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Articles

Taylor Watterson, PharmD, PhD, discusses how pharmacy technician burnout can impact pharmacy operations. 

Q&A: How Technician Fatigue Threatens Patient Safety, Care

Rob Frankil, RPh, discusses how independent pharmacies in Pennsylvania are dealing with the impact of Rite Aid stores closing.

Q&A: Pharmacies Grapple With Patient Influx Amid Rite Aid Closures

Pharmacist-led deprescribing can help reduce the number of medications a patient is taking in an effective way.

Deprescribing Interventions Could Safely Reduce Number of Potentially Inappropriate Prescriptions

Interest in community pharmacy practice is declining as pharmacists seek roles with better work-life balance, greater autonomy, and more meaningful patient care opportunities.

Declining Interest in Community Pharmacy Practice Reflects Career, Industry Uncertainty 

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

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Two Arizona pharmacists made headlines when it seems they may have not adhered to the Oath of the Pharmacist.

Opinion: Upholding Our Oath 

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

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In a phase 4 trial, dupilumab (Dupixent) showed superiority on all primary and secondary end points compared with omalizumab (Xolair) for patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP) and coexisting asthma. Data from the EVEREST (

) trial were presented at the 2025 European Academy of Allergy and Clinical Immunology Annual Congress in Glasgow, United Kingdom.

“Patients suffering from chronic rhinosinusitis with nasal polyps often live with the constant obstruction of their nasal passages that can lead to burdensome nasal congestion and loss of smell,” Eugenio De Corso, MD, PhD, ENT specialist at the A. Gemelli University Hospital, said in a news release.

 “EVEREST is the first-ever trial to demonstrate the superiority of Dupixent over Xolair on CRSwNP end points in patients with coexisting asthma, along with generally similar safety profiles. Together, these Dupixent outcomes provide important insights that will help guide patients and physicians through the treatment decision-making process.”

, the authors stated that “EVEREST is the first head-to-head trial assessing the comparative efficacy and safety of 2 biologics in patients with severe CRSwNP and comorbid asthma.” They explained the methods of the phase 4, randomized, double-blind trial.

Investigators conducted the trial to evaluate the efficacy of dupilumab compared with omalizumab in reducing the polyp size and improving sense of smell. The trial lasted 38 weeks, comprising of 3 periods: a 28-day screening and run-in period, a 24-week randomized investigational medicinal product intervention period, and up to a 12-week follow-up period. Patients included were 18 years and older, had bilateral sino-nasal polyposis, had a diagnosis of asthma, were treated with intranasal mometasone, and were eligible for omalizumab. Patients received either dupilumab every 2 weeks via subcutaneous injection or omalizumab every 2 weeks or every 4 weeks via subcutaneous injection.

The primary end points included change from baseline to week 24 nasal polyp score and change from baseline to week 24 in the University of Pennsylvania Small Identification Test. Secondary outcomes included change from baseline to week 24 in the loss of smell score of the CRSwNP nasal symptom diary, change in the nasal congestion score, change in total symptom score, change in 22-item sinonasal outcome test (SNOT), change in SNOT-22 nasal domain score, change in nasal peak inspiratory flow, change in rhinosinusitis visual analogue scale, incidence of treatment-emergent adverse events (AEs) and serious AEs, and AEs of special interest.

Investigators included 360 adults with severe uncontrolled CRSwNP and asthma, with 181 receiving dupilumab and 179 receiving omalizumab. Mometasone furoate nasal spray was used as a background therapy. The results showed a 1.6-point superior reduction in nasal polyp size with dupilumab compared with omalizumab, an 8-point superior improvement in ability to identify different smells, a 0.58-point superior reduction in nasal congestion and obstruction, and a 0.81-point improvement in loss of smell. Further, investigators found that dupilumab had a 1.74-point reduction in symptom severity, a 12.7-point difference in health-related quality of life, a 31.27-point difference in peak nasal inspiratory flow, and a 1.87 difference in overall severity of rhinosinusitis compared with omalizumab.

