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Articles

Researchers analyzed the association between adherence to a Mediterranean diet and obesity cancers, with a focus on the mediating role adiposity plays throughout the process.

Mediterranean Diet Adherence Reduced Risk of Obesity-Related Cancer

All dosages of semaglutide (Wegovy) under the new program will be available at $499 per month for patients that are uninsured or who do not have coverage for obesity medication.

Novo Nordisk to Provide Cash Options for Wegovy Through Online Pharmacy

Investigators found that zonisamide was associated with a reduction in monthly migraine days for pediatric populations.

Data Show Association Between Seizure Medication and Reduction in Migraine

In a third installment of our interview series with Chris Robinson, MD, PhD, we looked at the future of pain management and emerging technologies being used for treatment.

Q&A: The Role of Emerging Technologies in the Future of Pain Management 

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Using healthcare professionals to market products is not illegal, but has gained considerable scrutiny from authorities.

Opinion: Avoiding "White Coat Marketing" Accusations 

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

Artificial intelligence (AI) has made its way to health care and it is not leaving anytime soon. As with many new technologies, AI’s initial adoption has presented a variety of challenges and opportunities. But with its ability to serve as a tool for providers—rather than a replacement—AI may be the catalyst for a revolution in health care.

“AI is already here and already being used. It's being used a lot with drug discovery, research, purchasing, and inventory management; those kinds of things,” said Scott Nelson, PharmD, MS, FAMIA, ACHIP, Associate Professor in the Department of Biomedical Informatics at Vanderbilt University Medical Center. “Within the clinical context, it's also used in some decision support tools for identifying adverse drug events or even providing more context for alerts and drug information. So, there’re little pieces where it's being used.”

Already completing menial pharmacy tasks, Nelson believes that AI can humanize health care in the long-term by giving pharmacists time back to connect with patients and provide care of the utmost value. With almost an insurmountable number of notable challenges in the pharmacy industry today, AI may be a shining light at the end of the tunnel, as long as experts and providers work together to properly integrate it into health systems.

“I really hope that AI can humanize care again and address some significant issues like burnout and just bring back that human element into health care that it feels like we've lost over the years,” he continued.

Aside from his expertise in biomedical information, Nelson was also a contributing author of the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. He co-authored a section of the report titled “Navigating Generative AI: Opportunity and Risk.” 

 caught up with him to further discuss his section of the report and explore the current and potential future roles of AI in the pharmacy profession.

Stay tuned for weekly podcast episodes on 

 every Thursday afternoon. Check out our previous episode with 

Eric Tichy, PharmD, MBA, BCPS, FCCP, FAST

, who was also a co-author of the ASHP 2025 Pharmacy Forecast. In our ongoing coverage of the forecast, Tichy discussed the business of health-system pharmacy and the challenges that often arise.

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our 

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. 

. 2024;82(2). doi.org/10.1093/ajhp/zxae280

As artificial intelligence evolves from a novel technology to commonplace in health care, the pharmacy industry is adapting to its challenges and opportunities.

Health System

The Current, Future Roles of AI within the Pharmacy Profession

Health-system pharmacy has seen impactful growth in the recent past. However, as market pressures and regulatory framework create barriers in a unique health care landscape, the business of keeping health systems sustainable has become a unique challenge for pharmacists and other health-system providers.

“Health-system pharmacy has grown alongside the rapid growth of specialty pharmacy. Because of the high numbers of specialty medications that are generated out of health systems and the special care that goes into providing those medications, health systems have found that they play an important role in making sure patients get those medications,” said Eric Tichy, PharmD, MBA, BCPS, FCCP, FAST, Mayo Clinic Division Chair and Associate Professor at the Mayo Clinic College of Medicine and Science.

 to discuss his role in authoring the American Society of Health-System Pharmacists (ASHP) 

. Tichy contributed to a section titled “The Business of Health Care: Strategic Challenges in Health-System Pharmacy.” He talked to us about growth in health-system pharmacy businesses as well as the challenges impacting reimbursement, access, and costs.

“Even in the provider world, there are differences,” he continued. “A physician's office is different than a hospital infusion area. Some of it is that regulatory framework that I mentioned earlier.”

Discussing the ins and outs of health-system pharmacy business, Tichy provided insights on how these unique players within health care must navigate challenges that many providers elsewhere are not familiar with. Listen to our full conversation with Tichy to learn more about the business side of health-system pharmacies.

, who also co-authored a section of the ASHP 2025 Pharmacy Forecast. In our ongoing coverage of the forecast, Fox discussed the unique position patients and pharmacists are in when dealing with ultra-high-cost drugs.

