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Popular diabetes medications have different rates of heart failure and death

August 19, 2009 Toronto

Rosiglitazone (Avandia™), a widely-used drug for patients with type 2 (non-insulin dependent) diabetes, is associated with a higher risk of heart failure and death than the related drug pioglitazone (Actos™) according to a new study released by the Institute for Clinical Evaluative Sciences (ICES).

The two medications belong to the class of drugs known as thiazolidinediones, often referred to as “glitazones” or “TZDs.” The drugs are widely used to lower blood sugar levels in patients with type 2 diabetes, but recent studies have raised concerns about their cardiac safety. Both drugs are known to cause fluid retention and heart failure in some patients. Some authorities have assumed that rosiglitazone and pioglitazone share the same cardiac side effect profile. However, whether one is safer than the other has remained uncertain.

The study of 39,494 patients aged 66 years and older who started on either pioglitazone or rosiglitazone during a 6-year period (April 1, 2002 and March 31, 2008) found that, compared to rosiglitazone users, patients treated with pioglitazone had a 23 per cent lower risk of hospitalization for congestive heart failure and 14 per cent lower risk of death from any cause. There was no significant difference in the risk of heart attack.

The researchers estimate that one additional hospitalization for heart failure every year would occur for every 120 patients treated with rosiglitazone rather than pioglitazone, and that one additional death would occur for every 269 patients treated with rosiglitazone rather than pioglitazone.

“Worldwide, millions of patients receive these drugs each year. Based upon emerging safety concerns, the American Diabetes Association recently advised against using rosiglitazone. Rosiglitazone remains widely used in Canada, and the Canadian Diabetes Association currently recommends both drugs for the treatment and prevention of diabetes” says principal investigator and ICES scientist, Dr. David Juurlink.

“Our study provides compelling evidence that the cardiac safety profiles of rosiglitazone and pioglitazone are actually quite different. Given that rosiglitazone lacks a distinct therapeutic advantage over pioglitazone, it’s not clear why physicians would continue to prescribe rosiglitazone,” says Juurlink.

The study “Adverse cardiovascular events during treatment with pioglitazone and rosiglitazone: population based cohort study,” is in the August 19, 2009 online issue of the British Medical Journal.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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