Could a medication designed for weight loss change how we think about migraine prevention?
In this episode, host Diana Langworthy sits down with returning guest Dr. Natalie Heinrich, PharmD and student contributor Nena Abosi, PharmD Candidate 2026 to unpack a 2025 Headache pilot study evaluating liraglutide as an add-on therapy for adults with obesity and high-frequency or chronic migraine. The team breaks down study design, results, and limitations while questioning whether the observed benefit stems from weight loss, intracranial-pressure changes, or something else entirely.

• Study Design: Prospective open-label pilot (n = 31) using liraglutide 1.2 mg daily × 12 weeks in adults with BMI > 30 kg/m² and ≥ 8 headache days/month unresponsive to ≥ preventives.
• Results: Headache days decreased by ~9 per month (≈ 50 % reduction); disability scores improved significantly, but BMI change was minimal.
• Mechanism: Benefit appeared independent of weight loss—raising curiosity about GLP-1 effects on intracranial pressure and CGRP release.
• Tolerability: Mild GI symptoms (~40 %), no discontinuations.
• Caveats: Small sample, no control group, single center — results are hypothesis-generating, not practice-changing.
• Clinical Pearl: Pilot studies like this spark conversation and awareness for emerging mechanisms while reminding clinicians to stay evidence-curious.

• Braca S, Russo CV, Stornaiuolo A, et al. Effectiveness and tolerability of liraglutide as add-on treatment in patients with obesity and high-frequency or chronic migraine: A prospective pilot study. Headache. 2025; 00: 1–8. doi:10.1111/head.14991

• Natalie Heinrich, PharmD, BCPS – Clinical Pharmacist in Neurology, M Health Fairview
• Nena Abosi, PharmD Candidate (2026) – University of Minnesota College of Pharmacy

• Diana Langworthy, PharmD, BCPS – Associate Professor, University of Minnesota College of Pharmacy

Have a study you'd like us to decode on a future episode? Send it our way at whatsitworthpodcast@gmail.com.
We'd also love to hear your thoughts—drop a comment, share your takeaways, or let us know how you're using this evidence in practice.

New population-based study suggests SGLT2 inhibitors and GLP-1 receptor agonists may reduce COPD exacerbations in patients with type 2 diabetes.

In this episode of What's It Worth?, we examine a large real-world study assessing whether glucose-lowering medications influence the risk of COPD exacerbations in patients with type 2 diabetes and chronic obstructive pulmonary disease. We focus on SGLT2 inhibitors and GLP-1 receptor agonists and discuss whether potential pulmonary benefits should influence drug selection in patients with both conditions.

Guest: Ashley Wilke, PharmD — PGY2 Critical Care Pharmacy Resident at M Health Fairview East Bank Hospital.

Study at a Glance

• Design: Retrospective cohort study using nationwide claims and registry data
• Population: Adults with type 2 diabetes and COPD initiating glucose-lowering therapy
• Exposures: SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors
• Primary outcome: COPD exacerbations requiring hospitalization or systemic steroids
• Key Finding: SGLT2 inhibitors and GLP-1 receptor agonists were associated with a lower risk of COPD exacerbations compared with DPP-4's
• KEY Caveats: Results are observational and this study cannot prove causality - only association.
• Tune in for our conclusions when we ask, "What's it Worth?"!

Key teaching points

1. SGLT2 inhibitors and GLP-1 RAs may reduce pulmonary inflammation and fluid overload, potentially contributing to fewer exacerbations.

2. In a patient with both COPD and type 2 diabetes, these agents may offer meaningful extra-glycemic benefits.

3. This evidence supports shared decision-making, not mandatory therapy selection

4. Pharmacists can identify dual-benefit opportunities and tailor therapy based on comorbidities, cardiovascular risk, and exacerbation history.

Citation:
Patorno E, Feldman HA, Bykov K, et al. Glucose-lowering medications and risk of chronic obstructive pulmonary disease exacerbations in type 2 diabetes. JAMA Intern Med. 2025;185(4):405-414. doi:10.1001/jamainternmed.2024.7811

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Can stable patients with uncomplicated Staphylococcus aureus bacteremia finish therapy by mouth? The SABATO trial tested early oral switch versus full-course IV therapy.

In this episode, we decode the SABATO trial - a randomized, open-label, non-inferiority study that compared continued intravenous (IV) antibiotics with an early oral switch in low-risk Staphylococcus aureus bacteremia (SAB).

