In an analysis of observational studies comparing pioglitazone versus rosiglitazone, pioglitazone emerges as the safer of the two.
Analyzing studies comprising over 800,000 patients with type 2 diabetes, researchers report in BMJ that use of rosiglitazone was 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."
In 2010, the European Medicines Agency recommended withdrawal of rosiglitazone from the market, and the U.S. FDA placed restrictions on its use.
Editorialists ask why, despite the association with increased risks for heart failure and the availability of other agents, thiazolidinediones remain among the leading prescribed drugs in the U.S. That popularity, they conclude, "says much about how healthcare has become less about promoting patients' interests ... and much more about promoting other interests, including those of the drug industry."
Sunday, March 20, 2011
Saturday, March 12, 2011
benicar ups cv death but lowers protein in urine in type 2 dbtcs
Olmesartan, an angiotensin-receptor blocker, delays the development of microalbuminuria in patients with type 2 diabetes and well-controlled blood pressure, but its use is associated with an increased risk of death from cardiovascular events, according to a New England Journal of Medicine study.
The ROADMAP trial, sponsored by the drug's manufacturer, randomized some 4500 diabetic patients with normoalbuminuria to daily olmesartan or placebo. In addition, participants' blood pressures were treated to maintain values under 130/80 mm Hg.
After a median 3-year follow-up, the olmesartan group showed a significant advantage over placebo in delaying time to onset of microalbuminuria (the primary outcome). However, fatal cardiovascular events were more common with olmesartan.
An editorialist writes that the finding of delayed microalbuminuria was not unanticipated. And given the increased cardiovascular mortality found with olmesartan, she asks why wouldn't other renin-angiotensin blocking drugs be prescribed if they are not associated with fatal complications?
The ROADMAP trial, sponsored by the drug's manufacturer, randomized some 4500 diabetic patients with normoalbuminuria to daily olmesartan or placebo. In addition, participants' blood pressures were treated to maintain values under 130/80 mm Hg.
After a median 3-year follow-up, the olmesartan group showed a significant advantage over placebo in delaying time to onset of microalbuminuria (the primary outcome). However, fatal cardiovascular events were more common with olmesartan.
An editorialist writes that the finding of delayed microalbuminuria was not unanticipated. And given the increased cardiovascular mortality found with olmesartan, she asks why wouldn't other renin-angiotensin blocking drugs be prescribed if they are not associated with fatal complications?
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