Pioglitazone better for cardiovascular health than rosiglitazone
MedWire News: Results from a systematic review and meta-analysis suggest that rosiglitazone treatment is associated with significantly worse cardiovascular outcomes and higher mortality rates than pioglitazone.
Rosiglitazone has recently been withdrawn from the European market and significant restrictions have been placed on its use in the US due to concerns about increased incidence of adverse cardiovascular effects (congestive heart failure [CHF] and myocardial infarction [MI]), and mortality.
However, it is unclear to what degree these effects are drug-class related or associated with rosiglitazone alone.
To investigate further, Yoon Kong Loke (University of East Anglia, Norwich, UK) and colleagues carried out a systematic review and meta-analysis of 16 observational studies (four case-control and 12 retrospective cohort studies) including 810,000 users of rosiglitazone (n=429,000), or pioglitazone (n=381,000), to compare the risks for CHF or MI and mortality after treatment with each drug.
When compared with patients treated with pioglitazone, those treated with rosiglitazone were a significant 16%, 22%, and 14% more likely to experience MI or CHF, or die over a follow-up period ranging from 105.0 days to 7.1 years.
The researchers estimated that there would be 170 excess MIs, 649 excess CHF cases, and 431 excess deaths for every 100,000 patients treated with rosiglitazone versus pioglitazone.
"Our results show that among patients with Type 2 diabetes, use of rosiglitazone is associated with a modest but statistically significant increase in the odds of myocardial infarction, congestive heart failure, and death compared with patients receiving pioglitazone in real world settings," summarize Loke et al.
They conclude in the BMJ: "Clinicians, patients, and regulatory authorities should carefully consider these results in the context of the available information on the thiazolidinediones' benefits on glycaemic control and harm relating to different outcomes."
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By Helen Albert