Guest: Dr. Jen Ross, PharmD, BCIDP — Clinical Infectious Diseases Pharmacist at M Health Fairview

Study at a glance

• Design: Multicenter, randomized, open-label, non-inferiority trial
• Population: 213 adults with uncomplicated S. aureus bacteremia after > 5-7 days of IV therapy and no signs of complicated infection
• Intervention: Early oral switch (e.g., TMP-SMX, clindamycin, linezolid)
• Comparator: Continued full-course IV therapy
• Primary endpoint: SAB-related complications within 90 days
• Results: Primary outcome occurred in 13% of patients in oral group vs 12% in IV group which met non-inferiority criteria
• KEY Caveats: Did not include patients with IV drug use; stopped study early which can skew towards a significant finding; changed NI margin midway through which leads to accepting a wider risk of difference.
• Tune in to hear our perspectives on what this study is worth!?

Citation:
Kaasch AJ et al. Early Oral Switch vs Continued IV Therapy for Low-Risk Staphylococcus aureus Bacteremia (SABATO Trial). Lancet Infect Dis. 2024; 24(3): 310-320. DOI 10.1016/S1473-3099(24)00032-X.

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🎧 Email me at whatsitworthpodcast@gmail.com if you have an article suggestion for me to decode!

Large Danish study finds no link between aluminum-containing childhood vaccines and chronic diseases — including autism and ADD/ADHD.

In this episode, we unpack the 2025 Annals of Internal Medicine study evaluating whether early-life exposure to aluminum-adsorbed vaccines is associated with autoimmune, allergic, or neurodevelopmental outcomes such as autism spectrum disorder or ADHD. We review the data behind the headlines, explain the study design and data source, and discuss how clinicians can communicate this evidence to parents.

Guest: Dr. Ann Philbrick, PharmD, FCCP, BCACP — Professor of Pharmaceutical Care & Health Systems at the University of Minnesota College of Pharmacy, with expertise in vaccine/immunization delivery and ambulatory care.

Study at a glance
- Design Nationwide Danish cohort, 1.2 million children (1997–2020)
- Exposure Total aluminum (mg) from vaccines in first 2 years of life
-Outcomes 50 chronic conditions (autoimmune, allergic, neurodevelopmental)
- Results No increased risk; aHR 0.98 for autoimmune, 0.99 for atopic/allergic, 0.93 for neurodevelopmental disorders
- Takeaway Findings were incompatible with moderate or large increases in risk and reinforce vaccine safety.

Key teaching points

1. Policy-driven changes in Danish vaccine formulations allowed a natural quasi-experiment design.
2. Large registry-based cohorts can rule out moderate safety signals.
3. Epidemiologic evidence does not support prior theoretical aluminum toxicity concerns.

Citation:
Andersson NW et al. Aluminum-Adsorbed Vaccines and Chronic Diseases in Childhood: A Nationwide Cohort Study. Ann Intern Med. 2025. doi:[10.7326/ANNALS-25-00997](https://doi.org/10.7326/ANNALS-25-00997)

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Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy and returning co-host Dr. Meade Avery (2025 U of MN CoP Grad!!) as we PrEPare our clinical conclusions about a novel antiviral for HIV prevention. We also welcome an HIV expert, Dr. Daniel (Jude) Holt, who is a clinical pharmacist at North Memorial Health in the Infectious Diseases clinic. The study we critique compares twice yearly lenacapavir with daily emtricitabine/tenofovir alafenamide (F/TAF) or emtricitabine/tenofovir disoproxil fumarate (F/TDF) in cisgender women for HIV prevention (PrEP).

Key Points

1. HIV prevention is a critical step in the fight to end HIV
2. There are many barriers to compliance with daily oral HIV preventative medications including access and compliance
3. Twice yearly lenacapavir has been proven effective at preventing HIV in men who have sex with men and transgender women, but was yet to be studied in cisgender women
4. A twice yearly regimen can help patients overcome barriers to compliance
5. Will we find out "Where's "Wald"-o in our Stat Stop? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Bekker LG, Das M, Abdool Karim Q, et al. Twice-Yearly Lenacapavir or Daily F/TAF for HIV Prevention in Cisgender Women. NEJM 2024;391(13):1179-1192.

2. Kelley CF, Acevedo-Quinones M, Agwu AL, et al. Twice yearly lenacapavir for HIV prevention in men and gender-diverse persons. NEJM 2024;392(13):1261-1276.

3. Bekerman E, Hansen D, Lu B, et al. Long-acting capsid inhibitor effective as PrEP against vaginal SHIV transmission in macaques. In: Proceedings and Abstracts of the 11th IAS Conference on HIV Science, July 18–21, 2021. Virtual: International AIDS Society, 2021. abstract.

