Commentary
Video
According to Pranav Garimella, pharmacists are essential in counseling patients with CKD on the appropriate use of semaglutide.
In an interview with Pharmacy Times®, Pranav Garimella, MBBS, MPH, chief medical officer of the American Kidney Fund and board-certified nephrologist at UC San Diego Health, explains how pharmacists play a crucial role in guiding patients with chronic kidney disease (CKD) who may benefit from semaglutide (Ozempic, Wegovy; Novo Nordisk) by ensuring proper dosing, educating on potential gastrointestinal side effects, and monitoring for drug-drug interactions. Garimella discusses how CKD can be a silent killer that often goes undetected until advanced stages and that by fostering a collaborative care model involving endocrinologists, nephrologists, and primary care providers, pharmacists can help improve patient outcomes with semaglutide treatment.
Pharmacy Times: How can pharmacists appropriately counsel and educate patients with CKD who may benefit from treatment with semaglutide?
1. Pharmacists help patients understand semaglutide’s correct usage, potential side effects, and when to seek medical advice.
2. Chronic kidney disease often remains undiagnosed, necessitating a multidisciplinary approach for optimal management.
3. More studies are needed to assess semaglutide’s role in non-diabetic CKD, while pharmacoequity remains critical to ensuring patient access to these life-changing treatments.
Pranav Garimella, MBBS, MPH: Pharmacists are a critical part of our healthcare system, and they really play a vital role in ensuring safe and effective use of medications. As you know, semaglutide and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are being increasingly used for a variety of indications, but the doses and routes of administration of several of these GLP-1 RAs can vary, even for the same drug. For example, if you take semaglutide, Ozempic has been approved for treatment right now of type 2 diabetes (T2D) and CKD, whereas Wegovy is used for management of obesity. Pharmacists are key to ensuring that patients are really aware of the indications and doses prescribed to them and also ensuring that these drugs are used for the appropriate indications and making patients aware of any drug-drug interactions that they may have. Secondly, and something that we really need to consider when prescribing GLP-1 RAs, is that some patients can have side effects, especially gastrointestinal side effects. When these become profound—so when patients have loss of appetite, nausea, vomiting, and they're also on RAS inhibitors or SGLT2 inhibitors—these medications and their effects can compound the risk of adverse kidney outcomes, the thing that we're actually trying to prevent from happening. Ensuring that patients who are receiving GLP-1 RAs are aware of the side effects and strategies to manage them, are appropriately counseled on when to stop the drug if needed, and reach out to their prescribing doctor are things that pharmacists, I think, can really help with. Lastly, as experts in the field of medications, pharmacists really play a role in educating patients about any other drug-drug interactions that they may encounter when using drugs like semaglutide in managing their chronic conditions.
Pharmacy Times: Do you expect semaglutide or other GLP-1 receptor agonists to receive new indications related to CKD treatment in the future?
Garimella: The current FDA approval for Ozempic is for the management of CKD in patients with T2D and proteinuria. Prior to the publication of the FLOW trial on which this approval came through, most data came from cardiovascular outcomes trials where the indications for the reduction of albuminuria were the primary kidney outcome that was seen. What we don't yet know is whether there is a role for GLP-1 RAs such as semaglutide in patients with kidney disease who either don't have a large amount of proteinuria or don't have T2D. For instance, can GLP-1 RAs like semaglutide provide a benefit to patients with other forms of kidney disease and glomerular disorders, which also have albuminuria, but these patients don't really have diabetes? This really needs to be seen, and if so, there could be an extension of the use of semaglutide and this class of drugs for other conditions other than just diabetic kidney disease. But right now, we don't have data that supports its use.
Pharmacy Times: Is there anything else that you would like to add?
Garimella: There are a few things I would like to emphasize. One is that CKD often goes undetected, especially in patients with long-standing diabetes, and because there is a lack of symptoms and we don't quite have routine screening practices, the presentation of patients with kidney disease could be quite advanced. CKD is a silent epidemic, unfortunately, and managing both diabetes and CKD really requires coordinated care. This includes physicians, primary care physicians, endocrinologists, nephrologists, and pharmacy specialists; we really need a care team to take care of them, especially as we have drugs like semaglutide being approved, which cut boundaries between cardiologists, nephrologists, endocrinologists, and obesity specialists, all of whom at some point may be taking care of these patients. We really need to have a structured system with educational initiatives, harmonizing the guidelines across different organizations and making sure that providers and patients are well-educated on the use of these drugs that can have significant impacts on reducing kidney and adverse cardiovascular outcomes. The one last thing I'd like to say is that while we're thankful for the innovation that has gotten us to this point where we have so many new drugs available to treat diabetes and kidney disease, we really need to make sure that these medications and options are getting out there to the patients. The drugs are only useful if patients actually have access to them, can pay for them, and take them on a regular basis. We know that minority populations are disproportionately affected by diabetes, kidney disease, and kidney failure. Making sure that there is pharmacoequity and these drugs get out there to this patient population, making sure that it actually helps prevent complications, is, I think, something that we as clinicians, policymakers, and advocates should really be thinking about.
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