What's it Worth? A Journal Club Podcast

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  S4E9.5 - What's it Worth? For Everyone. Can Lavender Oil Help Anxiety? What to Know About Silexan 28.07.2026 11นาที

  In this What's It Worth? For Everyone episode, we're asking: Can lavender oil help with anxiety? If you've ever felt anxious before a big test, job interview, medical appointment, or major life event, you're not alone. But when is anxiety a normal response to stress — and when is it something more, like generalized anxiety disorder? In this episode, we talk about the difference between short-term situational anxiety and ongoing anxiety symptoms that may need support from a healthcare professional. We also discuss Silexan, a specific oral lavender oil preparation that has been studied for anxiety symptoms and is available in some over-the-counter products. The key question is not simply, "Does lavender help anxiety?" It's: What kind of anxiety are we talking about, what product is being used, and how strong is the evidence? Key Takeaways Anxiety surrounding a stressful event can be normal, even when it feels uncomfortable. Generalized anxiety disorder is different from short-term situational anxiety and requires diagnosis by a medical professional. Silexan is a specific, concentrated oral lavender oil preparation, not the same thing as lavender tea, food, scent, or any random lavender supplement. Over-the-counter does not always mean proven, risk-free, or safe for everyone. Product, dose, ingredients, and labeling matter when considering supplements. Ongoing anxiety that affects sleep, concentration, work, relationships, or daily life is worth discussing with a healthcare professional. Questions Worth Asking Use these questions to guide conversations with your pharmacist, clinician, or healthcare team if you are considering an over-the-counter product for anxiety (or for any condition): What ingredients are in this product? Is this the same product and dose that has been studied? Could this interact with anything I take? Is this appropriate for my symptoms? When should I seek more help? Silexan may be an interesting option for some people, but it is not a replacement for diagnosis, therapy, prescription treatment, or ongoing care when those are needed. The goal is not just to take something. The goal is to understand what you are treating and choose a path that is safe, thoughtful, and actually helpful. This episode is for educational purposes only and is not medical advice. It does not replace care from your own healthcare team. 🎙️ Host: Diana Langworthy, PharmD, BCPS | Associate Professor at the University of Minnesota College of Pharmacy | Clinical Pharmacist in Adult Internal Medicine, Fairview East Bank Hospital 📬 Enjoyed this episode? Find more evidence-based content, podcast episodes, social media, and ways to connect at https://beacons.ai/diana.the.pharm.d.etective        
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  S4E9 - Anxiety Treatment Rankings: What a Network Meta-Analysis Can and Can't Tell Us 28.07.2026 42นาที

  Welcome back to What's it Worth? In this episode, we tackle treatment options for a common mental health concern - anxiety. Your host, Dr. Diana Langworthy, is joined by Dr. Lucas Kosobuski, an inpatient pharmacist at St. Luke's in Duluth with prior experience providing ambulatory care services in an inpatient substance use treatment program. Together, they decode a 2025 systematic review and network meta-analysis comparing medications for anxiety disorders, including Silexan, a proprietary oral lavender oil preparation. As over-the-counter options gain attention, clinicians and patients are left with important questions: How strong is the evidence? What does "acceptable" really mean? And when a supplement ranks favorably in a network meta-analysis, how much confidence should we have? Key Points This systematic review and network meta-analysis evaluated anxiolytic medications across multiple anxiety disorders. The study included 100 randomized controlled trials and more than 28,000 patients. Silexan was represented by a much smaller subset of the overall evidence base in this paper. We discuss the difference between generalized anxiety disorder and situational/short term anxiety. We break down what a network meta-analysis can — and cannot — tell us and why definitions in these studies matter SO much! Is Silexan a meaningful option for anxiety, or is the ranking stronger than the evidence behind it? ———> Tune in to find out! Episode Study Müller TJ, Künzi A, Heitlinger E, et al. Comparative efficacy and acceptability of anxiolytic drugs for the treatment of anxiety disorders: a systematic review and network meta-analysis. Eur Arch Psychiatry Clin Neurosci. 2026;276:1879–1894. doi:10.1007/s00406-025-02082-0 Host & Guest Information Diana Langworthy, PharmD, BCPS | Associate Professor, University of Minnesota College of Pharmacy | Clinical Pharmacist -Inpatient Internal Medicine, M Health Fairview East Bank Hospital Lucas Kosobuski, PharmD | Inpatient Pharmacist, St. Luke's, Duluth | Prior ambulatory care experience in an inpatient substance use treatment program Join the Conversation Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice — I love hearing how clinicians and learners think through uncertainty. Or you can find me on my socials — check out my Beacons for links to my TikTok and LinkedIn: https://beacons.ai/diana.the.pharm.d.etective Additional References National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management. NICE Clinical Guideline CG113. Last updated June 15, 2020.  Bandelow B, Allgulander C, Baldwin DS, et al. World Federation of Societies of Biological Psychiatry guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders. World J Biol Psychiatry. 2023;24(2):79-117. doi:10.1080/15622975.2022.2086295.  Kasper S, Gastpar M, Müller WE, et al. Lavender oil preparation Silexan is effective in generalized anxiety disorder — a randomized, double-blind comparison to placebo and paroxetine. Int J Neuropsychopharmacol. 2014;17(6):859–869. doi:10.1017/S1461145714000017.  Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the lavender oil preparation Silexan in comparison to lorazepam for generalized anxiety disorder. Phytomedicine. 2010;17(2):94–99. doi:10.1016/j.phymed.2009.10.006. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. 5th ed., text rev. Washington, DC: American Psychiatric Association Publishing; 2022. doi:10.1176/appi.books.9780890425787.
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  S4E8 - Is it Possible to Decouple Bleeding from Clotting? Insights from the AZALEA-TIMI 71 Trial (Factor XI Series Part 2 of 2) 21.07.2026 19นาที

