API-CAT Trial reinforces NCCN Guidelines for cancer-Associated‌ Venous Thromboembolism Management

New data from the API-CAT​ (Apixaban for the⁣ Treatment of Cancer-Associated⁢ Venous Thromboembolism) trial⁣ further validate ⁤current National Extensive Cancer Network (NCCN) guidelines ⁤for⁢ preventing and treating blood clots​ in cancer patients, offering reassurance too clinicians and patients ​navigating‍ this complex area of​ care. Published⁣ in the⁢ New ⁣England Journal of ‍Medicine in 2025, the findings demonstrate the continued ⁣efficacy and⁢ safety‍ of extended ‍reduced-dose ​apixaban for cancer-associated venous thromboembolism (VTE), solidifying it’s role as a viable treatment option.

Cancer significantly elevates the risk of VTE -⁣ including deep vein thrombosis and pulmonary embolism ‍- due to factors like ⁢chemotherapy,surgery,and the cancer itself. Managing ⁤this risk is critical,as VTE can lead to⁢ serious complications and impact treatment ⁣outcomes. The ‍NCCN guidelines emphasize individualized care, incorporating risk assessment, prophylactic‍ measures, and tailored treatment plans. The API-CAT trial’s results, alongside previous research including the 2019 New England ‌Journal of Medicine study by Carrier et al. demonstrating apixaban’s preventative benefits, provide strong evidence supporting the NCCN’s approach.⁢

The⁤ API-CAT trial (Mahé I,et al.,⁣ 2025) specifically investigated ‌extended treatment ⁤with reduced-dose apixaban following an initial​ course of anticoagulation for cancer-associated VTE. Results showed sustained benefit with continued use of the medication. This aligns ‌with‍ the 2021 american Society of ⁢Hematology (ASH) guidelines (Lyman GH, et al., 2021)​ which ​address both⁣ prevention and treatment of VTE in cancer ‍patients, and the 2020 ASCO clinical ⁣practice guideline update (Key NS, et al., ​2020) ​which ⁢also supports ‌individualized approaches.

Risk assessment tools, such as the Khorana model developed ⁤in 2008 ​(Khorana AA, et al., ⁣2008), help clinicians identify patients at ⁤higher risk of chemotherapy-associated thrombosis, informing ⁣preventative strategies. Treatment options, as ⁣detailed in the NCCN‌ guidelines ‌and prescribing information​ for medications like Eliquis (Bristol myers Squibb,‌ May⁣ 2025), range from traditional anticoagulants to newer oral anticoagulants like apixaban.Ultimately,the API-CAT findings​ underscore the importance ⁣of ⁤a​ collaborative ⁢approach to cancer care,where treatment decisions are made through ongoing​ discussion ⁤of risks,benefits,and​ patient preferences,as highlighted by ‍the NCCN. Further research continues⁤ to ⁤refine these ⁢guidelines, ‌building on the foundational work of experts like Donnellan and Khorana (2017) who initially reviewed the link ⁤between cancer and VTE.

Navigating Rising Healthcare Costs: A Growing Role for Pharmacists

Healthcare access is facing a new wave of challenges as costs continue to climb, particularly impacting patients navigating complex insurance landscapes. Discussions are centering on how to best support individuals as they grapple wiht increasing premiums, fluctuating copays, and evolving formulary restrictions.

Recent changes, including a rise in the premium increase cap from $35 to $50 per month, are expected to trigger stricter cost-control measures within managed care systems, especially those tied to Medicaid. Experts anticipate a greater reliance on strategies like step therapy and tiered formularies – tools commonly used by Pharmacy Benefit Managers (PBMs) and managed care organizations to manage drug costs.

This tightening of formularies is highly likely to leave patients feeling confused and frustrated, seeking clear explanations for why certain treatments are covered while others aren’t.They’ll need straightforward answers, rather than a deep dive into the complexities of healthcare finance.

However, these changes could also spur a necessary evaluation of current treatment options. Questions are being raised about the need for a multitude of similar drugs – for example, the abundance of PD-1 inhibitors – and whether focusing on a smaller set of “workhorse” medications might be a more sustainable approach. There’s also potential for increased flexibility, with managed care groups possibly collaborating with clinical sites to cover treatments demonstrating promise in trials, even if not yet formally indicated.Crucially, pharmacists are poised to play a central role in addressing the “financial toxicity” these changes will create.This involves proactively engaging with patients to discuss financial barriers, collaborating with administrators and physicians, and advocating for solutions.

Open Enrollment & the need for Expert Guidance

The upcoming Open Enrollment period will be particularly critical, especially for older adults on fixed incomes. The sheer complexity of navigating Medicare Advantage,Medicaid,and other programs is overwhelming,often leading to patients unknowingly selecting plans that don’t meet their needs.

