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See what’s trending in pharmacy with a preview of the Total Pharmacy December issue.

In This Issue: Total Pharmacy December 2024

Articles

Denise Kelley, PharmD, BCPS, FASHP, joined Drug Topics to discuss various medications for chronic kidney disease and their common adverse reactions.

Q&A: Pharmacists’ Understanding of CKD Therapies, Adverse Effects | ASHP Midyear

A conversation with Nina Vadiei, PharmD, BCPP, clinical associate professor in the Division of Pharmacotherapy at University of Texas at Austin College of Pharmacy and a clinical pharmacy specialist in psychiatry at the San Antonio State Hospital.

Psychiatric Pharmacist Working to Optimize Treatment, Improve Patient Safety

Kathryn Litten, PharmD, discussed the pharmacist’s role in helping patients manage metabolic dysfunction-associated steatotic liver disease.

Q&A: Importance of Managing Comorbidities for Patients with MASLD | ASHP Midyear

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A conversation with Chelsea Keedy, PharmD, BCACP, clinical assistant professor at the University of Georgia.

Pharmacists Play Key Role in Educating Patients About RSV Vaccine | ASHP Midyear

journal explores issues within pharmacy, from the impact advocacy can have in community pharmacies to staffing shortages across multiple sectors within pharmacy. This month’s issue also explored the importance of disease awareness months and how they are opportunities to maximize valued care. Check out a preview of this month’s issue here.

download the PDF of the Total Pharmacy August 2024 issue here

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See what’s trending in pharmacy with a preview of the Total Pharmacy August issue.

Total Pharmacy

In This Issue: Total Pharmacy August 2024

Combining sodium glucose co-transporter 2 inhibitors (SGLT2is) with glucagon-like peptide-1 receptor agonists (GLP-1RAs) may offer additional protection against cardiovascular and kidney disease in patients with type 2 diabetes (T2D), according to the results of a new meta-analysis published in 

 and presented at the 61st European Renal Association Congress in Stockholm, Sweden.

Separately, SGLT2is and GLP-1RAs have demonstrated cardiovascular benefits. However, little clinical literature has focused on outcomes associated with using the medicines together. Due to the growing prevalence of GLP-1RAs in the 

 and obesity landscape, accelerated by an increasing number of indications for the agent class, this is a crucial area for further study.

The SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) is the largest assessment of outcomes for the combined therapeutic use of SGLT2is and GLP-1RAs. The study gathered data from 12 large-scale, placebo-controlled trials of SGLT2is involving 73,238 patients with diabetes. Of these, 3065 were already receiving GLP-1RAs.

Overall, SGLT2is lowered the risk of major adverse cardiovascular events by 11% and hospitalization for heart failure or cardiovascular death by 23% compared to placebo. Notably, this benefit was seen regardless of whether patients were also taking GLP-1RAs.

When used together with GLP-1RAs, SGLT2is reduced the risk of chronic kidney disease progression by 33% and slowed the annual loss of kidney function by nearly 60%.

The study found no additional safety concerns when SGLT2is were used in combination with GLP-1RAs.

Study Reveals Robust Benefits of Semaglutide in Protecting Against Kidney, CV Events in Patients With T2D

Current meta-analysis results build off positive results of the landmark FLOW trial (

). Published earlier in May, results of the international, double-blind, randomized, placebo-controlled phase 3 trial spotlighted semaglutide’s effectiveness in lowering the risk of kidney failure, decelerating worsening kidney function, and protecting against the risk of cardiovascular events and death, in patients with T2D.

“SGLT2 inhibitors have clear protective effects against heart failure and chronic kidney disease, while GLP-1 receptor agonists can reduce the risk of heart attack, stroke, and also kidney disease—as recently demonstrated in the landmark FLOW trial,” said Brendon Neuen, lead author, clinical associate professor, senior research fellow at The George Institute for Global Health, and director of kidney trials at Sydney’s Royal North Shore Hospital, in a news release.

