The Top 10 Trending Clinical Topics of 2019
The Top 10 Trending Clinical Topics of 2019
Each week, we choose one top search term or phrase that increased in popularity as that week's top trending clinical topic. We then compile the news that most likely contributed to the added interest and provide an infographic on key aspects or recent studies associated with related conditions.
Toward the end of the year, we determine which of those weekly trending topics make the top 10 for the entire year. From autism to warfarin, the topics that made the 2019 list are as surprising as they are varied. See the terms that resonated most with healthcare professionals this year, along with the important studies and crucial information you need to know about these popular topics.
The Top 10 Trending Clinical Topics of 2019
Trend #10: Ebola
News about promising new drugs, an overview of a major outbreak, and information regarding long-term disease complications helped make Ebola a top trending clinical topic in late August.
On August 12, the National Institute of Allergy and Infectious Diseases announced that a clinical trial of four Ebola drugs was ended early after preliminary data showed higher survival rates with two of the drugs. During a telebriefing, Jean-Jacques Muyembe-Tamfum, MD, PhD, director-general of the Institut National de Recherche Biomédicale in the Democratic Republic of Congo (DRC), stated, "We will no longer say that EVD [Ebola virus disease] is not curable." He added, "This advance will, in the future, help with saving thousands of lives that would have had a fatal outcome in the past."
That Ebola outbreak was the biggest ever in the DRC and second largest worldwide. Although the risk for those outside the region is not very high, an overview of the situation pointed out that modern society has become so interconnected that once-isolated diseases are now only "a plane ride away." On a positive note, Merck's investigational Ebola vaccine V920 has been shown to be 97.5% effective, although it has not yet been approved by the US Food and Drug Administration (FDA).
For patients who have survived EVD, evidence suggests that significant vitreoretinal pathologic changes require considerable precautions if they need treatment or surgery. The Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study found that uveitis was present in 35.6% of patients and visually significant cataracts were present in 23.2% of patients. Chorioretinal scarring was present in 7.8% of the patients' eyes, and choroidal thickening was present in 19.6% of their eyes. Although the EVICT study found cataract surgery to be safe in this population, the safety of vitreoretinal surgery in these patients is unclear. Experts recommend that considerable precautions be taken.
The outbreak in the DRC, new treatment options, and future health concerns worldwide led to Ebola becoming the top trending clinical topic in late August and the tenth overall topic for 2019.
The Top 10 Trending Clinical Topics of 2019
Trend #9: Autism
A retracted study, a disproven myth, prenatal concerns, and a learning aid incorporated into an existing device all helped make autism a top trending clinical topic in early April. A study that had identified a link between typical male brain anatomy and autism spectrum disorder (ASD) was retracted and replaced with a significantly different version. The study had previously claimed that the vast majority of women with autism (79.6%) have phenotypical male brains and that women with this brain makeup are three times more likely to have autism. The new version suggests that the male neuroanatomic brain phenotype does not carry this higher risk or association. Some critics feel that even the newly revised version still overstates the significance.
Correction of misinformation seemed to be a theme, as a separate study published in early March definitively found that vaccination against measles, mumps, and rubella (MMR) does not increase the risk for autism or trigger autism in susceptible children. The largest single study to date explored more than 650,000 medical records of children born from 1999 to 2010. Researchers found no evidence to support the widely disseminated belief that the MMR vaccine has any role in autism. However, new information may have identified actual potential factors in autism development. Fetal exposure to maternal infection has been found to increase the long-term risk for neuropsychiatric diseases, including autism and depression.
The prenatal period may also be vital for prevention. Research published in JAMA Psychiatry suggests that prenatal vitamins taken during the first month of pregnancy may reduce the risk for ASD in siblings of affected children by as much as half. Further research is needed to determine appropriate dose thresholds for folic acid and the effects of other nutrients during the prenatal period that may elevate the risk for autism. Finally, a small, randomized clinical trial found that the Google Glass wearable computing device may help in the treatment of children with ASD. Children who used the device for 6 weeks demonstrated higher scores on at least one socialization subscale compared with children receiving only the usual treatment of applied behavior analysis therapy. From correcting misinformation to providing helpful new findings, these significant studies helped make autism the ninth overall top trending clinical topic for the year.
