The digital therapeutics world during COVID-19 pandemic
2020 was a though and dramatic year, in which the world had to face the COVID-19 pandemic and it’s still struggling with it, although now we have new weapons available: vaccines.
However, among all the sufferings, restrictions and economic difficulties, 2020 was also characterised by a boost in digitalization. For example, remote working began the new normal for many jobs.
Healthcare too was obviously impacted: for example, prescription refills were managed online and telemedicine had to be adopted for many patients, supercomputers and cloud computing were used to model SARS-CoV-2 structure and try to find new or repurposed drugs.
Obviously, virtualization is not a panacea on its own. Some patients now forced to avoid hospital visits to limit risks of contagion will benefit again of in-person visits, but what before was seen just as a possible innovation – distant in the future – now was necessarily massively tested. And many clinicians and patients now can see digital health as a reliable option.
Among innovations, also the digital therapeutics field progressed a lot.
Mental health and behavioural health
A field particularly relevant for DTx is mental health. Even before COVID-19 this was an area actively explored by DTx companies and now the pandemic boosted both digital adoption but also the need of mental health care (because in-person therapies are less accessible but also due to the negative effect of the pandemic itself even on people not directly hit by the virus).
Some milestones in this field were
- On April FDA issued a guidance to help expanding the availability of digital health therapeutic devices for psychiatric disorders to facilitate consumer and patient use while reducing user and healthcare provider contact and potential exposure to COVID-19.
- EndeavorRx FDA approval and European CE mark granted on June: the first videogame medications, prescribed to children with ADHD (attention deficit hyperactivity disorder). More details can be found here: [Can video games treat diseases?]
- NightWare FDA approval on November: an Apple Watch app (prescription only) to fight sleep disturbances in adults who suffer from nightmare disorder or have nightmares from post-traumatic stress disorder (PTSD). The device monitors heart rate and motion during sleep, creates a unique sleep profile for the patient in few days and then provides gentle vibration when a nightmare is detected, interrupting it without waking the wearer.
Talking about sleep… Sleepio is not alone anymore, a competitor arrived. Somryst got on March FDA approval. It delivers digital Cognitive Behavioural Therapy for insomnia, including algorithm-driven sleep restriction and consolidation recommendations, providing patients with treatment when and where they need it.
Virtual reality is on the rise
Immersive virtual reality is emerging as a viable method of assessing older adults and people with dementia and is also explored as a potential therapy in this setting. Although there is to date limited evidence that VR can to contribute to real-world improvements it seems promising and is able to engage patients.
UK NHS starting on March offers new virtual reality treatment for patients with social anxiety. Oxford VR provide a virtual reality exposure therapy in which patients are encouraged to gradually face difficult situations in order to overcome anxiety, build confidence and feel more in control of themselves.
Virtual reality exposure therapy is an acceptable treatment for social anxiety disorder patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, its efficacy lessens as compared to in-person exposure.
AppliedVR’s EaseVRx got FDA breakthrough device designation to treat conditions related to chronic pain. Based on cognitive behavioural therapy principles and other behavioural methods, it alters the brain’s perception of pain, modulating sensory and emotional aspects. After its first randomized controlled trial (21-day VR program vs the audio-only version), on average participants noted a reduced pain intensity (-30%), pain-related activity interference (-37%), mood interference (-50%), sleep interference (-40%) and stress interference (-49%).
But many other VR solutions were developed (e.g. XRHealth’s post COVID-19 respiratory rehab or VR support groups) and many others will probably come soon. This is a really growing area with virtually no limit 😊
Digital therapeutics and COVID-19: an opportunity to boost change and adoption
We are facing a pandemic that is putting a strain on the health services of the countries involved. While strict policies are essential, especially in times of social distancing, support came also from technologies that until a few years ago were relegated to the world of science fiction.
And maybe this same moment of great difficulty could represent an opportunity to overcome the remaining resistance and pave the way for greater adoption of digital technology, in healthcare and beyond. A change that, once the emergency is over, we hope will continue to benefit all of us and also help to avoid the repetition of similar situations (or at least to counter them more effectively).
- FDA Permits Marketing of First Game-Based Digital Therapeutic to Improve Attention Function in Children with ADHD https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-game-based-digital-therapeutic-improve-attention-function-children-adhd
- FDA Permits Marketing of New Device Designed to Reduce Sleep Disturbance Related to Nightmares in Certain Adults https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-new-device-designed-reduce-sleep-disturbance-related-nightmares-certain-adults
- Clay F, Howett D, FitzGerald J, Fletcher P, Chan D, Price A. Use of Immersive Virtual Reality in the Assessment and Treatment of Alzheimer’s Disease: A Systematic Review. J Alzheimers Dis. 2020;75(1):23-43. doi:10.3233/JAD-191218
- Lin TY, Huang CM, Hsu HP, et al. Effects of a Combination of Three-Dimensional Virtual Reality and Hands-on Horticultural Therapy on Institutionalized Older Adults’ Physical and Mental Health: Quasi-Experimental Design. J Med Internet Res. 2020;22(11):e19002. Published 2020 Nov 2. doi:10.2196/19002
- NHS offers new virtual reality treatment for patients with social anxiety https://www.digitalhealth.net/2020/03/nhs-offers-new-virtual-reality-treatment-for-patients-with-social-anxiety/
- Horigome T, Kurokawa S, Sawada K, et al. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychological Medicine. 2020;50(15):2487-2497. doi:10.1017/S0033291720003785
- AppliedVR Receives FDA Breakthrough Device Designation to Treat Pain with Digital Therapeutic https://appliedvr.io/news/appliedvr-receives-fda-breakthrough-device-designation-to-treat-pain-with-digital-therapeutic/