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The Heart Failure Society of America 2024 Annual Meeting featured presentations exploring the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) for patients with heart failure.

SGLT2i Reduces Hospitalizations, Mortality in Patients With Heart Failure

Lauren Biscaldi is the Managing Editor of Drug Topics. 

Articles

Investigators compared semaglutide and other glucagon-like peptide-1 receptor agonists with dipeptidyl peptidase-4 inhibitors.

GLP-1 Therapies Reduce Risk of Cirrhosis, Complications of MASLD 

Several posters presented at the Heart Failure Society of America 2024 Annual Meeting looked into the landscape of guideline-directed medical therapy.

Examining Guideline-Directed Medical Therapy in Patients with HFrEF

In posters presented at the Heart Failure Society of America 2024 Annual Meeting, researchers assessed how substance use disorders impact cardiovascular outcomes.

Cocaine, Cannabis Use Significantly Increased Cardiovascular Events

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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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 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

Glucagon-like peptide 1 receptor agonists (GLP-1 RAs) may reduce the risk of heart failure hospitalization, mortality, and cardiovascular outcomes, even in individuals without diabetes, according to research presented at the Heart Failure Society of America 2024 Annual Meeting.

These findings build on existing evidence demonstrating the effectiveness of GLP-1 RAs in improving cardiovascular outcomes for patients with type 2 diabetes (T2D). To explore this potential benefit in a broader population, investigators conducted a meta-analysis of cardiovascular outcome trials to assess the effect of GLP-1 RAs on mortality and cardiovascular outcomes in patients without diabetes.

Using the Cochrane Central Registry of Controlled Trials, PubMed, Embase, and ClinicalTrials.gov, investigators gathered a total of 9 randomized controlled trials published until March 2024. The clinical outcomes of interest were all-cause mortality, cardiovascular death, heart failure hospitalization, myocardial infarction, revascularization, and stroke.

Of 77,684 participants included, 39,497 received GLP-1 RAs and 38,187 received placebo.

Higher Vaccination Rates Improve Outcomes in Heart Failure During Respiratory Virus Season

Compared to placebo, GLP-1 RA was associated with a significant reduction in all-cause mortality (95% CI: 0.82-0.92, 

 < .00001), cardiovascular death (95% CI: 0.81-0.93, 

 < .0001), myocardial infarction (95% CI: 0.79-0.97, 

 = .01), revascularization (95% CI: 0.74-0.94, 

 = .0005), and heart failure hospitalization (95% CI: 0.82-0.97, 

Previously, topline results from the pivotal FLOW trial demonstrated that semaglutide (Ozempic) was able to reduce kidney disease progression, major adverse cardiovascular events (MACE), and death by 24% in patients with T2D.

 This positive effect was confirmed by secondary endpoints, leading to the early termination of the trial due to its demonstrated efficacy.

Another meta-analysis involving 83,258 patients corroborated these findings, demonstrating that GLP-1 RAs reduced MACE, overall and cardiovascular mortality, stroke, coronary revascularization, and composite kidney outcomes across various patient subgroups.

 These included sex, estimated glomerular filtration rates, body mass index, and history of cardiovascular disease, in patients with and without diabetes. As a result, authors of the meta-analysis, published in the 

American Journal of Preventive Cardiology

, recommended that health care professionals consider prescribing GLP-1 RAs to all eligible patients to improve cardiovascular and renal outcomes.

By demonstrating that GLP-1 RAs significantly reduced heart failure hospitalization, mortality, and cardiovascular events, regardless of diabetes status, the current study adds to this body of research. These findings could inform future guidelines for GLP-1 RAs especially as they continue to grow in popularity. However, investigators noted that longer-term follow-up studies are necessary to determine if these improvements translate into increased overall survival.

 of the Heart Failure Society of America 2024 Annual Meeting.

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

1. Sammudeen I. Cardiovascular outcomes of glucagon-like peptide 1 receptor agonists irrespective of diabetes status: A meta-analysis of randomized controlled trials. Presented at: Heart Failure Society of America 2024 Annual Meeting; September 27-30, 2024; Atlanta, GA. Poster 1437-324.

2. Myshko D. Ozempic lowers risk of kidney disease progression, cardiovascular events by 24%. 

 March 6, 2024. Accessed October 1, 2024. 

https://www.drugtopics.com/view/ozempic-lowers-risk-of-kidney-disease-progression-cardiovascular-events-by-24-

3. Rivera FB, Cruz LLA, Magalong JV, et al. Cardiovascular and renal outcomes of glucagon-like peptide 1 receptor agonists among patients with and without type 2 diabetes mellitus: A meta-analysis of randomized placebo-controlled trials. 

. 2024;18:100679. Published 2024 May 7. doi:10.1016/j.ajpc.2024.100679

Research presented at the Heart Failure Society of America 2024 Annual Meeting demonstrated that glucagon-like peptide 1 receptor agonists (GLP-1 RAs) reduced cardiovascular events in patients without diabetes.

GLP-1s May Protect Against Cardiovascular Outcomes Regardless of Diabetes Status

American Pharmacies is a member-owned purchasing cooperative for independent pharmacies with more than 700 members in 38 states.

