Background: Patients with chronic kidney disease (CKD) undergoing hemodialysis commonly present multiple comorbidities and require complex medication regimens. Polypharmacy increases the risk of clinically relevant drug interactions that may compromise treatment safety and effectiveness. Objective: To estimate the prevalence of potential drug interactions among patients with CKD undergoing hemodialysis and classify these interactions according to clinical risk and mechanism of action. Methods: A cross-sectional study was conducted with patients undergoing hemodialysis at a dialysis clinic in Southern Santa Catarina, Brazil. Potential drug interactions were identified using the Medscape and Drugs.com databases and classified according to severity (major, moderate, or minor) and mechanism of action. Results: A total of 151 patients were included. Potential drug interactions were identified in all participants (973 interactions; mean 6.4 per patient). Of these, 234 (24.0%) were classified as major, 545 (56.0%) as moderate, and 194 (19.9%) as minor. The most frequent major interactions involved furosemide + losartan (n = 8) and acetylsalicylic acid + clopidogrel (n = 6). Among moderate interactions, the most common were sevelamer + calcium carbonate (n = 14) and losartan + amlodipine (n = 12). The most frequent minor interactions involved epoetin alfa + acetylsalicylic acid (n = 14) and epoetin alfa + calcium carbonate (n = 10). Pharmacodynamic interactions predominated, mainly involving additive effects of cardiovascular medications. Conclusions: Potential drug interactions were highly prevalent among patients undergoing hemodialysis, with moderate-severity interactions predominating. Routine screening for potential drug interactions may support safer prescribing, optimize pharmacotherapy, and strengthen multidisciplinary medication management in this high-risk population.
Background:Adalimumab is an antitumor necrosis factor agent approved by the U.S. Food and Drug Administration in 2002 for the treatment of various rheumatologic diseases. Recent approval of adalimumab biosimilars presents an important area of study to determine real-world efficacy and cost savings of biosimilars. Objectives:The primary objective was to evaluate the impact of nonmedical, insurance-mandated adalimumab switches on disease activity. The secondary objective was to assess the financial impact of these biosimilar switches. Methods:A retrospective cohort study was conducted of patients with rheumatic diseases who experienced payer-mandated switches to biosimilars. The primary outcome was change in disease activity, defined by provider assessment documented in the electronic health record before switching and at follow-up. Analyses were completed using chi-square or Fisher exact tests for categorical variables and t tests, analysis of variance (ANOVA), or nonparametric equivalents for continuous variables, with P < .05 required for statistical significance. Results:A total of 152 patients were included; among patients controlled at baseline, 84/119 (70.6%) remained unchanged and 35/119 (29.4%) worsened. Among those partially controlled at baseline, 6/17 (35.3%) improved, 7/17 (41.2%) remained unchanged, and 4/17 (23.5%) worsened. Among patients with active disease at baseline, 9/12 (75.0%) improved and 3/12 (25.0%) remained unchanged. Median out-of-pocket copay change was $0. Conclusion:Insurance-mandated switches did not appear to meaningfully impact disease control for most patients. In addition, median out-of-pocket costs did not change after switching. These findings should reassure pharmacists when helping patients with insurance-mandated adalimumab biosimilar switches.
Background: Preemptive, multigene pharmacogenomic (PGx) testing is on the rise in healthcare facilities. The emergency department (ED) has not historically been an area for high testing volume in many facilities; however, this could be an underutilized resource. Objectives: To describe the workflow and clinical utility of PGx testing in the ED. Methods: This was a single-center retrospective chart review of patients who received PGx testing in the ED (n = 100) with a 16-gene panel between January and November 2025. Medical records were reviewed for actionable gene variants and prescribed gene-drug pairs. Risk of adverse drug events (ADEs) was evaluated through the Vital, Important, Optional, Not indicated, Every medication has an indication (VIONE) score card. Baseline characteristics were also collected, and outcomes were described with descriptive statistics. Results: There were actionable genetic variants identified in 99% of patients tested, with the majority having multiple variants. Gene-drug pairs were found in 53% of patients: 38% one medication, 12% two medications, 3% three or more medications. A mean VIONE score of 5 revealed a moderate to high risk of ADE. Conclusion: PGx testing is feasible within ED workflow and has a high yield of potential clinical utility.
