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Researchers explored the efficacy of a targeted mailing campaign for improving pneumococcal vaccination coverage among adults 65 and over.

Mailing Campaign Feasible, Effective in Improving Pneumococcal Vaccine Rates

Black women and those living in Southern states had the highest rates of maternal mortality.

Maternal Deaths Due to Cardiovascular Disease Doubled in US Since 1999

Community pharmacies have a clear role in public health, as they manage ongoing services and take on a more significant role as immunizers.

COVID-19 Five Years Later

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The COVID-19 pandemic has exposed the cracks in health system pharmacy. Here’s how the workforce can adapt.

Workforce Challenges for Health System Pharmacy

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

The CDC Advisory Committee on Immunization Practices (ACIP) has voted to lower recommended age for pneumococcal vaccination from 65 years to 50 years of age.

Following the announcement, both Merck and Pfizer released statements applauding the ACIP decision.

 Both companies manufacture FDA-approved pneumococcal vaccines. ACIP also recommended that adults aged 19 to 49 years with certain underlying conditions or risk factors who have not received a 

, or whose vaccination history is unknown, receive a vaccination. CDC Director Mandy K. Cohen, MD, MPH, endorsed these recommendations.

“The CDC’s decision to lower the age-based vaccination recommendations to begin at age 50 has the potential to be a practice-changing milestone,” said Eliav Barr, senior vice president, head of global clinical development, and chief medical officer at Merck.

 “This recommendation is a significant step forward in the efforts to enhance equitable access and may improve vaccination rates.”

 Luis Jodar, PhD, pointed out that expanding the use of Pfizer's pneumococcal vaccine “also provides the opportunity to limit the reemergence of disease-causing strains like serotype 4, which has recently affected certain US adult populations.” Jodar is the senior vice president of vaccines and anti-infectives chief medical affairs officer at Pfizer.

 bacteria are responsible for pneumococcal pneumonia; infections are the leading bacterial cause of pneumonia hospitalizations in the US. Additionally, there are approximately 30,000 cases of, and 3000 deaths related to, invasive pneumococcal disease each year.

At Higher Risk, Vaccine Efficacy, Uptake Are Crucial for Older Adult Populations | IDWeek 2024

Currently, there are 4 recommended pneumococcal vaccines

: PCV21, a pneumococcal 21-valent conjugate vaccine (

); PCV15, a pneumococcal 15-valent conjugate vaccine (

); and PPSV23, a pneumococcal vaccine, polyvalent (

), all manufactured by Merck; and PCV20, a pneumococcal 20-valent conjugate vaccine (

Another potential immunization option is currently in development: 

 is a 31-valent pneumococcal conjugate vaccine candidate manufactured by Vaxcyte. In early September, the company reported positive topline data from its phase 1/2 of VAX-31 (

), which increases coverage to more than 95% of invasive pneumococcal disease circulating in adults aged 50 years and older in the US.

 and is indicated for active immunization to prevent invasive disease and pneumonia caused by 

serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15B, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F and 35B in adults, as well as active immunization for the prevention of pneumonia caused by 

serotypes 3, 6A, 7F, 8, 9N, 10A, 11A, 12F, 15A, 15C, 16F, 17F, 19A, 20A, 22F, 23A, 23B, 24F, 31, 33F and 35B in adults.

 Per national-level CDC data from 2018 to 2022, the serotypes covered by Capvaxive “are responsible for more cases of invasive pneumococcal disease in adults compared to PCV20,” the news release from Merck noted. “In adults 50 years of age and older, Capvaxive covers the serotypes responsible for approximately 84% of [invasive pneumococcal disease] cases, compared to approximately 52% covered by PCV20.” The company also noted that there are no current studies comparing the efficacy of Capvaxive and Prevnar 20.

Prevnar 20 is indicated for the prevention of invasive disease caused by 

strains 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in individuals aged 6 weeks and older; the prevention of otitis media caused by 7 of the 20 strains in individuals aged 6 weeks to 5 years of age, and active immunization for the prevention of pneumonia caused by 

 strains 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in adults. An indication for the prevention of pneumonia caused by 

serotypes 8, 10A, 11A, 12F, 15B, 22F, and 33F in adults “is approved based on immune response.”

