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Articles

Research found that SGLT2 inhibitors were associated with a lower risk of major cardiovascular events or hospitalization for heart failure.

SGLT2 Inhibitors May Have Clinical Benefits For Patients with Diabetes After Myocardial Infarction | ASHP Midyear

Lisa Faast, PharmD, discusses how to use technology to innovate within the pharmacy.

Must-Have Tools for Pharmacy Innovation

Whether due to jet lag, stress, major life events, or something else, there are a lot of issues that can cause short-term insomnia. Send patients on their way to a better night’s sleep with these OTC sleep aid recommendations.

OTC Product Roundup: Sleep Aids

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Ethan Melillo, PharmD, CDOE, senior manager of Integrated Health at L’Oréal, provides some of his favorite recommendations to help with irritated skin.

Top Products to Help with Winter Skin Concerns | ASHP Midyear

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Denise Kelley is a clinical assistant professor at the University of Texas at Austin's College of Pharmacy and a clinical pharmacy specialist of internal medicine at the University of Texas at Austin's Dell Seton Medical Center.

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

SGLT2 Inhibitors Recommended for Treating CKD | 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

Don’t get left behind: Sign up today for our 

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

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

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.

Q&A: Pharmacist on Medication Developments for People Living with HIV

With advancements in HIV care and ongoing collaboration amongst providers in this space, pharmacists have since separated themselves as a premier resource for patients living with AIDS. From pharmacist-friendly consultations to medications that have made the HIV virus undetectable, there are now more tools than ever in the HIV space that allow pharmacists to work at the top of their license.

“One of the really lovely things about California pharmacy law is they leave it very open for pharmacist collaboration with other providers under collaborative practice agreements. It's a very much ‘the world is your oyster’ type of situation, which is really lovely,” said Jay Holloway, PharmD, AAHIVP, Pharmacist with the AIDS Healthcare Foundation (AHF).

In part 2 of our interview series with Holloway, we discussed issues and challenges within the HIV space, and how pharmacists have stepped in as vital providers for people living with HIV.

Specialty Pharmacist Transforms HIV Care Outside of the Pharmacy

: Where do you think your specific focus area of HIV in the pharmacy is lacking? Do you have any insights on how the industry can be improved?

It has been talked about many times before that, while we do have the technology and we do have the medications to successfully manage HIV, there are definite major disparities in access to care for historically marginalized and oppressed groups. There are disparities of access to care by race; by economic class; by gender modality, such as cisgender or transgender individuals. Also, a big thing that I think should be addressed more is that there is major stigma to getting tested, to finding out your status, to accessing PrEP (pre-exposure prophylaxis). In some states, there are also laws that criminalize people living with HIV if they don't disclose their status, which can make a person more liable if they know their status versus if they don't know their status and accidentally pass it on to a partner. When addressing marginalized groups, we also need to be looking at systemic inequalities and not just things that are directly affecting the patients getting the meds, but also barriers to getting their food, getting their housing, getting adequate medical care, feeling safe.

That pivots into one of the things where we'll have patients who are unhoused, for example, and they're living with HIV. They need to make sure to take their medications daily or come in for their every 2-month appointment in order to stay undetectable. But when we're getting patients to be adherent, we also need to be cognizant of the fact that, if a person is struggling with day-to-day survival, they're not going to be prioritizing taking a medication that down the line will prevent them from complications in the future. Yes, it's important to take the ARVs (antiretrovirals), but if a person is like, “Well, I don't know where I'm going to sleep tonight or where I'm going to eat tonight.” We need to focus to also address that need as well.

: From your perspective, how do you think pharmacists are viewed within the HIV space? Do you feel like you and your peers receive the recognition you deserve?

One of the things I really love about working with AHF is that there is major collaboration between the pharmacists and the clinic providers. We have pharmacists at the clinics themselves that are doing medication consultations for patients. Every new patient, we do something called an initial assessment, where we go over the medications with them. We record their allergies, any existing medications they're on, their most previous labs. That enables us to see patients where they are and talk about them with the meds, assess their initial levels of understanding about their condition. One of the really nice things is I get time to know my patients a lot more closely. They can tell me about, “I have been struggling with depression since my new diagnosis,” or “I am dealing with these issues at home,” or “I need specific confidentiality needs in order to make sure that my status isn't disclosed.” That's really nice. I think at our workplace, we're operating with pharmacists at the top of our capability as providers.

Additionally, one of the things I have really liked is how my pharmacy peers at my location, which is East LA, have been very supportive of initiatives that I have wanted to develop. In California, under SB 159, we're able to furnish PrEP through our pharmacies. People come in when a tester is available, they do a rapid test, and then we get them started. We've been wanting to talk about expanding those pharmacy services because one of the really lovely things about California pharmacy law is they leave it very open for pharmacist collaboration with other providers under collaborative practice agreements. It's a very much “the world is your oyster” type of situation, which is really lovely.

Are you ready to elevate your pharmacy practice? Sign up today for our 

Jay Holloway, PharmD, AAHIVP, Pharmacist with the AIDS Healthcare Foundation, joined Drug Topics to discuss the role pharmacists play in providing care for people with HIV.

Q&A: How HIV Care Has Allowed Pharmacists to Practice at the Top of Their Licenses 

Laird Leavoy is President of American Pharmacies, a member-owned purchasing cooperative for independent pharmacies with members across the nation. We spoke with Laird about his journey in mastering and sharing the principles of leadership and its vital role in the independent pharmacy community.

“Leadership is a foundation of my life,” said Leavoy. “Leadership’s all about the people around you. It’s the people around you being heard. It’s mutual respect.”

Laird has always held a leadership role throughout his professional career. He’s worked for over 35 years in the wholesale drug and pharmaceutical industry. His last position was with AmerisourceBergen (now Cencora) as the Vice President of Retail Pharmacy for the South Region before joining American Pharmacies in 2010. At that time, American Pharmacies was only in Texas with $400 million in sales. Today, they are in over 40 states with $2 billion in total revenue.

 to share his perspectives on leadership and how he demonstrates key leadership qualities in his daily work. From his strategies for recruiting top team members to his approach to communication with colleagues, Leavoy explained why leadership is a crucial quality not only for his organization but also for the pharmacy profession as a whole.

Drug Topics sat down with Laird Leavoy, President of American Pharmacies, to discuss the role leadership plays in the independent pharmacy industry.

Denise Kelley, PharmD, BCPS, FASHP

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