Currently, benefit counseling during Open Enrollment is typically handled by financial counselors, with pharmacists largely excluded from these discussions. Though,a growing consensus suggests pharmacists must expand their knowledge of Medicare and medicaid reimbursement systems to effectively answer patient questions and provide informed guidance.

This requires a notable investment in pharmacist education over the coming months, equipping them to understand the intricacies of these programs and their implications for patient access. The goal is to empower pharmacists to become trusted advisors, helping patients decipher the evolving healthcare landscape and secure the coverage they need. The situation is particularly sensitive for “dual-eligible” patients – those on both Medicare and Medicaid – where even seemingly minor changes, like work requirements, can create significant uncertainty.

Ultimately, navigating these changes will require a collaborative effort, and a more proactive role for pharmacists in supporting patients through the financial and logistical challenges of accessing necessary care.

Diabetes Drug Combo Shields Kidneys Best

GLP-1 Agonists Offer Superior Protection in New Study

A recent analysis reveals that combining metformin with a GLP-1 receptor agonist significantly enhances kidney protection for individuals with type 2 diabetes and related kidney disease (DKD). This combination proves more effective than other metformin-based treatment regimens.

New Insights into DKD Management

A comparative study, published in July 2025, examined various antidiabetic medication combinations for their ability to preserve kidney function in patients aged 18 and older diagnosed with type 2 diabetes and DKD. Crucially, individuals with a glomerular filtration rate (eGFR) above 15 mL/min/1.73 m² were excluded from the research.

The research team categorized participants based on their metformin adjunct therapy: metformin plus a GLP-1 receptor agonist, metformin with a DPP-4 inhibitor, or metformin with other antidiabetic medications (oADMs). The study’s main goal was to assess a composite endpoint of a 50% decline in eGFR or the onset of end-stage renal disease (ESRD), defined as an eGFR below 15 mL/min/1.73 m². A secondary outcome included the primary endpoint alongside all-cause mortality. The analysis established a baseline one year before adjunct therapy initiation and tracked patients for three years.

Rigorous Analysis for Unbiased Results

To minimize bias, researchers meticulously stratified patients by age, sex, body mass index (BMI), glycated hemoglobin (HbA1c), and use of ACE inhibitors or ARBs. They employed propensity score matching (PSM) to account for factors like medications and comorbidities that might influence DKD progression, ensuring a more reliable comparison.

Following PSM, baseline characteristics such as age, HbA1c, and eGFR were comparable across groups. Hypertension was present in approximately 76% of patients, with 44% using ACE inhibitors and 16% using ARBs. The majority, about 80%, had DKD stage 1 (eGFR ≥ 90 mL/min/1.73 m²), while 20% had stage 2 (eGFR 60-89 mL/min/1.73 m²).

GLP-1 Agonists Emerge as Kidney Protectors

The study found that the metformin/GLP-1 receptor agonist group experienced a significantly lower risk of kidney impairment compared to the metformin/DPP-4 inhibitor group. Further analysis indicated that older patients (55+), females, those with a BMI of at least 31 kg/m², or individuals with an HbA1c above 6.5% showed a reduced risk when using metformin plus a GLP-1 receptor agonist.

When compared to the metformin/oADM group, the metformin/GLP-1 receptor agonist cohort demonstrated a substantially lower risk of the secondary outcome, including the composite endpoint and mortality. Specifically, older patients (55+) on this combination appeared to have a diminished risk of kidney impairment.

No significant differences in primary or secondary outcomes were observed between the metformin/DPP-4 inhibitor and metformin/oADM groups. Interestingly, females using metformin and a DPP-4 inhibitor seemed to face a lower risk of kidney impairment.

Clinical Recommendations and Considerations

These findings align with existing research highlighting the kidney-protective benefits of GLP-1 receptor agonists in DKD. While metformin/DPP-4 inhibitor combinations offer cardiovascular advantages alongside glycemic control, they do not appear to provide kidney protection.

Consultant pharmacists should consider GLP-1 receptor agonists as a second-line treatment for older adults with DKD needing enhanced glycemic management. It’s vital to monitor for potential side effects like nausea, vomiting, diarrhea, or constipation, as well as weight loss.

Emergency department pharmacists should be vigilant for volume depletion due to nausea and vomiting in patients on GLP-1 receptor agonists, as this can contribute to acute kidney injury. Nurse practitioners can consider GLP-1 receptor agonists after metformin and SGLT2 inhibitors when additional glycemic control is required. This study provides valuable real-world evidence supporting the guideline-recommended use of these agents for kidney protection in DKD.

The broader impact is significant: according to the CDC, in 2021, over 30 million Americans had diabetes, and a substantial portion also experienced chronic kidney disease (CDC, 2023). This research offers a clearer path to managing DKD effectively.