4. Centers for Disease Control and Prevention. "HIV Prevention Research Synthesis Project." HIV Compendium of Best Practices. October 24, 2024, June 6, 2025, https://www.cdc.gov/hivpartners/php/hiv-treatment/index.htmlnters for Disease Control and Prevention

Contact Information

Podcast email: whatsitworthpodcast@gmail.com

Expert Guest

Dr. Daniel (Jude) Holt, PharmD, AAHIVP, CSP

Clinical Pharmacy Specialist - Infectious Disease

Specialty Pharmacy Infectious Disease Support

Daniel.Holt@northmemorial.com

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Co-Host Information

Meade Avery, PharmD

2025 Graduate, University of Minnesota College of Pharmacy

Welcome back to What's it Worth! Join your hosts, Dr. Diana Langworthy and Dr. Peyton Braun (PGY1 Pharmacy Resident), as we sift through strengths and limitations of at trial assessing the effects of empagliflozin on nonalcoholic fatty liver disease. The authors sought to quantify the impact of Sodium Glucose Cotransporter 2 - inhibitors (SGLT2i's) on Metabolic Dysfunction Associated Liver Disease (MASLD). This episode is full of EBP detective moments - dissecting trial language to get a clear picture of the story. Let's dive in and see what its worth!

Key Points

1. MASLD is a condition marked by an accumulation of fat in the liver which can lead to inflammation and irreversible liver damage
2. MASLD is often associated with conditions such as obesity, diabetes and hypertension
3. SGLT2i's are an evidence based therapy for the treatment of type II diabetes and have also shown to improve outcomes in heart failure and kidney disease
4. Extraglycemic benefits of this class of agents are of particular interest, with an increasing number of clinical trials investigating their potential impact on a variety of diseases (including MASLD)
5. Does a trial conducted with non-probability sampling have enough internal validity for empagliflozin in MASLD? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Shojaei, F., Erfanifar, A., Kalbasi, S. et al. The effect of empagliflozin on non-alcoholic fatty liver disease-related parameters in patients with type 2 diabetes mellitus: a randomized controlled trial. BMC Endocr Disord 25, 52 (2025). https://doi.org/10.1186/s12902-025-01882-8

2. Zhang Y, Liu X, Zhang H, Wang X. Efficacy and safety of empagliflozin on nonalcoholic fatty liver disease: a systematic review and meta-analysis. Front Endocrinol 2022; doi: 10.3389/fendo.2022.836455

3. Rinella, Mary E.1; Neuschwander-Tetri, Brent A.2; Siddiqui, Mohammad Shadab3; Abdelmalek, Manal F.4; Caldwell, Stephen5; Barb, Diana6; Kleiner, David E.7; Loomba, Rohit8. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology 77(5):p 1797-1835, May 2023. | DOI: 10.1097/HEP.0000000000000323

4. Kanwal, Fasiha1,2,3; Neuschwander-Tetri, Brent A.4; Loomba, Rohit5; Rinella, Mary E.6. Metabolic dysfunction–associated steatotic liver disease: Update and impact of new nomenclature on the American Association for the Study of Liver Diseases practice guidance on nonalcoholic fatty liver disease. Hepatology 79(5):p 1212-1219, May 2024. | DOI: 10.1097/HEP.0000000000000670

5. Chen, Vincent L.1; Morgan, Timothy R.2,3; Rotman, Yaron4; Patton, Heather M.5,6; Cusi, Kenneth7; Kanwal, Fasiha8,9,10; Kim, W. Ray11. Resmetirom therapy for metabolic dysfunction-associated steatotic liver disease: October 2024 updates to AASLD Practice Guidance. Hepatology 81(1):p 312-320, January 2025. | DOI: 10.1097/HEP.0000000000001112
6. Stratton SJ. Purposeful Sampling: Advantages and Pitfalls. Prehospital and Disaster Medicine. 2024;39(2):121-122. doi:10.1017/S1049023X24000281

Contact Information

Podcast email: whatsitworthpodcast@gmail.com

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Co-Host Information

Peyton Braun, PGY1 Pharmacy Resident

University of Minnesota Medical Center - East Bank

Welcome back to What's it Worth! Join your hosts, Dr. Diana Langworthy and Dr. Garrison Avery (PGY1 Pharmacy Resident), as we discuss the STOP ACEi trial comparing continuation of ACEi/ARB (angiotensin converting enzyme inhibitors/angiotensin receptor blockers) therapy in ESKD vs discontinuation of ACEi/ARB therapy. The authors sought to answer the question - Does discontinuation vs continuation of ACEi/ARB therapy slow the decline in eGFR once someone progresses to Stage 4/5 CKD. Let's get into the weeds of baseline characteristics - follow the episode's breadcrumbs to see if you can spot the key unmeasured confounders in this publication!