Further, investigators found that dupilumab improved asthma end points as well, including a 150 mL difference in lung function and a 0.48-point difference in asthma control compared with omalizumab. As for safety, the data were consistent with the known safety profile of dupilumab, with AEs being observed at 64% for dupilumab and 67% for omalizumab. Serious AEs were reported in 2% and 4%, respectively. For discontinuation, 3% and 1% of patients discontinued the story, respectively.

Ready to impress your pharmacy colleagues with the latest drug information, industry trends, and patient care tips? Sign up today for our

1. Press Release: EAACI: Dupixent demonstrated superiority over Xolair (omalizumab) in chronic rhinosinusitis with nasal polyps in patients with coexisting asthma in first-ever presented phase 4 head-to-head respiratory study. News release. Sanofi. June 15, 2025. Accessed June 16, 2025. https://www.sanofi.com/en/media-room/press-releases/2025/2025-06-15-15-22-00-3099494

2. De Prado Gomez PharmD MSc L, Khan Mbbs Mph AH, Peters Md AT, et al. Efficacy and Safety of Dupilumab Versus Omalizumab in Chronic Rhinosinusitis With Nasal Polyps and Asthma: EVEREST Trial Design. 

. 2022;36(6):788-795. doi:10.1177/19458924221112211

3. Evaluating treatment RESponses of Dupilumab Versus Omalizumab in Type 2 Patients (EVEREST). ClinicalTrials.gov identification: NCT04998604. Updated January 20, 2025. Accessed June 16, 2025. https://clinicaltrials.gov/study/NCT04998604

This study is the first to compare 2 biologics for patients with chronic rhinosinusitis with nasal polyps and coexisting asthma.

Dupilumab Shows Superiority Over Omalizumab for Chronic Rhinosinusitis

A conversation with Taylor Watterson, PharmD, PhD, assistant professor at the University of Chicago Illinois Retzky College of Pharmacy.

Supporting the Well-Being of Community Pharmacy Technicians

Pharmacy technicians face many challenges in the workplace that can negatively impact their well-being. Most of the stress comes from high workloads and not enough resources to manage them. Pharmacy technicians handle many tasks, but there’s often not enough staff or time to get them all done, which can lead to occupational fatigue and burnout.

Pharmacy technicians also work in a unique setting that combines healthcare with a business model. They’re expected to care for patients while also meeting business goals, which adds pressure. They also often deal with frustrated or unwell patients, which can lead to stressful or even unsafe interactions.

A recent study used the US Surgeon General’s Framework for Workplace Mental Health and Well-being to look at these issues.

 One of the key ideas is “protection from harm,” which includes both physical and emotional safety. This could mean preventing violence, offering training on dealing with difficult situations, or creating patient behavior guidelines. It also includes basic things like allowing time for lunch or bathroom breaks, which are often skipped.

To help pharmacy technicians feel supported, workplaces can also build stronger connections among staff, recognize and celebrate their efforts, and include them in decision-making. Immediate steps like improving safety, ensuring proper rest, and reducing workload or increasing staff could go a long way in improving well-being. Pharmacy technicians are vital to the healthcare system, and supporting their needs helps improve care for everyone.

Drug Topics recently sat down with Taylor Watterson, PharmD, PhD, assistant professor at the University of Illinois Chicago Retzky College of Pharmacy and an author on the study, to discuss the primary contributors to stress or frustration among pharmacy technicians today and immediate steps that can be taken to reduce technician workload and prevent burnout.

1. Fick G, Osei J, Kim S, et al. A narrative literature review: Community pharmacy technician well-being and its implications. 

 (2003). 2025 May 9:102419. doi: 10.1016/j.japh.2025.102419. Epub ahead of print. PMID: 40349976.

Pharmacists played a critical role during the COVID-19 pandemic, administering vaccines at a higher rate than other health care professionals.

