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Simultaneous vaccination with IIV4 and PPSV23 proves safe and effective for patients with chronic diseases, matching results of healthy individuals.

Simultaneous Influenza, Pneumococcal Vaccination Shows Noninferiority for Patients With Chronic Disease

Integrating health-related social needs programs into pharmacy practice strengthens patient care and positions pharmacies as vital public health partners.

Q&A: Integrating Social Services Into Everyday Pharmacy Practice

Targeted education and hands-on experience  are helping pharmacists gain the confidence needed to guide patients in continuous glucose monitoring.

 Q&A: Training, Support Key to Pharmacist Confidence with CGMs

Recent studies reveal that while diabetes technology use rises, glycemic control in type 1 diabetes patients remains low, highlighting significant disparities.

Technology Use, Glycemic Control Increases Among Patients With Type 1 Diabetes

Drug Topics connects pharmacists across retail, health system, and specialty practice with clinical updates, pharmacy trends, and regulatory news.

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Patient data provides a rich resource that can help address the problem of opioid misuse and addiction among their health plan members.

Opinion: Data is a Vital Resource in Fighting the Opioid Crisis

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

Five years ago, we moved from central Pennsylvania to Morgantown, West Virginia. Our goal was to live closer to my grandson, Luke. “Living closer” turned out to be “next door.” Since then, we have added Leo, now 2 years old. Luke, my 8-year-old grandson, is on summer vacation.

My older grandson is beginning to understand the importance of money. He has conceived several ambitious projects, such as opening a lemonade stand on our street, which experiences minimal traffic. Granddad came up with a few ideas.

Recycling is not mandatory in our area, so we take the recycling for both households to the transfer station. I decided to make an additional stop at Jack’s Recycling, where Luke could redeem our aluminum cans. The owner provided him with an informative lecture about financial management and compensated him with $6. Luke has developed a keen interest in recycling now that he recognizes its economic benefits.

Weeds were appearing in the mulch beds at our homes, so I offered to pay Luke “a penny per weed.” Luke meticulously counted each weed he pulled and placed them in the bucket. He collected over 300 weeds and received $3 for his work. Luke recognizes the financial benefit of completing tasks around the house and is willing to perform these duties to earn money.

As pharmacists, we face numerous challenges daily while striving to provide optimal pharmaceutical care for our patients. We often encounter situations where we have a significant backlog of prescriptions, multiple phones ringing simultaneously, dissatisfied customers, and individuals awaiting their shingles vaccinations. Amid these demanding circumstances, we receive notifications to prioritize the completion of comprehensive medication reviews (CMRs).

Pharmacists play a pivotal role in modern health care, extending their expertise far beyond dispensing medications from “the bench.” CMRs represent one of the most impactful contributions pharmacists make to optimizing health outcomes for our Medicare Part D patients. By conducting thorough evaluations of patients’ medication regimens, pharmacists identify potential issues such as drug interactions, inappropriate dosages, or adherence challenges. These reviews ensure the safety and efficacy of treatments and empower patients with the knowledge to manage their medications effectively.

When we have a few minutes of downtime on the bench, we attempt to contact individuals on our roster to complete the CMRs. Unfortunately, we manage to reach a patient less than half the time. Typically, we spend around 10 minutes preparing for these encounters by reviewing medications, completing directions, and verifying ongoing use of the prescribed medications. Subsequently, we dial the phone number provided by the managed care organization (MCO).

Often, the phone line is disconnected, or we reach a voicemail asking us to leave a message. We then cross-check the MCO-provided phone number against our profiles and attempt another contact number. Patients frequently change their contact numbers, which leads to challenges in reaching patients.

It can be challenging for older adults to answer the phone. Many publications aimed at older adults advise against answering unsolicited calls due to the prevalence of “spoof calls” attempting to access personal information. This contributes to difficulties in reaching patients to complete CMRs.

When contact is made with a patient, important information is often provided. These interventions are beneficial for the pharmacy, not only in terms of financial remuneration but also due to their impact on the pharmacy’s Medicare Star Ratings.

