10 breakthrough treatments that will change medicine in 2021

One of the highest honors any state-of-the-art technology can receive is recognition from the Cleveland Clinic, one of the world’s foremost medical institutions. At the 18th annual 2020 Medical Innovation Summit, experts led by Will Morris, MD, executive medical director for Cleveland Clinic Innovations, and Akhil Saklecha, MD, managing director of Cleveland Clinic Ventures, recognized the top 10 medical advances for 2021. Drum roll, please …

10. New class of migraine medications

For more than 38 million Americans, migraines are a real pain, usually treated with multipurpose drugs not specifically earmarked to prevent the condition. Typical options include blood pressure medications, antidepressants, and anti-seizure drugs. These nonspecific treatments exhibit mixed efficacy. In 2018, a new class of drugs that blocks a molecule called calcitonin gene-related peptide (CGRP) hit the scene. CGRP levels shoot up during a migraine. In 2020, clinicians were prescribing the drug in earnest, signifying a new epoch for migraine treatment.

9. PARP inhibitors 

Although there have been recent prostate cancer treatment advances, this disease remains the second leading cause of cancer death among American men. Enter PARP inhibitors, which block PARP proteins that repair damaged tumor DNA in people with BRCA1 and BRCA2 mutations. To be sure, PARP inhibitors are not exactly new, and have been used to treat cancer in women. But, the FDA approval of two of these drugs in May 2020 to treat refractory prostate cancer and DNA repair pathway mutations is notable.

8. Vacuum-induced uterine tamponade device

Childbirth should be a joyous experience. But between 1% and 5% of women experience postpartum hemorrhage, which is a tragic complication. Treatments include blood transfusions, drugs with dangerous adverse effects, and acute hysterectomy. Until now, balloon devices have been the only nonsurgical option for this dreaded complication. Vacuum-induced uterine tamponade changed all that by creating negative pressure in the uterus to collapse the bleeding cavity and shut off leaking blood vessels. This low-cost, noninvasive procedure may prove particularly useful in developing countries with limited access to other treatment options.

7. Leaps and bounds in telemedicine

Telemedicine isn’t new, but thanks to COVID-19, patient virtual visits boomed. A sea change in policy at the provider and government levels facilitated this virtual move, with state and federal regulators swiftly reducing barriers to the technology starting in March 2020. In recent months, we’ve seen a wave of telehealth initiatives and expansions to extant networks.

6. Bubble CPAP 

Another childbirth advance highlighted by the Cleveland Clinic is bubble CPAP (b-CPAP), a ventilation breakthrough used to treat infant respiratory distress syndrome. The new technology obviates the application of surfactant during mechanical ventilation, a practice that can cause permanent damage to the lungs and lead to chronic lung disease. Fortunately, b-CPAP is noninvasive, and delivers continuous positive airway pressure to newborns to support exhalation lung volumes. Benefits of this novel approach include safety, efficacy, minimal barotrauma, and stimulation of lung growth when administered over an extended duration.

5. Universal hepatitis C treatment

Hepatitis C is nothing to scoff at, with infection possibly lethal and resulting in liver cirrhosis, liver failure, and liver cancer. No vaccine exists against this virus, and historically drugs used to treat this infection have led to serious adverse effects, in addition to only working in subsets of the population based on genotype. Fortunately, newly approved fixed-dose combinations of the medication have proven much better therapeutic options, with efficacy topping 90% in genotypes one through six, opening the door to successful treatment in more people with the disease.

4. Updated cystic fibrosis treatment

Renewed hope came in the form of wider efficacy of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Previous iterations of the drug corrected protein action in only a subset of those with the disease, but a new combination drug, approved by the FDA in October 2019, expanded efficacy to those with the most common CF gene mutation (F508 del), which is harbored by 90% of those with the disease. 

3. ‘Smart’ pacemakers/defibrillators

What’s better than a remotely monitored pacemaker or defibrillator? One that is monitored by a smartphone via Bluetooth, of course! Remote monitoring requires a bedside console that transmits data to the clinician. Adherence to remote monitoring has been patchy, with patients lacking insight into how the device functions. Smartphones plus mobile apps provide patients greater insight into their life-saving devices and transmit data to the provider.

2. New drug for primary-progressive multiple sclerosis

About 15% of those with multiple sclerosis harbor a subtype known as primary progressive, which results in a slow and steady progression. The FDA recently approved a monoclonal antibody as the first treatment for this subtype.

1. New thalassemia treatments

More than 330,000 children worldwide are born with hemoglobinopathies—including more than 100,000 Americans born with sickle cell disease. New research may help patients produce functional hemoglobin molecules, decreasing counts of sickled/ineffective red blood cells in sickle cell disease and other forms of thalassemia.