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Susan Cornell, PharmD, CDCES, FAPhA, FADCES, discusses how pharmacists can help patients who express fear when starting insulin therapy. 

Pharmacists Can Enhance Patient Confidence During Insulin Initiation

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Researchers examined the factors attributed to self-reported resilience among diverse and community-dwelling adults during the COVID-19 pandemic.

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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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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 

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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

Independent pharmacies are navigating a complex and challenging health care environment, with economic pressures and evolving regulatory requirements threatening their sustainability. In an interview at McKesson ideaShare in Nashville, Tennessee, from July 10 to 13, 2025, Crystal Lennartz, president of Health Mart & Health Mart Atlas at McKesson, discusses the company's Health Mart franchise, which supports over 4400 independent pharmacies nationwide. She states that these pharmacies are struggling with reimbursement issues, operational complexities, and the need to expand clinical services. Their approach focuses on providing multifaceted solutions that help pharmacies not just survive but potentially thrive in a rapidly changing health care ecosystem.

The future of independent pharmacies appears to be increasingly centered on expanded clinical services. These emerging opportunities include immunizations, medication therapy management, and point-of-care testing. By diversifying their service offerings, pharmacies can become more integral to patient care and create additional revenue streams. McKesson's strategy aims to enable pharmacies to focus on patient care by handling backend support, including business operations, marketing assistance, and advocacy. Independent pharmacies are crucial health care access points, particularly in communities where traditional medical infrastructure might be limited.

What challenges do you see independent pharmacies facing today?

Independent pharmacies are facing a lot of economic and operational pressures today. One of the major significant things that is impacting them is the ability to be reimbursed adequately for the clinical services that they provide, and they're faced with a lot of regulatory changes that are impacting pharmacy and their scope of practice. That's why we're focused on strengthening the health of pharmacies and also providing them with the operational and clinical tools that they need to succeed.

What solutions and services does McKesson provide to support the health of community pharmacies?

McKesson provides a variety of solutions to support the health of community pharmacies. HealthMart is our independent pharmacy franchise, and we support over 4400 pharmacies across the nation, and then we also have HealthMart Atlas, which is our pharmacy services initiative organization. We help with payer contracting and reimbursement and help with transparency and monitoring of that. Then [we] also [have] provider pay, which helps to make sure that pharmacies get paid for every claim that they deserve and matches that payment, and then, from an overall McKesson perspective, we also are providing them with operational support, like inventory management support. McKesson's automated potential inventory management solution, like Community Solutions, helps to ensure they have adequate inventory on hand to meet the patient's needs when they need them but helps them reduce any unnecessary inventory at a time when cash flow is really tight. So it's important to make sure that that's optimized. We're also supporting in terms of vaccinations, as that's a growing area that pharmacies are providing and making sure that the cost for the product that they provide and that they're adequately reimbursed as well.

What are some of the greatest opportunities for community pharmacies in the current environment?

Some of the greatest opportunities for community pharmacies in our current environment [are] the expansion of services that they provide, so whether it be immunizations or medication therapy management [or] point-of-care testing. [It's] the ability to really meet the needs of the whole patient and be able to expand that care and be reimbursed for it.

How do Health Mart/Health Mart Atlas enable member pharmacies to thrive, grow, and take advantage of emerging opportunities?

From a HealthMart perspective, we help to provide in terms of business operations, marketing, support, [and] advocacy so that the pharmacies can focus on what they do best, which is taking care of patients. From a HealthMart Atlas perspective, we're focused on the financial health of the pharmacy to help make navigating, contracting, and payment for those services easier and a little bit more transparent as well.

What is your vision for the future of Health Mart, and how will it continue to support the business of pharmacy?

When we think about the future of pharmacy and the expansion of services, HealthMart wants to continue to help to support, whether it be advancement of clinical services or optimizing their operational efficiency, and I'm optimistic about the future of independent pharmacy and how HealthMart can continue to grow and support.

Is there anything we haven’t discussed already that you’d like to add?