MCOs are known to incentivize patients with gift cards for undergoing physical examinations and other beneficial health interventions. The MCOs could easily motivate these patients to contact the pharmacy and arrange a mutually agreeable time for a call and subsequently reward the patient with a $25 gift card. It is important to note that many of our patients would greatly appreciate a gift card, as well as the personalized one-on-one treatment the CMR program was designed to provide.

Whether you are an 8-year-old like Luke or a 68-year-old like me, financial incentives can be effective. Sometimes, a monetary reward is necessary to motivate individuals to complete tasks such as pulling weeds, recycling cans, or finishing a CMR assignment.

download the PDF of the Drug Topics July/August issue here

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Pharmacists face numerous challenges daily while striving to provide optimal care for their patients.

Reaching Patients Could Use a Bit of Incentive

Positive results have been announced from a phase 3 trial evaluating the efficacy and safety of orforglipron for weight loss in adult patients with overweight or obesity, Eli Lilly announced in a release.

The therapy is an investigational, small molecule, oral glucagon-like peptide-1 (GLP-1) receptor agonist that can be taken without restrictions on food or water at any time of day.

) clinical trial showed orforglipron met its primary end point of mean percent change in body weight from baseline. The therapy also met all key secondary end points, including mean change in waist circumference from baseline, mean change in systolic blood pressure from baseline, and mean percent change in fasting non–high-density lipoprotein (HDL) cholesterol from baseline.

"Obesity is one of the most pressing global health challenges of our time, driving global chronic disease burden and impacting more than one billion people worldwide," Kenneth Custer, PhD, MBA, executive vice president and president of Lilly Cardiometabolic Health, said in a release.

 "With orforglipron, we're working to transform obesity care by introducing a potential once-daily oral therapy that could support early intervention and long-term disease management, while offering a convenient alternative to injectable treatments.”

ATTAIN-1 is a 72-week, randomized, double-blind, placebo-controlled phase 3 study evaluating the efficacy and safety orforglipron for weight loss in adult patients with overweight or obesity, with weight-related comorbidities and without diabetes. The primary study end point is superior body weight reduction compared with placebo.

The study includes 3127 adult patients who were randomly assigned to 1 of 4 cohorts: 6 mg orforglipron once daily, 12 mg orforglipron once daily, 36 mg orforglipron once daily, or placebo. All patients initially started on 1 mg orforglipron, which was increased in a step-wise approach every 4 weeks until their assigned dose was met. The trial took place at sites in the United States, Brazil, China, India, Japan, South Korea, Puerto Rico, Slovakia, Spain, and Taiwan.

The study data showed that patients who took the highest dose of orforglipron lost an average of 27.3 lb at 72 weeks compared with 2.2 lb for patients taking placebo. Of the patients taking the highest dose of orforglipron, 59.6% lost at least 10% of their body weight, and 39.6% lost at least 15%. The therapy was also associated with reductions in known markers of cardiovascular risk, including non-HDL cholesterol, triglycerides, and systolic blood pressure.

Additionally, the overall safety profile of orforglipron was consistent with the established GLP-1 receptor agonist class. The most common adverse events during the study were constipation, nausea, diarrhea, and vomiting.

Lilly said it plans to present more detailed data from the ATTAIN-1 trial at the European Association for the Study of Diabetes (EASD) Annual Meeting 2025. The company also said that it expects data later this year from the ACHIEVE phase 3 clinical trial program, which is evaluating orforglipron in adult patients with type 2 diabetes.

“With these positive data in hand, we are now planning to submit orforglipron for regulatory review by year-end and are prepared for a global launch to address this urgent public health need," Custer said in the release.

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1. Lilly's oral GLP-1, orforglipron, delivers weight loss of up to an average of 27.3 lb in first of two pivotal phase 3 trials in adults with obesity. News release. Eli Lilly and Company. August 7, 2025. Accessed August 7, 2025. 

https://investor.lilly.com/news-releases/news-release-details/lillys-oral-glp-1-orforglipron-delivers-weight-loss-average-273

At 72 weeks, patients who took the highest dose of orforglipron lost an average of 27.3 lb.

