Background/Objectives: Older adults with type 2 diabetes frequently have cardiovascular or kidney disease, and current guidelines strongly recommend the use of SGLT2 inhibitors or GLP-1 receptor agonists in these high-risk populations. This study aimed to critically evaluate their real-world utilization in a tertiary care setting to identify gaps in prescribing and opportunities for improvement. Methods: A retrospective cross-sectional analysis was conducted using electronic medical records from a tertiary academic hospital in Saudi Arabia (June 2019–May 2023). Patients aged ≥65 years with type 2 diabetes and documented ASCVD, heart failure, or CKD were classified as guideline-eligible. Prescribing rates, trends, specialty variation, and associated factors were assessed. Results: Among 223 older high-risk patients with type 2 diabetes, 83.4% received an SGLT2 inhibitor or GLP-1 receptor agonist. However, only 1.6% (223 out of 14,146 older adults) were identified in the electronic medical record as having ASCVD, heart failure, or CKD, suggesting potential underdiagnosis or incomplete recognition of guideline-eligible comorbidities. Overall, just 7.4% of older adults with type 2 diabetes were prescribed either therapy. Notably, approximately one-quarter of prescriptions originated from specialties not routinely involved in cardiometabolic care, indicating variability in prescribing patterns. Multivariable analysis showed that older age, female sex, and unmarried status were associated with lower odds of receiving therapy, while patients seen in cardiology or internal medicine had higher odds than those seen in primary care. Conclusions: Prescribing of GLP-1 receptor agonists and SGLT2 inhibitors was aligned with guideline recommendations in documented high-risk patients. Nevertheless, overall utilization remained low, indicating gaps in the recognition of cardiometabolic comorbidities. Enhancing routine cardiovascular and kidney risk assessment may improve therapy optimization.

Therapeutic drug monitoring (TDM) is key to optimizing vancomycin therapy, as accurate sampling timing ensures valid drug levels and supports safe, effective clinical decisions. This study aimed to assess the timing accuracy of blood draws for vancomycin TDM, evaluate its clinical implications, and identify predictors of timing errors. A cross-sectional study was conducted at King Saud University Medical City, involving 103 patients from October 2023 to December 2023. The primary outcome was adherence to the blood sampling timing guidelines. Secondary outcomes included clinical cure rates, acute kidney injury incidence, and in-hospital mortality. Of the analyzed samples, 80.6% were improperly timed. Clinical cure rates were significantly higher among patients with correctly timed samples (75%) compared to those with incorrectly timed samples (57.83%). Timely sampling improved cure rates for pulmonary and skin infections (85.71%), while improper timing reduced them to 72.22% and 62.5%, respectively. Improper timing was linked to higher in-hospital mortality (30.12%) and acute kidney injury (15.66%). Multivariate analysis revealed that bacteremia significantly reduced the likelihood of clinical cure (odds ratio = 0.387, 95% confidence interval [0.160, 0.933], P = .035), while 3 times daily dosing significantly increased the odds of correctly timed samples (odds ratio = 5.1, 95% confidence interval [1.125, 23.11], P = .035). This study highlights the critical role of accurate timing in vancomycin TDM for achieving favorable patient outcomes and reducing adverse events. Strengthened institutional protocols and targeted training programs are essential to improve adherence to sampling guidelines and enhance patient safety.

Background: New multiple myeloma (MM) medications have revolutionized the treatment landscape, but they are also associated with a range of adverse events (AEs). This study aims to provide a comprehensive overview of AEs reported for four new MM medications: daratumumab, ixazomib, elotuzumab, and panobinostat. Methods: This study uses a descriptive retrospective approach to analyze the FDA Adverse Event Reporting System (FAERS) from 2015 to 2022. It includes variables like medication names, report details, patient demographics, adverse events, and reporter types. The initial dataset consists of over 3700 adverse events, which are categorized into 21 groups for clarity and comparison. Results: The FAERS database revealed 367,756 adverse events (AEs) associated with novel multiple myeloma drugs from 2015–2022. Ixazomib had the highest number of reported AEs with 206,243 reports, followed by daratumumab with 98,872 reports, then elotuzumab with 26,193 AEs. Ixazomib’s AE reports increased dramatically over the study period, rising approximately 51-fold from 1183 in 2015 to 60,835 in 2022. Of the medications studied, ixazomib also recorded the highest number of deaths (24,206), followed by daratumumab (11,624), panobinostat (7227), and elotuzumab (3349). The majority of AEs occurred in patients aged 55–64 and 65–74 years. Conclusions: Ixazomib, a new MM medication, had the highest number of AEs reported. Also, it has the highest rate of reported deaths compared to other new MM medications. Clinicians should be aware of the potential AEs associated with this medication and further research is needed to understand the reasons for the high number of AEs and to develop mitigation strategies. More attention should also be paid to the safety of new multiple myeloma medications in younger patients.