Objective:To summarize and compare current pharmacologic treatment options for metabolic dysfunction-associated steatotic liver disease (MASLD). Data Sources:PubMed was searched for English-language articles published from January 1, 2000, to May 1, 2026. Search terms included MASLD, metabolic dysfunction-associated steatohepatitis (MASH), nonalcoholic fatty liver disease, nonalcoholic steatohepatitis (NASH), pioglitazone, semaglutide, liraglutide, sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin, empagliflozin, treatment, and management. Study Selection and Data Extraction:Eighteen publications, including randomized controlled trials, review articles, and practice guidelines, were included in this narrative review article. These articles were included to evaluate the efficacy, safety, and accessibility of the treatment options. Data Synthesis:Five primary treatment options were reviewed: resmetirom, semaglutide, empagliflozin, dapagliflozin, and pioglitazone. Semaglutide and resmetirom demonstrated the most consistent evidence for MASH improvement including statistically significant improvement in fibrosis (reduction of at least 1 fibrosis stage). Pioglitazone showed improvement in several histologic features; however, findings for fibrosis improvement and placebo-adjusted benefit were inconsistent. Evidence for SGLT2 inhibitors remains promising but limited. Conclusions:Semaglutide and resmetirom have the strongest evidence for histologic improvement in MASLD/MASH. Pioglitazone and SGLT2 inhibitors may offer benefits in patients with specific comorbidities, but additional research is needed.
Objective: To review the emerging evidence supporting the use of nerandomilast (Jascayd), a selective phosphodiesterase-4B (PDE4B) inhibitor, for the treatment of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). The review aims to summarize its mechanism of action, efficacy, safety, and potential role as monotherapy or in combination with existing antifibrotic therapies. Data Sources: A literature search was conducted using PubMed, Embase, ClinicalTrials.gov, and relevant conference proceedings from January 2018 through December 2025. Search terms included nerandomilast, BI 1015550, Jascayd, phosphodiesterase-4B inhibitor, idiopathic pulmonary fibrosis, progressive pulmonary fibrosis, interstitial lung disease, FIBRONEER-IPF, and FIBRONEER-ILD. Human studies published in English were included. Study Selection and Data Extraction: Original clinical studies, phase II and phase III trials, subgroup analyses, and regulatory publications evaluating nerandomilast in patients with IPF or PPF were reviewed. Studies were selected based on relevance to efficacy, safety, mechanism of action, and clinical outcomes. Data regarding study design, patient population, forced vital capacity (FVC) outcomes, adverse events, and concomitant antifibrotic use were extracted and qualitatively synthesized. Data Synthesis: Nerandomilast was approved in October 2025 for the treatment of IPF and PPF, representing the first PDE4B inhibitor approved for fibrotic lung disease. By inhibiting PDE4B, nerandomilast increases intracellular cyclic adenosine monophosphate (cAMP) levels, resulting in reduced inflammatory cytokine production and decreased fibroblast activation. Clinical trials, including the phase III FIBRONEER-IPF study, demonstrated a significant reduction in the rate of FVC decline compared with placebo, indicating attenuation of disease progression. Benefits were observed both in patients receiving nerandomilast alone and in those receiving background antifibrotic therapy with pirfenidone or nintedanib. Overall, nerandomilast demonstrated a favorable benefit-risk profile and offers a mechanistically distinct approach compared with currently available antifibrotic agents. Conclusions: Nerandomilast provides a novel anti-inflammatory and antifibrotic treatment option for patients with IPF and PPF. Available evidence suggests meaningful reductions in lung function decline with acceptable tolerability, including use alongside established antifibrotic therapies. As longer-term and real-world data emerge, nerandomilast may become an important component of the therapeutic strategy for progressive fibrotic lung diseases.