Oral GLP-1 Orforglipron Shows Meaningful Weight Loss in Phase 3 Trial

Among over 10 million postpartum mothers in the US, those with hypertensive disorders of pregnancy (HDP) exhibited a higher risk of never breastfeeding as well as a higher breastfeeding cessation hazard, according to study data published in 

With potential risks of breastfeeding erasure among women with HDP, researchers believe future tailored approaches are crucial in promoting breastfeeding, especially among those experiencing increased cardiometabolic risk.

“Despite 83% of US women initiating breastfeeding at delivery, only 25% exclusively breastfeed through 6 months as recommended by leading health organizations, highlighting the presence of multifactorial barriers to sustaining exclusive breastfeeding faced by families,” wrote authors of the study.

 “Though other maternal comorbidities, including gestational diabetes, have been seen to negatively influence breastfeeding outcomes, little is known about breastfeeding outcomes for the 16% of US pregnant women with HDP compared with women without HDP.”

Standing More May Improve Blood Pressure in Postmenopausal Women With Overweight, Obesity

Postpartum breastfeeding for women and their newborns is a significantly health-conscious choice for new mothers. Not only does breastfeeding provide children with proper nutrition and protection against illness, but it is also convenient and healthy for the mother. Breastfeeding is known to lead to a decreased risk of breast and ovarian cancer, type 2 diabetes, and hypertension for mothers.

Furthermore, leading into hypertension’s link to pregnancy and breastfeeding outcomes, HDP is an increasingly prominent development among pregnant women. Aside from authors of the current study noting that HDP more than doubled from 1993 to 2017,

 previous data have shown that at least 20.8% of pregnant women were diagnosed with hypertension.

Amid the benefits of breastfeeding and the risks—and prominence—of HDP throughout various populations, researchers of the current study wanted to better understand what led to women’s odds of never breastfeeding or discontinuing it with their children.

“We aimed to quantify the extent to which HDP exposure is associated with never breastfeeding and, for those who initiate breastfeeding, the hazard of and median time to breastfeeding cessation among a national sample of US women who were surveyed by the CDC between January 2016 and November 2022,” they continued.

 “We hypothesized that women with vs without HDP would have a higher probability of both never breastfeeding and earlier breastfeeding cessation.”

Researchers conducted a cross-sectional survey using the CDC’s Pregnancy Risk Assessment Monitoring System. The study included women who gave birth from January 2016 to November 2022. Participants resided in 43 different US states, including Washington, DC, and Puerto Rico.

For specific study parameters regarding breastfeeding and HDP outcomes, researchers defined the criteria for each. Women were determined to have HDP (primary independent variable) if they self-reported high blood pressure, hypertension, preeclampsia, or eclampsia before or during pregnancy.

If women reported “no” to breastfeeding, they were considered to have never breastfed. For those who responded “yes,” they either provided the exact number of weeks they had been breastfeeding, or they were still breastfeeding and provided their children’s ages when responding to breastfeeding times. For those who breastfed for under a week, their duration to cessation was simply 0.5 weeks.

The final analysis included 205,247 women (mean age, 30; 50.8% White). Among these women’s children, the mean infant age at survey completion was 18.2 weeks. Of the study population, 17% reported HDP diagnoses, with it being most prominent among women under age 18 and over age 34, those with lower household incomes, and women who were Black, American Indian, or Alaska Native.

“Exposure to HDP was associated with 11% higher odds of never breastfeeding and, among those who do initiate breastfeeding, a 17% higher hazard of breastfeeding cessation in the postpartum period,” continued the authors.

 “The median time to breastfeeding cessation was 17 weeks shorter for women with HDP than those without HDP.”

Providing further evidence highlighting the negative relationship between HDP and breastfeeding outcomes, researchers confirmed their hypothesis that women with HDP were more likely to never breastfeed and were quicker to cease breastfeeding than women who did not report HDP.

In an exploration of recent mothers across the US, researchers addressed the association of hypertensive disorders during pregnancy with breastfeeding and breastfeeding cessation.

A. Bartley Bryt, MD

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