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Articles

Researchers compared changes in diet quality and waist-to-hip ratio during midlife with that of hippocampal connectivity and cognitive function in later life.

Healthier Diet, Lower WHR Improved Cognitive Brain Function

Approximately, 62% of respondents stated that the number of active drug shortages could potentially increase by more than 25% within the next 5 years.

Drug Shortages, Affordability Remain Top Concerns in Managed Care Pharmacy

With minimal pharmacological treatments coming to market for chronic pain, researchers have explored new technologies for advancing pain treatment across the globe.

What Does the Future of Pain Medicine Look Like?

US Senators on both sides of the aisle came together to announce the Protecting Pharmacies in Medicaid Act.

Bipartisan Bill Aims to Combat PBMs’ Medicaid Spread-Pricing

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Authors

Jeffrey P. Bratberg, PharmD, BCPS, is a clinical professor of Pharmacy Practice, University of Rhode Island, College of Pharmacy, Kingston, RI.

A conversation with Ginger Lemay, PharmD, Jeffrey Bratberg, PharmD, and Audrey Whalen, PharmD.

Q&A: Pharmacist Prescribed Contraception Can Mitigate Barriers to Care

Investigators from the University of Rhode Island College of Pharmacy discuss 2 studies that assessed perspectives on pharmacist prescribed hormonal contraceptives.

Majority of People Support Pharmacist Prescribed Hormonal Contraceptives

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

According to Chris Robinson, MD, PhD, a future with no acute and chronic pain is much further down the line than optimists may expect. However, throughout his work researching new technologies for the treatment of pain, he believes there is a future where chronic is mitigated beyond what has been capable in the past.

“I think we have to understand what is pain, why it's there, and not have our hopes up that we think we can get 100% pain relief,” he told 

. “Our bodies do degenerate, and we have to understand that. My goal, and especially with these newer technologies, is to use it to mitigate pain in the present moment.”

With emerging technologies in the pain management space, as well as an immense amount of capital pouring into it, he believes finding objective measures for chronic and acute pain is the first step in advancing what we know about this subject.

Robinson, who is Director of Pain and Headache Rounds at Harvard-Massachusetts General Hospital, sat down with us to discuss the future of pain management in emerging technology, including virtual reality (VR), neuromodulation, artificial intelligence, wearable technology, and psychedelics.

Stay tuned for our full conversation with 

 podcast channel and get a full breadth of where the industry is at regarding pain management technology, and where it’s headed going forward.

Q&A: Innovative Technologies Revolutionizing Pain Medicine

: Do you believe that these technologies have the future potential of finally alleviating issues of pain within the US, or do you think chronic pain is something that will burden the population indefinitely?

I think we will never be able to get rid of pain long term. If we're 65, 75, 85, our body is continuing deteriorating. There's a degenerative process occurring. In order for us to really stop pain, we have to regenerate our tissues, our cartilage, our joints, our muscle. It's hard to maintain muscle as you get older. Until we're at that point, it may be quite difficult because we have trillions of cells in our body. To coordinate that process can be difficult. There is a hope of regenerative medicine, but we may not be at that point at the moment. Can everything that we're doing now alleviate pain? I think we can push it off until further.

Let's say, you got a virtual reality headset. You just had a total knee replacement. Your knee is hurting still. You don't want to go to physical therapy because you have no one to take you. You put on that headset. You have an avatar talking with you. You get up, you're moving around at your home. Instead of you not going through physical therapy appointment, you have your headset. Now we have changed your path. Your acute pain after your knee replacement doesn't become chronic pain. Rather than having to become a chronic pain patient at the age of 55, we've gotten you moving again and again and again, and maybe that pain returns at the age of 65. We alleviated or pushed off that chronic pain for 10 years, but then again, at 65 maybe other joints are going.

Will we be able to cure pain entirely? At the current moment, I don't think we're going to get that point. Unless [with] Neuralink, we can transfer conscience into another new body, or into the cloud—joke, but not a joke. I don't see us alleviating pain entirely. I do see us giving patients better pain relief that's targeted, personalized medicine. I can prevent that conversion to chronic pain. I can delay the degeneration of some of your joints with regenerative medicine. I think we need to come to terms with what pain is. A lot of it is psychological and we don't do such a great job, just generally, on treating that as well. There's not a sufficient number of properly trained professionals to handle that aspect. Chronic pain and mental health, they're tied. About 80% of chronic pain patients have some sort of mental health disorder, which when you treat one, the other one gets better.