Background: Using Veterans Affairs (VA) clinical practice guidelines as a reference, this study compared long-term opioid prescribing practices and risk mitigation strategies in veterans receiving care at the Greater Los Angeles VA compared with veterans receiving Care in the Community (CITC). A retrospective chart review was performed on 46 CITC patients and a random sample of 50 VA patients who received 90 days or more of an opioid prescription between July 1, 2018, and June 30, 2019, and were followed for 1 year. Results: The 2 populations were prescribed similar opioid treatments, and although not statistically significant, there was a trend toward CITC prescribing higher mean daily morphine equivalent values (VA = 32.71 ± 41.34, CITC = 48.22 ± 56.85, P = .13). The most commonly prescribed opioids were hydrocodone and oxycodone products. The vast majority of pain diagnoses were seen in equivalent numbers across the VA and CITC groups. VA prescribers more frequently recommended nonpharmacological options (86% VA vs 82.61% CITC, P = .65) and nonopioid co-analgesics compared with CITC providers (80% VA vs 63.04% CITC, P = .07). Veterans Affairs providers also more frequently completed informed consent for long-term opioid use (96% vs 65.22%, P < .005), Prescription Drug Monitoring Program checks (98% vs 93.48%, P = .25), and urine drug screens (92% vs 69.57%, P = .006). Veterans Affairs providers prescribed concurrent benzodiazepines less frequently than CITC providers (8% vs 15.22% P = .28); however, CITC providers more frequently saw patients at 3-month intervals (60.9% vs 26%, P < .005). Finally, both groups had similar naloxone kit prescribing rates (30.4% CITC vs 30% VA, P = .96). Conclusion: Overall, opioid prescribing behaviors between VA and CITC providers were similar. However, this study also identified a trend for the VA providing lower doses of opioids and improved safety measures. Future studies are needed to understand areas of collaboration and mechanisms to improve veterans’ pain care across all health care settings.
Background:During hospital admission and discharge, investigational drugs administered due to participation in clinical trials are at risk for medication errors if not accurately documented. Objective:The primary objective of this study is to assess whether investigational drug service (IDS) pharmacy-led investigational medication reconciliation during outpatient investigational drug dispensing improves the rate and accuracy of investigational drug documentation in the electronic health record (EHR) medication list. Methods:This retrospective study was conducted at Rady Children's Hospital Orange County and compared investigational drug dispensing encounters in the pre-IDS period (August 1, 2022-July 31, 2023) to the IDS period (November 1, 2023-October 31, 2024). Differences between periods were estimated using binomial generalized estimating equations to obtain absolute risk differences, with robust standard errors to account for multiple prescriptions within patients. Results:Of 174 dispensed prescriptions, the investigational drug was documented on the EHR medication list for 27 of 90 drugs in the pre-IDS period (30.0%) and 80 of 84 drugs in the IDS period (95.2%; P < .001). Complete and accurate documentation increased from 6.7% to 95.2% for formulation, 21.1% to 94.0% for dose, 28.9% to 95.2% for route, 27.8% to 94% for frequency, and 7.8% to 95.2% for investigational drug alert (all P < .001). Conclusions:Baseline documentation of investigational drugs on the EHR medication list was low. Investigational drug service pharmacy-led documentation was associated with significant improvement in documentation rate and accuracy.