  In Part 2 of our back-to-back series on the novel frontier of Factor XI inhibition, host Dr. Diana Langworthy and student co-hosts Caleb Nelson-Lange and Tim Haas dive into the AZALEA-TIMI 71 trial. Following our Part 1 discussion on the early termination of the OCEANIC-AF trial (asundexian), we turn our attention to abelacimab—a high-affinity, fully human monoclonal antibody that targets Factor XI. Unlike the small-molecule asundexian, abelacimab offers a unique pharmacokinetic profile with a once-monthly dosing potential. We explore safety outcomes of this novel agent. The team also tackles a crucial Pharmacy Detective Moment: Why did the study use rivaroxaban as the comparator instead of apixaban? We discuss how this choice impacts the "Worth" of the findings... Key Takeaways Factor XI sits at the intersection of the intrinsic and common pathways. By inhibiting it, can we stop pathologic thrombosis while leaving "protective" hemostasis intact? Abelacimab (both 90mg and 150mg) achieved a staggering reduction in the primary outcome compared to rivaroxaban —a composite of major and clinically relevant non-major bleeding—with hazard ratios of 0.33 and 0.26, respectively. Why rivaroxaban? We dissect the strategic selection of a once-daily Xa inhibitor with a known higher GI bleeding profile and how it influences the trial's dramatic safety margin. Was the early termination a win for patients or a loss for long-term efficacy data? ---> Tune in to find out! Featured Study Ruff, C. T., Patel, S. M., Giugliano, R. P., Morrow, D. A., Hug, B., Kuder, J. F., Goodrich, E. L., Chen, S. A., Goodman, S. G., Joung, B., Kiss, R. G., Spinar, J., Wojakowski, W., Weitz, J. I., Murphy, S. A., Wiviott, S. D., Parkar, S., Bloomfield, D., & Sabatine, M. S. (2024). Abelacimab versus rivaroxaban in patients with atrial fibrillation. New England Journal of Medicine, 391(1), 21-33. https://doi.org/10.1056/NEJMoa2406674 Host Diana Langworthy, PharmD, BCPS | Associate Professor, University of Minnesota College of Pharmacy | Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital Student Co-Hosts Caleb Nelson-Lange | PharmD Candidate | Class of 2026 | University of Minnesota College of Pharmacy Tim Haas | PharmD Candidate | Class of 2028 | University of Minnesota College of Pharmacy Join the Conversation Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. Or you can find me on my socials - Check out my Beacons for links to my TikTok and LinkedIn https://beacons.ai/diana.the.pharm.d.etective Additional References & Guidelines Piccini, J. P., Patel, M. R., Steffel, J., et al. (2025). Asundexian versus apixaban in patients with atrial fibrillation. New England Journal of Medicine, 392(1), 23-32. https://doi.org/10.1056/NEJMoa2411777 Cohen, A. T., Hill, N. R., Luo, X., et al. (2024). A systematic review and network meta-analysis of the comparative safety of direct oral anticoagulants in patients with atrial fibrillation. Journal of Comparative Effectiveness Research, 13(2), 45-58. https://doi.org/10.2217/cer-2023-0182 Joglar, J. A., Chung, M. K., Armbruster, A. L., et al. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of patients with atrial fibrillation. Journal of the American College of Cardiology, 83(1), 109-279. https://doi.org/10.1016/j.jacc.2023.08.017
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  S4E8.5 - What's it Worth? For Everyone. Are We Waiting Too Long for New Treatments? 14.07.2026 9นาที

  In this What's It Worth? For Everyone episode, we're asking: Are we waiting too long for new treatments? If you've ever heard about a promising new medication, peptide, or breakthrough therapy and wondered, "If it works so well, why isn't everyone using it yet?"—you're not alone. It can feel frustrating to hear about exciting discoveries while waiting years before they become part of routine healthcare. In this episode, we take you behind the scenes of the scientific process to explore what happens between an exciting idea and a treatment that is recommended for patients. Along the way, we use recent blood thinner research as a real-world example of why asking the right questions—and taking the time to answer them—matters. Key Takeaways A promising scientific idea is not the same as a proven treatment. Clinical trials help researchers answer two critical questions: Does it work? and Is it safe? Many exciting discoveries change as they are studied in larger groups of people. The goal of the scientific process is not to slow innovation—it is to help ensure new treatments provide meaningful benefits while minimizing harm. Progress in medicine depends on both curiosity and careful testing. Questions Worth Asking Use these questions to help guide conversations with your healthcare team when you hear about a new treatment: How strong is the evidence supporting this treatment? Has it been studied in people, or only in laboratory or animal studies? What are the known benefits? What are the known risks? How does it compare with treatments that are already available? Is this treatment appropriate for someone with my medical history? New discoveries are exciting—and they are how medicine moves forward. But every promising idea deserves careful testing before it becomes routine care. The goal isn't simply to bring new treatments to patients faster. It's to bring forward treatments that have been shown to make a meaningful difference in people's lives. This episode is for educational purposes only and is not medical advice. It does not replace care from your own healthcare team. 🎙️Host: Diana Langworthy, PharmD, BCPS | Associate Professor at the University of Minnesota College of Pharmacy | Clinical Pharmacist in Adult Internal Medicine, Fairview East Bank Hospital 📬 Enjoyed this episode? Find more evidence-based content, podcast episodes, social media, and ways to connect at https://beacons.ai/diana.the.pharm.d.etective.
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  S4E8 - Why Efficacy Matters: Dissecting the Early Termination of Asundexian (Factor XI Series Part 1 of 2) 14.07.2026 30นาที