I think in order for us to really, truly get the maximal impact with our current treatments is to incorporate both mental health and pain treatment. And again, how do we do that? We can use AI virtual reality to provide some mental health treatments. We can use psychedelics or new oral therapeutics that are coming out to tone down the initial acute pain. Someday, I would love to cure pain, but I think we have to understand what is pain, why it's there, and not have our hopes up that we think we can get 100% pain relief. Our bodies do degenerate, and we have to understand that. My goal, and especially with these newer technologies, is to use it to mitigate pain in the present moment.

: What are your short- and long-term hopes for these emerging technologies?

My short-term goals are to start clinical trials, to reopen the spigot of new drug discoveries for pain. We have Vertex that came out with suzetrigine. There's Xgene that's coming out with a potential new pain drug. Short term is to really understand what these new oral therapeutics are doing for us, [and] to provide objective measures for our current interventional treatments. Your 1 out of 10 smiley face versus the frowny face may be different for you than it is for me. I want to find ways to provide objective outcomes for a lot of our treatments, so that they're here to stay.

Long term, it's more about personalized medicine. Your perception of pain may be very different of my perception of pain. Maybe my pain tolerance is not really there. That's not to say that your pain of 8 out of 10 is any worse than my 3 out of 10. Let's say I have a higher pain tolerance. There should be and there will be, I know at some point, more objective measures of pain. Just the way, if your heart is dysfunctional and you're in atrial fibrillation, or you have a heart attack, we can now objectively measure that.

At some point we will have some sort of objective measure of pain. Whether it's going to be in a decade or 50 years or next year, these are my long-term goals. I think it's not fair for someone who's been in the field for 50 years, whose knee pain—if you transfer that knee pain to me—that would probably crush me. It's not fair to that individual to say their knee pain is 2 out of 10 versus, let's say, I live in the city and my knee pain is 10 of 10, when it's actually 2 out of 10, but I'm getting more attention. That individual who's had a tougher life doesn't want to say, ‘Oh, you know, it's excruciating.’ So long term, I want to find objective ways to advocate for patients, because it's not fair that some payers put a cut-off for pain as a way to say, ‘Hey, you know what, we're not going to approve this.’ Well, that's not fair to the patient. Subjectively, I want to find objective measures for our outcomes as well as for our patients. You may say you're 2 out of 10, but we can detect that you're in significant pain. That's not fair. So long term, offering patients personalized pain treatment as well as more objective measures to say these treatments work [and] payers should cover them.

And one thing I did not mention is that chronic pain, if you adjust for inflation, it's well over $1 trillion to the health care system. We have new drugs come out for heart disease, cancer, diabetes, but yet, chronic pain consumes more health care dollars than all those 3 together. But if you look at the number of treatments coming out for those 3, it's insignificant to what's coming out for pain. Two new approvals versus the plethora that's coming out for all those 3. Long term, we need more awareness. At some point, you and I will have chronic pain whether we see a physician or not. It would be nice [if] there's treatments out there for everybody.

Q&A: Why Educating Patients on Emerging Pain Technology is Key

Slitzky M, Yong RJ, Lo Bianco G, et al. The future of pain medicine: emerging technologies, treatments, and education. 

. 2024 Aug 30;17:2833-2836. doi: 10.2147/JPR.S490581.

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 

Join Shawn Bjorndal, PharmD, RPh, and Jesse McCullough, PharmD, for the first episode of Dispensing Leadership, a new podcast from Drug Topics and RPhAlly.

Dispensing Leadership: Defining Your Philosophy

In today’s complex health care landscape, having leadership skills is an integral part of being a pharmacist. Strong leadership skills allow pharmacists to improve workflows, successfully guide their teams, and improve health outcomes. Without them, the result is disjointed dispensing of medication, uncoordinated patient care, and stagnated innovation.

In Dispensing Leadership, a new podcast offering from Drug Topics® and RPhAlly, Shawn Bjorndal, PharmD, RPh, a visionary health care executive with over 16 years of experience and founder of PGxAlly, and Jesse McCullough, PharmD, a pharmacist-turned-entrepreneur with a passion for leadership development, will discuss essential leadership skills for pharmacists, how to develop them, and, ultimately, how to advance the pharmacy profession.

In the first episode, Shawn and Jesse discuss why defining a philosophy is key for pharmacists who want to excel in their career. Jesse outlines the key components of creating a philosophy, including taking an inventory, asking how it can serve you, and the importance of not being afraid to upgrade or change if there are better ways to think about it.

“My call to action would be, to begin by taking an inventory,” Jesse said. “What are some of those common phrases or what are some of those common beliefs that you have? Those are absolutely your philosophy. Take an inventory of that. As you make that list, you need to ask yourself, ‘How do those philosophies serve me?’ Are they beneficial or are they detrimental to the work that you are trying to do?”

