steroids or calcineurin inhibitors have been mainstay of therapy for recalcitrant atopic dermatitis, but several new systemic drugs have recently been evaluated.
Dupilumab is a monoclonal antibody that blocks the cytokines interleukin 4 (IL-4) and IL-13, which contribute to the inflammatory progression of lesions. While it has been used for atopic dermatitis in adults for a few years, a new randomized trial showed efficacy of dupilumab plus topical corticosteroids in children as young as six years old. Two additional trials published in 2020 evaluated the Janus kinase (JAK) 1 inhibitor abrocitinib (Simpson et al and Silverberg et al). While this remains an investigational therapy, abrocitinib improved symptom severity in adults and adolescents with moderate-to-severe atopic dermatitis. Taken together, these new studies provide evidence that new uses of current medications and new drugs on the horizon may be beneficial in patients with recurrent atopic dermatitis.
Heart Failure with Reduced Ejection Fraction
Heart failure with reduced ejection fraction (or systolic heart failure) is a complex clinical syndrome characterized by structural and/or functional impairment of the left ventricle. Decreased heart pump function results in an insufficient amount of oxygenated blood delivery throughout the body, causing a variety of manifestations from dyspnea to edema. A few classes of drugs are commonly used including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta blockers, but prognosis remains poor.
In 2020, a few new studies evaluated a different class of drug, sodium-glucose cotransporter 2 (SGLT2) inhibitors, for patients with heart failure with reduced ejection fraction. SGLT2 inhibitors are more commonly used to lower blood sugar in adults with type 2 diabetes, but they are also known to have cardioprotective effects. A large meta-analysis showed that SGLT2 inhibitors reduced mortality in patients with heart failure and reduced ejection fraction, including patients without diabetes, uncovering the potential for a new class of medications for heart failure.
Treatment of Infertility in Women
Worldwide, infertility occurs in about 15 percent of reproductive-aged couples trying to conceive. In women, causes of infertility may be multifactorial and may include ovulatory dysfunction, including ovulation disorders and ovarian failure or insufficiency, uterine/cervical/peritoneal disorders, or remain unexplained. Management of infertility is based on the underlying cause and varies widely. Several assisted reproductive technologies exist to help couples with infertility. In 2020, several Cochrane reviews were published evaluating various assisted reproductive modalities.
One study evaluated in vitro fertilization (IVF) using embryo transfer media with and without hyaluronic acid, a natural compound found in the body that acts as a binding agent and is thought to help embryo implantation. This study found that a high concentration of hyaluronic acid (above 0.5 mg/mL) was associated with increased rate of live birth in an analysis of 10 trials with 4,066 women. Another Cochrane review evaluated whether the number of embryos transferred following IVF or intracytoplasmic sperm injection affected success rate and risk of multiple pregnancy in women with infertility. This analysis found that repeated single embryo transfer was associated with similar live birth rate as double embryo transfer in a single cycle and resulted in fewer multiple pregnancies. However, single embryo transfer may be associated with decreased likelihood of pregnancy and live birth compared to double embryo transfer. New research in this area opens opportunities for families having difficulty conceiving.
Asthma in Adults and Adolescents
Asthma is a chronic inflammatory disorder of the airways with a wide variation in prevalence worldwide. Despite a stepwise treatment plan, five to 10 percent of patients continue to have exacerbations that do not respond to therapy. Options for these patients are limited and often long-term or frequent high-dose corticosteroids are needed. Data on novel options in combination therapy for severe asthma have recently been published.
The CAPTAIN trial found that triple therapy with fluticasone furoate/vilanterol/umeclidium improved lung function compared to dual therapy with fluticasone furoate/vilanterol in patients with uncontrolled moderate-to-severe asthma on inhaled corticosteroid plus long-acting beta-agonist therapy. Unfortunately, this combination did not reduce exacerbations. Considering this option with data from TIMARAN and TRIGGER trials on combination beclomethasone/formoterol/glycopyrronium, these additional options may help reduce need for corticosteroids in patients with severe, uncontrolled asthma.
Bariatric surgery may be one element of care for patients with severe obesity. When included with exercise and healthy diet, bariatric surgery can result in significant and durable weight loss with improvement or remission of obesity-related comorbidities and increased life expectancy. New research in this area has involved evaluating bariatric surgical options in specific populations such as older adults and patients with diabetes or hypertension.
One systematic review published in 2020 showed that laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass were safe and effective in patients over 60 years old, though older adults did not lose as much weight as younger adults. Another systematic review found that Roux-en-Y gastric bypass increased diabetes remission compared to sleeve gastrectomy in adults with obesity and type 2 diabetes. And another study showed similar findings for remission of hypertension. Future research will help patients decide if and what type of bariatric surgery to consider in their care plan.