There's a lot of excitement here at ideaShare. It's an opportunity for independent pharmacies to connect and grow [and] share ideas, and we're really looking forward to next year already in Denver, so we hope that even more pharmacies can join us here.

Crystal Lennartz, president of Health Mart & Health Mart Atlas at McKesson, discusses challenges that independent pharmacies are facing in today's health care landscape.

Total Pharmacy Interviews

Independent Pharmacies Face Mounting Challenges in Modern Health Care Landscape | McKesson ideaShare

SureCost’s 2025 Smarter Purchasing Report identified five key areas of smarter purchasing amid staff and drug shortages. This white paper will summarize those results and explain how pharmacies can optimize their own purchasing.

Learn how smarter purchasing strategies helped pharmacies tackle drug shortages and other challenges in 2024, saving over $255M while boosting compliance.

SureCost collects anonymized pharmacy purchasing data each year from a nationwide cohort of pharmacies. We remove outliers to standardize this data for a realistic “apples-to-apples” comparison. SureCost’s leadership then examines each dataset to address potential anomalies. Customer interviews provide qualitative data, while industry research and experience help frame the trends.

Download The 2025 Smarter Purchasing Report

The 2025 Smarter Purchasing Report for Pharmacies: How Retail Pharmacies Save More and Operate Smarter with Data-Driven Purchasing

Positive results have been announced from a phase 3 trial evaluating the efficacy and safety of icotrokinra in patients 12 years of age and older with plaque psoriasis affecting high-impact skin sites, Johnson & Johnson announced in a release.

The data was presented at the 2025 Society for Investigative Dermatology Annual Meeting.

) showed that icotrokinra met its primary endpoint of the percentage of patients achieving a score of 1 to 0 and grade 2 or more improvement on the Investigator's Global Assessment (IGA) at week 16. The therapy also demonstrated a favorable safety profile, with a similar number of adverse events in the treatment and placebo groups.

Roflumilast Foam Improves Symptoms of Scalp, Body Psoriasis

"While plaque psoriasis can appear in any location on the body, most high-impact skin sites affect areas critical for mobility, personal care, and intimacy, and can be very challenging to treat effectively,” Melinda Gooderham, MSc, MD, FRCPC, an investigator on the study, said in a release.

“Results from the ICONIC-TOTAL study demonstrate impressive rates of skin clearance in these difficult-to-treat areas and show the potential for treatment with icotrokinra to offer patients a novel therapeutic option that aligns with their treatment needs and preferences."

Icotrokinra is an investigational oral peptide that selectively blocks the IL-23 receptor. By binding to the receptor, icotrokinra inhibits signaling to T cells. IL-23 is responsible for the inflammatory response in moderate to severe plaque psoriasis, ulcerative colitis and many other autoimmune disorders. The therapy was jointly discovered by Protagonist Therapeutics, Johnson & Johnson, and Janssen Biotech.

ICONIC-TOTAL is a multicenter, randomized, double-blind, placebo-controlled, phase 3 trial evaluating the efficacy and safety of icotrokinra in patients 12 years of age and older with plaque psoriasis affecting high-impact skin sites, including the scalp, genitals, and palms of the hands or soles of the feet. The study cohort included 311 patients with plaque psoriasis for at least 26 weeks prior to the study, and a total body surface area (BSA) of 1% or greater at both screening and baseline. Patients received either icotrokinra from week 0 to week 156 or placebo from week 0 to week 16, after which they received the therapy through week 156.

The study found that 57% of patients who received icotrokinra achieved an IGA score of 1 or 0 and a grade 2 or more improvement at week 16, compared to 6% of patients who received the placebo. Of the patients with scalp psoriasis, 66% who received the therapy met the primary endpoint, compared to 11% who received placebo. Of patients with genital psoriasis, 77% who received the therapy met the primary endpoint, compared to 21% who received placebo.

Additionally, of the patients in the smaller subgroup with hand and/or foot psoriasis, 42% who received icotrokinra achieved a score of 1 or 0 on the hand and/or foot Physician's Global Assessment, compared to 26% who received placebo.