CDC recommends lowering the age for pneumococcal vaccination from 65 to 50 years old. News release. CDC. October 23, 2024. Accessed October 24, 2024. 

https://www.cdc.gov/media/releases/2024/s1023-pneumococcal-vaccination.html

CDC’S ACIP recommends Merck’s Capvaxive (pneumococcal 21-valent conjugate vaccine) for pneumococcal vaccination in adults 50 years of age and older. News release. Merck. October 23, 2024. Accessed October 24, 2024. 

https://www.merck.com/news/cdcs-acip-recommends-mercks-capvaxive-pneumococcal-21-valent-conjugate-vaccine-for-pneumococcal-vaccination-in-adults-50-years-of-age-and-older/

Advisory Committee on Immunization Practices recommends Prevnar 20 (20-valent pneumococcal conjugate vaccine) for adults aged 50 and older. News release. Pfizer. October 23, 2024. Accessed October 24, 2024. 

https://www.pfizer.com/news/press-release/press-release-detail/advisory-committee-immunization-practices-recommends

Pneumococcal disease. National Foundation for Infectious Diseases. Accessed October 24, 2024. 

https://www.nfid.org/infectious-disease/pneumococcal/

Kahn R, Zielinski L, Gedlinske A, et al. Health care provider knowledge and attitudes regarding adult pneumococcal conjugate vaccine recommendations — united states, September 28–October 10, 2022. 

About pneumococcal vaccines. CDC. Accessed October 24, 2024. 

https://www.cdc.gov/vaccines/vpd/pneumo/hcp/about-vaccine.html

Vaxcyte reports positive topline data from phase 1/2 study of VAX-31, its 31-valent pneumococcal conjugate vaccine candidate, in adults aged 50 and older. News release. Vaxcyte. September 3, 2024. October 24, 2024. 

https://investors.vaxcyte.com/news-releases/news-release-details/vaxcyte-reports-positive-topline-data-phase-12-study-vax-31-its

Biscaldi L. FDA approves pneumococcal 21-valent conjugate vaccine Capvaxive. 

June 18, 2024. Accessed October 24, 2024. 

https://www.drugtopics.com/view/fda-approves-pneumococcal-21-valent-conjugate-vaccine-capvaxive

The new recommendations suggest vaccination at age 50, rather than age 65. 

ACIP Votes to Lower Recommended Age of Pneumococcal Vaccination 

Providing education interventions to pharmacists can affect the nature of conversations about 

 in older adults, according to a new study published in the 

Journal of the American Pharmacists Association

Although the Public Health Agency of Canada has a target vaccination rate of 80%, only 58% of Canadiens aged 65 years and older have been vaccinated for pneumococcal pneumonia.

The researchers wanted to discover the reasons behind patients’ reluctance to get vaccinated. They sought to explore the conversations about the pneumococcal vaccine between pharmacists and patients.

Investigators randomly selected pharmacies to receive education packages, which were designed to increase knowledge, skills, and abilities for promoting pneumococcal vaccination. The educational toolkit included patient screening tips, a decision tree for patient eligibility, consent forms, a poster on vaccine safety, vaccine comparison table, frequently asked questions, and several documentation templates. Pharmacists watched a 1-hour video that gave them an overview of the study and all educational materials.

During the control stage, pharmacists provided usual care. The intervention stage occurred after the pharmacists received the educational packages. The researchers used weekly scorecards to assess pharmacist-patient conversations, including the number of conversations, the length of each conversation, and reasons for vaccine refusal. They used chi-squared tests to compare the time taken for conversations and patient-reported reasons for refusing the vaccine during the control and intervention stages.

The study included 656 pharmacist-patient conversations from 13 pharmacies across Alberta, Canada. Of these conversations, 271 occurred during the control stage, and 385 occurred during the intervention stage.

At Higher Risk, Vaccine Efficacy, Uptake Are Crucial for Older Adult Populations

After receiving the educational package, the duration of pharmacist-patient conversations that resulted in a vaccine decreased—65% of conversations during the control phase took less than 20 minutes compared with 88% during the intervention phase. Conversations that resulted in vaccine refusal remained about the same length between the control and interventional stages, with 70% and 76% lasting for less than 5 minutes, respectively.

During both phases of the study, the most common reason for 

Pharmacist education can positively impact patient counseling around vaccinations in older adults.

Kimber Boothe, PharmD, MHA

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