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

DiPiro JT, Hoffman JM, Tichy E, et al. ASHP and ASHP Foundation Pharmacy Forecast 2025: Strategic planning guidance for pharmacy departments in hospitals and health systems. AJHP. 2024;82(2). doi.org/10.1093/ajhp/zxae280

From market pressures to regulatory framework, Eric Tichy, PharmD, MBA, BCPS, FCCP, FAST, discussed growth in the business of health-system pharmacy and the challenges it has faced.

The Unique Challenges, Growth in the Business of Health-System Pharmacy

Pharmacists’ expertise in medications and managing patients’ prescription regimens makes them the authority, among other providers, for helping patients use and access ultra-high-cost drugs.

Because of their reach in such small amounts of the population, gene and cell therapies have skyrocketed in price, leading to the coining of the term “ultra-high-cost drugs” (UHCDs). According to the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast, UHCDs are commonly reserved for rare and orphan diseases, showing little pharmaceutical demand and driving prices up to the millions.

Erin Fox, PharmD, MHA, BCPS, FASHP, was a co-author for the latest edition of the ASHP’s Pharmacy Forecast, contributing to a section titled “Managing Ultra-High-Cost Drugs.” She joined 

 to dive deeper into this section of the report and gave us her thoughts on the pharmacist’s role in helping patients manage these costs.

“Pharmacists can help patients end up being able to access those products, if we can think of good terms that are agreeable to [the] payer as well as the health system,” said Fox. “Pharmacists uniquely—maybe even different than providers—are very familiar with the payer side as well as the clinical side. I think that ability to have that broad view makes them a really helpful asset to the folks at the health system that might be working on that specific contract.”

Stay tuned for weekly podcast episodes on 

 every Thursday afternoon. Check out our previous episode with 

, who also co-authored a section of the ASHP 2025 Pharmacy Forecast

In our ongoing coverage of the forecast, Watanabe discussed workforce shortages and the role pharmacists play in alleviating them.

Erin Fox, PharmD, MHA, BCPS, FASHP, joined Drug Topics to discuss ultra-high-cost drugs and the American Society of Health-System Pharmacists 2025 Pharmacy Forecast.

Pharmacists as the Authority on Ultra-High-Cost Drugs

With an estimated 75 million Americans living in areas of primary workforce shortages, health care experts and providers around the country are teaming up to address the issue. In a push to utilize the expertise of multiple providers, health care professionals believe it is necessary for pharmacists, physicians, and various other providers to work together in a team-based setting to ensure better outcomes and alleviate shortages.

“When we really think about the provider, the pharmacist [should] not [be] left out of that dialog, because we saw that also during the pandemic,” said Jonathan Watanabe, PharmD, MS, PhD, BCGP. “Pharmacists took on this heroic role, but that role, that emotional toll, the time, and the fatigue, those components weighed heavily. We have to be really strategic about incorporating that, otherwise the gains that we're going to have, potentially for pharmacists being involved, are going to be short lived.”

Watanabe was a contributing author for the American Society of Health-System Pharmacists (ASHP) 2025 Pharmacy Forecast. The section he co-authored, titled “Addressing the Gap in Primary Care,” focused on identifying gaps within the primary care workforce, possible legislation to alleviate the issue, and the role pharmacists can play within a team-based practice to address shortages.

“How do we make sure that we make pharmacists whole for these contributions that they're making to primary care? I think a lot of that really needs to be looked at and there's groups that are doing it, but I think we need to enhance that,” he continued.

Listen to our full conversation with lead Pharmacy Forecast author Jonathan Watanabe as he discusses the scope of pharmacists’ practice, highlighting past instances of their unique skills within the community and their future potential to be key players within a primary care team.

“I think we're getting better at understanding how collaborative practice agreements can be best developed to maximize. I think it's almost the implementation science of it is now becoming very important. We know that it works, but how to do it in a way that's going to meet the needs of the setting, of the population, that we could show the benefit.”

Stay tuned for weekly podcast episodes on Over the Counter every Thursday afternoon. Check out our previous episode with 

, who also played a part in the 2025 Pharmacy Forecast as leading co-editor. In our ongoing podcast series on the ASHP 2025 Pharmacy Forecast, DiPiro introduced the industry-encompassing report and why it’s such a crucial resource for health-system pharmacy.

Jonathan Watanabe, PharmD, MS, PhD, BCGP, discussed gaps within primary care in the context of the American Society of Health-System Pharmacists 2025 Pharmacy Forecast.

Jason Mehta

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