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Report outlines new definition for Long COVID, reviews evidence for diagnosis, risk, and symptoms
Long COVID can cause more than 200 symptoms and it affects each person differently, according to a June 2024 report from the National Academies of Sciences, Engineering, and Medicine.
The new definition proposed by the Academies for Long COVID is “an infection-associated chronic condition that occurs after COVID-19 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”
In the report, the authors urge the federal government, state and local authorities, clinicians, medical societies and organizations, public health practitioners, employers, educators, and others to adopt this new definition for Long COVID.
The report includes conclusions about Long COVID diagnosis, symptoms, and effect on daily function, noting that some health effects of the condition can impede an individual’s ability to work or attend school for 6 months to 2 years or more after COVID-19 infection.
“Diagnosing, measuring, and treating Long COVID is complicated,” said Paul Volberding, from UC San Francisco and chair of the committee that wrote the report. “This disease, which has existed in humans for less than 5 years, can present differently from person to person and can either resolve within weeks or persist for months or years.”
The report noted that a formal COVID-19 diagnosis or positive test is not necessary to consider a Long COVID diagnosis. Additionally, the condition is associated with a broad range of new or worsening health conditions that affect multiple organ systems, and the risk of Long COVID increases with the severity of COVID-19 illness.
The report includes a list of all the symptoms and conditions that have been associated with Long COVID, noting there is no curative treatment for Long COVID, only managing symptoms and optimizing quality of life and function. The report, which was sponsored by the Social Security Administration, said that Long COVID is a relatively novel and rapidly evolving condition, and continued research will be needed to effectively understand, treat, and manage it. ■
FDA issues alert about compounded drugs containing sulfites
FDA is raising awareness for patients and health care providers about the risk of potentially severe allergic-like reactions to compounded drugs that contain sulfites.
Research shows that sodium bisulfite, potassium metabisulfite, and similar agents, which typically are added as preservatives to prevent the breakdown of active ingredients in a drug, can trigger anaphylactic symptoms in susceptible individuals, especially those with asthma.
FDA has received reports of eye-related issues such as conjunctivitis, itchy eyes, swollen eyelids, and respiratory failure in users of compounded drugs with sulfites.
The agency’s guidance is for patients with known sulfite sensitivity or allergy to share that information with their physician and for providers and patients to ask compounders about the use of sulfites in their products.
For their part, compounders are asked to note the presence of sulfites on drug labels or include a warning statement. ■
CDC updates RSV vaccination recommendations for adults
CDC now recommends that older adults who were not immunized against RSV last year, when vaccines first became available, do so late this summer or early this fall ahead of the upcoming RSV season.
CDC’s ACIP voted unanimously to recommend all adults aged 75 years and older receive a single dose of any RSV vaccine, and adults aged 60 to 74 years who are at increased risk of severe RSV disease receive a vaccination or dose of a vaccine.
Previous guidance, which the new recommendations supplant, suggested shared decision making between adults aged 60 years and older and their health care provider in receiving the RSV vaccination.
“CDC has updated its RSV vaccination recommendations for older adults to prioritize those at highest risk for serious illness from RSV,” said Mandy Cohen, MD, CDC director, in a CDC press release. “People 75 or older, or between 60–74 with certain chronic health conditions or living in a nursing home should get one dose of the RSV vaccine to provide an extra layer of protection.”
CDC updated its recommendations based on cost-effectiveness and vaccine efficacy research plus analyses of disease burden in older adults. The RSV vaccine currently is not administered on an annual basis; therefore, anyone who was immunized in 2023 is still covered. In other words, those who received the RSV vaccine should not receive a booster. Data show that another dose did not improve outcomes. ■
JAPhA’s impact as a journal grows significantly
Pharmacists’ research is spreading to wider audiences, according to new data. JAPhA’s impact factor, a measure of the importance of a journal based on article citations, has increased substantially. JAPhA is APhA’s peer-reviewed journal and includes research on medication use and health outcomes, health care policy, and pharmacist-provided services.
JAPhA’s Journal Impact Factor, a metric calculated from data indexed in the Web of Science Core Collection, increased to 2.5 compared with less than 1.5 in 2017.
In 2023, JAPhA articles were cited by other journals 4,062 times, according to Journal Citation Reports. In 2017, by comparison, JAPhA articles were cited 2,031 times.
The top five cited research articles published in JAPhA in 2021 and 2022 are:
Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis, lead author Lucas A. Berenbrok, PharmD, MS, of the University of Pittsburgh
The impact of the COVID-19 pandemic on medical conditions and medication adherence in with chronic diseases, lead author Rima A. Mohammad, PharmD, BCPS FCCP, of the University of Michigan
Essential services: Quantifying the contributions of America’s pharmacists in COVID-19 clinical interventions, lead author John D. Grabenstein, RPh, PhD, FAPhA, FASHP, of Immunize.org
Expanded roles of community pharmacists in COVID-19: A scoping literature review, lead author Tanapong Pantasri, PharmD, RPh, BCMTMS, AAHIVP, of Organization Las Americas Pharmacy
COVID-19 and influenza vaccine hesitancy among college students, lead author Jeffrey Bratberg, PharmD, FAPhA, of the University of Rhode Island ■
Drug shortages are lasting longer and reach all-time high
In its first report on drug shortages, the U.S. Pharmacopeia (USP) noted that drug shortages are lasting longer than before and are affecting a broad range of therapeutic classes.
