Merck Sharp & Dohme
Circulation:Volume 117(3)22 January 2008pp 440-449
New Drugs for the Treatment of Diabetes Mellitus: Part I: Thiazolidinediones and Their Evolving Cardiovascular Implications
Conclusions
In summary, thiazolidinedione effects on the cardiovascular system extend beyond their impact on glucose metabolism, yielding much interest in their effect on CVD risk, with numerous trials underway. Both rosiglitazone and pioglitazone are similarly associated with peripheral edema and, much less commonly, HF, warranting continued caution for their use in HF patients according to their product labels, Food and Drug Administration guidance, and AHA/American Diabetes Association recommendations.57 Pioglitazone has demonstrated favorable trends for CVD risk reduction in the PROactive study, the largest CVD outcomes trial of glucose-modifying therapy completed to date. The safety signal associated with potential increased CVD risk associated with rosiglitazone warrants caution for its use, but the paucity of evaluable data in this context justifies continued clinical trial assessment with judicious safety monitoring of ongoing clinical trials. Until such additional safety and efficacy data are available, in the context of what may now appear to be safer alternatives to rosiglitazone available, including but not limited to pioglitazone, its routine use in the treatment of hyperglycemia in patients with T2DM at increased CVD risk cannot be recommended.
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