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Two posters presented at the annual meeting of the American College of Chest Physicians, CHEST 2024, offered insights into the accurate diagnosis and appropriate treatment of ACOS.

Exploring Challenges in Diagnosis, Treatment of Asthma-COPD Overlap Syndrome | CHEST 2024

Research presented at CHEST 2024 examined outcomes of COVID-19 on patients with alcoholic liver disease, cirrhosis, and non-alcohol steatohepatitis.

Examining the Impact of COVID-19 on Patients with Liver Disease 

Emily Endres, BSPS, vice president of pharmacy at PQS by Innovaccer, provides insights into the industry’s next phase.

Strategies for Success: How to Navigate the Evolving Health Care Landscape and Unlock Alternate Revenue Streams

On October 3,2024, Texas Attorney General Ken Paxton issued the lawsuit, which involves Eli Lilly, Express Scripts, CVS Pharmacy, and other pharmaceutical entities.

Texas Sues Multiple PBMs, Drug Manufacturers Over Inflated Insulin Prices

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The FDA acceptance marks the first step in addressing the unmet need for a lasting treatment option for patients with relapsed/refractory chronic lymphocytic leukemia or small lymphocytic lymphoma.

FDA Grants Priority Review to Liso-Cel in Relapsed/Refractory CLL/SLL

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

This year marks the 20th anniversary of American Pharmacists Month.

, “dedicated to the single thread that runs through all pharmacy professionals and the services they provide.” According to the American Pharmacists Association (APhA), there are more than 700,000 pharmacy professionals working in the US—a number inclusive of pharmacists, pharmacy technicians, and student pharmacists.

In recent years, the pharmacy profession has weathered many storms, including increasing workload, staffing shortages, drug shortages, rising drug costs, and public health crises. But through it all, pharmacists have retained their spot as one of the most trusted professions, according to research from Gallup. More than 90% of Americans live within 5 miles of a pharmacy, and pharmacists are—for some communities—the only accessible form of health care.

 will be shining the spotlight on pharmacists who are making a difference across community, health system, and specialty pharmacy.

American Pharmacists Month also includes observance days focused on other areas of pharmacy practice:

October 11 is National Student Pharmacist Day

Check back on Tuesday, October 8 for our first interview, and 

 to make sure you don’t miss a minute of our American Pharmacists Month Coverage.

American Pharmacists Month Resource Center

American Pharmacists Month. Accessed October 7, 2024. 

Brenan M, Jones JM. Ethics ratings of nearly all professions down in US. Gallup. January 22, 2024. Accessed October 7, 2024. 

https://news.gallup.com/poll/608903/ethics-ratings-nearly-professions-down.aspx

American Pharmacists Month Shines a Spotlight on Community Caregiving

It is “highly likely” that pharmacy benefit management (PBM) legislation will cross the legislative finish line this year, according to Patrick Cooney, president of The Federal Group, a Washington, DC-based lobbying firm. Cooney was interviewed during the 2024 Pharmacy Benefit Management Institute Annual National Conference by 

where he discussed the role of the Federal Trade Commission (FTC) interim report in galvanizing legislators, as well as his predictions on what provisions the potential PBM legislation might contain.

What are the chances that Congress will pass PBM legislation this year?

 I think the prospects are high. After the PBMI conference, I head back to Washington, DC. We have about a 3-week period where Congress is going to try to get a lot of different things done, [including] a number of health policy matters.

I do think PBM legislation is on the table, but I think it's unlikely something's going to happen [in] the next 3 weeks. I think more likely this is going to be legislation in a lame duck session of Congress. Postelection, Congress will come back before the new Congress sits on January 1 to finish up some of the difficult legislation; by difficult, I mean some of the things that they have to spend a lot of money on. 

The PBM legislation that we've seen in the House and the Senate saves some money under Medicare, so that savings is going to be used to bolster other areas of Medicare. That's why I think it's highly likely that PBM legislation will get across the finish line.

The other reason is that in July, we saw the FTC came out with [an interim report on its investigation into PBM practices], which highlighted some of the concerns [the agency] had with the PBM community today. I think that's galvanizing action as well.

Senator [Ron] Wyden (D-Oregon), the Senate Finance Committee chair, spoke very vehemently after the report came out and said he was fully committed to getting something done quickly.

If Congress does pass PBM legislation, what will be included?

 The 3 things we can likely guarantee—because they've been pretty universal throughout the legislation that we've seen, and there's been a lot of legislation in the House and Senate—is the elimination of spread pricing under Medicaid, pass-through of all rebates 100%, and some type of robust reporting requirements. Transparency is the name of the game in DC this year with this Congress [and] not just [for] PBMs; the focus is definitely on hospitals, it is definitely on insurers, [and] I think some reporting requirements to create greater transparency. Those 3 elements I think will be in anything that we see at the end of the year.

Discussing the Lack of Transparency in GPOs of 'Big 3' PBMs

Are you ready to elevate your pharmacy practice? Sign up today for our

and get the latest drug information, industry trends, and patient care tips, straight to your inbox.

Following the Federal Trade Commission’s interim report on PBMs, legislators are galvanized to make change happen. 

Practice Management

Q&A: PBM Legislation “Highly Likely” to Pass This Year

In recent years, the US has witnessed a devastating surge in drug-related deaths, with 107,941 lives claimed in 2022 alone.

