Matthew Gavidia

Improving on the ability to confirm diagnosis of 

 (PD) earlier and determining who is at risk for PD were referenced as key factors in further slowing progression of the disease, according to review findings published in 

The complexity of PD can often cause physicians to mistake initial symptoms for those of other conditions. In fact, a poll of patients with PD (PwP) indicated that more than 1 in 4 PwP had been initially misdiagnosed, with 48% of these individuals receiving treatment for the wrong condition.

In slowing the progression of PD, early diagnosis is crucial. As researchers note, “there is a substantial latency between the actual onset of PD pathology and our ability to confirm diagnosis, during which accumulating structural and functional damage might be too advanced for effective modification or protection.”

So, what obstacles are limiting physicians from identifying PD earlier?

As referenced prior, the complexity of PD is a major issue, as researchers are still learning more on the condition. Currently, symptomatic management through efforts to prevent further dopamine deficiency serves as the gold standard of clinical treatment for PD.

While this may be successful in the early stages of the disease, the continued decline of dopaminergic neurons can make this strategy difficult. The frequency of OFF periods, which are characterized by the recurrence of symptoms after a period of symptom control, has been 

 to increase as the disease progresses, affecting 70% of PwP after 9 years, up from 40% after 4 to 5 years of diagnosis.

Moreover, nonmotor symptoms in PD are additional factors that researchers note play an integral role in defining the condition at an early stage, but have limited treatment options. These nonmotor symptoms have extensive implications to a 

 of major disorders, ranging from sleep to olfactory issues.

In evolving the ability to diagnose PD at an early stage, researchers highlighted the potential efficacy of biomarkers in identifying those who may be at risk. So far, a growing number of markers have been proposed as effective screening tools for PD, including clinical, imaging, biochemical, and genetic markers, noted the researchers. Although no proposed biomarker can definitively predict PD onset, some markers are focused on the earliest phases of PD, which can provide novel information on the presence and progression of the disease.

The potential of identifying biomarkers within PD pathogenesis can prove a breakthrough in treating patients as physicians can tailor symptomatic approaches based on the individualized symptoms of a PwP. The efficacy of these possible diagnostic tools is still not confirmed, however, with researchers still examining the latest diagnostic, prognostic, and therapeutic methods in PD.

“Fundamentally what is needed to move forward in our search for PD solutions is a better understanding of the natural progression of PD and the underlying pathological processes and mechanisms,” concluded the study authors.

Poortvliet PC, O’Maley K, Silburn PA, et al. Perspective: current pitfalls in the search for future treatments and prevention of Parkinson's disease. 

. Published online July 8, 2020. doi:10.3389/fneur.2020.00686

Articles

Improving on the ability to confirm diagnosis of Parkinson disease (PD) earlier and determining who is at risk for PD were referenced as key factors in further slowing progression of the disease, according to review findings.

What Obstacles Are Impeding Early Diagnosis of Parkinson Disease?

In the current state of musculoskeletal (MSK) care, there is a significant disconnect in the continuum of care as self-funded 

 and health plans do not have access to a complete solution that offers the full spectrum of MSK treatments. For employers interested in solving their MSK care issues, they have to assemble a collection of disconnected vendors, ranging from prevention and wellness to center of excellence.

Beginning in 2021, this will all change. Recently, Hinge Health, the top-selling MSK solution for employers and health plans, 

 the expansion of its digital MSK clinical capabilities to be the first Digital Musculoskeletal Clinic from prevention to post-surgery care.

"Musculoskeletal care is uniquely fractured and hard for employers and members to navigate,” said Daniel Perez, chief executive officer and co-founder of Hinge Health, in an interview with 

®). “Hinge Health has created the first Digital MSK Clinic to bring together best practice care at every stage from prevention to post surgery care.”