Now, the average drug shortage lasts for more than 3 years, versus about 2 years in 2020, and 53% of new drug shortages involved generic sterile injectable products, according to the report.
USP highlights four factors that individually, or in combination, may make a drug more at risk of being in short supply: low prices, manufacturing complexity, geographic concentration, and quality concerns.
To resolve the issues, USP recommends market and policy solutions that focus on both long- and short-term requirements, including risk mitigation efforts, public and private investment and partnerships, payment reform to reward reliability, and manufacturing quality, coordination, and accountability.
Earlier this year, USP signed onto a collective call to action to alleviate and prevent drug shortages. ■
CDC recommends doxy PEP for STI prevention
Cases of syphilis, chlamydia, and gonorrhea are on the rise in the United States, but clinical evidence shows that taking doxycycline 200 mg within 72 hours of a sexual encounter can significantly reduce infections.
CDC recommends doxycycline postexposure prophylaxis (doxy PEP) for high-risk populations, including men who have sex with men and transgender women.
According to the agency’s guidelines, individuals in these groups who have had a bacterial STI within the past year should be counseled on doxy PEP and offered a prescription to be self-administered as needed, within dosing recommendations.
The optimal setting for doxy PEP, according to CDC sources, is in the context of a comprehensive sexual health plan, to also include risk reduction counseling, STI testing and treatment, recommended vaccination, and continuation of care with HIV services and other resources as warranted.
Users of doxy PEP should be screened at baseline and every 3 to 6 months thereafter, at which time providers should also reevaluate the need for doxy PEP and perform HIV testing. ■
WSU research finds pharmacists are an effective, less costly care option for minor illnesses
Community pharmacist–provided care for minor conditions could be cost-effective, new research shows.
A research team from Washington State University (WSU) found that for minor illnesses—such as UTIs, shingles, animal bites, and headaches—care in pharmacies cost about $278 less compared with treatment for similar conditions in traditional sites of primary care, urgent care, or emergency department settings.
Most of the patients included in the research reported their illnesses were resolved after their initial pharmacist visit. According to the researchers, treating all of the illnesses that were handled at traditional sites during the 3-year study at a pharmacy instead would have saved an estimated $23 million in health care costs.
“The results showed pharmacists did provide quality care comparable with practitioners at other care sites and reduced the financial burden on the health care system,” said Julie Akers, PharmD, lead researcher and associate professor from WSU College of Pharmacy and Pharmaceutical Sciences.
The findings, published May 3, 2024, in ClinicoEconomics and Outcomes Research, are based on data from nearly 500 patients who received care from 175 pharmacists at 46 pharmacies in Washington from 2016 to 2019. The pharmacists completed a certificate program through the Washington State Pharmacy Association before offering patient care services.
The cases were compared with insurance data for patients with conditions of the same type and level who received care at a physician’s office, urgent care center, or emergency department during the same time period.
“We partnered with a major health plan in Washington state to provide matched episodes of care to allow for more accurate comparison between patients who sought care at a pharmacy against patients utilizing emergency department, urgent care, or primary care sites of care,” said Akers.
Akers said they were surprised how many providers referred their patients to the pharmacy for care. The study was designed to facilitate patient access to primary care services, and Akers said when patients would come in to seek care at the pharmacy, often they would tell the pharmacist that their primary care provider’s office told them to go to the local pharmacy to receive care sooner.
“My hope is that we can use this research data to help patients, especially Medicare patients, receive greater access to care through community pharmacies,” said Akers. “Not only are there opportunities to reduce up-front costs, as seen in the study, but pharmacy-based care can help patients who may not otherwise have access to care.” ■
Newer diabetes treatment associated with lower hyperkalemia risk in patients with T2D
Recent study findings suggest new diabetes treatments, which have properties that protect the heart and kidneys, could reduce hyperkalemia risk in patients with T2D.
Researchers of the population-based cohort study, published June 26, 2024, in The BMJ, analyzed claims data from Medicare and two large U.S. commercial insurance databases to identify patients with diabetes who initiated therapy with SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors between April 2013 and April 2022.
Investigators compared hyperkalemia outcomes with SGLT2 inhibitors and GLP-1 receptor agonists to outcomes with DPP-4 inhibitors and also against each other.
SGLT2 inhibitors had a lower 3-year absolute risk for the complication than both GLP-1 receptor agonists in patients with T2D, especially those at risk of hyperkalemia, according to the study.
“The consistency of associations among individual agents in the SGLT-2 inhibitor and GLP-1 receptor agonist classes suggests a class effect. These ancillary benefits of SGLT-2 inhibitors and GLP-1 receptor agonists further support their use in people with type 2 diabetes, especially in those at risk of hyperkalemia,” concluded the study authors. ■