Rosiglitazone, brand name Avandia, has higher rates of heart failure and death than similar alternative
Scientists say doctors should stop prescribing a commonly used diabetes drug, after studies show that it is linked to higher rates of heart failure and death than a similar alternative.
David Juurlink, a Toronto-based pharmacologist and lead author of a paper published online today by the British Medical Journal, says that doctors should no longer prescribe rosiglitazone, which is sold under the brand name Avandia.
His study looked at nearly 40,000 patients aged 66 or older who had been given either rosiglitazone or a similar drug, pioglitazone, by their doctors between April 2002 and March 2008 for type 2 (obesity-related) diabetes. They found that those on pioglitazone had a significantly lower risk of heart failure or death than those on rosiglitazone.
For every 93 patients treated with rosiglitazone rather than pioglitazone, one extra heart failure or death would occur every year, they say.
There has been controversy for some time over rosiglitazone's effects on the heart. Some scientists have argued over the interpretation of previous studies. But Dr Juurlink, division head of clinical pharmacology and toxicology at the Sunnybrook Health Sciences Centre in Toronto, believes it is time for doctors to stop using the drug.
"As a clinician, I cannot envision an instance in which I would recommend rosiglitazone over pioglitazone," he said.
"My logic for recommending that rosiglitazone no longer be used is several-fold: there is an increasing body of evidence that rosiglitazone is associated with more harm than pioglitazone, there is biological plausibility to support this (outlined in our paper – rosiglitazone is a more potent stimulus for salt and water retention in the kidney) and not a single study, to my knowledge, has suggested that pioglitazone might be less safe than rosiglitazone.
"Importantly, rosiglitazone has not a single advantage – not even a theoretical one – over pioglitazone."
The risks and benefits of the drug have been evaluated by the European Medicines Agency, responsible for licensing across Europe, which said in October 2007 that the benefits of both drugs outweighed their risks. But it warned that rosiglitazone should only be used after a careful assessment of any patient with heart disease.
An editorial published online with the paper suggests that it is still too soon to dismiss rosiglitazone. Two experts, Corinne de Vries, professor of pharmacoepidemiology at the University of Bath, and David Russell-Jones, professor of diabetes and endocrinology at the University of Surrey, say that more studies should be done. They urge patients to consult their GP and not discontinue their medicine.
Theo Guardian.co.uk Â© Guardian News and Media Limited 2009
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20/08/2009 08:20:09 AM