The move, which will be rolled out in the first quarter of 2021, will include a dedicated Digital Care Pathways program for members at any stage of their MSK care. Also participating in an interview with 

®, Jeffrey Krauss, chief medical officer at Hinge Health and clinical assistant professor at Stanford University, explained that the expansion will “cover a member no matter where they may be on their MSK journey including access to 1-on-1 virtual [physical therapists] and health coaches, and free Expert Medical Opinion focused on avoiding unnecessary elective MSK procedures.”

With the goal of delivering a higher return on investment for clients, the expansion will include a myriad of novel programs, including prevention, acute/episodic, and surgical, which will all compliment Hinge Health’s flagship Chronic Pathway. Chronic Pathway has already been shown to address 75% of MSK spend, is clinically validated to reduce pain by 69%, and avoids 2 in 3 surgeries.

Building on the commitment to avoiding unnecessary care and surgeries, the organization will provide expert medical opinion that will focus on replacing unnecessary elective MSK surgeries with evidence-based conservative care. Moreover, its Digital Care Pathways program will ensure higher utilization of second opinion before members commit to surgery.

As the market leader, Hinge Health serves as the choice of 4 in 5 employers with a digital MSK solution. To efficiently and effectively ensure unlimited access to MSK care for all partnered employers and health plans, the organization will hire an additional 100 plus full-time physical therapists and doctors for 2021.

“We’ve seen positive responses from our nearly 200 enterprise clients, including Boeing who after launching about 6 weeks ago, already has nearly 5000 members on our program,” said Perez.

Hinge Health announced the expansion of its clinical and technical musculoskeletal (MSK) capabilities to cover the full continuum of MSK care. The move will provide the most complete back and joint health solution to employers and health plans.

Hinge Health Announces Expansion to Become the First Digital Musculoskeletal Clinic

Cognitive behavioral therapy for insomnia (CBTi) delivered via telemedicine was found to be noninferior to in-person delivery in managing severity, with similar improvements of daytime functioning exhibited between the 2 methods, according to study findings published in 

Although telemedicine has been questioned on its comparative efficacy to in-person visits and applicability to the older generation, as well as reimbursement issues, usage has risen 

 amid the coronavirus disease 2019 (COVID-19) pandemic.

Aligned with social distancing guidelines, telemedicine allows patients to receive consultations from physicians without risking infection. Moreover, a 

® indicated that for established patients, telehealth virtual video visits may provide effective follow-up and enhanced convenience  compared with traditional office visits.

Researchers sought to examine whether patients with insomnia would also benefit from CBTi delivered via telemedicine as opposed to face-to-face. They conducted a randomized, controlled, noninferiority trial that recruited 65 adults with chronic insomnia (46 women; mean [SD] age, 47.2 [16.3] years) who were randomized to 6 sessions of CBTi delivered individually via the telemedicine platform 

 (n=33; CBT-TM) or in person (n=32; CBT-F2F).

 (ISI), and daytime functioning measures at pretreatment and post treatment visits and a 3-month follow-up. The trial’s primary end point compared how CBT-TM and CBT-F2F improved insomnia/sleep and daytime functioning, in which ISI served as the primary noninferiority outcome.

The secondary objective aimed to compare treatment credibility, satisfaction, and therapeutic alliance between CBT-TM and CBT-F2F.

When examining ISI based on a noninferiority margin of 4, CBT-TM was found to be noninferior to CBT-F2F at post treatment (β = 0.54; SE = 1.10; 95% CI, -1.64 to 2.72) and follow-up (β = 0.34; SE = 1.10; 95% CI, -1.83 to 2.53). Additionally, no difference was exhibited between the 2 treatment options in daytime functioning measures, which were significantly improved at post treatment and follow-up for all variables except the physical composite scale of the 

Although CBT-TM sessions were nearly 10 minutes shorter on average, participant ratings of therapeutic alliance was shown to be similar to that of CBT-F2F.

“Telemedicine delivery of CBT for insomnia is not inferior to face-to-face for insomnia severity and yields similar improvements on other sleep and daytime functioning outcomes,” said the study authors. “Further, telemedicine allows for more efficient treatment delivery while not compromising therapeutic alliance.”