Background:The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends initial bronchodilator therapy over inhaled corticosteroids (ICS) for most patients. However, real-world prescribing often diverges. Management is further complicated in hospitalized patients with suspected but unconfirmed chronic obstructive pulmonary disease (COPD), where providers must decide on therapy initiation and outpatient follow-up. Objective:To describe inhaler prescribing in suspected but unconfirmed COPD upon hospital discharge. Methods:This was an institutional review board-approved retrospective cohort study of patients of ages 40 years or older with a smoking history of at least 10-pack years, but without a prior COPD diagnosis, who presented with a suspected COPD exacerbation or acute respiratory failure secondary to suspected COPD. The primary outcome was inhaler prescribing at discharge. Secondary outcomes included confirmed COPD diagnosis, guideline concordance, hospital readmission for a COPD exacerbation, and ICS-related adverse events within 180 days. Results:Of the 51 patients included in the study, 29 (56.9%) were prescribed new inhalers, with 15 (29.4%) prescribed ICS-containing regimens. Following discharge, 15 patients (29.4%) completed pulmonary function testing, with 8 (15.7%) receiving a COPD diagnosis. Guideline concordance could not be assessed due to absent documentation. Eight patients (15.7%) were readmitted with a COPD exacerbation, and 13 ICS-related adverse events were documented. Limitations include the sample size and retrospective study design. Conclusion:This study found a high frequency of initial ICS prescribing for suspected but unconfirmed COPD, as well as limited follow-up and diagnostic reassessment. These findings highlight the need for system-level interventions to optimize discharge prescribing and ensure timely follow-up.
Background: Federally qualified health centers (FQHCs) use core quality measures to guide care and secure funding. One core measure is “Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet.” A pilot program at an FQHC utilized the clinical pharmacy team to improve appropriate aspirin prescribing. Clinical pharmacy technicians identified eligible patients through a best practice advisory (BPA) in the electronic health record and contacted individuals with IVD not prescribed aspirin to schedule a clinical pharmacist appointment. Pharmacists then conducted medication reconciliations and ordered aspirin when indicated. This study evaluated the impact of incorporating pharmacy technicians into the clinical pharmacy workflow on the IVD quality measure. Methods: This retrospective chart review compared aspirin prescriptions ordered from June to November 2023 between patients contacted by pharmacy technicians and those who were not. Demographics, outreach attempts, aspirin orders, and diagnosis codes were collected. Descriptive statistics and Fisher’s exact test were used for analysis. Results: Pharmacy technicians attempted to contact 65 eligible patients, with 49 successfully reached. Aspirin was prescribed for 3.1% of control patients vs 30.6% in patients successfully contacted by the pharmacy team ( P < .001). Resolved BPAs increased to 53.8% in the intervention group. Conclusion: A clinical pharmacy team significantly increased aspirin therapy among eligible patients with IVD, demonstrating the value of pharmacy team involvement on quality metrics. Future research should explore expanded integration of clinical pharmacy team services to enhance patient care.
Objective: To review the efficacy, safety, and clinical selection considerations of azole antifungal agents for prophylaxis of invasive fungal infections (IFIs) in immunocompromised patients using a clinically oriented, pharmacist-focused framework. Data Sources: A literature review was conducted using PubMed and Embase to identify relevant studies evaluating azole antifungal prophylaxis in immunocompromised adult populations. Search terms included combinations of “azole,” “antifungal prophylaxis,” “immunocompromised,” and “invasive fungal infection,” with emphasis on contemporary studies reflecting current prophylaxis practices. Study Selection and Data Extraction: Studies were included if they evaluated prophylactic use of azole antifungal agents in immunocompromised adults, including patients with hematologic malignancies, hematopoietic stem cell transplantation, or other defined immunocompromised states. Studies focused on treatment rather than prophylaxis, non-azole agents, pediatric populations, or lacking relevant clinical outcomes were excluded. Data extracted included study design, patient population, antifungal agent and dosing, incidence of IFIs, and reported safety outcomes. Data Synthesis: Randomized controlled trials and observational studies demonstrate that azole antifungal prophylaxis significantly reduces IFI incidence in high-risk immunocompromised populations. Posaconazole has demonstrated superiority over fluconazole and itraconazole in neutropenic leukemia populations, while mold-active azoles including voriconazole and isavuconazole offer expanded prophylactic options in select patients. Therapeutic drug monitoring, drug interaction management, and individualized risk stratification are critical pharmacist-driven components of care. Safety findings remain consistent with known azole-associated toxicities including hepatotoxicity, QT interval alterations, neuropsychiatric effects, and cytochrome P450-mediated drug interactions. Conclusions: Azole antifungal prophylaxis remains a cornerstone strategy for prevention of IFIs in immunocompromised patients. Current evidence supports individualized, risk-based selection of prophylactic agents based on patient-specific risk factors rather than universal application of a single regimen. Pharmacists play a central role in optimizing prophylaxis through therapeutic drug monitoring, medication reconciliation, and toxicity mitigation. Additional studies are needed to optimize prophylaxis strategies and improve patient outcomes.