 Through the Federal Retail Pharmacy Program, they delivered over 300 million COVID-19 vaccine doses nationwide. This high level of engagement not only improved vaccination rates and patient satisfaction but also reshaped the role of community pharmacies.

At the American Associated Pharmacies (AAP) Annual Conference, held April 10 to 12 in Austin, Texas, 

sat down with Greg Mitchell, owner of United Drug Superstore in Hatch, New Mexico, to discuss how important vaccine administration is to a pharmacy’s overall profitability, what strategies pharmacists can use to maximize vaccine uptake and patient engagement, and how retail pharmacies can leverage vaccine services to build long-term patient relationships.

Importance of Vaccination to Independent Pharmacy Profitability | AAP 2025

 How significant is vaccine administration to a pharmacy’s overall profitability?

 It's just been huge for us. It's been amazing. We jumped into the vaccination business in 2020, before the COVID-19 vaccines came out. We were very fortunate to have been one of the states where our wholesalers supplied the federal supply of vaccines. We jumped right in with both barrels and finished that year with about 5800 vaccines. The profitability that year was well above anything we'd seen in previous years. What we look at now is that typically, if vaccines are 5% of our business, they're 10% of our gross margin. That tells you that it's very significant.

 What strategies can pharmacists use to maximize vaccine uptake and patient engagement?

 That was a question that I had after looking at the deck that Scott shared with us today when I saw that another classic chain was actually up in vaccine administration, whereas our stores, independent stores, all seem to be down. My store was down 30% this last year. We went into some of the grocery stores to see what was going on, and they did a fantastic job of point of purchase advertising. They had advertising when you walked in the door, advertising when you picked up your cart, advertising on the end caps, advertising at the checkouts, to try and get the patients over to the pharmacy. For us, we've got to really concentrate on doing that this next year.

The other thing is, you can mine your state immunization information system database. We've started doing that in the last 3 months and we've had a huge uptake. We're actually calling the patients and saying, “Hey, we see where you got your first shingles vaccine. You didn't get your second one. We need to get you in here.” That's really bringing people in. We are concentrating on having our staff mining that immunization information system every time we fill a prescription for somebody. On the state site it shows exactly what they're due for. Then we're going to call them and say, “Hey, when you come in, you might want to get your COVID-19 shot, or your second Shingrix, or whatever it is. That's been tremendous for us.

How can retail pharmacies leverage vaccine services to build long-term patient relationships?

: it's interesting that you asked that. We're in a rural area, and when we started off doing the COVID-19 vaccines, we actually did more vaccines in our small, rural pharmacy in Hatch, New Mexico, than any other pharmacy in our county. Our county includes the second most populous city in the state, with multiple Walgreens, multiple CVS, multiple Walmarts, every chain pharmacy you could think of. We did a great job on it, and a lot of the patients were so happy that we've made patients out of them and they've come 40 miles to our pharmacy from the city where there's plenty of pharmacies to choose from. They've decided to come back and do business with us. Just do a good job and people will stay with you.

Be sure to keep up with all of our coverage from AAP 2025 here.

1. Carroll JC, Herbert SMC, Nguyen TQ, et al. Vaccination equity and the role of community pharmacy in the United States: A qualitative study. 

. 2024 Jan 25;42(3):564-572. doi: 10.1016/j.vaccine.2023.12.063. Epub 2024 Jan 9. PMID: 38195264.

2. Religioni U, Vaillancourt R, Kazmierczak J, et al. Patient Opinions and Satisfaction Regarding Pharmacists Delivering Vaccinations in Community Pharmacies. 

. 2025 Mar 13;12:23743735241309473. doi: 10.1177/23743735241309473. PMID: 40092975; PMCID: PMC11907534.

A conversation with Greg Mitchell, owner of United Drug Superstore in Hatch, New Mexico, at AAP 2025.

Mohamed A. Jalloh, PharmD

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