 “Our findings support using this combination to further improve outcomes in patients with type 2 diabetes who meet guideline recommendations for both therapies.”

Elevated glucose from diabetes can damage blood vessels in the heart and kidneys, increasing the risk of 

 and kidney disease. In fact, diabetes is the most common cause of chronic kidney disease.

Moreover, estimates predicting that T2D prevalence will more than double in the next 30 years, surpassing 1 billion global cases by 2050, further strengthen the need for research into diabetes care.

 According to Neuen in an interview with 

 conducted over email, the current study offers valuable insights for developing global treatment strategies for the condition.

"These findings, which represent the largest and most comprehensive evaluation of the combined use of SGLT2i and GLP-1RA, provides the clearest evidence yet that combined use of both medicines can further reduce cardiovascular and kidney disease," said Neuen. "We anticipate that these findings will inform how people with diabetes are treated worldwide, including influencing major clinical practice guidelines.

Although current results suggest that using SGLT2is and GLP-1RAs in tandem may offer robust protection against cardiovascular and kidney disease, further research is needed to fully understand the long-term effects of the combination therapy.

Pharmacy practice is always changing. Stay ahead of the curve: Sign up for our 

 and get the latest drug information, industry trends, and patient care tips, straight to your inbox.

1. Apperloo E, Neuen BL et al. Efficacy and safety of sodium glucose co-transporter 2 inhibitors with and without glucagon-like peptide-1 receptor agonists: A SMART-C collaborative meta-analysis of randomised controlled trials. 

. 2024. doi: 10.1016/S2213-8587(24)00183-9

2. Massaro L. Study reveals robust benefits of semaglutide in protecting against kidney, CV events in patients with T2D. 

https://www.drugtopics.com/view/study-reveals-robust-benefits-of-semaglutide-in-protecting-against-kidney-cv-events-in-patients-with-t2d

3. Combining popular diabetes drugs offers complementary heart and kidney benefits. News release. The George Institute for Global Health. July 9, 2024. Accessed July 10, 2024. 

https://www.georgeinstitute.org/media-releases/combining-popular-diabetes-drugs-offers-complementary-heart-and-kidney-benefits

4. Mayo Clinic Staff. Chronic kidney disease. Fact sheet. Accessed July 8, 2024. 

https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

5. Klein HE. Diabetes prevalence expected to double globally by 2050. 

https://www.ajmc.com/view/diabetes-prevalence-expected-to-double-globally-by-2050

When used together, sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) were able to lower the risk of major adverse cardiovascular events and kidney disease by 11% and 33%, respectively.

Clinical

SGLT2i, GLP-1RA Combination Therapy Offers Robust Protection Against Cardiovascular, Kidney Disease

SGLT2 Inhibitors Recommended for Treating CKD

From glucagon-like peptide-1s (GLP-1s) to non-steroidal mineralocorticoid receptor antagonists (ns-MRAs), there are multiple variations of medications suited to treat chronic kidney disease (CKD). However, when it comes to the beginning of a CKD medication regimen, experts believe sodium-glucose cotransporter-2 (SGLT) inhibitors are the standard medications for patients with CKD and an estimated glomerular filtration rate (eGFR) equal to or greater than 20.

“Specifically, canagliflozin (Invokana) has been FDA approved for diabetic kidney disease. Empagliflozin (Jardiance) and dapagliflozin (Farxiga) have been approved for [CKD] in general,” Denise Kelley, PharmD, BCPS, FASHP, told 

At the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana, Kelley gave a presentation titled “Nephr Give Up: Pharmacologic Strategies for Slowing Chronic Kidney Disease Progression.” She discussed the various medications approved for CKD and the specific opportunities for when patients can benefit from them.

After her presentation, Kelley caught up with 

 to further discuss therapies that treat CKD. She also talked about the additional comorbidities that patients with CKD commonly experience, touching on the possible drug-drug interactions that accompany these patients.

2024 ASHP Midyear Clinical Meeting and Exhibition here

Denise Kelley, PharmD, BCPS, FASHP, discussed the efficacy of medications designed to treat the progression of chronic kidney disease.