The Top 10 Trending Clinical Topics of 2019
Trend #8: Dementia
From surprising data to emerging treatment options, a wealth of studies and news items related to virtually all aspects of dementia made this condition the top trending clinical topic in late July. Here's a rundown of the major findings that garnered attention:
- A Danish registry study of almost 33,000 patients with dementia found an increased risk for mortality among those who received an antipsychotic drug.
- Research suggests that adhering to a healthy lifestyle may reduce the risk for dementia. Investigators found that fewer individuals at high genetic risk who followed a healthy lifestyle developed dementia than those at a high risk who followed an unhealthy lifestyle.
- Heavy alcohol use was found to possibly triple the risk for dementia in certain individuals, according to new research.
- Although the exact relationship is unclear, a study found that the frequent use of sleep medications may increase the risk for future cognitive impairment.
- A phase 2/3 trial involving the use of an investigational agent that targets gum disease bacteria associated with the development of Alzheimer disease is now under way. This ties into a larger movement to "look beyond amyloid" when investigating Alzheimer disease.
- The use of comprehensive remote care via telemedicine to older adults with dementia was found to significantly reduce emergency department visits (24% over a 3-year period).
- A global group of neurology experts intent on reducing dementia incidence has called for an increased emphasis on stroke prevention.
- New research revealed that sexual or gender minorities (SGM) are almost 30% more likely to report subjective cognitive decline compared with the non-SGM population. These results emphasize the need to educate healthcare professionals about the importance of screening the SGM community for memory problems.
The nearly overwhelming amount of news and research related to dementia contributed to a dramatic increase in searches earlier this year, making it the eighth overall trending clinical topic for 2019.
The Top 10 Trending Clinical Topics of 2019
Trend #7: Fluoroquinolones
Safety concerns about a powerful type of antibiotic garnered attention in early February, resulting in that week's top trending clinical topic. In late December of 2018, the FDA issued a warning that fluoroquinolone use is associated with increased risk for aortic aneurysm. Certain patients receiving a fluoroquinolone drug have been found to be twice as likely to experience aortic dissection or aortic aneurysm, which may lead to bleeding and death. The FDA pointed to four published observational studies that found this dangerous association.
In July 2018, the FDA ordered label changes to warn patients about the risk for serious mental health side effects and blood sugar level disturbances associated with fluoroquinolone use. The new labels list mental health side effects separately from other central nervous system side effects and include disturbances in attention, disorientation, agitation, nervousness, memory impairment, and delirium. Additionally, the labels now explicitly reference the potential risk for coma with hypoglycemia.
Meanwhile, the European Medicines Agency's Pharmacovigilance Risk Assessment Committee recommended restricting the use of systemic and inhaled fluoroquinolone and quinolone antibiotics following a safety review. They also recommended that fluoroquinolone antibiotics not be used (1) to treat infections that might improve without treatment or are not severe, (2) to treat patients who have previously had serious side effects, or (3) to treat mild or moderately severe infections unless other antibacterial medicines cannot be used. The significant clinical implications related to all of this information helped make fluoroquinolones the seventh overall trending clinical topic in 2019.
Read more information on dosing and usage regarding fluoroquinolones.
The Top 10 Trending Clinical Topics of 2019
Trend #6: Renal Cell Carcinoma
A potential new standard of care for the most common type of kidney cancer in adults made renal cell carcinoma the top trending clinical topic in early March. Findings released in early 2019 suggested that first-line therapy with a combination of a tyrosine kinase inhibitor (TKI) and an immune checkpoint inhibitor improved outcomes in patients with metastatic renal cell carcinoma (mRCC) when compared with sunitinib, the current standard-of-care therapy. The combination of pembrolizumab and axitinib increased both overall and progression-free survival in patients with previously untreated mRCC compared with similar patients who were treated with sunitinib. In fact, the risk for death was cut nearly in half.
Another combination of this new regimen pairs the immunotherapy avelumab with axitinib. A trial found that patients with advanced renal cell carcinoma who received that combination demonstrated significantly extended progression-free survival compared with those treated with sunitinib (89.9% vs 78.3%). Because of these results, researchers are suggesting that the combination of a TKI and an immune checkpoint inhibitor may represent the new standard of care and is likely to be incorporated into guidelines in the near future.
