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From theory to therapy: Digital health

The COVID-19 pandemic certainly cast the spotlight on the possibilities of digital health and Iceland possesses both unique health data for research studies and also a few very interesting companies taking the lead in this development.

Part of the World Health Organization (WHO)’s strategic vision is for digital health to be supportive of equitable and universal access to quality health services. “Digital health can help make health systems more efficient and sustainable, enabling them to deliver good quality, affordable and equitable care,” the WHO states.

In the light of the COVID-19 pandemic, digital health has proven to play a pivotal role in supporting health systems. In Iceland, digital health company Sidekick Health teamed up with the country’s national emergency services and infectious disease experts and developed a nationwide COVID-19 program that allowed health professionals to monitor the condition of their patients through a mobile phone app. With their solution they helped take the pressure off overburdened hospitals and clinics.

“The pandemic has moved the digital health sector forward by a few years. We are witnessing a sharp rise in interesting conversations from possible partners and collaborators. This is especially true when it comes to providers of healthcare, who by need and nature are slow movers,” said Gulli Arnason, Chief Marketing and Communications Officer (CMCO) at Sidekick Health in an interview with NLS in 2020.

I firmly believe that in the coming years no drug will be launched to market without a digital companion, i.e., a digitally delivered clinical treatment that augments pharmacotherapy to boost health outcomes.”

Before the pandemic came and changed the world, Sidekick’s platform had been proven in clinical studies to help manage weight control, medication adherence and psychological health – filling an important void in chronic disease treatment.

“I firmly believe that in the coming years no drug will be launched to market without a digital companion, i.e., a digitally delivered clinical treatment that augments pharmacotherapy to boost health outcomes. Patients access the treatment via a mobile phone application that is designed to address lifestyle factors and nudge people towards lasting behavior modification that increases the overall efficacy of combination treatment. As a combination treatment, medicine agencies such as the FDA and EMA will then approve a treatment that consists of a drug and a digital therapeutic to be marketed and reimbursed by payers,” said Arnason.

 

Gulli Arnason, Chief Marketing and Communications Officer (CMCO), Sidekick Health

 

A unique country

At the beginning of the COVID-19 pandemic Iceland’s unique combination of genetic homogeneity, genealogical tradition and high participation in research also gained a lot of attention globally. Scientists at deCODE genetics and Iceland’s Directorate of Health and the National University Hospital published a population-based study of the early spread of the virus in Iceland. The aim of the study was to provide as comprehensive a view as possible of how the virus spreads in a population, in this case a population of 360,000, and implementing early and aggressive testing, tracking and isolation measures to contain the epidemic.

 

COVID-19 sampling at deCODE Genetics. Photo: Jon Gustafsson

 

Iceland has been a prime location for discovery and validation of drug targets because of these unique assets. Research findings documenting variations in the genomes of Iceland’s inhabitants have laid the groundwork in the development of effective therapeutics for genetic disorders over the past two decades. Much of this research has been driven by the company deCODE, founded in 1996 by Kari Stefansson. Stefansson and his colleagues curated all available genealogical information into a single online database. Through integration with two other databases, one detailing genetic information collected from biological samples of more than 100,000 citizens and the other storing medical records of people participating in related research projects collected from national registers, the research power came. In 1998 Hoffman-La Roche invested 200 million dollars in the company and in early 2000 deCODE invested in its own diagnostics and drug development, advancing one therapeutic as far as phase III trials. After the 2008 financial crisis the company was forced to declare bankruptcy and in 2012 Amgen acquired it for 415 million dollars in cash.

Since the acquisition several important findings have been made by the Icelandic part of Amgen, as well as by other scientists in the country. For example, research derived from the major Icelandic study iStopMM have been used to redefine monoclonal gammopathy of undetermined significance (MGUS), a precursor to multiple myeloma. The clinical implications of this are quite large, states Þórir Einarsson Long, one of the authors behind the new study.

 

Photo of Þórir Einarsson Long: University of Iceland/iStopMM

 

“As you get older you are more likely to have both MGUS, and myeloma, and other related diseases and you’re also more likely to have kidney disease. The number of people with chronic kidney disease and possibly some pre-malignant or malignant state of monoclonal gammopathies is quite a large group. It’s been very unclear until now how to interpret the results of this important test in individuals with kidney disease,” he says to NLS.

There is also a lot of genetic data, but it’s also a limitation as it’s mostly Caucasian and very genetically homogeneous. That is maybe the largest limitation to this study, whether it could be replicated in other populations.”

He also says that being a small nation is both a strength and a limitation.

“We have good records of individuals and their diseases, and it is easy to follow up with these individuals. There is also a lot of genetic data, but it’s also a limitation as it’s mostly Caucasian and very genetically homogeneous. That is maybe the largest limitation to this study, whether it could be replicated in other populations,” he says.

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