Background: Asthma is a common chronic respiratory disease, reducing the quality of life and increasing the mortality risk of patients. Medication adherence and proper inhaler technique play an important role in asthma control. Objective: To investigate medication adherence, inhaler use, asthma control level, and its related factors among asthma outpatients treated at a specialized tertiary respiratory hospital. Methods: A descriptive cross-sectional study was conducted on asthma outpatients treated at the specialized respiratory hospital (April 1, 2022-June 30, 2022). Medication adherence, inhaler use, and asthma control were assessed using the General Medication Adherence Scale, content-validated checklists, and the asthma control test. Data were analyzed using SPSS software, P value of < 0.05 was considered statistically significant.Results: There were 184 patients included (mean age 48.86 ± 13.28, females 53.8%). More than half of the patients had at least one comorbidity (mainly allergic rhinitis). All patients were prescribed inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) as controller medications, and the most prescribed combination was ICS-LABA + leukotriene receptor antagonist (66.8%). The rates of patients with high medication adherence, proper inhaler technique, and good asthma control were 89.6%, 67.4%, and 75.0%, respectively. The higher medication adherence was associated with better asthma control (odds ratio = 4.584, 95% confidence interval 1.633-12.870, P = 0.004). Small sample size and single-center study may limit the generalizability of the results. Conclusions: Medication adherence was generally high, whereas inhaler technique errors remained common. Despite overall favorable asthma control, ongoing inhaler technique counseling and sustained medication adherence remain essential.
Background/Objectives: Eravacycline is a fluorocycline with activity against multidrug-resistant (MDR) and difficult-to-treat (DTR) pathogens, but real-world outcome data are lacking for the treatment of infections caused by these organisms. The objective of this study was to evaluate the efficacy and safety of eravacycline for infections caused by MDR and/or DTR organisms. Methods: This was a retrospective, observational study of adult patients receiving eravacycline for at least 72 hours for MDR or DTR organisms. The primary outcome was 30-day mortality. Secondary outcomes included 60-day relapse, 30-day readmission, and adverse drug events (ADEs). Results: A total of 17 patients were included in the analysis. The cohort had a high baseline mortality risk (median Charlson Comorbidity Index of 5). Osteoarticular infections were the most common indication (52.9%). The most frequently isolated pathogens were Enterococcus spp. and Enterobacterales spp. (58.9% each). Most infections were polymicrobial. Eravacycline minimum inhibitory concentrations (MIC) were available in only 47% of cases, and the median time to treatment initiation was 6 days after culture collection. Thirty-day all-cause mortality occurred in 17.6% of patients. Among survivors, 60-day relapse and 30-day readmission were low (6% each). The ADEs occurred in 35% of patients but led to no discontinuations. Conclusions: In this cohort of severely ill patients with complex, predominantly polymicrobial MDR and DTR infections, eravacycline demonstrated favorable safety and efficacy results despite delays from index culture to initiation of targeted therapy. These data suggest eravacycline may be a viable treatment option for infections caused by MDR and DTR organisms.