Be sure to tune in every month on Drug Topics for important conversations that will help you develop your skills to become an effective pharmacy leader. All episodes of Dispensing Leadership will be available in a video format via 

, with an audio version available through Spotify.

1. Aman M, Arakawa N, Anderson C. Leadership competencies and behaviors in pharmacy: A qualitative content analysis. 2025. 

https://doi.org/10.1016/j.sapharm.2025.02.001

Join Shawn Bjorndal, PharmD, RPh, and Jesse McCullough, PharmD, for the first episode of Dispensing Leadership, a new podcast from Drug Topics® and RPhAlly.

Practice Management

Increasing vaccine administration at complementary sites—including pharmacies, mobile clinics, and pop-up clinics—may help expand access in the United States, according to data published in the 

Journal of the American Pharmacists Association

While vaccines remain effective for preventing infectious disease, the United States still fails to meet certain national targets, with disparities that persist in different racial and ethnic populations. In this study, the researchers wanted to explore the possibility of expanding vaccine delivery by nonphysician healthcare providers (NPHPs) in settings outside of traditional clinics.

The researchers conducted interviews with healthcare providers (HCPs) and vaccination policy experts. They aimed to better understanding perspectives and experiences with complementary settings and vaccine administration by NPHPs. They also sought to determine how policies and patient preferences affect initiatives to increase vaccine administration and to determine any barriers or facilitators to vaccine administration.

Overall, 38 participants completed interviews between April and August 2021. Each interview was conducted by 2 moderators to help reduce bias and variance in interview style; the interviews themselves centered around a pre-tested, structured interview guide.

Out of all participants, 47.4% were NPHPs, 21.1% were physicians, 18.4% were advocates, and 13.1% were policy makers. More than half (60.5%) worked in health care delivery, 31.6% worked in academic research, 28.9% worked in education, and 18.4% worked in program implementation, policy making, and advocacy. Places of employment included hospital/clinic (34.2%), academic institution (26.3%), nonprofit or governmental organization (13.2%), local government agency (7.9%), pharmacy (5.3%), and national government agency (2.6%).

The results indicated that views around vaccine delivery shifted significantly since the COVID-19 pandemic—during the pandemic, there was an increased use of complementary sites for vaccine delivery. The participants noted that these delivery systems increased visibility and use by the public. Notably, participants discussed the success of “drive-through” vaccination locations, which largely did not exist before the pandemic.

Patient preference, paired with site convenience, played a key role in willingness to receive a vaccine at a complementary site. Some patients continue to express preference to receive a vaccine in a clinical setting, while others were willing to be vaccinated at a complementary site due to the convenience. Participants noted that the more flexible hours and reduced costs associated with complementary sites were major advantages. They also said that perceived cleanliness and professionalism was important to make patients feel confident in receiving vaccines at complementary sites.

When asked, most participants indicated that they believed patients would be comfortable receiving vaccines from NPHPs. Again, many participants cited the COVID-19 pandemic with increasing patient confidence in NPHP vaccine administration. However, some participants noted that certain patient populations, including those with chronic or complex health conditions, should only receive vaccines from physicians rather than NPHPs. Currently, there is no standardized training program for vaccine administration for clinical and complementary providers; this may represent an area for future improvement.

Participants identified several factors that can be barriers to vaccine access for vulnerable populations, including language barriers, digital literacy, limited technology access, out-of-pocket costs, and transportation barriers. For NPHPs administering vaccines to these populations, the participants underscored the importance of understanding cultural and subcultural issues affecting these patients.

In order to increase confidence and trust in NPHP vaccine administration, participants noted that physicians play a key role. Patient willingness to receive vaccines at complementary sites can be strongly influenced by their physician’s opinion. Participants also believed there is an opportunity for scope of practice laws to empower more health care providers to administer vaccines.

“In particular, participants advised that state and local public health and patient advocacy organizations should work with state and local level governments to overcome logistical and bureaucratic hurdles to ensure NPHPs are able to practice to the top of their license,” wrote the researchers.

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.

1. Eiden AL, Cagle C, Esselman K, et al. Exploring perspectives on vaccinations delivered in complementary nonclinical settings and by nonphysician health professionals: A qualitative interview study. 

. 2024;e102193. doi:10.1016/j.japh.2024.102193.

In order to meet national targets, the United States should expand vaccination administration in complementary sites like pharmacies.

Jeffrey P. Bratberg, PharmD, BCPS

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