Health System

SGLT2 Inhibitors Recommended for Treating CKD | ASHP Midyear

How Pharmacists Can Help Patients Manage MASLD

Nonalcoholic fatty liver disease, now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD), is prominent in nearly 25% of the US population, according to the American Liver Foundation.

 While many therapies have come to market to calm patients’ MASLD symptoms, some individuals need further attention in order to achieve the best outcomes.

Kathryn Litten, PharmD, clinical assistant professor at the University of Texas at Austin’s College of Pharmacy, met up with 

 at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana. She discussed MASLD therapies in a presentation titled “Getting the Skinny on Existing and Emerging Therapies for Non-Alcoholic Fatty Liver Disease

“Using motivational interviewing strategies is so important for us as pharmacists to talk to our patients and to help encourage them to promote that weight-loss and promote those healthy outcomes,” said Litten.

She discussed how pharmacists are uniquely positioned to not only provide therapies for patients with MASLD, but also counseling. From their knowledge of medications to the efficacy of lifestyle behaviors, Litten believes pharmacists play a vital role as part of the health care team in treating liver disease.

1. Nonalcoholic fatty liver disease (NAFLD). American Liver Foundation. October 24, 2024. Accessed December 11, 2024. 

https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-fatty-liver-disease-nafld/

Kathryn Litten, PharmD, joined Drug Topics to discuss how pharmacists can counsel patients with metabolic dysfunction-associated steatotic liver disease.

How Pharmacists Can Help Patients Manage MASLD | ASHP Midyear

iA provides centralized pharmacy fulfillment solutions for retail, health system, and government pharmacies, using semi and fully automated technology to help pharmacies streamline their workflows and put a greater focus on their business’ bottom line.

While large-chain retail pharmacies and supermarkets were the early adopters of the centralized pharmacy fulfillment model, there’s been significant growth lately as more independent pharmacies and health systems are discovering the benefits of using centralized fulfillment. These pharmacies are showing a concerted effort to reclaim reimbursement, alleviate workforce burnout, and ultimately improve their bottom line.

“We're now seeing growth in smaller retail independents, but also in the health system market. More and more there's staffing challenges out there of pharmacists being overburdened and also just reimbursement pressures overall. We're really seeing more interest beyond the bigger initial adopters [of central fulfillment] that we saw in the market,” said Tom Utech, PharmD, CEO of iA.

iA modular robotic systems and adaptable dispensing units are designed to seamlessly integrate with existing pharmacy workflows utilizing NEXiA Software Suite.

“Our software produces a lot of knowledge and insight for the customer to be able to optimize their systems. [We’re] really looking at historical patterns, and patterns that are seen today, both in dispense profiles and how they're staffing the site to be able to understand what's the optimum go-forward plan to meet the customer needs,” continued Utech.

To learn more about centralized fulfillment and how it’s impacting pharmacies today, listen to the 

 of our discussion with iA’s Tom Utech.

Tom Utech, PharmD, CEO of iA, joined Drug Topics to discuss his company’s centralized pharmacy fulfillment solutions.

Total Pharmacy Interviews

How Centralized Fulfillment is Making Pharmacy More Efficient

Since the discovery of the HIV virus in the early 1980s, the last 40 years have seen exponential advancements regarding patient care in the HIV space.

 From the peak of AIDS stigmatization to the promotion of pre-exposure prophylaxis (PrEP), patients living with HIV are no longer left in the dark when it comes to receiving care. However, experts within the space still believe more needs to be done to advance what the industry knows about HIV and AIDS.

Jay Holloway, PharmD, AAHIVP, is a staff pharmacist with the AIDS Healthcare Foundation. He sat down with 

 to discuss the current status of HIV care in the state of California and beyond.

“HIV is, nowadays with our developments in medicine, a very manageable health condition. If you're adherent to your medications, then we can get you down to undetectable levels,” said Holloway.