Background: Fungal infections, particularly among immunocompromised individuals, present significant challenges due to rising incidence rates, treatment costs, and increasing resistance to antifungal agents. This study evaluates trends in antifungal use among Medicaid beneficiaries, focusing on prescribing patterns, costs, and pricing to optimize therapy. Methods: Using the national Medicaid outpatient pharmacy claims data collected by the US Center of Medicare and Medicaid Services, a retrospective drug utilization analysis was conducted for antifungal medications from 2009 to 2023. Antifungal medications were categorized based on therapeutic use. The study examined annual utilization, reimbursement, and pricing trends, along with the market share. Results: Overall Medicaid utilization of superficial fungal infections’ (SFIs’) medications increased from 3.95 million prescriptions in 2009 to 6.16 million in 2023. Nystatin was the most frequently utilized SFI agent, while fluconazole emerged as the most commonly prescribed agent for invasive fungal infections (IFIs). In 2022, a notable spike occurred in the number of prescriptions for both SFIs and IFIs. Medicaid’s total expenditure on SFI medications rose from USD 121.9 million in 2009 to USD 155 million in 2023, while spending on IFI medications fluctuated substantially, peaking at USD 156.8 million in 2022 before declining to USD 80.7 million in 2023. After being introduced to the market, efinaconazole became the most expensive SFI agent over the years. Isavuconazole, the latest approved IFI medication, demonstrated sustained utilization, reimbursement, and price increases. Conclusions: The substantial rise in antifungal utilization and spending underscores the growing financial burden on Medicaid, emphasizing the need for policy interventions to manage costs and generic drug substitution while ensuring equitable access to these essential treatments. However, this study is limited by the lack of clinical outcome data and information on off-label use. Additionally, reimbursement data may not accurately reflect actual drug prices.

Background: Lipid metabolism disturbances are common in end-stage renal disease (ESRD) patients on hemodialysis (HD), leading to dyslipidemia, which is characterized by abnormal plasma lipids and lipoproteins. Although large randomized controlled trials have generally not demonstrated a survival benefit associated with statin therapy among patients receiving hemodialysis, limited observational studies have reported potential associations with improved clinical outcomes in this population. Methods: This retrospective cohort study investigated the clinical and safety outcomes of statin use in ESRD patients on HD with documented dyslipidemia over a two-year period from 1 January 2018 to 30 December 2019. The primary endpoints evaluated the clinical outcomes of statins by assessing changes in specific lipid parameters, including low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), and high-density lipoprotein cholesterol (HDL-C). The secondary endpoints assessed safety by monitoring liver enzymes and creatine kinase (CK) levels. Results: Among 179 participants, diabetes mellitus was present in 134 patients (74.9%), while 168 patients (93.9%) had hypertension. Cardiovascular events occurred in 95 patients (53.1%). Statin therapy was administered to 146 patients (82.0%), with atorvastatin being the most frequently prescribed statin (69.3%). Modest reductions in LDL-C levels were observed in the rosuvastatin and atorvastatin groups, whereas slight increases were noted in the simvastatin and non-statin groups. None of these within-group changes were statistically significant. In the atorvastatin group, LDL-C decreased slightly from 2.058 to 2.003 mmol/L. The rosuvastatin group experienced a more pronounced LDL-C reduction from 2.607 to 2.113 mmol/L. Conversely, the simvastatin group showed an LDL-C increase from 1.550 to 1.901 mmol/L. Among the non-statin group, LDL-C increased from 2.678 to 2.820 mmol/L. Liver enzyme and CK levels fluctuated slightly but remained within normal ranges. Conclusions: This study evaluated statin therapy in hemodialysis patients with dyslipidemia. Although modest reductions in LDL-C levels were observed in the atorvastatin and rosuvastatin groups, statin therapy did not reduce the incidence of atherosclerotic events in hemodialysis patients with dyslipidemia. Additionally, statin use was not associated with any clinically or statistically significant effects.