  Welcome to Part 1 of our "What's it Worth?" deep dive into the next generation of anticoagulation. In this episode, host Dr. Diana Langworthy and student co-hosts Tim Haas and Caleb Nelson-Lange take on the OCEANIC-AF trial. This Phase 3, non-inferiority trial was designed to prove that the oral Factor XIa inhibitor, asundexian, could match the gold-standard apixaban in preventing stroke while significantly reducing bleeding. However, the trial took a dramatic turn when it was stopped early—not for safety, but for futility in efficacy . We unpack why asundexian failed to clear the non-inferiority hurdle and what this means for the "Factor XI hypothesis. In this episode, we move past the excitement of a "bleeding-free" anticoagulant to look at the clinical necessity of efficacy. We explore the challenge of going head-to-head with apixaban—widely considered the safest and most effective agent in our current toolkit—and discuss whether the "Factor XI hypothesis" was flawed or if the bar was simply set too high for this specific molecule. Key Takeaways OCEANIC-AF was halted because asundexian was inferior to apixaban for preventing stroke and systemic embolism . In this trial, asundexian went head-to-head with apixaban, the current market leader for safety and efficacy .  While asundexian showed numerical trends toward less bleeding, those gains were overshadowed by the increased risk of ischemic events compared to standard-of-care apixaban . Is the Factor XI class dead on arrival, or was asundexian just the wrong molecule? ---> Tune in to find out! Episode Resources Link to the Coagulation Cascade: https://www.bleeding.org/educational-programs/education/online-education/the-clotting-cascade Featured Study Piccini, J. P., Patel, M. R., Steffel, J., Ferdinand, K., Van Gelder, I. C., Russo, A. M., ... & OCEANIC-AF Steering Committee and Investigators. (2025). Asundexian versus apixaban in patients with atrial fibrillation. New England Journal of Medicine, 392(1), 23–32. https://doi.org/10.1056/NEJMoa2407105 Host Diana Langworthy, PharmD, BCPS | Associate Professor, University of Minnesota College of Pharmacy | Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital Student Co-Hosts Caleb Nelson-Lange | PharmD Candidate | Class of 2026 | University of Minnesota College of Pharmacy Tim Haas | PharmD Candidate | Class of 2028 | University of Minnesota College of Pharmacy Join the Conversation Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. Or you can find me on my socials - Check out my Beacons for links to my TikTok and LinkedIn https://beacons.ai/diana.the.pharm.d.etective   Additional References & Guidelines Joglar, J. A., Chung, M. K., Armbruster, A. L., et al. (2024). 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of patients with atrial fibrillation. Journal of the American College of Cardiology, 83(1), 109–279. https://doi.org/10.1016/j.jacc.2023.08.017 Ruff, C. T., Patel, S. M., Giugliano, R. P., et al. (2024). Abelacimab versus rivaroxaban in patients with atrial fibrillation. New England Journal of Medicine, 391(1), 21–33. https://doi.org/10.1056/NEJMoa2406674 Piccini, J. P., Caso, V., Connolly, S. J., et al. (2022). Safety of the oral factor XIa inhibitor asundexian compared with apixaban in patients with atrial fibrillation (PACIFIC-AF): A multicentre, randomised, double-blind, double-dummy, dose-finding phase 2 study. The Lancet, 399(10333), 1383–1390.
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  S4E7.5 - What's it Worth? For Everyone. AFib, Blood Thinners, and Liver Disease: Questions to Ask Your Doctor 30.06.2026 7นาที

  In this What's It Worth? For Everyone episode, we're talking about AFib, blood thinners, and liver disease. AFib stands for atrial fibrillation. It is a common heart rhythm problem that can increase the risk of stroke. Because of that stroke risk, many people with AFib are prescribed a blood thinner. But what if someone has AFib and also has liver disease or cirrhosis? That decision can be more complicated. In the full What's It Worth? episode, we discussed a systematic review and meta-analysis comparing DOACs with warfarin in people with atrial fibrillation and liver disease. DOACs are a group of blood thinners that include apixaban, also known as Eliquis, and rivaroxaban, also known as Xarelto. Key Takeaways In this study, DOACs appeared to work similarly to warfarin for preventing stroke in people with AFib and liver disease. DOACs also appeared to have a more favorable bleeding profile than warfarin in many patients, including patients with cirrhosis. This episode explains why blood thinner decisions in liver disease are not one-size-fits-all. We talk about how liver function, kidney function, bleeding history, clotting risk, and other medications can all affect which blood thinner may be the safest choice. The core takeaway from the review is that DOACs may be reasonable options for many people with AFib and liver disease, but the decision still needs to be individualized. Practical takeaway: Bring your full medication list to your appointment and ask your healthcare team how your liver disease, kidney function, age, weight, bleeding risk, and other medicines affect the blood thinner choice. Questions Worth Asking Use these questions to help guide a conversation with your healthcare team: Why do I need a blood thinner? What is my risk of stroke if I do not take one? What is my personal risk of bleeding? How severe is my liver disease? Is this blood thinner safe for my level of liver function? How is my kidney function? Are any of my medicines raising my bleeding risk? Are any of my medicines interacting with this blood thinner? What bleeding symptoms should I watch for? Who should I call if I notice bleeding or need a procedure? Bring your full medication list to your appointment. This includes prescription medicines, over-the-counter medicines, pain relievers like ibuprofen or naproxen, aspirin, vitamins, supplements, and medicines you only take once in a while. Having liver disease or cirrhosis does not automatically mean a person with AFib can never take a blood thinner. But it does mean the decision needs extra care. The goal is thoughtful, personalized care. This episode is for educational purposes only and is not medical advice. It does not replace care from your own healthcare team.
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  S4E7 - The Cirrhosis Paradox: Solving the DOAC vs. Warfarin Mystery in Liver Disease 30.06.2026 26นาที

