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A conversation with Douglas Hoey, CEO of the National Community Pharmacists Association, at the American Associated Pharmacies 2025 Annual Conference.

PBM Reform Delays Continue to Negatively Impact Pharmacies | AAP 2025

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Pharmacists have positive impacts on health outcomes for diabetes and patients using CGM devices, including reductions in A1c.

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Investigators find 5 distinct obesity trajectories that influenced brain morphology, function, and cognition.

Data Show Neural Mechanisms Between Obesity and Cognition

Hypertension and obstructive sleep apnea are considered independent risk factors for cardiovascular diseases as well as diabetes.

Persistent Statin Use Shows Increase of Risk Diabetes for Obstructive Sleep Apnea, Hypertension Patients

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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

Celebrating American Pharmacists Month

Staying Safe This Summer

Taking Care of Yourself and Others

Kudos to WHO

A New Era for Total 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

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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.

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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

Two more US patients have been hospitalized with bird flu complications as cases continue to rise slowly among humans but much more quickly among animals, according to 

When H5N1 (bird flu) cases first took off in the US in 2024, all patients who tested positive made a full recovery. However, at the start of 2025, the first severe case of bird flu led to the hospitalization and subsequent death for a patient in Louisiana.

 Although the CDC has reported no human-to-human contact at this time,

recent cases are causing officials to raise alarms.

“This shows that H5N1 can be very severe, and we should not assume that it will always be mild,” Angela Rasmussen, PhD, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan, said in an interview with 

 “I am very worried about H5N1 in patients [who] are being treated in hospitals where there are also many [patients with] seasonal flu because this creates opportunities for reassortment, which could produce a pandemic-capable H5N1.”

Of the 2 recent patients who tested positive, one was reported in Ohio and the other in Wyoming, marking the first human case of bird flu in either state. Since reporting symptoms, the Ohio patient recovered, but the Wyoming patient remains hospitalized.

The Ohio patient was a male facility worker responsible for killing poultry infected with bird flu. The Wyoming patient was an older woman with multiple underlying health conditions that heightened her complications from the disease, according to a Wyoming Department of Health news release.

She started experiencing symptoms after coming into contact with an infected bird in her backyard.

“Experts continue to track the spread of H5N1 through wild birds, poultry, and dairy cattle across the country,” Alexia Harrist, MD, PhD, an epidemiologist with the Wyoming Department of Health, said in the news release. “A small number of people have also been infected. Most of those confirmed cases involved on-the-job close contact with poultry or cattle and mild symptoms.”

As of April 2024, bird flu has infected 70 humans. Additionally, over 12,500 wild birds and over 41 dairy herds across the US have been affected. According to epidemiologists and influenza experts, the fact that no human-to-human transmission has been reported is a source of some relief. The main source of humans contracting the virus has been dairy herds (41 human cases), followed by poultry farms (24 cases), other animal exposures (2 cases), and unknown sources (3 cases).

The first case of bird flu due to unknown exposure was reported in Missouri last September.

 At the time, this was just the 14th human case of bird flu in the US. Human cases have continued to rise as researchers and public health officials attempt to stop the spread among animals. This winter season has been especially debilitating, as cases of influenza in general have reached record highs.

“The news comes amid one of the worst seasonal flu outbreaks in 15 years—raising the potential for the emergence of a more dangerous virus that combines bird flu and seasonal flu in a process called reassortment,” wrote Melody Schreiber for 

Despite the recent improvement in bird flu testing, the rare occurrence of reassortment is a real concern, according to Andrew Pekosz, PhD, an immunology expert at Johns Hopkins Bloomberg School of Public Health.

He said that reassortment has been responsible for the influenza viruses that caused the last 3 human pandemics, and its recent impacts on hospitalized patients with bird flu may cause experts to be even more cautious.

The public is significantly close to exiting the current influenza case spikes and respiratory virus season. Although reassortment will be less of a concern by spring, keeping a close eye on the bird flu virus and monitoring its reaction among animals will continue to be of the utmost importance.

“The more we know about where the virus is in animals, the more we’re able to not only halt the spread within at least the species that we raise for food but also know which people may be at greatest risk of exposure,” concluded Pekosz.

download the PDF of the Drug Topics March/April issue here

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1. Schreiber M. Two people in US hospitalized with bird flu, CDC reports. 

. February 24, 2025. Accessed March 12, 2025. https://www.theguardian.com/us-news/2025/feb/24/bird-flu-hospitalizations-wyoming-ohio

2. First H5 bird flu death reported in United States. News Release. CDC. January 6, 2025. Accessed March 12, 2025. https://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html

3. H5 bird flu: current situation. CDC. February 24, 2025. Updated March 12, 2025. Accessed February 26, 2025. https://www.cdc.gov/bird-flu/situation-summary/index.html

4. Wyoming’s first human bird flu case confirmed. Wyoming Department of Health. February 14, 2025. Accessed February 26, 2025. https://health.wyo.gov/wyomings-first-human-bird-flu-case-confirmed/

5. Centers for Disease Control and Prevention. H5N1 Response. Published February 26, 2025. Accessed March 12, 2025. https://www.cdc.gov/bird-flu/spotlights/h5n1-response-02262025.html

6. Centers for Disease Control and Prevention. Situation Summary: Highly Pathogenic Avian Influenza (HPAI) Detections in Wild Birds. Accessed March 12, 2025.https://www.cdc.gov/bird-flu/situation-summary/data-map-wild-birds.html

