The objective of this review article was to identify and examine current evidence surrounding the potential renoprotective effects of newer antidiabetic agents such as sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucose-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors. A literature search of MEDLINE and PubMed (January 2000 to April 2019) was performed using the following search terms: “diabetes treatment,” “renoprotection,” “kidneys,” “SGLT-2 inhibitors,” “GLP-1 receptor agonists,” “DPP-4 inhibitors,” and the drug names in each of those classes as well as any combination of these terms. Literature was excluded if published in a language other than English, performed in nonhuman subjects, did not include patients from the United States, was nonrandomized, or the data were available from poster presentations. There were 11 studies that met the search criteria. The majority of the studies focused on renal outcomes as secondary end points and looked at albuminuria, estimated glomerular filtration rate changes from baseline, urinary albumin-to-creatinine ratio, serum creatinine, and need for renal replacement therapy. There are fewer studies that focused on renal protection as a primary end point. After reviewing the available literature, the use of SGLT-2 inhibitors and GLP-1 agonists in addition to standard of care may be considered in patients with or at risk of developing chronic kidney disease. SGLT-2 inhibitors and GLP-1 agonists should be considered when patients’ diabetes is no longer well controlled with metformin. Other factors such as cost, cardiovascular disease, and other comorbidities may also be taken into consideration when recommending therapy for patients.
Lefamulin (Xenleta -Nabriva), a semisynthetic pleuromutilin antibiotic, has been approved by the FDA for IV and oral treatment of community-acquired bacterial pneumonia (CABP) in adults. It is the first systemic pleuromutilin antibiotic to be approved in the US; retapamulin (Altabax), a 1% topical ointment for treatment of impetigo, was approved in 2007. 1 CABP is a leading cause of hospitalization and death in adults, especially the elderly. 2 Causative bacterial pathogens include Streptococcus pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, Chlamydophila pneumoniae, and Legionella species.For outpatient treatment of CABP in otherwise healthy adults without recent antibiotic exposure, monotherapy with a macrolide such as azithromycin has been the regimen of choice, but rates of macrolide resistance among S. pneumoniae in parts of the US currently exceed 40%. Doxycycline is a reasonable alternative, but resistance to doxycycline is also increasing among S. pneumoniae. A respiratory fluoroquinolone (levofloxacin or moxifloxacin) is often used for adults with comorbidities or antibiotic exposure during the previous 90 days. These drugs can also be considered for otherwise healthy adults in areas where the rates of pneumococcal resistance to macrolides and doxycycline are Ն25%, but they can cause serious adverse effects. 3 Combining a beta-lactam (such as high-dose amoxicillin or cefpodoxime) with a macrolide or doxycycline is another option in areas with high rates of macrolide or doxycycline resistance. 4,5 For empirical treatment of CABP in hospitalized patients (not ICU), an antipneumococcal IV beta-lactam (such as ceftriaxone, cefotaxime, ceftaroline, or ampicillin/sulbactam) plus a macrolide (or doxycycline) or monotherapy with an IV respiratory fluoroquinolone (levofloxacin or moxifloxacin) is recommended. Omadacycline, a broad-spectrum IV and oral tetracycline recently approved for treatment of CABP, is an expensive alternative with limited data. 6 Addition of vancomycin or linezolid to standard treatment is recommended for patients at increased risk for methicillin-resistant S. aureus (MRSA). Short-course antibiotic therapy (5-7 days) is as effective as longer-course therapy for treatment of CABP.Lefamulin binds to the peptidyl transferase center of the 50S subunit of the bacterial ribosome, inhibiting bacterial protein synthesis. The probability of cross-resistance to beta-lactams, macrolides, fluoroquinolones, tetracyclines, or glycopeptides appears to be low. 7 Lefamulin is active in vitro and in vivo against S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, Legionella pneumophila, and methicillin-susceptible strains of S. aureus (MSSA). It has in vitro activity against other streptococcal species, MRSA, Haemophilus parainfluenzae, and M. catarrhalis, but data establish-
Objective: To describe the pharmacology, clinical and safety evidence, and relevance to clinical practice of finerenone. Data Sources: A literature search was conducted utilizing PubMed, MEDLINE, and clinicaltrials.gov with search terms of “finerenone” and “BAY94-8862.” Study Selection and Data Extraction All available studies with human participants in English were considered. Studies were included if they investigated drug pharmacology, efficacy, and safety information. Data Synthesis In addition to standard of care with a renin-angiotensin system inhibitor (RASi), finerenone lowered the risk of kidney disease progression (17.8% vs 21.1%) in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo. Similarly, finerenone reduced cardiovascular risk in patients with type 2 diabetes mellitus and chronic kidney disease compared to placebo (12.4% vs 14.2%). Relevance to Patient Care and Clinical Practice It is anticipated that finerenone will be added to therapy after a RASi and a sodium-glucose cotransporter-2 inhibitor, as tolerated, based on adverse events and potassium levels. Conclusions Finerenone offers a unique approach to further delay the progression of chronic kidney disease in patients with type 2 diabetes mellitus. It also provides another option for patients who cannot tolerate RASi or sodium-glucose cotransporter-2 inhibitors.
Background The Department of Health and Human Services and the Food and Drug Administration released the Safe Importation Action Plan in July 2020 detailing methods to import medicines from Canada to combat increasing drug costs. In November 2020, Florida became the first state in the United States to create and propose an importation plan from Canada. This study examines the proposal submitted by Florida, Florida pharmacists’ perceptions of the program on patient safety, and Florida pharmacists’ thoughts on the pharmacy operational impact. Methods This was a cross-sectional study utilizing an electronic questionnaire sent to pharmacist members of the Florida Pharmacy Association. The survey incorporated closed-ended and open-ended questions. The results from the study were reported and analyzed through descriptive statistics, qualitative and quantitative data. Results Two-hundred and forty-four pharmacists responded to the survey. Of those respondents, 25% stated they had no knowledge about Florida’s drug importation plan. Less than 12% of respondents stated they would trust the safety and quality of imported medicines. Seventy percent of pharmacists expressed concerns regarding the changes required in pharmacy operations to increase medicine safety. About half of the respondents questioned whether this plan would promote cost-savings as intended. Conclusion Florida pharmacists believe the drug importation plan does not address all aspects of patient and medicine safety and expressed concerns regarding logistical operations of a pharmacy. This article highlights those concerns and acts as a summons to action.
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