  For patients with atrial fibrillation and chronic liver disease, the "correct" anticoagulation strategy has long been a clinical catch-22. Balancing the high risk of stroke against the elevated risk of catastrophic bleeding—all while navigating a lack of randomized controlled trial (RCT) data—leaves clinicians in a difficult position. In this episode, host Dr. Diana Langworthy is joined by Dr. Erin Pauling (ambulatory care and cardiology specialist) and Caleb Nelson-Lange, PharmD (Class of 2026!) to decode a 2025 systematic review and meta-analysis. Together, they explore how DOACs perform against warfarin in this complex population and whether apixaban truly holds a safety edge. As evidence evolves, we must ask: Does the safety signal in observational data outweigh the lack of RCTs? Does the "worth" of DOACs hold up when the liver is failing? Key Points  This systematic review and meta-analysis evaluated DOACs versus VKAs in patients with atrial fibrillation and liver disease, including a cirrhosis subgroup. Most included studies were observational, with limited randomized data. Overall, DOACs appeared to have a favorable bleeding profile compared with VKAs, with similar stroke/systemic embolism outcomes. Similar bleeding trends were seen in the cirrhosis subgroup. We discuss why anticoagulation in liver disease requires individualized decision-making, including liver disease severity, bleeding history, clotting risk, and medication-specific considerations. We also dig into the apixaban versus rivaroxaban subgroup findings and why they may differ between the broader liver disease population and the cirrhosis subgroup. How should we interpret DOAC safety in liver disease and cirrhosis — and what do the agent-specific findings add? ---> Tune in to find out!   Featured Study Zhou Q, Liu X, Liu S, Gu Z, Wu Y, Yang Y, Tao Y, Wei M. Effectiveness and safety of direct oral anticoagulants versus vitamin K antagonists in atrial fibrillation patients with liver disease: a systematic review and meta-analysis. Front Pharmacol. 2025 Jul 14;16:1620394. doi: 10.3389/fphar.2025.1620394.  Host & Guest Information Diana Langworthy, PharmD, BCPS | Associate Professor, University of Minnesota College of Pharmacy Clinical Pharmacist | Inpatient Internal Medicine, M Health Fairview East Bank Hospital Erin Pauling, PharmD, BCACP, FAPhA | Clinical Associate Professor, Pharmacy Practice Binghamton University School of Pharmacy and Pharmaceutical Sciences | Ambulatory Care Pharmacist, United Health Services (UHS) Caleb Nelson-Lange PharmD | Class of 2026 | University of Minnesota College of Pharmacy Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. Additional References Joglar, J. A., Chung, M. K., Armbruster, A. L., et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 2024 149(1), 109–279. https://doi.org/10.1016/j.jacc.2023.08.017 Miranda, M., Sangos CKM, Barbosa GA, et al. Efficacy and safety of direct oral anticoagulants compared to vitamin K antagonists for atrial fibrillation in patients with liver cirrhosis: An updated systematic review and meta-analysis. J Clin Exper Hepatol 2025;15(4): https://doi.org/10.1016/j.jceh.2025.102534 Simon TG, Singer DE, Zhang Y, Mastrorilli JM, Cervone A, DiCesare E, Lin KJ. Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation : A Nationwide Cohort Study. Ann Intern Med. 2024 Aug;177(8):1028-1038. doi: 10.7326/M23-3067.  Yoo SY, Kim E, Nam GB, Lee D, Shim JH, Kim KM, Lim YS, Lee HC, Chung YH, Lee YS, Choi J. Safety of direct oral anticoagulants compared to warfarin in cirrhotic patients with atrial fibrillation. Korean J Intern Med. 2022 May;37(3):555-566. doi: 10.3904/kjim.2020.622.
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  S4E6.5 - What's It Worth? For Everyone: Does Tylenol Cause Autism? What Studies Can and Can't Tell Us 19.06.2026 12นาที

  Welcome to What's It Worth? For Everyone — a shorter, everyone-friendly version of What's It Worth? focused on making health evidence clearer, calmer, and easier to use. In this episode, Dr. Diana Langworthy revisits the recent What's It Worth? long-form discussion with Dr. Tory Pressman and Dr. Alexis Quade about Tylenol — also known as acetaminophen or paracetamol — during pregnancy and concerns about autism, ADHD, and other neurodevelopmental disorders. The full episode breaks down a 2026 systematic review and meta-analysis in more detail. This companion episode pulls out the big-picture takeaways: what the study asked, why this question is hard to answer, what makes the evidence reassuring, and what we still cannot say with 100% certainty. If you've seen headlines about Tylenol and autism and wondered what to do with that information, this episode is designed to help you slow down the claim, understand the evidence, and ask better questions with your healthcare team. Key Points Tylenol, acetaminophen, and paracetamol refer to the same medication, which is commonly used during pregnancy for fever and pain. Questions about autism, ADHD, and neurodevelopmental disorders can feel deeply personal for parents and pregnant people, which is why clear and careful communication matters. The episode explains why observational studies can be tricky, especially when people take a medication because of fever, pain, infection, or another condition. We unpack the idea of confounding by indication — the possibility that the reason someone took the medication may also be part of the story. The 2026 systematic review and meta-analysis is reassuring because its stronger analyses, including sibling-comparison studies, did not show a meaningful association between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability. The practical takeaway is not "take it whenever, however, forever," but rather: use medications thoughtfully, talk with your healthcare team, and do not let scary headlines become a source of blame. Questions Worth Asking What are the risks of not treating fever or pain during pregnancy? If I need acetaminophen, what dose and timing make sense for me? How often is too often to need it? Are there non-medication options that fit my symptoms? Is there anything about my pregnancy or health history that changes the risk-benefit balance? This episode is for informational and educational purposes only and is not intended to replace advice from a licensed healthcare professional. Host Information Diana Langworthy, PharmD, BCPS Associate Professor, University of Minnesota College of Pharmacy Clinical Pharmacist, Adult Inpatient Internal Medicine LinkedIn: Diana (Mack) Langworthy www.linkedin.com/in/diana-langworthy-4a765957 TikTok: Diana The Pharm.D.etective (@whatsitworthrx) References [Episode Study] D'Antonio F, Flacco ME, Della Valle L, Prasad S, Manzoli L, Samara A, Khalil A. Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis. Lancet Obstet Gynaecol Womens Health. Published online January 16, 2026. doi:10.1016/S3050-5038(25)00211-0 Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environmental Health. 2025;24:56. doi:10.1186/s12940-025-01208-0 American College of Obstetricians and Gynecologists. Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes. Practice Advisory. Published September 22, 2025. Accessed April 13, 2026. Bérard A, Cottin J, Leal LF, et al. Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood. J Am Acad Child Adolesc Psychiatry. 2026;65(4):484-504. Sheikh J, Allotey J, Khashan AS, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141. Lee PC, Chen CY, Pan ML, et al. Maternal Acetaminophen Use and Child Neurodevelopment. JAMA Pediatr. Published online March 9, 2026. doi:10.1001/jamapediatrics.2026.0071.
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  S4E6 - Tylenol and Neurodevelopmental Disorders: Reassurance from a 2026 Systematic Review 16.06.2026 47นาที

  Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy, and guests Dr. Alexis Quade and Dr. Tory Pressman, as they break down a 2026 systematic review and meta-analysis evaluating prenatal paracetamol exposure and child neurodevelopmental outcomes, including autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and intellectual disability. After renewed public attention in 2025 around Tylenol use in pregnancy and neurodevelopmental disorders, clinicians and patients are left asking how much weight to give observational medication safety signals. This episode explores how study design, confounding, outcome definitions, and risk-benefit thinking shape what we can — and cannot — conclude from the evidence. Let's dive in and see what it's worth! Key Points We explore why Tylenol, pregnancy, autism, ADHD, and neurodevelopmental disorders became such a high-profile medication safety conversation. The episode critiques a 2026 systematic review and meta-analysis, with a focus on study design choices like sibling comparisons, adjusted observational data, validated outcomes, and risk-of-bias assessment. We discuss why confounding by indication matters when the exposure is a medication used for fever, pain, or illness during pregnancy. We contrast the 2026 systematic review with the 2025 Navigation Guide paper and ask whether environmental health methods can be directly applied to pregnancy medication safety questions. Drs. Quade and Pressman help translate the evidence into real-world counseling about uncertainty, risk, benefit, and trust. When headlines move faster than evidence, how should clinicians and patients decide what's actually worth changing? ------> Tune in to find out! References [Episode Study] D'Antonio F, Flacco ME, Della Valle L, Prasad S, Manzoli L, Samara A, Khalil A. Prenatal paracetamol exposure and child neurodevelopment: a systematic review and meta-analysis. Lancet Obstet Gynaecol Womens Health. Published online January 16, 2026. doi:10.1016/S3050-5038(25)00211-0 Prada D, Ritz B, Bauer AZ, Baccarelli AA. Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology. Environmental Health. 2025;24:56. doi:10.1186/s12940-025-01208-0 American College of Obstetricians and Gynecologists. Acetaminophen Use in Pregnancy and Neurodevelopmental Outcomes. Practice Advisory. Published September 22, 2025. Accessed April 13, 2026. Bérard A, Cottin J, Leal LF, et al. Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood. J Am Acad Child Adolesc Psychiatry. 2026;65(4):484-504. Sheikh J, Allotey J, Khashan AS, et al. Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews. BMJ. 2025;391:e088141. Lee PC, Chen CY, Pan ML, et al. Maternal Acetaminophen Use and Child Neurodevelopment. JAMA Pediatr. Published online March 9, 2026. doi:10.1001/jamapediatrics.2026.0071.
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  S4E5 - COBRRA Trial Breakdown: Bleeding Risk with Apixaban vs Rivaroxaban 27.05.2026 46นาที

  Welcome back to What's it Worth! Join your host, Dr. Diana Langworthy, and guest host Tim Haas, PharmD Candidate 2028, as they break down the COBRRA trial — a head-to-head comparison of apixaban vs. rivaroxaban for the treatment of acute venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). For years, clinicians have debated whether one DOAC may carry a lower bleeding risk than another, despite both apixaban and rivaroxaban being widely used first-line therapies for acute VTE. Did the COBRRA trial finally give us a clearer answer? Let's dive in and see what it's worth! Key Points COBRRA was a randomized trial comparing apixaban vs. rivaroxaban in patients with acute symptomatic DVT and PE, with a primary focus on clinically relevant bleeding risk. The trial included a broad real-world VTE population, including patients with both provoked and unprovoked thromboembolism, pulmonary embolism, and deep vein thrombosis. We break down the Kaplan-Meier curve for clinically relevant bleeding and discuss what the timing of events may tell us about differences between these DOAC regimens. The study used a prospective randomized open-label blinded endpoint (PROBE) design, giving us an opportunity to discuss pragmatic trial methodology and real-world applicability. Which patients with acute VTE might benefit most from apixaban over rivaroxaban from a bleeding risk perspective? ------> Tune in to find out! References [Episode Trial] Castellucci LA, Chen VM, Kovacs MJ, et al. Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism. N Engl J Med. 2026;394(11):1051-1060. doi:10.1056/NEJMoa2510703 Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. Chest. 2021;160(6):e545-e608. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism. Circulation. 2026. doi:10.1161/CIR.0000000000001415. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 Guidelines for Management of Venous Thromboembolism: Treatment of Deep Vein Thrombosis and Pulmonary Embolism. Blood Adv. 2020;4(19):4693-4738. Agnelli G, Buller HR, Cohen A, et al. Oral Apixaban for the Treatment of Acute Venous Thromboembolism. N Engl J Med. 2013;369:799-808. The EINSTEIN Investigators. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med. 2010;363:2499-2510. Beyer-Westendorf J, Lensing AWA, Arya R, et al. Choosing wisely: the impact of patient selection on efficacy and safety outcomes in the EINSTEIN-DVT/PE and AMPLIFY trials. Thromb Res. 2017;149:29-37.
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  S4E4 - Beyond Dopamine: Xanomeline-Trospium in Acute Schizophrenia 21.04.2026 40นาที

