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Gudzune KA, Kushner RF. Medications for Obesity: A Review. JAMA 2024:2821290. [PMID: 39037780 DOI: 10.1001/jama.2024.10816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Importance Obesity affects approximately 19% of women and 14% of men worldwide and is associated with increased morbidity. Antiobesity medications (AOMs) modify biological processes that affect appetite and significantly improve outcomes, such as type 2 diabetes, hypertension, and dyslipidemia. Observations AOMs should be administered in combination with lifestyle interventions and can be classified according to their mechanisms of action. Orlistat modifies digestive tract absorption and causes gastrointestinal adverse effects, such as oily fecal spotting and urgency, in more than 25% of patients. Centrally acting drugs, such as phentermine-topiramate and naltrexone-bupropion, regulate appetite in the brain and are associated with constipation in approximately 20% of patients, although the incidence of other adverse effects (eg, paresthesia, nausea) varies by medication. Nutrient-stimulated hormone-based medications, such as liraglutide, semaglutide, and tirzepatide, mimic the actions of enteropancreatic hormones that modify central appetite regulation and provide multiple cardiometabolic weight-loss benefits. Adverse effects of these drugs include nausea (28%-44%), diarrhea (21%-30%), and constipation (11%-24%). The relative potency of adult obesity medications has been studied in meta-analyses. Compared with placebo, orlistat was associated with 3.1% greater weight loss (52 randomized clinical trials [RCTs]; 16 964 participants), phentermine-topiramate was associated with 8.0% greater weight loss (5 RCTs; 3407 participants), naltrexone-bupropion was associated with 4.1% greater weight loss (6 RCTs; 9949 participants), liraglutide was associated with 4.7% greater weight loss (18 RCTs; 6321 participants), semaglutide was associated with 11.4% greater weight loss (5 RCTs; 4421 participants), and tirzepatide 15 mg was associated with 12.4% greater weight loss (6 RCTs; 1972 participants). Conclusion and Relevance Obesity is associated with increased morbidity. Antiobesity medications are effective adjunctive therapy to lifestyle changes for improved weight loss and health outcomes.
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Affiliation(s)
- Kimberly A Gudzune
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Robert F Kushner
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Balzan P, Tattersall C, Palmer R, Murray M. Mapping the development process of transcutaneous neuromuscular electrical stimulation devices for neurorehabilitation, the associated barriers and facilitators, and its applicability to acquired dysarthria: a qualitative study of manufacturers' perspectives. Disabil Rehabil Assist Technol 2024; 19:1923-1934. [PMID: 37855610 DOI: 10.1080/17483107.2023.2269976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The fragmented nature of the medical device market limits our understanding of how particular sub-markets navigate the device development process. Despite the widespread use of transcutaneous neuromuscular electrical stimulation (NMES), its use for acquired dysarthria treatment has not been sufficiently explored. This study aims to provide a preliminary understanding of the stages involved in the development of NMES devices designed for neurorehabilitation. It also aims to investigate manufacturers' perceptions concerning factors that facilitate or impede its development and determine its applicability for acquired dysarthria. MATERIALS AND METHODS In-depth semi-structured online interviews were conducted with eight NMES device manufacturers located across Europe, North America and Oceania. The interviews were video-recorded, automatically transcribed, manually reviewed, and analysed using a qualitative content analysis. RESULTS NMES device development for neurorehabilitation involves six complex phases with sequential and overlapping activities. Some emerging concepts were comparable to established medical device models, while others were specific to NMES. Its adaptability to different neurological disorders, the positive academia-industry collaborations, the industry's growth prospects and the promising global efforts for standardised regulations are all key facilitators for its development. However, financial, political, regulatory, and natural constraints emerged as barriers. Indications and challenges for the applicability of NMES for acquired dysarthria treatment were also discussed. CONCLUSION The findings provide a foundation for further investigations on the NMES market sub-sector, particularly in the context of neurorehabilitation. The study also provides insights into the potential adoption of NMES for acquired dysarthria, which can serve as a reference for future research.