7. Wyoming’s first human bird flu case confirmed. Wyoming Department of Health. February 14, 2025. Accessed February 26, 2025. https://health.wyo.gov/wyomings-first-human-bird-flu-case-confirmed/

8. Bird flu is raising red flags among health officials. Johns Hopkins Bloomberg School of Public Health. January 14, 2025. Accessed February 26, 2025. https://publichealth.jhu.edu/2025/bird-flu-is-raising-red-flags-among-health-officials

9. Centers for Disease Control and Prevention. 2024-2025 Estimated Influenza Illnesses, Medical visits, Hospitalizations, and Deaths in the US. Accessed March 12, 2025. https://www.cdc.gov/flu-burden/php/data-vis/2024-2025.html

Bird flu cases total 70 US patients as more animals are infected.

Bird Flu Hospitalizes 2 More Patients as Outbreaks Increase

However, there are also risks involved with the use

Research supports cannabis use for specific disease states

The FDA's recent literature review reveals nuanced insights into cannabis's therapeutic potential across various medical conditions. While the research supports cannabis use for specific scenarios like anorexia secondary to HIV or cancer, nausea and vomiting from chemotherapy, and neuropathic pain, it also highlights significant limitations, according to Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of Southern California.

Neuropathic pain treatment shows moderate relief using THC-type cannabis at doses between 2 and 10 milligrams, though it's not recommended for acute pain management due to potential complications. Franson emphasizes the complex pharmacological profile of cannabis, particularly distinguishing between THC and CBD types. THC-type cannabis can produce notable adverse effects, including increased heart rate, dizziness, euphoria, and potential anxiety or panic attacks. CBD-type cannabis generally demonstrates better tolerance at lower doses, with minimal adverse effects. However, long-term use of THC-type cannabis raises substantial concerns, including potential development of cannabis use disorder, cannabis hyperemesis syndrome, decreased sperm count in males, and increased risks of psychosis and depression.

Most critically, the research unveils significant cardiovascular and mental health risks associated with cannabis use. Epidemiological data indicates nearly 50% increased risk of myocardial infarction, 2-fold stroke risk, and small increases in arrhythmias. Mental health considerations are particularly nuanced, with heightened risks for individuals with pre-existing substance use disorders, depression, or anxiety.

A particularly alarming finding involves patients with major depressive disorder using cannabis: while providing temporary symptomatic relief, long-term use can paradoxically worsen underlying depression, creating a potentially dangerous reinforcement cycle. Franson underscores the importance of health care providers carefully evaluating individual patient contexts, monitoring long-term cannabis use, and maintaining a cautious, informed approach to its therapeutic application.

"Let's say [a patient] got depressed; they would utilize cannabis, and if they smoked it, 20 minutes later, they're feeling better, right?" Franson said. "What [researchers] found is, over the months that they were following these patients, that their baseline symptoms continued to decline over time."

Read more from our coverage of the American Pharmacists Association 2025 Annual Meeting and Exposition

Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of Southern California, discusses the risks associated with cannabis use.

Research Supports Cannabis Use for Specific Disease States | APhA 2025

She also discusses the risk factors and consideration for cannabis use disorder

Expert Discusses Potnetial Rescheduling of Cannabis

Cannabis use disorder presents a complex landscape of risk factors and clinical considerations, with experts highlighting the nuanced nature of potential dependency. While the overall risk of developing cannabis use disorder remains relatively low at around 9%, certain populations face significantly higher chances of addiction, according to Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of Southern California. Younger users, particularly those who begin cannabis use early, can experience up to a 16% risk of developing a use disorder. The risk escalates dramatically with daily, high-dose consumption, potentially reaching 30%.

Franson emphasizes the critical need for more precise definitions surrounding cannabis use disorder. Current research suggests that the risk is relatively consistent across recreational and medical users, indicating that dosage and consumption patterns may be more influential than the user's intention. She also advocates for a comprehensive approach to managing potential substance use disorders, recommending a 4-fold clinical strategy: assessing patient history, recommending lower-risk cannabis variants like CBD, implementing frequent monitoring, and being prepared to advise against cannabis use when risks are too high.

Additionally, Franson further highlights the potential role of pharmacists in cannabis regulation and patient safety. With potential rescheduling of cannabis to Schedule III, there's an opportunity for pharmacists to reclaim their traditional health care role by providing expert guidance on safe cannabis use. She discusses existing federal laws that could enable pharmacists to dispense nonFDA-approved cannabis products, potentially creating a structured framework for responsible distribution and patient education. This approach could help mitigate risks associated with unregulated cannabis consumption while ensuring patients receive professional, evidence-based advice about their cannabis use.

"This is probably the ultimate area for [pharmacists] to get involved in because then we are seizing and saying, 'Hey, don't worry about it. We'll take responsibility of identifying appropriate products that we know the dosages of how much you're getting [and] what's in it to really give the patients the ultimate health care experience when they're trying to use cannabis for health," Franson said.

Kari Franson, PharmD, PhD, BCPP, senior associate dean for academic and student affairs and professor of clinical pharmacy at the University of Southern California, discusses the risk factors and considerations for cannabis use disorder.

Mike Hennessy Jr, President and CEO, MJH Life Sciences

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