  Welcome back to What's it Worth! For over 70 years, the treatment of schizophrenia has been synonymous with dopamine D2 receptor blockade—until now. Join your host, Dr. Diana Langworthy, and guest Dr. Alexandra Rola (Psychiatry Clinical Pharmacist and Assistant Professor at Binghamton University) as they dive into the EMERGENT-3 trial. We're dissecting the efficacy and safety of xanomeline-trospium, a first-in-class muscarinic agonist that targets psychosis without the traditional side effects of dopamine antagonists. Is this the breakthrough psychiatry has been waiting for? Let's dive in and see what it's worth! Key Points Unlike traditional antipsychotics, xanomeline is a dual M1/M4-preferring muscarinic receptor agonist. By pairing it with trospium (a peripheral muscarinic antagonist), the "KarXT" combination aims to deliver CNS antipsychotic effects while minimizing peripheral side effects like nausea and vomiting. In this 5-week, Phase 3 trial of 256 adults with acute psychosis, xanomeline-trospium demonstrated a statistically significant and clinically meaningful 9.4-point greater reduction in the PANSS total score compared to placebo by week 5. The study showed significant improvements in both the Positive Syndrome Scale (hallucinations/delusions) and the Negative Syndrome Scale (social withdrawal/apathy), suggesting a more holistic impact on schizophrenia symptoms. While it avoids dopamine-related side effects, KarXT is associated with cholinergic-driven GI issues; nausea, dyspepsia, and vomiting were the most frequently reported adverse events. What are the ethics of a placebo controlled trial in acute psychosis when we have proven medications for treatment? Join us for an important conversation about equity and ethics in clinical trials. Can we treat psychosis without touching a single dopamine receptor? ------> Tune in to find out! References [EPISODE TRIAL] Kaul I, Sawchak S, Walling DP, et al. Efficacy and Safety of Xanomeline-Trospium Chloride in Schizophrenia: A Randomized Clinical Trial. JAMA Psychiatry. 2024;81(8):749-756. doi:10.1001/jamapsychiatry.2024.0785 World Medical Association. WMA Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants. Adopted by the 18th WMA General Assembly, Helsinki, Finland, June 1964, and amended by the 75th WMA General Assembly, Helsinki, Finland, October 2024. Waltz JA, Pujji SD, Colloca L. Placebo and nocebo phenomena in schizophrenia spectrum disorders: a narrative review on current knowledge and potential future directions. Psychol Med. 2025 Jul 18;55:e199. doi: 10.1017/S0033291725100901. Erratum in: Psychol Med. 2026 Feb 02;56:e37. doi: 10.1017/S0033291726103493.  Gara MA, Vega WA, Arndt S, et al. Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Arch Gen Psychiatry. 2012 Jun;69(6):593-600. doi: 10.1001/archgenpsychiatry.2011.2040.  Lawrence RE, Appelbaum PS. Ethics in placebo-controlled, acute treatment trials in schizophrenia: Two rival ethical frameworks. Schizophrenia Research 264 (2024) 372-377. 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 Guest Information Alexandra Rola, PharmD Clinical Assistant Professor, Pharmacy Practice, Binghamton University Psychiatry Clinical Pharmacist
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  S4E3 - The GLP-1 Battle: Cardiovascular outcomes of Tirzepatide vs. Dulaglutide in the SURPASS-CVOT Trial 02.04.2026 43นาที

  Welcome back to What's it Worth! In this episode, your host Dr. Diana Langworthy is joined by Mia Lussier, PharmD, MS, Clinical Assistant Professor at Binghamton University and ambulatory care specialist, to dissect the results of the SURPASS-CVOT trial . As the first large-scale trial directly comparing a dual GLP-1/GIP agonist to a proven GLP-1 receptor agonist for cardiovascular outcomes, we ask: is tirzepatide officially the champion of metabolic and cardiovascular health? Join us for an evidence detective session as we evaluate the clinical worth of these findings Key Points SURPASS-CVOT was an active-comparator, double-blind trial that randomized 13,299 patients with Type 2 Diabetes and established ASCVD to receive either tirzepatide (up to 15 mg) or dulaglutide (1.5 mg) once weekly . Tirzepatide met its primary end point of noninferiority to dulaglutide for MACE (cardiovascular death, MI, or stroke) with a hazard ratio of 0.92. However, it did not achieve statistically significant superiority for this composite outcome (P=0.09) While CV outcomes were noninferior, tirzepatide showed superior metabolic benefits, including a -1.66 percentage point reduction in A1c (vs. -0.88 with dulaglutide) and an 11.6% reduction in total body weight (vs. 4.8% with dulaglutide). In a pre-specified secondary analysis of high-risk CKD patients, tirzepatide significantly slowed the decline of eGFR compared to dulaglutide, showing a difference of 3.17 ml/min/1.73m² over 36 months. Both agents had similar overall adverse event rates Was dulaglutide 1.5 mg weekly the best comparator vs tirzepatide for cardiovascular outcomes? ---> Tune in to find out! References [EPISODE TRIAL] Nicholls SJ, Pavo I, Bhatt DL, et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes. N Engl J Med. 2025;393(24):2409-2420. doi: 10.1056/NEJMoa2505928. Gerstein H, Colhoun H, Dagenais G et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. The Lancet, 2019; 394, 121-130. Pratley RE, Aroda VR, Lingvay I, et al. SUSTAIN 7 investigators. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol. 2018 Apr;6(4):275-286. doi: 10.1016/S2213-8587(18)30024-X. Epub 2018 Feb 1. PMID: 29397376. Marson SP, Bain SC, Consoli A, et al.  Semaglutide and cardiovascular outcomes in patients with Type 2 Diabetes. N Engl J Med 2016;375:1834-1844. Join the Conversation Subscribe to the What's it Worth? Podcast on Substack If you want to get new episode alerts, bonus content, and continue reflecting on what studies like this mean for real clinicians and real patients—head over to the What's it Worth? substack.  Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. 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 Guest Information Mia Lussier, PharmD, MS Clinical Assistant Professor, Pharmacy Practice, Binghamton University Ambulatory Care Specialist
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  S4E2 - The Kidney Formula Conundrum: Navigating eCrCl vs. eGFR in DOAC Dosing 20.03.2026 51นาที