Arnedt JT, Conroy DA, Mooney A, Furgal A, Sen A, Eisenberg D. Telemedicine versus face-to-face delivery of cognitive behavioral therapy for insomnia: a randomized controlled non-inferiority trial. 

. Published online July 13, 2020. doi:10.1093/sleep/zsaa136

Cognitive behavioral therapy for insomnia delivered via telemedicine was found to be noninferior to in-person delivery in managing severity, with similar improvements in daytime functioning exhibited between the 2 methods, according to study findings.

Can Cognitive Behavioral Therapy for Insomnia be Effectively Delivered Via Telemedicine?

Overall, there are 145 registered and ongoing clinical trials for therapies targeting 

 (PD), of which 28 are currently in phase 3, according to review findings published in the 

In the second half of the last century, researchers highlight that the majority of pharmacological treatments approved for clinical use only provide symptomatic relief as opposed to slowing or reversing the progression of PD. In examining the current evolution of potential pharmacological interventions within PD, they note that a number of similar treatments to those already approved are being assessed in current clinical trials.

While additionally accounting for these therapies tailored toward symptomatic issues, the researchers sought to create greater awareness toward disease modifying therapies (DMT) in the current state of clinical trials within PD. They conducted a review and breakdown analysis of clinical trials for drug therapies in PD that were active as of January 21, 2020.

Of the 145 registered and ongoing clinical trials for therapies targeting PD, 37 (26%) were phase 1, 14 (10%) were phase 1/2, 61 (42%) were phase 2, 5 (3%) were phase 2/3, and 28 (19%) were phase 3.

Based on review findings, 57 (39%) of these trials were considered to be DMT trials and 88 (61%) were symptomatic treatment (ST) trials. Focusing on notable phase 3 DMT trials, 

 (testing inosine) were referenced. Phase 1 and 2 DMT studies that provided encouraging results included the Herantis CDNF trial and the Denali-sponsored evaluation of their LRRK2 inhibitor, DNL-201, both of which focused on novel targets and achieved their primary endpoints, noted the researchers.

“We are also still awaiting the results of some studies that recently completed, such as the phase 2 trial assessing the DMT potential of the iron chelator, deferiprone,” the authors noted.

Assessing the ST studies, about 65% were focused on motor symptoms, including overall movement (45 trials), levodopa-induced dyskinesia (6 trials), gait and balance (4 trials), and tremor (3 trials). Only 1 of these ST studies focused on both motor and nonmotor symptoms.

The remaining ST studies focused on nonmotor symptoms, such as pain (3 trials), PD dementia (2 trials), PD psychosis (2 trials) and 1 trial each for anxiety, constipation, depression, fatigue, hallucinations, neuropsychiatric symptoms, PD mild cognitive impairment, sialorrhea, sleepiness, and urinary symptom.

In looking at the pipeline of PD therapies under consideration, the researchers were encouraged at the wide range of options across multiple phases of clinical development. However, they note that it remains challenging to bring DMTs to clinical use in PD.

“Improvements in the clinical trial process may accelerate the assessment of ST and DMTs, and we look forward with hope to further therapies becoming available for people with PD,” they concluded.

McFarthing K, Buff S, Rafaloff G, et al. Parkinson disease drug therapies in the clinical trial pipeline: 2020. 

. Published online July 28, 2020. doi:10.3233/JPD-202128

Overall, there are 145 registered and ongoing clinical trials for therapies targeting Parkinson disease, of which 28 are currently in phase 3, according to review findings.

Author | Matthew Gavidia

Articles

What Obstacles Are Impeding Early Diagnosis of Parkinson Disease?

Hinge Health Announces Expansion to Become the First Digital Musculoskeletal Clinic

Can Cognitive Behavioral Therapy for Insomnia be Effectively Delivered Via Telemedicine?

What Emerging Drug Therapies Are in the Clinical Trial Pipeline for Parkinson Disease?