Bulletin Today
APhA staff
Health care costs rose after VA formulary switch to fluticasone-salmeterol dry-powder inhalers
Researchers reported an association with increased health care costs when the Veterans Health Administration (VHA) formulary transitioned from budesonide-formoterol metered-dose inhalers to fluticasone-salmeterol dry-powder inhalers.
The investigation findings, reported in JAMA Internal Medicine on July 7, 2025, found that after the VHA formulary change, patients who were switched from a budesonide-
formoterol metered-dose inhaler to a fluticasone-salmeterol dry-powder inhaler saw increased hospitalizations.
Individuals who switched to a fluticasone-salmeterol dry-powder inhaler had no difference in mortality. However, at 180 days after the switch, compared with matched patients who did not switch, there were increases in all-cause hospitalizations (16.14% vs. 15.64%), respiratory-related hospitalizations (3.15% vs. 2.74%), and pneumonia-related hospitalizations (1.15% vs. 1.03%). In addition, there were 10% fewer albuterol fills and 2% more prednisone fills.
The formulary change, which occurred in July 2021, was evaluated with a within-person, self-controlled case series and matched observational cohort study that used data from the U.S. Veterans Affairs health care system from January 2018 through December 2022, including data from 260,268 patients who switched inhaler medicines before the formulary change, between January 2018 and December 2022.
“A key question raised by our study is whether the increased incidence of adverse outcomes among patients who switched to the dry-powder fluticasone-salmeterol inhaler was associated with the medication, the device, or other factors. The answer likely involves all three factors,” the researchers wrote. ■
GLP-1s could positively affect neurodegeneration and stroke
For adults with T2D and obesity, there is a correlation between use of semaglutide and tirzepatide and a reduced risk of dementia, stroke, and all-cause mortality, according to new research published July 15, 2025, in JAMA Network Open.
“These findings highlight the possible role of [GLP-1s] in mitigating neurodegenerative and cerebrovascular risks in this high-risk population,” the researchers wrote.
The cohort study of 60,860 patients aged 40 years or older with T2D and obesity were examined for the incidence of dementia, Parkinson’s disease, ischemic stroke, intracerebral hemorrhage, and all-cause mortality when taking GLP-1s compared with other antidiabetic drugs.
Over 7 years of follow up, there was a lower risk of dementia, stroke, and all-cause mortality in the GLP-1 group compared with the other antidiabetic drug group.
There was no difference in the risk of Parkinson’s disease or intracerebral hemorrhage. In subgroup analyses, the benefits of the GLP-1s were higher for individuals aged 60 years or older, women, and patients with a BMI of 30 to 40 kg/m2. ■
Initial antibiotic selection could be most critical, says study
Investigators learned from the four INSPIRE trials—which consisted of non-critically ill adults hospitalized with common infections—that real-time computerized provider order entry (CPOE) discourages initial use of extended-spectrum antibiotics.
In the studies, published in JAMA on July 17, 2025, participating hospitals randomly selected for CPOE received prompts within the first 3 days of hospitalization—the empiric period before contributing pathogens are confirmed. Prompts described individual patient risk for infection with multi-drug resistant organisms and recommended standard-spectrum or extended-spectrum antibiotics accordingly. The remaining hospitals were allocated to routine antibiotic stewardship.
While CPOE was shown to safely curtail initial extended-spectrum antibiotic use by as much as 35% compared with usual practice, whether the reductions were sustained for the rest of the hospital stay was not immediately clear.
To learn more, researchers compared extended-spectrum antibiotic therapy use beyond day 3 in the hospital, which decreased to a greater extent in the CPOE hospitals than in the non-CPOE centers.
Importantly, where use of extended-spectrum antibiotics had been lowered, researchers determined that 65% to 84% of those reductions remained in place for the duration of hospitalization, indicating that clinicians often stuck with initial therapy decisions.
According to the study authors, the results support focusing on stewardship for initial antibiotic selection, rather than on de-escalating treatment once initiated, as a way to reduce inappropriate utilization of extended-spectrum antibiotics each year for millions of hospitalized patients in the United States. ■
CDC: Roughly one in three teens have prediabetes
Based on data from the National Health and Nutrition Examination Survey, a recent CDC report sounds the alarm over increasing rates of prediabetes in juveniles aged 12 to 17 years.
Almost one in three U.S. residents in this age bracket are already showing signs of insulin dysfunction, which could advance to T2D in some. There is also an associated higher risk for heart disease and stroke, CDC found.
“These new prediabetes data among adolescents serve as a wake-up call,” Christopher Holliday, director of CDC’s Division of Diabetes Translation, said in a statement. “The good news is it’s not too late to change course. Simple lifestyle changes—like healthy eating and staying active—can make a big difference in preventing or delaying type 2 diabetes.”
Experts point out that prediabetes can have a direct but transient correlation to hormonal changes during puberty, and they assure that not every young person diagnosed will develop T2D.
“This data… cements that there needs to be scientific funding of more research to really understand how to best treat kids,” said Meg Bensignor, MD, with the University of Minnesota’s Center for Pediatric Obesity Medicine. “We just need more research to really understand how to prevent and then also how to effectively treat kids that do develop type 2 diabetes.” ■
Could vaccine uptake for pharmacists influence patient rates?
Pharmacists not only increasingly administer vaccines, but they can also influence consumer decisions to get immunized.
According to a systematic review and meta-analysis published in Communications Medicine on July 1, 2025, vaccination rates within the profession vary widely and average only about 50%. Identifying strategies, including continuous education, to raise pharmacist uptake from the current moderate level is important, conclude the authors.
Expanding uptake of vaccines among pharmacists themselves could improve overall community vaccination rates, the authors said.
“High vaccination rates among pharmacists could increase their credibility as vaccination advocates,” researchers wrote. “The vaccination rate indicates the professional group’s stance towards this preventive measure. Understanding the factors facilitating pharmacists’ uptake of influenza and pneumococcal vaccines could prove essential in increasing their involvement in vaccination programs and augmenting vaccination rates across the broader population.” ■