Background: Pain is prevalent among critically ill patients and is frequently underrecognized due to sedation and mechanical ventilation. Opioids remain the primary analgesic therapy in the intensive care unit (ICU); however, opioid-related adverse effects have prompted increased adoption of multimodal analgesia strategies. Centrally acting skeletal muscle relaxants, including cyclobenzaprine and methocarbamol, are commonly used as adjuncts, yet data evaluating their anticholinergic adverse effects in critically ill populations are limited. Methods: The primary objective of this study is to determine the prevalence of anticholinergic adverse drug events (ADEs) associated with cyclobenzaprine and methocarbamol among ICU patients. Purpose: This retrospective cohort study evaluated adult patients (≥18 years) admitted to any ICU at a single academic medical center between January 1, 2023 and January 31, 2025, who received at least 1 dose of cyclobenzaprine or methocarbamol during ICU admission. The primary outcome was the prevalence of anticholinergic ADEs, identified through provider documentation and International Classification of Diseases, Tenth Revision (ICD-10) codes. Secondary outcomes included types of ADEs, dosing of the study drugs, and medication discontinuation rates. Results: Of 367 eligible patients, 260 were included in the final analysis. Cyclobenzaprine was administered to 112 patients (43%) and methocarbamol to 148 patients (57%). Potential anticholinergic ADEs were identified in 29 patients (14.4%) receiving cyclobenzaprine and 17 patients (10.8%) receiving methocarbamol. Among the 69 total ADEs, 55 (79%) prompted an intervention, most commonly pharmacologic therapy adjustments. Medication discontinuation due to ADEs was infrequent. Conclusions: Cyclobenzaprine and methocarbamol were associated with anticholinergic adverse effects in critically ill ICU patients, though this did not translate to medication discontinuation. These findings support the cautious use of centrally acting muscle relaxants as part of multimodal analgesia strategies. Pharmacists are uniquely positioned to evaluate and mitigate adverse drug effects in the critically ill.
Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on weight loss medication management for adults without diabetes in an outpatient Internal Medicine primary care resident clinic. Methods: This matched case-control study included adults without diabetes with at least 1 weight management visit with a clinical pharmacist between July 2023 and May 2024. Controls were matched on insurance and baseline body mass index, and included patients prescribed weight loss medications by clinicians and those without pharmacotherapy. Data were collected over 6 months. The primary outcome was percent weight loss. Rate of weight loss was explored as a secondary outcome. Results: 94 patients were included: 35 pharmacist-managed, 24 clinician-managed, and 35 without pharmacotherapy. At 6 months, mean weight change was -11.8%, -8.3%, and +1.3% in the pharmacist, clinician, and nonmedication groups, respectively. Absolute weight loss was greater in the pharmacist group, but not statistically significant compared with the clinician-managed group (P = 0.12). The weekly rate of weight loss was significantly higher in the pharmacist group (-0.29 kg/week; P = 0.04 and P < 0.001 vs controls). Conclusion: Patients prescribed obesity medications experienced significant weight loss, regardless of whether the patients were managed by pharmacists or primary care clinicians. These findings support a collaborative care model in obesity management.
Background:Posterior reversible encephalopathy syndrome (PRES) is a rare but potentially life-threatening neurological condition characterized by seizures, headache, visual disturbances, and altered mental status, typically associated with vasogenic edema on neuroimaging. Although several anticancer therapies have been implicated in PRES, evidence regarding its association with lenvatinib remains limited. Purpose:The aim of this study was to investigate a potential safety signal between lenvatinib and PRES using a pharmacovigilance approach and evaluate whether reports of PRES are disproportionately associated with lenvatinib in a large spontaneous reporting database. Methods:A retrospective pharmacovigilance study was conducted using the FDA Adverse Event Reporting System (FAERS) database. Individual Case Safety Reports (ICSRs) mentioning lenvatinib and PRES were identified and extracted. Disproportionality analysis was performed by calculating the reporting odds ratio (ROR), proportional reporting ratio (PRR), and chi-square statistic. According to Evans' criteria (n > 2, PRR > 2, chi-square > 4), a drug-event combination is considered suggestive of a potential safety signal. Results:The disproportionality analysis revealed a statistically significant signal for PRES associated with lenvatinib. The PRR was 5.79 (95% CI: 4.80-6.98), and the ROR was 5.81 (95% CI: 4.81-7.00), both exceeding commonly accepted signal detection thresholds. These findings suggest that reports of PRES occur more frequently with lenvatinib than with other drugs in the database. Conclusion:This pharmacovigilance analysis identified a significant disproportionality signal suggesting a potential association between lenvatinib and PRES. Although spontaneous reporting systems cannot establish causality, these findings highlight the importance of clinical awareness and further investigation to better characterize this rare but serious adverse event.
