Type 1 diabetes
Jessica L. Dunne, PhD, research director at the Juvenile Diabetes Research Foundation, says development of treatments for type 1 diabetes has been slow, partly because insulin works so well in treating it.
"While insulin may seem on the surface like a great therapy, and it is, there's still a burden of maintaining adequate blood sugars," Dunne says.
Technology may help, with insulin pumps, implantable monitors, and other devices easing the burden of the disease for some patients. Continuous glucose monitors are becoming more readily available, with a 20% uptake in use over recent years, and studies show they lead to improved outcomes, Dunne says.
There is also some progress in medication development, with researchers looking into new immunotherapies like SGLT 1 and 2 inhibitors. These inhibitors affect glucose absorption in the kidneys, providing glycemic control in a new way outside of simply increasing insulin levels. Researchers are also looking into encapsulating and implanting beta or islet cells into patients that could potentially reduce or eliminate the need for insulin therapy for the life of those implanted cells.
Increased interest in adjunct therapies like this for type 1 diabetes will improve access for patients, Dunne says. "It will make them easier to prescribe and improve insurance coverage," she says. "It's a huge step. I hope this opens the door for more adjunct therapies."
There are also studies investigating the role of cytokine inhibitors and antigen-specific therapies, a viral vaccine that may prevent the development of type 1 diabetes, and how the gut microbiome affects disease development and progress, she says.
"There has been some evidence showing the microbiome is changed in diabetes, but the big question now is, what do we do about it?" Dunne says.
Christopher Morris, MD, a Tennessee board-certified rheumatologist who serves on the government affairs committee for the American College of Rheumatology and on the board of directors for the Southern Medical Association, says biologics, such as adalimumab (the top-selling medication in the world) have shown tremendous progress in treating RA. Still, the cost of these new treatments can be prohibitive, Morris says, and the problem is compounded in rheumatology because there are so few FDA-approved medications and treatments are often used off-label. Patients have trouble getting medications approved for coverage by insurance companies, and can rarely afford them on their own, he says.
“This is something we are frustrated with in medicine. My first consideration when I write a patient a medication is, are they able to afford it?" Morris says. "We want a medicine that works and we want a medicine they can afford."
Biosimilars could be a more cost-effective alternative to biologics, he says, but there is hesitation over fears that cost savings could come at the expense of efficacy.
He says Janus kinase (JAK) inhibitors are likely the next big thing in treating RA, and future treatments are becoming increasingly selective to improve efficacy while reducing negative effects.
There has also been some research into vagal nerve stimulation—which usually involves either manual or electrical stimulation of the vagal nerve, Morris says, highlighting the idea that there is a neurologic component to some autoimmune diseases. "Maybe by modifying how the body is reacting neurologically, it can have an effect on rheumatoid arthritis.”
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