Find out more about the current developments surrounding HIV care from the perspective of a certified pharmacist with experience in this area. Also, be sure to stay tuned for more content from our interview with Holloway, diving deeper into developments in the HIV space and how pharmacists are viewed amongst other providers working with patients who have AIDS.

Lenacapavir for PrEP Demonstrates Strong Efficacy in Second Phase 3 Trial

: How would you describe the current state of HIV medications within the US drug supply chain? Are these medications thriving, failing, or plateauing in regard to success and improving patient outcomes?

 I can't speak to the state of other states, but here within California, the situation is good in terms of supply. We're able to have meds accessible. I haven't seen any issues with medication shortages. In regards to antiretrovirals (ARVs), one of the things that has been wonderful has been single-tablet regimens; how that is the go-to medication regimen to start patients on when we do a quick start of ARVs at the clinics. For single-tablet regimens, the fewer pills that a patient has to take, the better the adherence, the better the outcomes.

We're also seeing an increase in the use of injectable ARVs, which is CABENUVA (cabotegravir). Injectable ARVs are really helpful for our patients who may have, due to scheduling issues, due to forgetfulness, or any other reason, difficulty taking a tablet every day. Many patients just don't want to take a tablet every day. We have to meet those patients where they are. For patients who qualify for CABENUVA, that is a good option.

One of the nice things about practicing in California is we also have a very strong ADAP program, which for people living with HIV, enables them to get not just their ARVs, but also other medications at zero cost to them. People can get not just their ARVs through us, but they can get their entire set of maintenance medications as well.

: Are there specific developments in the HIV space that have made a significant impact on patients in recent history?

 I would definitely say the long-acting injectables has been the biggest development that I'm most excited about because that just gives us another tool for patients. It also especially helps for patients that have major difficulties with adherence. It's really nice that you can just come in every 2 months, get your injection, and be done with it. However, there are some patients who are still falling through the cracks in that regard, and that's why we should still continue to refine our long-acting injectables.

One of the things I'm very excited about is the PURPOSE trial, which utilizes lenacapavir for PrEP. We saw the results of the PURPOSE 1 trial come through and it shows that long-acting injectables for PrEP for cisgender women and girls is a good option. Now, PURPOSE 2, we're hopefully going to get the results of that soon, and that will focus on PrEP for all other populations. One of the things I feel that's important to improve patient outcomes, especially in a condition like HIV, is having a bunch of different tools, having not just your single-tablet regimens, but also having injectables, having things where you can meet the patients at their needs.

: What is one thing about HIV as a whole that you think the general public should understand?

 One of the things that I want to tell people who maybe just recently had a new diagnosis, or they may not know very much about HIV, is that it is nowadays—with our developments in medicine—a very manageable health condition. If you're adherent to your medications, then we can get you down to undetectable levels. There is also the concept of U equals U, which is undetectable equals untransmissible, which means that if you have an undetectable viral load, you cannot transmit it via sex.

A positive status is not an indicator of one's morality. It's just another thing that patients have, like high blood pressure or asthma. We're here to support you. I think for people who want to be allies in health care and want to end the HIV epidemic, we can't just provide meds, but we also need to address disparities. There's a really good quote from a presentation by Black and Pink, which helps incarcerated and formerly incarcerated people living with HIV: “If you want someone to take meds to save their life, you have to give them a reason to live.” And I hope that inspires people who want to help end the HIV epidemic to not just make sure meds are available, but also to address those health disparities and to do things in their everyday life, no matter how small, that make the world more accessible and equitable.

1. 40 years of HIV discovery: the virus responsible for AIDS is identified on May 20, 1983. Institut Pasteur. Published May 15, 2023. Accessed November 27, 2024. 

https://www.pasteur.fr/en/research-journal/news/40-years-hiv-discovery-virus-responsible-aids-identified-may-20-1983

Jay Holloway, PharmD, AAHIVP, Pharmacist with the AIDS Healthcare Foundation, discussed the ongoing developments impacting patients with HIV and their prescription drugs.

Chelsea Keedy, PharmD, BCACP

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