Pembrolizumab has also shown promising activity in patients with non–clear cell renal cell carcinoma (nccRCC). Monotherapy with the drug resulted in a 25% overall response rate while maintaining the expected safety profile. Most renal cell carcinomas are clear cell in origin, so studies often exclude patients with nccRCC. Thus, the potential of a safe and effective therapy for these patients is being met with much optimism. Evolving treatment options for patients with renal cell carcinomas helped make the topic the sixth overall trending clinical topic for 2019.
The Top 10 Trending Clinical Topics of 2019
Trend #5: Vegan Diet
News out of the European Association for the Study of Diabetes 2019 Annual Meeting further expounded on previous evidence regarding the benefits of plant-based diets and resulted in a top- trending clinical topic in late September. A randomized controlled trial in overweight/obese adults found that a low-fat vegan diet causes gut microbiota changes that are related to altered body composition and insulin sensitivity. Participants who followed a vegan diet lost about one pound per week on average. They also had an increased presence of the commensal bacterium Faecalibacterium prausnitzii; lower amounts are found in patients with diabetes.
This supports the findings of a large meta-analysis published earlier in 2019, which found that middle-aged people who ate more plant-based foods were less likely to develop type 2 diabetes than their peers who ate more meat, fish, eggs, and dairy. The researchers do acknowledge that the evidence does not directly show cause and effect, but it does suggest a possible role for vegetarianism and veganism in protecting against diabetes.
Findings are similar in regard to the risk for chronic kidney disease (CKD). A community-based cohort study found that a diet favoring plant-based foods modestly reduces CKD risk, provided that individuals are not overweight or obese. Given all of this, increased interest in vegan diets is not surprising. For example, the number of vegan Brits has quadrupled over the past 4 years. Although the United States has not seen a similar increase, information about substantial health benefits has the potential to change that. At the very least, the recent news about vegan diets captured plenty of attention from medical professionals, becoming the fifth overall trending clinical topic of 2019.
Read more about type 2 diabetes prevention and CKD risk factors.
The Top 10 Trending Clinical Topics of 2019
Trend #4: Memory
Various prevention and treatment strategies to combat mental decline resulted in memory becoming the top trending clinical topic in mid-March. "An apple a day" may "keep the doctor away," but daily consumption of pomegranate juice may help protect memory. A randomized trial of more than 200 participants found that those who received pomegranate juice scored higher on memory tests over 12 months than those who received a placebo drink. The findings presented at the American Association of Geriatric Psychiatry annual meeting complement earlier research about foods such as blueberries, which have been associated with preserved mental faculties.
Hunger may also play a separate role in the prevention of memory loss and related conditions. Researchers found that higher levels of cholecystokinin (CCK), an amino acid involved in appetite regulation, is associated with decreased risk for mild cognitive impairment and Alzheimer disease. Data from about 300 patients suggest that those with higher levels of CCK have better memory and overall cognitive skills, as well as a reduced likelihood of developing Alzheimer disease. Preventive strategies may also focus on vitamin D deficiency. A separate study found that a vitamin D deficiency disrupts structural brain connectivity and harms memory. Patients who were deficient in vitamin D had a significant decline in their ability to remember and learn compared with a control group.
For those who are already struggling with cognition-related complaints and depression, a study suggested that the drug memantine may help improve executive function and reduce depressive symptoms in patients being treated with a selective serotonin reuptake inhibitor (SSRI). Patients who received memantine in addition to an SSRI demonstrated immediate improvement of anxiety, depression, and apathy, as well as improved cognitive outcomes at 12 months. Given the concerns about memory loss and associated impairments in all aging populations, new preventive tools and possible treatment strategies led to the fourth overall trending clinical topic of 2019.
Read more information on memory loss and mild cognitive impairment.
The Top 10 Trending Clinical Topics of 2019
Trend #3: New Lipid Guidelines
News out of the European Society of Cardiology (ESC) Congress 2019 and new guidance from the American Heart Association (AHA) helped make new lipid guidelines a top trending clinical topic in mid-September. On August 31, at the ESC conference, the ESC/European Atherosclerosis Society unveiled aggressive new lower targets for low-density lipoprotein cholesterol (LDL-C) reduction. The guidelines were simultaneously published online in the European Heart Journal and have a simple focus: Lower is better. For patients at the highest risk, the guidelines suggest that LDL-C should be lowered as much as possible, with no low limit indicated. The guidelines also removed the distinction between primary and secondary prevention and emphasize the use of high-dose statin therapy in certain populations.
