What's Ahead for Health in 2008
Experts predict medical trends in the new year.
Rheumatology: New Drug Alert
Leslie J. Crofford, MD, the Gloria W. Singletary Professor of Rheumatology
and the chief of rheumatology at the University of Kentucky in Lexington, has
her eye on the prize in 2008. "I hope we will see another new biologic
approved to treat rheumatoid arthritis (RA) in
2008," she tells WebMD. Specifically, she is referring to tocilizumab
(Actemra). This drug blocks an inflammatory chemical known as interleukin-6
(Il-6), and is in final stages of clinical trials.
Crofford says she is "really excited" about this drug for people who
may not respond to similar drugs. Biologic drugs block substances that cause or
worsen joint inflammation in RA. They copy the effects of chemicals made
by the immune system, which block inflammatory substances such as tumor
necrosis factor (TNF).
"Preliminary studies look extremely promising and it seems to have a
particularly good effect in pediatric patients. And we may ultimately, when
approved, see studies of this agent in other rheumatic diseases."
Speaking of other rheumatic diseases, Crofford says, "I hope that we
will see clinical trials looking at biologics in lupus
and I hope that we will see approvals for more medications to treat fibromyalgia that target the central nervous system."
In 2007, the first ever such drug to treat the chronic pain
condition fibromyalgia was approved, and according to Crofford, Lyrica (pregabalin) won't be the last.
Neurology: Mixed Outlook for 2008
2008 will be a mixed bag for stroke and other neurological
conditions, says Deepak L. Bhatt, MD, the associate director of the
cardiovascular coordinating center and an interventional cardiologist at the
Cleveland Clinic in Ohio.
"There are two warring factors," he explains. "We have
better treatments and less invasive therapies on the horizon, but this has the
potential to be overwhelmed by the twin epidemics of diabetes and obesity,"
he warns. While some researchers suggest that the diabetes epidemic may be
reaching a plateau, there are still millions of Americans who have the
condition and may not have it under control.
"There is trouble brewing," he says. "Even though there have
been some encouraging downward trends in stroke rates, those gains could easily
be reversed by epidemic of diabetes."
Cardiologists and neurologists will be working together more often in 2008
as strokes and heart
disease share many of the same risk factors including high
blood pressure, diabetes, and smoking, Bhatt predicts.
There has been some back and forth on the potential use of cholesterol-lowering drugs called statins in preventing
future strokes among people who have had strokes due to a blockage in the brain
arteries. Research has shown that such stroke survivors who took statins had a
lower risk of fatal and nonfatal strokes of any kind as well as heart attacks
and heart disease. That said, stroke survivors who take statins may also have
an increased risk of experiencing a bleeding or hemorrhagic stroke.
"We are going to see a lot more enthusiasm among neurologists about the
use of statins in patients who have had an ischemic stroke," he predicts.
"The data overall in these patients show that use of a statin does reduce
risk of future heart attack, stroke, and death."