Increased Competition, Changing Patient Needs Are Both Threat & Opportunity

The urgency for PBM reform has reached new heights as many pharmacies struggle to keep their doors open under the weight of poor reimbursements and loss of patients to PBM-owned mail-order and specialty pharmacies. Many independent owners hope that new laws curbing PBM behaviors will enable them to survive in a more fair and competitive landscape. But will PBM reform — and the stabilization of pharmacy revenue that is expected to follow — be enough to ensure independents’ long-term survival? The evidence says it won’t.

Prescription Drug Fulfillment is Rapidly Changing

Many independents attribute their declining revenues and loss of prescription volume to poor reimbursements and PBM steering of business to affiliated mail-order and specialty pharmacies. 

But those well-publicized problems distract from a powerful reality:  ending abusive PBM practices and poor reimbursements will not end disruptions of the dispensing model.

Growth of mail order, central fill, specialty pharmacies and alternative distribution and payment models are eroding the core dispensing business of traditional brick and mortar pharmacies. Disruptors like Amazon, GoodRx, Cost Plus Rx, etc., are slicing off their own pieces of dispensing revenue. And though automated dispensing through kiosks is allowed in only seven states at this time, that number is sure to expand greatly in the next few years.

Online operators like hims, hers, ro and GoodRx Care are merging telemedicine with mail-order pharmacy to offer low-cost, on-demand consults for conditions ranging from ED, hair loss, STDs, fertility and skin conditions to minor illnesses and mental health. Prescriptions are issued and mailed promptly. 

Rx costs are often higher, but people are willing to pay for convenience and privacy.

In fact, convenience and speed of service rank #2 and #3 in patients’ stated criteria for choosing a pharmacy; price ranked only #5. Pharmacist knowledge and advice ranked only #8! Companies with larger scale and resources are finding ways to deliver prescriptions faster, more conveniently and cheaper than you can.

 So, how do you compete with a company that allows a patient to visit a provider online about a health condition, and get a script mailed to them, eliminating two trips? 

You give them other compelling reasons to come to your pharmacy.

As patients shift from hierarchical health care relationships to a partnership role with providers, wellness and prevention grow in importance along with self-care options. And the escalating shortage of primary care providers creates timely opportunities for independent pharmacies to take on chronic disease management, wellness and prevention, diagnostic testing and digital therapeutics to help patients monitor and report data on their conditions.

The Association of American Medical Colleges projects a shortage of up to 48,000 primary care physicians by 2034,

which will disproportionately impact smaller communities and rural areas. The number of Americans 65 & older is expected to increase 42.4% over this period. 

The number of pharmacists will continue to grow.

 Clearly, the opportunity is ripe for pharmacies to become health care destinations where patients can be tested for infections, get immunizations and advanced clinical services, and purchase nutrients, vitamins, CBD, probiotics and digital health monitors.

More than half of Gen Z (56%) and Millennial (54%) respondents said they’d like to visit the pharmacy to get primary care, according to a May 2023 Wolter Kluwers survey of more than 1,000 U.S. health care consumers. That compares to 40% of Gen X and 35% of Boomers who said the same. More than half of adult patients said they would visit a retail health clinic in a pharmacy. 81% of those surveyed say they trust a pharmacist, nurse or nurse practitioner to diagnose minor illnesses and prescribe medications to treat them.

The traditional pharmacy derives its revenue from the profits made on dispensing medications. 

 that measures success by profit per sale.

 Success depends on growing both dispensing volume and margins, a near-impossible task in an era of rising competition and inadequate third-party reimbursements.

The Traditional Pharmacy is a transaction-based model focused on profit per script, which is outdated and increasingly untenable.

Innovation is best engendered by a new-generation model that seeks to generate substantial revenue — cash sales — outside third-party reimbursement channels. 

 measuring success by cumulative profit per patient or household. It is a model driven by opportunities.

Transitioning to a relationship-based economic model means expanding the products and services offered to patients to better assess and address their whole-health needs. It means evaluating a patient’s economic value not by the number and cost of scripts filled, but by the value of all products and services purchased over time. It requires access to PHI and demographic data to better understand your potential customer base and shape your offerings and marketing to appeal to them.

Most importantly, it requires a staff that is forward-focused, well-trained and empowered to implement new services and workflows.

Knowing that pharmacists are often averse to risk and change, American Pharmacies decided to invest in resources and infrastructure to engage/educate/empower owners to make the changes that will transform their pharmacies. We created change/innovation blueprints and identified change agents among our members to help us LEAD all members through change.

Acting on the vision of President Laird Leavoy, American Pharmacies created the Pharmacy & Clinical Services (PCS) department in late 2023 to advance the clinical and revenue capabilities of the co-op and its members. Headed by VP of Pharmacy and Clinical Services Danny Nelson and VP of Pharmacy Analytics and Clinical Services Jeff Jacobs, PCS guides our staff in providing members the intelligence and tools to optimize their ROI and workflow efficiency. PCS engages innovative vendors and carefully evaluates their solutions to gauge viability, performance and affordability. American Pharmacies regularly brings members into partnership evaluations to gain perspective and to better understand the potential for successful, widespread adoption.

The PCS team works closely with American Pharmacies primary wholesale partner, Cencora, to ensure that members are supported to take full advantage of the many Cencora programs and resources at their disposal.

“Raising awareness among our members is the first step in supporting pharmacies that are focused on diversification and revenue growth,” Jacobs said. “These are the attributes of tomorrow’s pharmacy health center, which will bring favorable outcomes for both owners and their patients.”

Sponsored by Jones Healthcare Group

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