 According to the CDC, fentanyl and other synthetic opioids are responsible for approximately 70% of these fatalities, making fentanyl the nation's most urgent drug threat.

 The crisis is particularly acute in the Kensington neighborhood of Philadelphia, where the streets have become a stark battleground in the war against drug abuse.

As an independent pharmacist, I have seen firsthand the havoc that fentanyl wreaks on individuals and communities. Fentanyl, a powerful synthetic opioid, is up to 50 times more potent than heroin and 100 times more potent than morphine. Even a minuscule dose of 2 mg can be fatal. The Drug Enforcement Administration (DEA) has reported that the average fentanyl pill seized contains 2.4 mg of the drug, with some containing as much as 9 mg.

 This potency, combined with its increasing presence in other illicit drugs, has led to a dramatic rise in overdose deaths.

The problem is exacerbated by the fact that fentanyl is often mixed with other synthetic opioids or sedatives such as 

, making it even more dangerous. In 2023, 30% of the fentanyl powder seized by the DEA contained xylazine, up from 25% in 2022.

 These mixtures increase the risk of overdose and complicate the efforts of first responders to save lives, as traditional opioid overdose treatments such as naloxone may not be as effective against these drug combinations.

In Philadelphia's Kensington neighborhood, the fentanyl crisis is particularly severe. Once known for its vibrant community, Kensington is now infamous for its open-air drug markets and rampant addiction. The neighborhood has become a microcosm of the larger opioid epidemic, with fentanyl at the center of the chaos. Streets are littered with the remnants of addiction: discarded needles, crumpled packets, and the hollowed eyes of those who have fallen prey to the drug's deadly allure.

Pharmacists Should Adapt Harm Reduction Efforts to Address Unregulated Substances

For pharmacists working in or near these hard-hit areas, the challenge is immense. We are on the front lines, dispensing medications that can save lives, but also witnessing the heartbreaking consequences of addiction. Every day, we see patients struggling with substance use disorders, some of whom are seeking help, while others are spiraling deeper into their addiction. The presence of fentanyl in so many illicit drugs has made the situation even more precarious, as users often don't know what they are taking. This uncertainty increases the risk of overdose, particularly for those who are not regular opioid users.

The DEA's efforts to combat the fentanyl crisis are substantial. In 2023, the agency seized 13,176 kilograms (29,048 pounds) of fentanyl powder, nearly double the amount seized in the previous 2 years.

 Additionally, more than 79 million fentanyl pills were confiscated, almost triple the number seized in 2021.

 Despite these efforts, the flow of fentanyl into the United States continues, fueled by international drug cartels with deep ties to precursor chemical companies in China and money laundering organizations.

The digital age has also transformed the drug trade. Social media platforms and encrypted messaging apps have become new avenues for drug dealers, allowing them to reach customers without ever meeting face-to-face. This shift has pushed drug dealing off the streets and into the digital realm, making it harder for law enforcement to track and intercept these transactions. As a result, fentanyl is now more accessible than ever, reaching communities across the country, including those where drug abuse was once a rarity.

The situation in Kensington is a stark reminder of the broader challenges we face in addressing the fentanyl crisis. As pharmacists, we must advocate for stronger measures to control the distribution of prescription opioids and increase access to 

. Education is also critical: We need to ensure that both healthcare providers and the public are aware of the dangers of fentanyl and the importance of proper medication management.

However, the solution to this crisis extends beyond the pharmacy counter. It requires a comprehensive approach that includes law enforcement, public health initiatives, and community support. We need more resources for addiction treatment, mental health services, and programs that address the social determinants of health, such as poverty and homelessness, which are prevalent in areas like Kensington.

The fentanyl crisis is a complex and multifaceted problem that demands our immediate attention. As an independent pharmacist, I see the toll it takes on individuals and communities every day. We must work together—pharmacists, health care providers, law enforcement, and community leaders—to combat this epidemic and save lives. The streets of Kensington and countless other neighborhoods across the country depend on our collective action.

, is a registered pharmacist with over 33 years of clinical experience. He has worked across nearly every aspect of pharmacy, and for the last 18 years has been the owner of Delmar Pharmacy in Folcroft, Pennsylvania

Provisional data shows US drug overdose deaths top 100,000 in 2022. CDC. National Center for Health Statistics. May 18, 2023. Accessed August 29, 2024. 

https://blogs.cdc.gov/nchs/2023/05/18/7365/

Fentanyl. CDC. Reviewed May 7, 2024. Accessed August 29, 2024. 

https://www.cdc.gov/overdose-prevention/about/fentanyl.html

DEA releases 2024 National Drug Threat Assessment. News release. Drug Enforcement Administration. May 9, 2024. Accessed August 29, 2024. 

https://www.dea.gov/press-releases/2024/05/09/dea-releases-2024-national-drug-threat-assessment

Statement from DEA Administrator Anne Milgram on the increase in DEA fentanyl seizures containing xylazine. Drug Enforcement Administration. April 26, 2024. Accessed August 29, 2024. 

https://www.dea.gov/documents/2024/2024-04/2024-04-26/statement-dea-administrator-anne-milgram-increase-dea-fentanyl

Independent pharmacists, health care providers, community leaders, and law enforcement must all work together to address the fentanyl epidemic. 

Russ Conroy

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