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Is it Time to “Step Up” Rescue Treatment for Asthma to Prevent Exacerbations?

We’ve been managing asthma, for the most part, the same way for quite some time now … short-acting beta agonist (SABA) for quick relief, inhaled corticosteroids (ICS) as first-line maintenance treatment, step up if needed, step down if possible … plus self-management education and a written asthma action plan.  Despite many treatment options, numerous adults, adolescents, and children still suffer from asthma exacerbations, leading to reduced quality of life, missed work and school, higher costs, and increased asthma-related morbidity and mortality. Exacerbations can be triggered by acute respiratory infections, exposure to allergens and other environmental conditions, and poor medication use behaviors. Regardless of cause, finding ways to reduce or prevent exacerbations should be a priority.

Guest Author:  Kristen A. Pate, Pharm.D., BCACP

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Stop the Shots: Edoxaban vs Dalteparin in Cancer-Associated VTE Treatment

For the treatment of cancer-associated VTE, LMWHs are recommended over warfarin (Grade 2B) and DOACs (all Grade 2C).  Warfarin therapy in cancer-associated VTE is often made more difficult by wildly fluctuating international normalized ratios, procedure-related interruptions, as well as numerous drug-drug and drug-food interactions.  While DOACs have been widely used in the treatment of VTE, there is very little data supporting their use in patients with active cancer until now with the publication of the Hokusai VTE Cancer study.

Guest Authors:  Elizabeth Scheffel, PharmD and Christa George, PharmD, BCPS, BCACP, CDE

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Hypertension – Time for Patients to Control the Wheel

Traditionally, the management of hypertension requires routine blood pressure checks by a health professional to adjust medications. Could self-monitoring lead to better outcomes?  Would a greater percentage of patients achieve their goal blood pressure (BP)?  Self-monitoring may be an efficient method to improve blood pressure control; however, results from published reports are inconsistent. The authors of the TASMINH4 study sought to compare the effectiveness of three different approaches to BP monitoring.

Guest Authors:  Vicky Shah, PharmD, BCPS and Daniel Longyhore, MS, PharmD, BCPS

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Cutting Down HIV Treatment to a 2-Drug Regimen

While multi-drug combination therapies for HIV has resulted in longer lifespans, simplified medication regimens are needed to reduce pill-burden in an aging population with HIV. Two-drug regimens are potentially attractive because they may minimize drug exposure; reduce risks for adverse effects, drug-drug interactions, and long-term toxicities; and potentially increase patient adherence.  The SWORD-1 and SWORD-2 trials evaluated the efficacy and safety of a two-drug regimen to maintain viral suppression in HIV infected patients.

Guest Authors Tinh An (April) Nguyen, PharmD and Jihae Lim, PharmD

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Strategies for Managing Hypertension: Is the Paradigm Shifting?

Forty-five percent of all adults in the United States have high blood pressure — that’s more than 100 million people! Of those treated with pharmacotherapy, more than half are not achieving their blood pressure goals. Thus, millions of Americans are receiving suboptimal care.  A recently published systematic review and meta-analysis examined various implementation strategies to improve BP control in patients with high blood pressure. Which implementation strategies work best?

Guest Author: Lauren G Pamulapati, PharmD

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Don’t Kid Yourself: Broad- versus Narrow-Spectrum Antibiotics in Children

Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and higher prevalence of adverse drug reactions. Nearly 2 million infections and 23,000 deaths are caused by bacteria that are antibiotic-resistant each year in the United States costing the healthcare system an estimated 20 billion dollars. Moreover, adverse reactions to antibiotics are the most common reason for pediatric patients to visit the emergency department.  Narrow-spectrum antimicrobials are generally preferred, but there are instances where broader coverage is recommended.  A recent study attempts to “clean up” the debate by examining the benefits and risks of using narrow- versus broad-spectrum antibiotics in children with acute respiratory tract infections.

Guest Authors:  Amber Giles, PharmD, MPH, BCPS, AAHIVP  and Paige Hughes, PharmD

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Using Sotagliflozin In Tandem with Insulin: Weighing the Benefits in Type 1 Diabetes

Patients with type 1 diabetes often have sub-optimal glycemic control.  The gold standard of treatment is basal-bolus insulin or continuous subcutaneous insulin infusion via an insulin pump.  However, only a third of patients with type 1 diabetes achieve the American Diabetes Association A1C goal <7%.  There has been particular interest in using SGLT-2 inhibitors in patients with type 1 diabetes due to their ability to decrease body weight and blood pressure as well as improve glycemic control and perhaps cardiovascular outcomes. InTandem3 was a phase III, multicenter, randomized, double-blind, placebo-controlled trial evaluating the safety and efficacy of sotagliflozin, a novel dual SGLT 1 and 2 inhibitor, in patients with Type 1 diabetes.

Guest Author:  Diana Isaacs, Pharm.D., BCPS, BD-ADM, CDE

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Treating Opioid Use Disorder - X:BOT Offers a Pragmatic Approach

Opioid-use disorder (OUD), a risk factor and major contributor to opioid-related deaths, is often underdiagnosed and undertreated.  Currently there are three FDA-approved pharmacologic treatments for OUD maintenance therapy: methadone, buprenorphine (with or without naloxone), and naltrexone.  Despite definitive evidence that methadone and buprenorphine products are effective in the treatment of OUD, there are still considerable accessibility and availability barriers that patients face when seeking Medication Assisted Treatment (MAT). The EXtended-release naltrexone vs Buprenorphine/naloxone for Opioid Treatment (X:BOT) trial compared the efficacy and safety of XR-NTX and BUP-NX to induce and maintain a patient with OUD on MAT as well as reducing opioid overdoses, relapses, and cravings.

Guest Author:  Jordan L. Wulz, PharmD, MPH, BC-ADM, CHC

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Can We KEEP Perimenopausal Women Sexually Satisfied?

Female sexual dysfunction (FSD) effects women of all ages but is common among perimenopausal / postmenopausal women and may be related to a reduction in circulating estrogen.  Oral estrogens increase sex hormone-binding globulin (SHBG) which lowers available free testosterone and thus may negatively impact sexual function.Transdermal estrogens are typically preferred because they lack a high first-pass effect and are not associated with risk of thromboembolic events. However, additional research – directly comparing oral and transdermal preparations – was needed.  An ancillary study of the Kronos Early Estrogen Prevention Study (KEEPS) did just that - examined the impact of oral and transdermal estrogens on sexual functioning.

Guest Authors:  Stefanie C. Nigro, PharmD, BCACP and Christine Dimanculangan, Pharm.D.

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Know When to Hold 'Em - Know When to Fold 'Em. Deprescribing in BPH.

A recently published study explores the possible benefits to discontinuing an alpha-1 blocker after receiving combination therapy with a 5-alpha reductase inhibitor for the treatment of benign prostatic hyperplasia (BPH).  In more symptomatic patients, or patients with confirmed, enlarged prostates, it is recommended to use both medication classes (alpha-1 blocker and 5-alpha reductase inhibitor) to minimize symptoms by relaxing the prostatic smooth muscle and reducing the size of the prostate – producing a potentially synergistic effect.  This study found that withdrawal of alpha 1-blockers after a year of combination therapy did not worsen urinary symptoms, QOL, and voiding or storage function.  This provides evidence that combination therapy may not be needed indefinitely for all patients.

Guest Authors:  Erica Crannage, PharmD and Stephanie Crist, PharmD

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