  Welcome back to What's it Worth! Join your hosts, Dr. Diana Langworthy and guest Dr. Rachel Khan (Associate Professor at VCU School of Pharmacy), as they navigate the murky waters of renal function assessment in anticoagulant users. This episode dissects a critical insight from the ORBIT-AF II registry: the variability in DOAC (NOAC) dose eligibility when labs use newer kidney estimates . While clinical trials used Cockcroft-Gault (eCrCl), modern labs often report eGFR (MDRD or CKD-EPI), leading to a "renal identity crisis" for clinicians . We're putting on our EBP detective hats to explore why these formulas disagree—and what that means for your patients. Let's dive in and see what it's worth! Key Points The Gold Standard Gap: Landmark DOAC trials and product monographs almost exclusively use Cockcroft-Gault (eCrCl) for dosing, yet clinical labs have moved toward automated eGFR reporting . Formula Discordance: In the ORBIT-AF II cohort, agreement between eCrCl and eGFR was high overall (~93%), but declined in patients with established chronic kidney disease (CKD) . The "Misclassification" Mystery: Up to 42% of CKD patients could be classified for a different dose depending on which formula is used, with rivaroxaban showing the highest rates of variability . The Interpretive Challenge: While the study noted an association between formula-driven "undertreatment" and worse outcomes, we discuss the critical limitations—such as the lack of BSA-adjusted eGFR data—that make it difficult to conclude that eGFR is directly leading us to miss our target doses. Is your patient truly underdosed, or are we just using the wrong yardstick? ------> Tune in to find out! References [EPISODE TRIAL] Yao RJR, Holmes DN, Andrade JG, et al. Variability in Nonvitamin K Oral Anticoagulant Dose Eligibility and Adjustment According to Renal Formulae and Clinical Outcomes in Patients With Atrial Fibrillation With and Without Chronic Kidney Disease: Insights From ORBIT-AF II. J Am Heart As soc. 2023 Mar 21;12(6):e026605. doi: 10.1161/JAHA.122.026605.  St Peter WL, Bzowyckyj AS, Anderson-Haag T, et al; Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. Am J Health Syst Pharm. 2025 Jun 11;82(12):644-659. Möller E, McIntosh JF, Van Slyke DD. STUDIES OF UREA EXCRETION. II: Relationship Between Urine Volume and the Rate of Urea Excretion by Normal Adults. J Clin Invest. 1928 Dec;6(3):427-65. doi: 10.1172/JCI100206. PMID: 16693839; PMCID: PMC434761. U.S. Food and Drug Administration (FDA). Pharmacokinetics in Patients with Impaired Renal Function — Study Design, Data Analysis, and Impact on Dosing and Labeling: Guidance for Industry. March 2024. Accessed December 2025.   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 Guest Information Dr. Rachel Khan, PharmD, BCPS Associate Professor, VCU School of Pharmacy Clinical Pharmacist - Internal Medicine, VCUHS  
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  S4E1 | Asking Better Questions of Evidence in 2026 11.02.2026 5นาที

  In this brief 2026 season opener, host Diana Langworthy, PharmD, BCPS pauses to acknowledge the weight of the moment—particularly here in Minnesota—where uncertainty, fear, and harm are being felt in very real ways across communities. This episode is not about policy analysis or debate. It's a reflection on what it means to hold space for thinking, teaching, and care when the world feels unstable—and why asking good questions, slowing down our reasoning, and practicing intellectual humility still matter in healthcare education and clinical practice. Diana also shares how What's It Worth? will move forward this season, and how the podcast, Substack (whatsitworthpodcast.substack.com), and future TikTok (Diana the Pharm.D.etective - @whatsitworthrx) content will work together as connected—but distinct—spaces for evidence critique, reflection, and public-facing curiosity.
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  S3E14 | Defending Evidence in a Broken Trust Environment 19.12.2025 7นาที

  Welcome back What's it Worth? listeners. This episode steps away from traditional trial critique. It's a year-end reflection on what it means to practice evidence-based healthcare at a moment when trust in science, institutions, and clinicians is eroding—and when evidence itself is increasingly being misused to create fear rather than understanding. This episode is for frontline healthcare professionals and future providers who feel the weight of that shift and are asking how to respond without becoming part of a polarized conversation. The answer, I believe, is not louder certainty—but better questions. As we move into the next year, evidence-based practice will require more than knowing the literature. It will require clinicians who are willing to defend evidence with transparent communication, clarity, humility, and compassion—and who can help patients ask not just "Is there a study?" but "What's it worth?" Learn more and continue the conversation: Substack: https://whatsitworthpodcast.substack.com/ Email: whatsitworthpodcast@gmail.com
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  S3E13 | Secondary SBP Prophylaxis — Asking Better Questions of Retrospective Data 16.12.2025 37นาที