Key Points

1. ACEi/ARB therapy has demonstrated proven benefit in slowing the progression of CKD when initiated in Stages 1-3
2. Robust evidence is lacking to guide continuation vs discontinuation of ACEi/ARB therapy once a patient progresses to Stage 4/5 CKD
3. Compound symmetry covariance structures can be a useful statistical tool when the change between study visits in the key measurements is not anticipated to vary greatly (confused? So were we! Listen in for an explanation.)
4. What baseline characteristics might impact the primary outcome that may not have been accounted for? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Bhandari S, Mehta S, Khwaja A, et al. Renin-Angiotensin System Inhibition in Advanced Chronic Kidney Disease. The STOP ACEi Trial. NEJM 2022;387:2021-2032.

2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024 Apr;105(4S):S117-S314. doi: 10.1016/j.kint.2023.10.018. PMID: 38490803.

3. Delgado C, Baweja M, Crews, D, et al. A Unifying Approach for GFR Estimation: Recommendations of the NKF-ASN Task Force on Reassessing the Inclusion of Race in Diagnosing Kidney Disease. JASN 2021;32(1@):2994-3015

4. Xie X, Liu Y, Perkovic V, et al. Renin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients with CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials. AJKD 2016;67(5):728-741.

5. DynaMed. Chronic Kidney Disease (CKD) in Adults. EBSCO Information Services. Accessed May 19, 2025. https://www-dynamed-com.ezp3.lib.umn.edu/condition/chronic-kidney-disease-ckd-in-adults-1

Contact Information

Podcast email: whatsitworthpodcast@gmail.com

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Co-Host Information

Garrison (Griest) Avery, PGY1 Pharmacy Resident

University of Minnesota Medical Center - East Bank

Episode 2 of the Double Header with the Minnesota Twins! The first article, the SEQUOIA trial, was discussed in the preceding episode with Mckay Carstens... did you guess correctly for which twin was speaking? He's passing the baton to his brother Kane to discuss management of portal hypertension in patients with cirrhosis. We're looking back in time with a retrospective study that investigated whether carvedilol showed more effectiveness compared with classical NSBBs to prevent decompensation in patients with cirrhosis. Stick with us to see if the weight of portal hypertension is lifted in this cohort and explore the role of selection bias in retrospective cohort studies.

Key Points

1. Cirrhosis is a leading cause of liver-related morbidity worldwide and managing complications like portal hypertension is key to improving outcomes
2. Progression to decompensated cirrhosis—marked by ascites, variceal bleeding, or encephalopathy—reduces median survival to approximately 2 years thus highlighting the importance of prevention of decompensating events.
3. Carvedilol has gained attention for its added alpha-1 blockade, offering greater portal pressure reduction—though its long-term benefits and safety compared to traditional NSBBs remain under investigation
4. Get curious about selection bias - can we confidently interpret and apply these trial results? ------> Tune in to find out!

References

1. [EPISODE TRIAL] Fortea JI, Alvarado-Tapias E, Simbrunner B, et al. Carvedilol vs. propranolol for the prevention of decompensation and mortality in patients with compensated and decompensated cirrhosis. Journal of Hepatology 2025; https://doi.org/10.1016/j.jhep.2024.12.017.

2. Kaplan DE, Ripoll C, Thiele M, et al. AASLD Practice Guidelines on risk stratification and management of portal hypertension and varices in cirrhosis. Hepatology 2024;79:1180-1211.
3. Turco L, Reiberger T, Vitale G, La Mura V. Carvedilol as the new non-selective beta-blocker of choice in patients with cirrhosis and portal hypertension. Liver International 2023;43(6):1183-1194.
4. Villanueva C, Torres F, Kumar Sarin S, et al. Carvedilol reduces the risk of decompensation and mortality in patients with compensated cirrhosis in a competing-risk meta-analysis. Journal of Hepatology 2022;77(4):1014-1025.
5. Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Statistics in Medicine 2015;34(28);3661-3679.

Contact Information

Podcast email: whatsitworthpodcast@gmail.com

Host Information

Dr. Diana R. Langworthy, PharmD, BCPS

Clinical Associate Professor, University of Minnesota College of Pharmacy

Clinical Pharmacist - Inpatient Internal Medicine, M Health Fairview East Bank Hospital

Co-Host Information

Kane Carstens, PharmD

PGY1 Resident, University of Minnesota Medical Center East Bank

Mckay Carstens, PharmD

PGY1 Resident, University of Minnesota Medical Center East Bank