Treating Peripheral Arterial Disease After Revascularization - Episode 11

Unmet Needs in PAD

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Marc Bonaca, MD, MPH, discusses unmet needs seen in the PAD therapeutic landscape.

Manesh Patel, MD: That was really helpful. Thanks, Sonia. I guess I’ll wrap it up with our group here saying what do you see coming? What’s the next big challenge in PAD and what are the unmet gaps? Maybe I’ll start with you Marc.

Marc P. Bonaca, MD, MPH: Well, I think the big challenge in PAD is actually to diagnose it and improve the provision of care. I mean, I’ve been struck by the underutilization of multiple therapies, and it’s not just rivaroxaban but lipid-lowering therapies, for example. If you look at real-world populations, LDL cholesterols are around 90-100 mg/dL which is like in the toxic range for this population even though we know getting them below 70, below 50, maybe to 30 would be even better. We know that there are high rates of amputations because of underutilization of sort of systems of care for diabetes. I think that one of the big issues is going to be awareness, educating people.

You started off this conversation, Manesh, with the word peripheral. And why is it called peripheral, sort of a coronary syndrome. Well, there’s nothing peripheral about it, especially to a patient that has it. I think awareness is going to be crucial and having better systems of care. And I think implementation science may be an area where folks want to invest and where we can do more to understand how to actually improve the provision of care. And then there will be a bunch of new drugs that are going to be really exciting, too. There are going to be factor XI inhibitors, and targets towards LP(a), and maybe icosapent ethyl and other things looking in PAD. But, to me, until we use the drugs, we have then we’re not going to really improve outcomes. Unless we diagnose PAD, we’re never going to know to treat anyway. That’s what I’m sort of hearing, and thinking, and where I think we have a lot of work to do.

Manesh Patel, MD: How about you, Sonia, what do you think? Do you agree with what Marc said?

Sonia Anand, MD, PhD: Yeah, I agree with Marc completely. I think implementation science is crucial, so we need to put the best minds in that area, understanding our patient population with PAD, and how do we get all those great drugs into people over a long period of time. Maybe it’s a poly-pill, maybe it’s something else. So that for sure is number one for me. Just to add to Marc’s list of future potential therapeutics, I would add anti-inflammatory agents and simple therapies, they don’t have to be expensive, such as colchicine may play a role in the future. I think we have work to do implementing our current evidence and we look forward to future trials to test new therapies.

This transcript has been edited for clarity.