Background:Atrial fibrillation (AF) and venous thromboembolism (VTE) are common conditions requiring anticoagulation in patients with severe obesity (body mass index ≥40 kg/m2). Comparative safety and efficacy data for direct oral anticoagulants (DOACs) vs warfarin in this population remain limited. Objective:To compare the safety and efficacy of DOACs and warfarin in non-valvular atrial fibrillation (NVAF) and VTE in patients with severe obesity in a real-world setting. Methods:This single-center, retrospective matched cohort study included adults with severe obesity receiving a DOAC or warfarin for NVAF or VTE from January 1, 2019, to December 31, 2024. Patients were matched by age, sex, and indication. Primary outcomes were composite thrombotic events (recurrent VTE or ischemic stroke occurrence) and composite bleeding events (clinically relevant non-major and major bleed). Secondary outcomes were assessments of predictors for these events. Results:The study included 182 patients, 91 per cohort. Composite bleeding was significantly higher in the warfarin group (39.6% vs 23.1%, P = 0.017), but it was not significantly different after adjustment for time on therapy. Composite thrombotic events were similar between groups (12.1% vs 9.9%, P = 0.89). History of major bleed (hazard ratio [HR] = 2.37, P = 0.022, 95% confidence interval [CI] = [1.13-4.96]) and concomitant antiplatelet use (HR = 3.80, P < 0.001, 95% CI = [1.98-7.26]) were predictors for bleeding. History of cerebrovascular accident (CVA)/transient ischemic attack (TIA) (HR = 3.34, P = 0.014, 95% CI = [1.28-8.74]) was a predictor for thrombosis. Conclusion:DOACs demonstrated comparable safety and efficacy to warfarin in patients with severe obesity with NVAF or VTE.
Treatment of extensively drug-resistant (XDR) organisms is complicated by pharmacodynamic and pharmacokinetic (PK) limitations of current antimicrobial agents. Prostatitis is an infection that is historically difficult to treat with beta-lactams given poor tissue penetration as compared to fluoroquinolones and sulfamethoxazole-trimethoprim. Cefiderocol is a novel cephalosporin that is often used to treat a wide variety of gram-negative bacteria that have extensive resistance to other antibiotics. Cefiderocol remains stable against many β-lactamases and shows enhanced bacterial cell entry as a result of siderophore uptake. However, its penetration into prostatic tissue has not been studied. This review presents the use of cefiderocol in a patient with complicated urinary tract infection and prostatitis caused by XDR Klebsiella pneumoniae resistant to almost all tested antibiotics, including novel beta-lactam/beta-lactamase combinations. Although PK data suggest that cefiderocol may achieve therapeutic concentrations in prostatic tissue, further studies are needed to confirm its efficacy in treating prostatitis, particularly in cases of chronic or complicated infection. This case highlights cefiderocol as a potential therapeutic option for XDR Enterobacterales prostatitis, though additional research is required to fully understand its prostate penetration and clinical outcomes.
