We kick off our annual recap series with some reflections from our expert advisory board, on topics ranging from AI and cell therapies, to semaglutide and RSV vaccines.
It’s so hard to avoid spoilers online. Take, for example, right now.
Welcome back to our 7th edition of This Year in Medicine, our annual end-of-year recap series that highlights the greatest stories, challenges, moments and innovations in health care. On every Monday, Wednesday and Friday this December, our team will be publishing feature articles and video content reviewing every major development in our specialties of focus.
Same as every year, the series will feature contributions from every team in the HCPLive Network:
Readers can follow the recap series on Facebook, Twitter and LinkedIn through the hashtag #ThisYearInMedicine, and each new entry will also be shared on HCPLive’s homepage and daily newsletter.
Now, for those spoilers: to kick off this year’s series, we asked HCPLive’s inaugural Editorial Advisory Board—a collection of caregivers from various specialties and backgrounds—to answer the question, “In 10 years, what will we remember as the biggest story in medicine from 2023?” The board provided answers that highlighted 7 unique storylines from the last 12 months—6 stories that we’ve already planned to cover in our series in the coming weeks.
Enjoy our board’s thoughts on the half-dozen storylines that made 2023 and stay tuned for more at-length reflections—and spoiler-free features—in our latest This Year in Medicine.
Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES, FCCP: I think the biggest story of 2023 are the SELECT results with semaglutide and cardiovascular benefits in people with overweight and obesity, with established cardiovascular disease. While we have had the cardiovascular data in people with diabetes for several years (LEADER, SUSTAIN, HARMONY, AWARD, etc), this is the first time we have a large randomized controlled trial showing the cardiovascular benefits of a GLP-1 agonist in people with overweight and obesity without diabetes.
I think this is especially significant because it will hopefully change the coverage/payor landscape of these agents and make them more accessible for weight management.
In the upcoming years, we are likely to see more incretins become available and cardiovascular outcome data published for tirzepatide and others for weight management. We hope that data will look favorable as well, but this will always be remembered as the first, landmark trial to show benefits of an incretin therapy for treatment of overweight and obesity to improve cardiovascular outcomes. This also takes weight management beyond what many unfortunately think of as a cosmetic condition and showcase how this is a chronic disease that should be treated to improve health outcomes.
Stephen J. Greene, MD: We will remember 2023 as the year of the GLP-1 receptor agonist, and specifically semaglutide. This year we saw evidence that obesity can be a pharmacologically modifiable risk factor to improve hard clinical outcomes. However, in 2023, the story also started that the cardiovascular benefits of GLP-1 receptor agonist therapy likely extend to mechanisms beyond weight loss, and that these drugs may be best viewed as cardiovascular drugs that happen to cause weight loss, rather than as solely a weight loss therapy.
Lawrence E. Eichenfield, MD: While not directly related to dermatology, I believe the biggest story of 2023 relates to the recognition of GLP-1 agonists as ‘paradigm changers’ in response to obesity. In the lay press, and our medical articles, this year has pushed us to see the weight loss associated with use of these agents with more and more evidence focusing in on positive impacts on type 2 diabetes, pre-diabetes, and heart disease. I expect that many of our dermatologic conditions that may be influence by overweight and obesity, including acanthosis nigricans, metabolic risks associated with psoriasis and perhaps hidradenitis suppurativa may be positively impacted by use of these agents.
As will the general health of the individuals, if they use the peptide as a ‘kick-start’ for life changes, that may reduce the chance for gaining weight back and losing some of the positive health benefits. A second part of the story is disparities in access to these medications—it seems like much of affluent Los Angeles is on the drug, while there is little use of it in our teenagers and pre-teens with severe obesity, already having secondary health complications. I hope we can get these drugs where they can give us the greatest yield in health impact over time!”
Veeral Sheth, MD, MBA, FASRS, FACS: A decade from now, we will reflect on 2023 as the foundational year when we initiated the effective management of geographic atrophy. Although the progress may seem incremental, the advancements achieved this year are set to catalyze a significant transformation in our perception and treatment of this condition, ultimately enhancing the quality of life for our patients.
David R. Lally, MD: I suspect we'll remember the biggest story of medicine from 2023 as being a landmark year for the treatment of geographic atrophy with FDA-approval of 2 therapies. We now, for the first time, have therapy to slow progression of disease!
Albert Rizzo, MD: Based on the years that went into its development and the ultimate impact on children and adults alike, I believe the RSV vaccines and monoclonal antibody approvals will have the greatest impact on reducing morbidity and mortality from this viral disease. The biggest challenge now is for it to be accepted by the population most at risk.
Taha Qazi, MD: I had to think about the question for a bit, but I think the biggest research that will define this year and era in gastroenterology will likely be the advent and propagation of AI in GI/Endoscopy. Whether it comes to detecting polyps or lesions or its use in research, I think this era will be defined by the reliance of AI not only for patient care, but also improvements in the practice of medicine.
Raj Chovatiya, MD: From a dermatology perspective, 2023 was the tipping point for clinical investigation into the other diseases’: chronic immune-mediated conditions that we both poorly understood and had few or no unique, pathogenesis-driven treatment options. Seborrheic dermatitis resides at the top of this list, followed closely by hidradenitis suppurativa and alopecia areata. In addition, diseases that are better understood and have multiple targeted therapies also had a stellar year as well, with major advancement seen in efficacy for psoriasis therapy.
Viet T. Le, DMSc, PA-C, FACC, FAHA: It is always difficult to not approach a question like this without the bias of contemporary context and perhaps a little bit of hubris that what we consider a ‘big story’ real-time in 2023 will stand the test of a decade. While seemingly ‘lower key’ than the news of yet another GLP-1 receptor agonist success—this time semaglutide in patients without diabetes but known coronary disease and BMI >27—CRISPR-Cas9, I suspect, via the VERVE-101 and NTLA-2001 trials, will be looked back upon as the biggest story to come out of 2023. The medical community has been discussing its potential impact on disease and in-animal studies before 2023; however, this is the year in which we learned of in-human results for efficacy and safety. Durability, efficacy, long-term safety, and adherence will be the markers that will determine just how ‘big’ on reflection of the in-human application of CRISPR-Cas9, 10 years forward from now.
Jack Arnold, MBBS, MRCP: I think within rheumatology you would have to talk about CAR-T cell therapy in SLE. Whilst I don't consider it to be the panacea that many think it is, it's definitely an interesting development and long-term follow up in those cases will be very interesting.
Chris Wincup, MBBS MRCP: The CAR T cell data was presented, initially last year, so it's just been over 12 months. But I think the excitement that's been driven from that—the expanded patient numbers, the development of trials and looking at a number of other indications for cell-based therapies in rheumatology—it's incredibly exciting. It certainly seems to be the thing that's caused the biggest buzz in the community in terms of clinicians, patients, and industry all moving toward this. And it's going to be the thing that potentially revolutionizes how we treat our patients in the future if these results are borne out. I think those results are incredibly fascinating and gives us a good hint towards why we may change or shift the paradigm in the future.
So, although those results initially came out more than 12 months ago, I think the enthusiasm that's followed, that's continued to grow over this year, has been one of the highlights for me. And having recently returned from ACR Convergence 2023 in San Diego—that was the thing that most people were talking about and I spoke to most people about. Whether we look back at this in in 2033 and say we got it wrong, and that wasn't the right thing at that time, it's interesting to know. But it does seem that we have an exciting new therapy to potentially work with, and we will only learn more about the disease with this therapy.