iForumRx.org

FAST Take: Update on Febuxostat Cardiovascular Safety

We know gout is among the many comorbidities that increase the risk of cardiovascular disease (CVD). In 2018, the cardiovascular safety of febuxostat and allopurinol in patients with gout and cardiovascular morbidities (CARES) trial concluded that febuxostat was non-inferior to allopurinol. BUT, two of the secondary endpoints were very concerning. Febuxostat was inferior to allopurinol in terms of cardiovascular death and all-cause mortality. Many clinicians were left wondering whether febuxostat was cardiotoxic …. or conversely, perhaps allopurinol was cardioprotective. Will another cardiovascular outcome trial provide greater clarity to guide clinical practice?

Guest Authors: Sophia Dietrich, PharmD and Michael W. Nagy, PharmD, BCACP

Guest Panelist: Dawn Fuke, PharmD, BCPS

Music by Good Talk

Metformin During Pregnancy: Are the Results MiTy Enough to Change Practice?

The American Diabetes Association (ADA) currently recommends insulin as the preferred agent for the management of type 2 diabetes mellitus during pregnancy. However, metformin is routinely used as it has several advantages over insulin including the lower cost, less maternal weight gain, and less maternal hypoglycemia. The MiTy study explores the benefits and risks of a combination of metformin plus insulin. 

Guest Authors:  Hugh Quinn, PharmD and Mallory Telese, PharmD
Guest Panelists: Erin Raney, PharmD, BCPS, BC-ADM and Rebecca Stone, PharmD, BCPS, BCACP

Music by Good Talk

Can a Polypill ‘TIP’ the Scale to a One-Size-Fits All Approach?

Creating an ideal therapeutic regimen is often like putting a puzzle together, with adherence being a critical piece of that puzzle. Studies, and clinical experience, show that patients are more likely to adhere to once-daily medication administration when compared to regimens that require more frequent dosing.  Given that pill burden and medication cost are an increasing problem, would our patients benefit from a simple, low-cost, one-size-fits-all approach to addressing cardiovascular risk?

Guests:  Ebony Isis Evans, PharmD, Katy Pincus, PharmD, BCPS, BCACP, and Sara Wettergreen, PharmD, BCACP

Music by Good Talk

There’s an App for That! Can Smartphone Apps Assist with Smoking Cessation?

Despite numerous anti-smoking campaigns, millions of adults continue to use traditional tobacco-cigarettes or e-cigarettes. Nearly 70% of smokers state they want to quit, however, less than 10% are successful.  Disappointingly, less than 60% of smokers report being offered any advice from healthcare professionals when trying to quit.  Smartphone applications are a new option for patients attempting to quit smoking in the digital age, but it is unclear if these apps improve quit rates.

Guest Authors:  Yue Pheng Vang, PharmD and Michelle Balli, PharmD, BCACP

Music by Good Talk

DECLARE-ing Another Victory for Dapagliflozin

Until now, only two classes of medications have been definitively shown to delay the decline in renal function in patients with CKD: angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs).  The sodium glucose co-transporter 2 inhibitors are increasingly prescribed to a wider and wider population of patients. And the latest data suggest they may have an important role in the treatment of chronic kidney disease (CKD) in patients with ... or without ... diabetes. 

Guest Authors:  Stefanie C. Nigro, PharmD, BCACP and Jennifer N. Clements, PharmD, BCPS, BCACP, CDCES, BC-ADM

Music by Good Talk

Closing the Loop for Children with Type 1 Diabetes

Insulin pumps and continuous glucose monitors (CGM) have changed the standard of care for managing Type 1 Diabetes. A closed-loop system (also described as an artificial pancreas or automated insulin delivery system) consists of a CGM, an insulin pump, and a control algorithm that automatically calculates basal insulin delivery based on real-time glucose levels. Closed-loop insulin pumps may offer an opportunity to improve glycemic management while reducing some of the associated stress. However, there are limited data evaluating the safety and efficacy of this technology in children less than 14 years old.

Guest Authors:  Mary K Culp, PharmD and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES

Music by Good Talk

Is it Time to Add Colchicine to the CVD Cocktail?

Systemic inflammation appears to be an important contributor to atherosclerotic cardiovascular disease but, to date, no medications have been approved that specifically target systemic inflammation. Could colchicine, an anti-inflammatory drug that has been used for decades, move from “perhaps-do” to a “must-do” standard of care for patients with coronary artery disease (CAD)? Data from two previous trials have demonstrated colchicine’s positive impact on cardiovascular outcomes. The LoDoCo2 study asks us, again, to consider colchicine for patients with CAD.

Guest Authors:  Augustus (Rob) Hough, PharmD, BCCP and Taylor Huff, PharmD

Music by Good Talk

Canagliflozin Comeback? New Data on the Risk of Amputation

Patients with diabetes are 10 times more likely to experience lower limb amputations than the general population and amputations have very significant morbidity, mortality, and financial implications. While common risk factors for amputation in patients with diabetes include poor glycemic control, diabetic peripheral neuropathy, or peripheral arterial disease, canagliflozin use was implicated in the CANVAS and CANVAS-R trials. However, the CANVAS Program trials were not specifically designed to evaluate the risk of lower-extremity amputations.  Clearly, we need more information about the magnitude of risk when canagliflozin is used widely in a general population and who is at most risk.

Guest Authors:  Julie Dally, PharmD, BCPS, BCACP and Amanda Schartel, PharmD, BCACP

Music by Good Talk

Using shared decision-making tools: Are they worth it?

There’s no denying that shared decision making (SDM) is an effective communication approach for making patient-centered medical decisions across a variety of health conditions. However, while tools for SDM are often useful during patient visits with practitioners, studies have yielded mixed results with regard to patient outcomes.  A new study explores the impact of a SDM tool for anticoagulation selection in patients with atrial fibrillation compared to standard care.

Guest Authors:  Ashley Meredith, PharmD, BCACP, BCPS, CDCES and Chandler Howell, PharmD

Music by Good Talk

Less Might Be Better: Deprescribing Antihypertensive Medications in Older Adults

Health care professionals often don’t think twice about adding a new medication when a patient is not at goal. But we’re reluctant to stop a medication for a chronic condition when the patient appears to be stable and doing well.  Polypharmacy in older adults is a significant problem.  It’s costly and increases the likelihood of adverse effects. Several observational studies have suggested that lower blood pressure and multiple antihypertensive medications may be harmful in the elderly. Is it possible to discontinue medications without causing serious harm?

Guest Authors: Keturah Weaver Pharm D, BCPS and Daniel Longyhore Pharm D, M.S., BCACP

Music by Good Talk