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GPs should 'consider switching patients from rosiglitazone'

By Lilian Anekwe

Patients with type 2 diabetes treated with rosiglitazone could be at increased risk of heart attacks and heart failure, according to a new analysis.

Compared with rosiglitazone, patients on pioglitazone had a 17% lower risk of either death or hospitalisation as a result of a heart attack or heart failure.

The researchers estimated one extra patient a year would suffer a heart attack or heart failure for every 93 patients treated with rosiglitazone, and urged GPs to consider switching patients on rosiglitazone to pioglitazone.

The results, published online today in the BMJ, will swing the pendulum back in favour of pioglitazone, after an analysis published earlier this month in Archives of Internal Medicine found pioglitazone increased the risk of fractures by 61% in men and 77% in women – but did not find a significantly increased risk in patients taking rosiglitazone.

This retrospective study of the healthcare records of nearly 40,000 patients aged 66 years or older who were started on either rosiglitazone or pioglitazone between April 2002 and April 2008.

Over the six years, 1,563, or 6.9%, of patients on rosiglitazone were either hospitalised or died from a heart attack or heart failure, compared with 895, or 5.3% on pioglitazone.

The difference works out as an 17% lower risk relative to pioglitazone treatment and an absolute risk equivalent to one additional hospitalisation or death a year for every 93 patients on rosiglitazone instead of pioglitazone.

Examining heart attacks and heart failure separately, researchers found patients on pioglitazone had a 14% lower risk of death and a 23% lower risk of heart failure, although no difference was observed in the risk of heart attacks.

Lead author Dr David Juurlink, head of clinical pharmacology and toxicology at the University of Toronto, Canada, said: ‘Given the accumulating evidence of harm with rosiglitazone treatment and the lack of a distinct clinical advantage for the drug over pioglitazone, questioning whether ongoing use of rosiglitazone is justified in any circumstance is reasonable.

‘Pending the availability of additional data on the benefits and harms of these drugs and a clarification of their role in the pharmacotherapy of type 2 diabetes, we believe that clinicians should re-evaluate the appropriateness of new or ongoing treatment with rosiglitazone.'

But in an accompanying editorial, Professor Corinne de Vries, professor of diabetes and endocrinology at the University of Bath, said the study ‘reinforces the message that thiazolidinediones should be avoided in patients with heart failure'.

But she added: ‘Longer term safety data are needed before a change in practice is warranted.'

A spokeperson for GSK, the manufacturer of rosiglitazone, said: 'Heart failure is a known class effect for both glitazones and is reflected in prescribing information already available.

'The study is not reflective of evidence from two randomised controlled trials comparing rosiglitazone and pioglitazone, where no differences in heart failure were seen between rosiglitazone and pioglitazone.'

Patients with type 2 diabetes treated with rosiglitazone could be at increased risk of heart attacks and heart failure, a new study has warned.. Patients with type 2 diabetes treated with rosiglitazone could be at increased risk of heart attacks and heart failure, a new study has warned..

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