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Opinion: Liquid Glass

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

What was your motivation to pursue the pharmaceutical industry as a career path?

My motivation to pursue a career in the pharmaceutical industry is rooted in my lifelong desire to make a genuine and lasting difference in the lives of patients around the world. Because the pharmaceutical sector plays a critical role in developing and delivering innovative therapies, I was naturally drawn to pursue a career in research and development. Working on phase 3 clinical trials affords me the opportunity to learn something new every day while simultaneously pursuing my goal of improving patient outcomes and health equity outcomes around the globe.

Talk about diversity, equity, and inclusion in the pharmaceutical industry; what should companies be doing to continue making progress?

To continue making progress in improving DEI initiatives within the pharmaceutical industry, companies should prioritize implementing comprehensive diversity initiatives, ensuring fair and inclusive hiring practices, and fostering a supportive and inclusive work environment for all employees. This includes actively seeking diverse talent, establishing mentorship and sponsorship programs for students and post-grads, promoting diversity at the leadership level, and regularly evaluating and addressing any disparities or biases within the organization. Additionally, collaboration with diverse patient communities and stakeholders can help ensure that medicines and healthcare solutions meet the needs of all individuals.

Dr. Filmon Emnetu, PharmD, RPh, is the global clinical trial project manager
at Eli Lilly.

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Industry Pharmacy

An Interview with Dr. Filmon Emnetu, PharmD, RPh

Pharmacist job satisfaction and burnout is a growing challenge to the pharmacy profession as evidenced by a growing quantity and quality of pharmacist data. Survey data from nationally conducted studies of pharmacist practice settings including community, health system, and clinical pharmacy are consistently showing between 40-60% reporting job dissatisfaction and/or burnout.

There are significant concerns that this dissatisfaction may be impacting the well-being of many pharmacists and contributing to decreasing pharmacy school enrollment. It may even have the potential to impact patient safety. Some of the data indicates that over 30% of pharmacists were so dissatisfied that they were either looking to change careers or would not have enrolled in pharmacy school if they had to choose all over again. This data is very disconcerting and reflects continuing trends during the past decade. In fact, recently there have been well publicized pharmacist walkouts at some of the largest community pharmacy chains.

https://www.industrypharmacist.org/resources/2d739c86cc7a4e0cabcaca7825773d9f.pdf

Survey data from nationally conducted studies of pharmacist practice settings including community, health system, and clinical pharmacy are consistently showing between 40-60% reporting job dissatisfaction and/or burnout

Industry Pharmacists Organization (IPhO) Releases a New Report Summarizing the Current State of Pharmacist Job Satisfaction

I first started my career as a pharmacy school adjunct professor at my alma mater. From there, I transitioned to clinical practice as a hospital clinical pharmacist and quickly developed passion for it. When the doors opened to transition into the pharmaceutical industry, I decided to take on the challenge. The opportunity to join a company that is committed to the relentless pursuit of science that could improve the lives of patients was exhilarating and a unique chance to expand my experience and knowledge of the pharmacy field. I was fascinated by the idea of building and fostering relationships with key experts in shared therapeutic areas to deliver scientific knowledge, while still helping patients indirectly. I immediately knew, by taking on this unique opportunity, I had a chance to make a great impact in the lives of patients with scientific innovation and research.

This question has a two-fold answer. While it is important to continue to foster an inclusive and diverse environment within the pharmaceutical industry that supports hiring professionals from different ethnicities, cultural back grounds, languages, religions, genders, race, etc., it is far more important to support and promote growth for all of those already in the industry. This reflects the idea that growth and progress happen from within, which supports the notion that we need to embrace diversity by acknowledging and recognizing professionals in the field that bring upon said diversity.

This is done by continuously providing and facilitating the professional advancement of every employee, bridging income gaps within groups, and fostering safe environments for equal participation and growth. In summary, there must be recognition that we need to continue to work hard to level the playing field, while agreeing to promote diversity, inclusion and equity, which in the end will make for a better industry, empathizing with its own workers while also improving outcomes for our patients.

Dr. Daled Serrano-Bahri, PharmD, is the associate director of MSL Training, and Inflammation & Autoimmunity at Incyte.

An Interview with Dr. Daled Serrano-Bahri

StreamCare improves your profitability by removing PBMs from the Workers' Comp reimbursement process.

StreamCare bills the responsible payers directly which results in significantly higher reimbursement. Our technology and experienced team uniquely position us to take on all the obstacles of the Workers Comp reimbursement process while improving your bottom line.

Kelly McCarty

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