In terms of statin therapy, the results of a new trial suggest that adding the PCSK9 inhibitor evolocumab to high-intensity statin therapy in patients with acute coronary syndrome safely lowers LDL-C levels. In the EVOPACS study, 95.7% of patients in the evolocumab group and 37.6% in the placebo group reached an LDL-C target level of < 70 mg/dL at 8 weeks.
Meanwhile, a science advisory from the AHA suggested that using prescription omega-3 fatty acids is a safe and effective method of reducing elevated triglyceride levels alone or in combination with other lipid-lowering therapy. However, the AHA cautions that dietary supplements containing omega-3 fatty acids should not be used in place of prescription medication for long-term management of high triglyceride levels. According to the advisory, for patients with triglyceride levels of 200-499 mg/dL, prescription omega-3 fatty acids at a dose of 4 g/day reduce triglyceride levels by 20%-30% without significantly increasing LDL-C levels.
Healthcare providers around the world are focused on heart health, so these new lipid guidelines have seized their attention, becoming the third overall trending clinical topic of 2019.
The Top 10 Trending Clinical Topics of 2019
Trend #2: Vaping
Although many more cases of vaping-related illness have been reported and much more is known now about potential causative elements, associations with three separate, serious conditions helped make vaping a top trending clinical topic in late August. At that time, the Centers for Disease Control and Prevention and the FDA were investigating the initial reports of severe pulmonary disease among users of electronic cigarette (e-cigarette) products. Some patients had severe enough disease to require intensive care and mechanical ventilation support. Many affected said they had recently used tetrahydrocannabinol -containing products.
Beyond respiratory concerns, a study released in August found that vaping just one nicotine-free e-cigarette produces transient changes in blood vessels similar to those seen in early atherosclerosis. These changes suggest that repeated vaping could lead to chronic vascular endothelial dysfunction. The participants were healthy men and women, aged 18-35 years, who had never smoked or vaped. A separate study found that nicotine-free e-cigarette vaping caused a transient increase in serum markers of inflammation (C-reactive protein level) and oxidative stress.
At that time, the FDA had also started an investigation into a link between e-cigarettes and seizures or other neurologic symptoms. Some users had also reported fainting or tremors, which may or may not be related to seizures. All of this came after the US Surgeon General officially declared e-cigarette use among youth an "epidemic" in December 2018. Although individuals of all ages are at risk for harms related to vaping, concerns about how vaping affects young people who are still growing and developing are even more pressing. Vaping may be regarded as "trendy" by some, but the reasons why it became the second overall trending clinical topic for 2019 are anything but positive.
The Top 10 Trending Clinical Topics of 2019
Trend #1: Warfarin
Results of a study on treatment for atrial fibrillation (AF) and findings regarding treatment for antiphospholipid syndrome (APS) helped make warfarin this year's top trending clinical topic.
A study published in the Journal of the American College of Cardiology found that direct-acting oral anticoagulant (DOAC) therapy for patients with AF is associated with a lower risk for osteoporotic fractures in these patients compared with warfarin. Results from the 2-year study of more than 37,000 patients with AF found a significantly reduced relative risk for fracture or for starting osteoporosis medication. This prompted the authors to conclude that clinicians should consider switching treatments in patients receiving warfarin who are at risk for osteoporosis or osteoporotic fractures. However, an accompanying editorial suggested that the choice between warfarin or a DOAC in patients with AF and no prior osteoporotic fracture (the population studied) shouldn't be made on the basis of risk for osteoporotic fracture but on other risks, including ischemic stroke and hemorrhage, as well as the need for monitoring and drug affordability.
Alternatively, a randomized study published in the Annals of Internal Medicine showed that warfarin was superior to rivaroxaban for anticoagulant treatment used to address thrombosis in patients with APS. In fact, patients with APS who were treated with rivaroxaban demonstrated nearly double the risk for recurrent thrombosis than patients treated with warfarin. One patient in the rivaroxaban group developed catastrophic APS. Proposed guidelines by the European League Against Rheumatism recommend against the use of rivaroxaban in patients with triple-positive APS, and these findings appear to support that guidance. These additional pieces of evidence regarding the best approaches for the use of warfarin in different patient groups helped make the commonly used drug the top trending clinical topic for 2019.
Read more about the uses for warfarin and its adverse effects.
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