"When plaque psoriasis affects sensitive areas of the body, patients often experience unique challenges that can have a profound impact on their daily lives," Liza O'Dowd, MD, vice president of Immunodermatology Disease Area Lead at Johnson & Johnson Innovative Medicine, said in a release.

 "These new findings build upon the impressive scalp psoriasis results seen in ICONIC-LEAD and strengthen the breadth of data demonstrating the potential for icotrokinra to shift the treatment paradigm in moderate-to-severe plaque psoriasis, by offering a combination of skin clearance and favorable safety in a once daily pill."

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. Icotrokinra results show significant skin clearance in patients with difficult-to-treat scalp and genital psoriasis. News Release. Johnson & Johnson. May 9, 2025. Accessed May 12, 2025. 

https://www.prnewswire.com/news-releases/icotrokinra-results-show-significant-skin-clearance-in-patients-with-difficult-to-treat-scalp-and-genital-psoriasis-302450309.html

In a phase 3 study, 57% of patients treated with icotrokinra achieved an Investigator's Global Assessment score of 1 or 0 and a grade 2 or more improvement at week 16.

Icotrokinra Shows High Rates of Skin Clearance in Scalp, Genital Psoriasis

The FDA approved ustekinumab-hmny (Starjemza) as a biosimilar referencing ustekinumab (Stelara). Ustekinumab is a medication used to treat and manage inflammatory conditions, including psoriasis, psoriatic arthritis, and inflammatory bowel disease.

"The approval of Starjemza is another significant accomplishment for Bio-Thera, establishing Bio-Thera as a premier global biosimilar developer and manufacturer," Shengfeng Li, CEO at Bio-Thera, said in a news release.

 "As our third FDA-approved biosimilar, Starjemza demonstrates Bio-Thera's commitment to developing more biosimilars, expanding patient access to important therapies."

The FDA approval was based on a nonclinical and clinical package submitted to the agency. In a randomized, double-blind, parallel phase 1 study, investigators analyzed the pharmacokinetics, safety, and immunogenicity of the drug compared to the US and EU Stelara formulations. In a phase 3 study, investigators compared the biosimilar and reference product for efficacy, safety, and immunogenicity in patients with moderate to severe plaque psoriasis.

In the phase 1 study, investigators included 270 healthy male individuals aged 18 to 55 years with a body weight between 55 and 85 kg. Patients received 1 of the 3 treatments, and 266 completed the study. There were 90 patients that received the biosimilar, 88 that received the US Stelara formulation, and 88 that received the EU formulation.

“There were no deaths, serious AEs [adverse events], or discontinuations due to treatment-emergent AEs (TEAEs). A total of 425 clinical TEAEs were reported in 186 (69.1%) subjects with medication administration, including 63 (70.0%) subjects in the BAT2206 group, 63 (70.8%) subjects in the ustekinumab (EU) group, and 60 (66.7%) subjects in the ustekinumab (USA) group,” the study investigators stated.

They added that TEAEs were similar across the groups, with the most frequent being hypertriglyceridemia, hyperglycemia, elevated alanine aminotransferase, elevated neutrophil count, decreased neutrophil count, elevated white blood cell count, elevated hemobilirubin, and hematuria. As for pharmacokinetics, the mean serum concentration-time profile had similar trends.

In the phase 3 study, investigators randomized treatment 1:1 for 45 mg or 90 mg of the biosimilar or the reference product, with 278 patients being treated until week 28. The primary end point included the percentage change from baseline in Psoriasis Area and Severity Index score to week 8 or 12. The secondary end points included safety, pharmacokinetics, and immunogenicity, according to the study authors.

Investigators found that the least squares mean difference for the primary end point was 0.964 at week 8 and 1.774 at week 12, demonstrating comparable results for the biosimilar and the reference product. Investigators found similar results for the secondary end points.

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Ustekinumab is a medication used to treat and manage inflammatory conditions, including psoriasis, psoriatic arthritis, and inflammatory bowel disease.

Jake Galdo, PharmD

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