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Affiliation(s)
- Pasquale Balzan
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Catherine Tattersall
- Division of Human Communication Sciences, School of Allied Health Professions, Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Rebecca Palmer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Michael Murray
- Sheffield Healthcare Gateway, University of Sheffield, Sheffield, UK
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Hillis JM, Visser JJ, Cliff ERS, van der Geest-Aspers K, Bizzo BC, Dreyer KJ, Adams-Prassl J, Andriole KP. The lucent yet opaque challenge of regulating artificial intelligence in radiology. NPJ Digit Med 2024; 7:69. [PMID: 38491126 PMCID: PMC10942968 DOI: 10.1038/s41746-024-01071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Affiliation(s)
- James M Hillis
- Data Science Office, Mass General Brigham, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Jacob J Visser
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Edward R Scheffer Cliff
- Harvard Medical School, Boston, MA, USA
- Program on Regulation, Therapeutics and Law, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Bernardo C Bizzo
- Data Science Office, Mass General Brigham, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Keith J Dreyer
- Data Science Office, Mass General Brigham, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Katherine P Andriole
- Data Science Office, Mass General Brigham, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
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Aboy M, Crespo C, Stern A. Beyond the 510(k): The regulation of novel moderate-risk medical devices, intellectual property considerations, and innovation incentives in the FDA's De Novo pathway. NPJ Digit Med 2024; 7:29. [PMID: 38332182 PMCID: PMC10853500 DOI: 10.1038/s41746-024-01021-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
Moderate-risk medical devices constitute 99% of those that have been regulated by the U.S. Food and Drug Administration (FDA) since it gained authority to regulate medical technology nearly five decades ago. This article presents an analysis of the interaction between the 510(k) process -the historically dominant path to market for most medical devices- and the De Novo pathway, a more recent alternative that targets more novel devices, including those involving new technologies, diagnostics, hardware, and software. The De Novo pathway holds significant potential for innovators seeking to define new categories of medical devices, as it represents a less burdensome approach than would have otherwise been needed historically. Moreover, it supports the FDA in its effort to modernize the long-established 510(k) pathway by promoting the availability of up-to-date device "predicates" upon which subsequent device applications can be based, reflecting positive spillovers that are likely to encourage manufacturers to adopt current state-of-the-art technologies and modern standards of safety and effectiveness. We analyze the of characteristics all the De Novo classification requests to date, including the submission type, trends, FDA review times, and device types. After characterizing how the De Novo process has been used over time, we discuss its unique challenges and opportunities with respect to medical device software and AI-enabled devices, including considerations for intellectual property, innovation, and competition economics.
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Affiliation(s)
- Mateo Aboy
- Centre for Law, Medicine, and Life Sciences (LML), Faculty of Law, University of Cambridge, Cambridge, UK.
| | - Cristina Crespo
- Centre for Law, Medicine, and Life Sciences (LML), Faculty of Law, University of Cambridge, Cambridge, UK
| | - Ariel Stern
- Harvard Business School and Harvard-MIT Center for Regulatory Science, Boston, MA, USA
- Hasso-Plattner-Institut für Digital Engineering, Potsdam, Germany
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Robles O. Regulatory Submission Characteristics and Recalls of Medical Devices Receiving 510(k) Clearance. JAMA 2023; 329:1609. [PMID: 37159040 DOI: 10.1001/jama.2023.4089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Omar Robles
- Mossavar-Rahmani Center for Business and Government, John F. Kennedy School of Government at Harvard University, Cambridge, Massachusetts
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Rathi VK. Regulatory Submission Characteristics and Recalls of Medical Devices Receiving 510(k) Clearance. JAMA 2023; 329:1608-1609. [PMID: 37159039 DOI: 10.1001/jama.2023.4092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
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Everhart AO, Zhu Y, Stern AD. Regulatory Submission Characteristics and Recalls of Medical Devices Receiving 510(k) Clearance-Reply. JAMA 2023; 329:1609-1610. [PMID: 37159037 DOI: 10.1001/jama.2023.4095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Alexander O Everhart
- Harvard-MIT Center for Regulatory Science, Harvard Medical School, Boston, Massachusetts
| | - Yi Zhu
- Carlson School of Management, University of Minnesota, Minneapolis
| | - Ariel D Stern
- Harvard Business School, Harvard University, Boston, Massachusetts
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