Maria G. Tanzi

Improving HPV vaccination rates: Real-world examples

APhAs Annual Pharmacy-Based Influenza/Adult ImmunizationSurvey from 2014 indicated that approximately 34% of surveyedpharmacists are currently administering the human papilloma virus(HPV) vaccine to patients, and 11% plan to administer this vaccine inthe future. These numbers are lower than the number of pharmacistsadministering other recommended adolescent vaccinations, such astetanus toxoid, reduced diphtheria toxoid, and tetanus–diphtheria–acellular pertussis (Tdap; 68%) or meningococcal conjugate vaccine(MCV4; 50%).

Pharmacy-based immunizations growing, improving

Using an ever-increasing network of patient-referral relationships and taking steps to improve documentation practices, pharmacists are increasing the volume and diversity of immunization services they offer in the pharmacies of America, according to a 2013 survey conducted by APhA.

Diabetes update: Key research at 2014 ADA meeting

Cutting-edge diabetes research was featured at this years 74th Scientific Sessions of the American Diabetes Association (ADA). Research was presented on oral antidiabetic agents and fracture risk, long-term follow-up from the Diabetes Prevention Program Outcomes Study, dietary effects on diabetes risk, and much more. Highlights from the June 13–17 meeting in San Francisco are available at http://professional.diabetes.org. Following are a few key research studies with a pharmacotherapy focus.

Ocriplasmin: Proteolytic enzyme for eye disorder

Vitreomacular adhesion Vitreomacular adhesion generally occurs with aging and can contribute to eye problems if the vitreous starts to move away from the macula, resulting in damage of the macula because of pulling or tugging. Patients may experience symptoms such as blurring of visual acuity with central visual-fi eld defects. Vitrectomy is the primary treatment to manage symptomatic vitreomacular adhesion. Because it is a surgical procedure and associated with various risks such as infection, retinal detachment, hemorrhage, and cataract, vitrectomy is not performed until there is a clinically signifi cant loss of vision. Nonsurgical approaches such as chondroitinase, dispase, and hyaluronidase have been tested for management of symptomatic vitreomacular adhesion, but these treatments were abandoned because of lack of effi cacy, safety concerns, or both. Ocriplasmin is the fi rst pharmacologic agent to show effi cacy in preclinical and clinical studies, and its approval offers patients a nonsurgical option to manage this serious eye condition.

Meeting summaries: HIV, bacterial infections, anticoagulation

■ Results of the Women AntiretroViral Ef cacy and Safety (WAVES) study, the rst-ever clinical trial of antiretrovirals enrolling only women, found that treatment-naive women with HIV-1 infection taking elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild—Gilead) had better viral suppression and fewer adverse effects than women taking atazanavir (Reyataz—Bristol-Myers Squibb) boosted by ritonavir (Norvir— AbbVie) plus tenofovir/emtricitabine (Truvada—Gilead).

Meeting summaries: Major depressive disorder, obesity, diabetes, cancer

■ Results of a Phase III trial with Natesto by Trimel, the testosterone nasal gel, in 306 men with low testosterone from 39 outpatient centers in the United States showed that threetimes daily dosing was more effective than twice-daily dosing at raising testosterone blood levels within the normal range; 90% of men who used the nasal gel three times daily compared with 71% of men using it twice daily achieved appropriate levels.

Meeting summaries: Acute coronary syndromes, peanut patch, skin disorders effects

■ In a study of more than 400 patients aged 80 years and older with nonST elevation myocardial infarction (NSTEMI) or unstable angina, those who received invasive testing (i.e., coronary angiography) with or without subsequent procedures such as angioplasty or coronary artery bypass graft surgery had a 47% risk reduction in the combined endpoint of subsequent MIs, urgent revascularization procedures, stroke, and death compared with similar patients who were treated using a more conservative, noninvasive approach (e.g., medications).

Challenges and opportunities in adolescent immunizations

Vaccines recommended for adolescent patients are underused,leaving this patient population at risk for serious diseases. Thereare numerous reasons why vaccines are underutilized in adolescentpatients, from knowledge gaps to limited provider interactions tocost concerns. Pharmacists can play a substantial role in improvingvaccination rates in this patient population by maximizing everyopportunity to educate parents and patients, strongly recommendingneeded vaccines, and administering them as appropriate accordingto state laws.

First two drugs approved for idiopathic pulmonary fibrosis

Two novel therapies, nintedanib (Ofev—Boehringer Ingelheim) and pirfenidone (Esbriet—InterMune, Roche), are the first FDA-approved drugs for the management of idiopathic pulmonary fibrosis (IPF), a rare but often fatal lung disease. Both drugs were granted approval ahead of schedule through a multiple-path process involving fast track, priority review, orphan product, and breakthrough designations.

Controversies in management of dyslipidemia

The American College of Cardiology (ACC) and the American Heart Association (AHA) lipid guidelines released in 2013 were viewed as controversial by some clinicians, with many disagreeing about the lack of LDL cholesterol (LDL-C) targets. Since then, the National Lipid Association (NLA) has released recommendations for the management of dyslipidemia that incorporate LDL-C targets.