  Episode Summary Secondary prophylaxis after spontaneous bacterial peritonitis (SBP) has long been considered standard of care—but how strong is the evidence behind it? In this episode, host Dr. Diana Langworthy is joined by Dr. Ben Webber (hospital medicine physician) and Danielle Luettel (PharmD Candidate 2026) to unpack a contemporary observational study examining outcomes associated with SBP prophylaxis. Together, they explore how historical trials, modern resistance patterns, and guideline recommendations intersect—and where uncertainty still remains. As care evolves over time, it is important to revisit standard practices to ensure they still make sense. How we revisit them is important and strong internal validity is still what we need to make practice changing claims.  Key Takeaways Secondary SBP prophylaxis is rooted in strong historical evidence but largely based on older trials. Contemporary observational data raise important questions about mortality benefit and patient selection. Guideline recommendations still support prophylaxis, but resistance patterns and evolving microbiology matter. Association does not equal causation—especially in retrospective database studies. Does this retrospective cohort study rise above the rest? ---> Tune in to find out! Featured Study Silvey S, Patel NR, Tsai, SY, et al. Higher Rate of Spontaneous Bacterial Peritonitis Recurrence With Secondary Spontaneous Bacterial Peritonitis Prophylaxis Compared With No Prophylaxis in 2 National Cirrhosis Cohorts. The American Journal of Gastroenterology 120(5):p 1066-1075, May 2025. | DOI: 10.14309/ajg.0000000000003075  Host Diana Langworthy, PharmD, BCPS Associate Professor, University of Minnesota College of Pharmacy Clinical Pharmacist, Inpatient Internal Medicine, M Health Fairview East Bank Hospital Guests Ben Webber, MD Associate Professor, Division of Hospital Medicine Senior Medical Director, Adult Med/Surg University of Minnesota Medical Center – East Bank Danielle Luetell PharmD Candidate, Class of 2026 Join the Conversation Subscribe to the What's it Worth? Podcast on Substack If you want to get new episode alerts, bonus content, and continue reflecting on what studies like this mean for real clinicians and real patients—head over to the What's it Worth? substack.  Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com or share how you're navigating evidence in practice—I love hearing how clinicians and learners think through uncertainty. Additional References & Guidelines American Association for the Study of Liver Diseases (AASLD) Biggins, Scott W.*,1; Angeli, Paulo2; Garcia‐Tsao, Guadalupe3,4; et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 74(2):p 1014-1048, August 2021. | DOI: 10.1002/hep.31884 European Associate for the Study of the Liver EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis Journal of Hepatology, Volume 53, Issue 3, 397 - 417 Foundational Trial for Secondary Prophylaxis Ginés P, Rimola A, Planas R, et al. Norfloxacin prevents spontaneous bacterial peritonitis recurrence in cirrhosis: results of a double-blind, placebo-controlled trial. Hepatology. 1990 Oct;12(4 Pt 1):716–724. doi:10.1002/hep.1840120416. PMID:2210673.
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  S3E12 | Tirzepatide vs Semaglutide for Obesity — What Did SURMOUNT-5 Teach Us? 09.12.2025 35นาที

  Episode Summary SURMOUNT-5 delivers the first head-to-head comparison of tirzepatide vs semaglutide in adults with obesity but without diabetes. In this episode, host Dr. Diana Langworthy and expert guest Dr. Kylee Funk (clinical pharmacist in primary care at Mill City Clinic specializing in weight management and diabetes) unpack the trial's design, results, interpretation, safety considerations, and what these findings mean for real-world clinical practice. Key Takeaways Tirzepatide achieved greater weight loss than semaglutide over 72 weeks. Both drugs improved cardiometabolic markers with similar safety profiles. Open-label design and exclusion criteria affect how broadly results apply. Clinical decisions still hinge on access, coverage, tolerability, and goals. Want the full trial breakdown? I created a deeper analysis, including statistics, estimands, subgroup data, and my extended critique on my What's it Worth? Substack.  Subscribe there for extra trial notes, bonus insights, and updates between episodes. Featured Study Aronne LJ, Bade Horn D, le Roux CW, et al. Tirzepatide as Compared with Semaglutide for the Treatment of Obesity. N Engl J Med. 2025;393(1):26-36. doi:10.1056/NEJMoa2416394. Host Diana Langworthy, PharmD, BCPS – Associate Professor, University of Minnesota College of Pharmacy Guest Kylee Funk, PharmD, BCPS – Clinical Pharmacist in Primary Care, Mill City Clinic (focus: weight management & diabetes) Join the Conversation Have a study you'd like us to decode on a future episode? Email whatsitworthpodcast@gmail.com. Share comments or takeaways — I love hearing how you're using evidence in practice. And for full-length study breakdowns and bonus content, subscribe at whatsitworthpodcast.substack.com.
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  S3E10 | GLP-1 Medications and Migraine - Exploring the Pressure Hypothesis 18.11.2025 32นาที

  🧠 Episode Summary 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. 💬 Key Takeaways 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. 🧩 Featured Study 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 🎙️ Guests Natalie Heinrich, PharmD, BCPS – Clinical Pharmacist in Neurology, M Health Fairview Nena Abosi, PharmD Candidate (2026) – University of Minnesota College of Pharmacy 🎙️ Host Diana Langworthy, PharmD, BCPS – Associate Professor, University of Minnesota College of Pharmacy 💬 Join the Conversation 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.
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  S3E9 | Glucose-Lowering Drugs and COPD Exacerbations — Dual Benefits of SGLT2 and GLP-1 Therapy? 04.11.2025 33นาที

  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 🎧 If you find this episode helpful, follow and leave a quick rating—it helps other clinicians and learners find high-quality, evidence-based content. 🎧 Email me at whatsitworthpodcast@gmail.com if you have an article suggestion for me to decode!
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  S3E8 | SABATO Trial - Oral vs IV Antibiotics for Uncomplicated MSSA Bacteremia 28.10.2025 41นาที

  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. 🎧 If you find this breakdown helpful, follow and leave a quick rating—it helps other clinicians and learners find high-quality, evidence-based content. 🎧 Email me at whatsitworthpodcast@gmail.com if you have an article suggestion for me to decode!