Background: Pharmacists support diabetes technology in practice, yet formal instruction on continuous glucose monitoring (CGM) in Doctor of Pharmacy (PharmD) curricula is limited. Hands-on learning may build confidence and practice readiness for CGM-enabled care. Objective: To assess the impact of a diabetes education module, paired with short-term personal CGM use on pharmacy students' confidence, beliefs, and reflections related to diabetes care. Methods: Three cohorts of third-year pharmacy students completed pre- and post-surveys surrounding a 2-week diabetes education module delivered within a pharmacy skills laboratory. The intervention included didactic instruction and hands-on stations addressing core components of diabetes management including a personal CGM user wear experience. Quantitative analyses included t tests and analysis of variance. Student reflections were thematically analyzed. Results: Data from 148 student responses (84 pre-intervention; 64 post-intervention) were analyzed as independent samples. Belief scores demonstrated low reliability and remained stable over time (P > 0.05). In contrast, confidence scores showed high reliability and increased significantly following the intervention (mean 2.44 vs 4.50; P < 0.001), with a large effect size. Confidence differed by academic year, while belief scores did not. Qualitative analysis of 159 student responses identified themes of increased knowledge, awareness of glucose impacts, and readiness for pharmacy practice. Limitations include the single-institution setting, unpaired surveys, and reliance on self-reported, short-term outcomes. Conclusion: A diabetes education module incorporating short-term CGM use substantially improved student confidence and yielded practice-relevant insights, while beliefs remained stable. Structured hands-on CGM education may better prepare pharmacy graduates for technology-enabled diabetes care.
Objective: To review the pharmacology, pharmacokinetics, efficacy, safety, and clinical role of elinzanetant for the treatment of vasomotor symptoms (VMS) associated with menopause. Data Sources: PubMed and Google Scholar were searched for English-language articles published through January 2026 using the terms elinzanetant, NT-814, OASIS, SWITCH, vasomotor symptoms, and menopause. Study Selection and Data Extraction: Phase 2 and phase 3 clinical trials evaluating elinzanetant in postmenopausal women with moderate to severe VMS were included. Data Synthesis: Elinzanetant is a dual neurokinin-1 (NK-1) and neurokinin-3 (NK-3) receptor antagonist targeting hypothalamic pathways involved in thermoregulation. Clinical trials demonstrated statistically significant reductions in VMS frequency and severity compared with placebo. Efficacy was observed as early as week 1 and sustained across treatment periods. Elinzanetant was generally well tolerated, including in long-term studies and in women receiving endocrine therapy for breast cancer. Conclusion: Elinzanetant represents an additional nonhormonal treatment option for menopausal VMS. As a dual NK-1 and NK-3 receptor antagonist, it differs mechanistically from selective NK-3 antagonists and may offer an alternative for patients who are not candidates for hormone therapy.
Background: As coronavirus disease 2019 (COVID-19) has evolved, patients increasingly present with milder disease, raising questions about optimal management of those hospitalized for other conditions, but found to have COVID-19 with high risk of progression. While these patients may traditionally be managed with a 3-day course of remdesivir (RDV) and nirmatrelvir/ritonavir (N/R) in the outpatient setting, these therapies have not been explicitly studied in a similar population, but in the inpatient setting. Objective: To evaluate outcomes with 3-day RDV versus 5-day N/R in high-risk hospitalized patients with mild COVID-19. Methods: This single-center, retrospective, propensity score-matched cohort study included hospitalized adult patients who were found to have mild COVID-19 between January 2023 and December 2023. Patients were grouped by treatment received, including 3-day RDV or 5-day N/R. Baseline characteristics and risk factors for disease progression were collected. Endpoints included incidence of disease progression, need for oxygen and respiratory support, length of stay, 30-day readmission, and mortality. Results: One-hundred and fifty patients were included in the analysis, with 75 in each group. Baseline characteristics between groups were similar. There was no significant difference in the rate of disease progression between the RDV and N/R group (19% vs 11%, respectively; P = 0.166). There was no difference in additional endpoints including hospital length of stay, 30-day readmission, or mortality. Conclusion: There was no significant difference in rates of disease progression or other outcomes among high-risk hospitalized adults with mild COVID-19 treated with RDV or N/R. Larger studies are needed to confirm these findings.
