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ARCH Study: Is Romosozumab better than Alendronate for the Fracture-Prone?

It’s been 20 years since alendronate was approved to treat osteoporosis.  Although effective, bisphosphonates aren’t ideal. Romosozumab is an investigational monoclonal antibody that increases bone formation and decreases bone resorption. Is romosozumab a potentially better alternative to bisphosphonate therapy?  That’s what the ARCH study attempted to answer.

Guest Authors:  Yanqun Evonne Lee, MClinPharm and Joyce Yu-Chia Lee, PharmD

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SPRINTing towards lower BP goals : A re-analysis of the ACCORD-BP trial

The new 2017 ACC/AHA guidelines recommend a BP goal of <130/80 mmHg for everyone – including patients with diabetes. The 2018 ADA guidelines also recommend a goal of <130/80 mmHg, but only in patients at high risk of cardiovascular disease and only when it can be achieved without undue treatment burden. This change in recommendations is largely driven by results of the Systolic Blood Pressure Intervention Trial (SPRINT), which demonstrated a 25% reduction in the primary composite outcome of CV events with intensive BP control (SBP target <120 mmHg). However, extrapolating these findings to patients with T2DM has been challenging as patients with diabetes were excluded from SPRINT. A recent re-analysis of the ACCORD-BP study shed some new light.

Guest Authors: Kevin Cowart, Pharm.D. and Karen Sando, Pharm.D.

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Therapy for Early-Stage COPD: What is the GOLDen Regimen?

Nearly 16 million adults in the United States have chronic obstructive pulmonary disease (COPD) but this is probably a woeful underestimate as many adults are asymptomatic in early stages.  Screening is only recommended if patients exhibit symptoms and have risk factors.  However, the most rapid decline in lung function occurs during GOLD stage 1. As COPD progresses, mortality, morbidity, and the economic burden increase very significantly. These facts suggest a need to detect and treat early-stage disease to slow its progression. The Tie-COPD study provides some new evidence that early treatment might be beneficial.

Guest Authors: Amy Robertson, Pharm.D. and Michelle Balli (Piel), Pharm.D.

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Inflammatory Statements about Cardiovascular Risk Reduction: The CANTOS Trial

We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and might be able to address? New evidence suggests systemic inflammation may be one.

Guest Authors:  Ian Hatlee, Pharm.D and Scott Pearson, Pharm.D.

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Top Ten Things Every Clinician Should Know About the 2017 Hypertension Guidelines

We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017.  Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals.  Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we move forward to making these recommendations a reality.

Guests:  Kristin Rieser, Pharm.D., Joseph Saseen, Pharm.D, and Eric MacLaughlin, Pharm.D.

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Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone.  Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.

Guest Authors:  Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.

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Azithromycin to Prevent Asthma Exacerbations: What AMAZES Us and What Doesn’t

Despite good adherence to high-dose inhaled corticosteroids (ICS) and concomitant long-acting beta agonists (LABA), millions of people with asthma continue to experience exacerbations.  What more can patients and clinicians do to reduce the risk of exacerbations?  Does the routine use of antibiotics reduce the frequency of exacerbations?  This is the question the recently published AMAZES study attempted to answer.

Guest Authors: Michael Nagy, Pharm.D. and Ashley Crowl, Pharm.D.

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Painstaking Efforts to Improve Opioid Stewardship

Drug overdose is now the leading cause of death among Americans under the age of 50.  In 2016, the United States (U.S.) Centers for Disease Control and Prevention (CDC) released a seminal guideline for primary care clinicians regarding opioid prescribing. These guidelines are now being implemented by clinicians, insurers, and healthcare institutions. The Transforming Opioid Prescribing in Primary Care (TOPCARE) study sought to assess the impact of a multicomponent care management intervention on opioid stewardship in four primary care centers.

Guest Authors:  Lucas Hill and Jennifer Shin

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Painting a New CANVAS for SGLT-2 Inhibitors?

While good glycemic control has been shown to prevent microvascular complications (e.g. retinopathy, nephropathy, neuropathy), only a few anti-diabetic agents have been shown to reduce macrovascular complications (e.g. cardiovascular events. Empagliflozin, a sodium glucose transporter-2 (SGLT2) inhibitor, not only reduced the risk of CV events but also all-cause mortality in the EMPA-REG OUTCOME study.  Based on this data, the SGLT2 inhibitors were given favorable second-line treatment status in the most recent AACE/ACE clinical practice guidelines. But do all SGLT2 inhibitors confer the same benefits… and risks? The Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes (CANVAS) trial assessed the cardiovascular and renal benefits from long-term canagliflozin use.  The results are both reassuring and unexpected.

Guest Author:  Sean Lasota, Pharm.D.

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Validating HERDOO2 - When is it Safe to Stop Therapy After an Unprovoked VTE?

According to the 2016 CHEST VTE Guidelines, at least 3 months of therapy is recommended for an unprovoked DVT or PE (Grade 1B). Thereafter, the clinician is expected to weigh the risks and benefits to determine if extended therapy is appropriate. Balancing the risk of mortality from recurrent VTE versus major bleeding has been challenging.  A validated clinical decision tool is sorely needed!  Until recently, no risk assessment tool has been validated and therefore none have been widely adopted in practice.

Guest Author:  Carol Chan, Pharm.D.

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