Bulletin Today
APhA staff
Study ties lower anticonvulsant prescriptions to pharmacy closures
While previously published findings pointed to a decline in adherence to cardiovascular drug regimens following community pharmacy closures, new research suggests a similar pattern with anticonvulsants.
Research published in JAMA on November 4, 2024, found that pharmacy shutdowns correlated to a reduction of 1.15 fills per patient per month, tantamount to 1 month of missed medication over a 6-month period. They found that the use of mail-order pharmacies had no effect on the reduction.
The authors examined claims data in Colorado from January 2018 to June 2022 to investigate whether the shutdown of a community pharmacy had an effect on anticonvulsant prescription fills over the ensuing 6 months. For comparison, they tracked fills in a control group of patients who used a pharmacy that did not close.
A total of 39 locations stopped doing business during the study period, affecting 3,614 state residents, while 783 locations remained open to serve 123,439 patients.
Nonadherence to anticonvulsant medication regimens has been associated with unfavorable outcomes, including more emergency department visits and greater mortality in epilepsy and symptom exacerbation related to neuropathic pain.
What could help? The authors suggested allowing patients to fill a greater supply of medication—with plan coverage—ahead of a pending closure. Pharmacists could proactively assist patients in finding a new pharmacy and transferring prescriptions as well. ■
DEA extends telemedicine flexibilities through 2025
DEA announced the extension of current telemedicine flexibilities for prescription-controlled medications, including substances such as buprenorphine and Adderall, through the end of 2025.
During the COVID-19 pandemic, DEA issued temporary rules that allowed providers to prescribe these substances without first meeting a patient in person. Those rules were set to expire at the end of 2024 but have now been extended for 1 more year—until the end of 2025.
Last year, DEA received tens of thousands of comments and held 2 days of public listening sessions in response to a set of proposed telemedicine rules. Given that feedback and discussion, the agency made its decision. The full text of the “Third Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” is posted in the Federal Register. ■
Unfavorable trends in diabetes prevalence
Recent research from CDC found that from 2021 to 2023, the total prevalence of diabetes among U.S. adults was 15.8%, with diagnosed cases accounting for 11.3% and undiagnosed cases accounting for 4.5%.
According to the research, total, diagnosed, and undiagnosed diabetes prevalence increased with age and weight status, while total and diagnosed diabetes prevalence dropped with increased education. Total and diagnosed diabetes was also more prevalent among men than women.
According to a study in the November 23, 2024, issue of The Lancet, an estimated 828 million people worldwide aged 18 years and older suffered from diabetes in 2022 versus 198 million in 1990. The incidence rate increased in most of the 200 countries and territories studied, especially in low- and middle-income nations in southeast and south Asia, the Middle East, North Africa, Latin America, and the Caribbean. Notable exceptions to the trend included parts of western and central Europe, sub-Saharan Africa, east Asia, and Canada.
Researchers also found that in most countries, treatment coverage did not budge at all or did not expand enough to absorb the increase in disease prevalence.
Findings came from 1,108 population-representative studies with 141 million adult participants. ■
Researchers seek to understand AFib risk in Black adults
Increased resting heart rate was associated with a higher risk of new-onset AFib for Black adults, according to a recent study published in JAMA Network Open. Researchers conducted a longitudinal analysis—a median of 14 years follow up—of the Jackson Heart Study, which is the largest prospective cohort study of cardiovascular disease in Black adults.
Of the 4,965 Black adults included in the study cohort, researchers found that every 10 beats per minute increase in resting heart rate was associated with a 9% increased risk of AFib.
The authors said the findings suggested that increased resting heart rate is associated with new-onset AFib for Black individuals, independently of other established risk factors, but “additional research is needed to determine whether [measuring resting heart rate] can improve the selection of individuals for [AFib] screening, which may help to mitigate long-standing health disparities,” they wrote.
AFib, the most common sustained cardiac arrhythmia, can lead to heart failure, stroke, dementia, and death. Black adults with AFib tend to have higher rates of ischemic stroke and AFib-related complications compared with white adults, even though large population-based studies have reported that the incidence of clinically recognized AFib is lower in Black adults than white adults. ■
Can vitamin D decrease BP in overweight patients?
Vitamin D deficiency has been tied to numerous unfavorable health outcomes, including hypertension, but new clinical evidence suggests supplementation may alleviate high BP in older adults who are overweight.
In a recent study published in the December 2024 issue of the Journal of the Endocrine Society, researchers performed post-hoc analyses of a 1-year study that had randomized patients to an oral dose of 600 IU/day of vitamin D—
standard for healthy individuals—or 3,750 IU/day, which is higher than recommended but still within the range of tolerability. All vitamin D doses were administered with a calcium supplement.
Researchers found that in comparing systolic and diastolic readings in 111 patients in the lower-dose treatment arm and 110 in the higher-dose cohort, vitamin D supplementation lowered both—
especially in the presence of hypertension and/or a BMI of 30 or higher.
However, the study authors noted that “more is not necessarily better,” considering that the positive effect of vitamin D does not appear to hinge on dose. The research, they concluded, underscores the importance of demographics and health status in predicting BP response to vitamin D supplementation. ■
Metformin may decrease asthma attacks in patients with both diabetes and asthma
Diabetes and asthma are often frequent comorbidities, but results from a population-based U.K. study, published November 18, 2024, in JAMA Internal Medicine, suggest that treating one may actually help the other.
Researchers examined outcomes associated with two exposures: the first-line diabetes treatment metformin and adjuvant interventions for glucose control. They found that among patients with both conditions, metformin was associated with an estimated 30% reduced risk of asthma attacks over 12 months of follow up.
Among multiple add-on diabetes therapies, only GLP-1 receptor agonists had an additive association, lowering the risks by an additional 40%, roughly.
According to the study authors, the effect was achieved via pathways other than glycemic control or weight loss and occurred across asthma phenotypes.
The findings “suggest potential for repurposing antidiabetic drugs to much-needed alternative treatments for asthma,” the authors concluded. “Further research, including randomized clinical trials and mechanistic studies, are now needed to confirm their effect and the mechanism of action in asthma.” ■