Diabetes medications in same class carry different risks of heart failure, death

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Public release date: 24-Nov-2008

http://www.eurekalert.org/pub_releases/2008-11/jaaj-dmi112008.php

Contact: Holly Brown-Ayers

JAMA and Archives Journals

Diabetes medications in same class carry different risks of heart

failure, death

CHICAGO – Older adults who take the diabetes medication rosiglitazone

appear to have a higher risk of death and heart failure than those

taking the related medication pioglitazone, according to a report in the

November 24 issue of Archives of Internal Medicine, one of the

JAMA/Archives journals.

In 1997, a new class of oral medications known as thiazolidinediones

expanded the available options for diabetes treatment, according to

background information in the article. These drugs offered several

clinical benefits, including decreased insulin resistance, better

control of blood sugar and, for some patients, a delay in beginning

insulin therapy. Two agents in this class, rosiglitazone maleate and

pioglitazone hydrochloride, were approved and marketed beginning in

1999. Not long after, it became apparent that these drugs had important

adverse effects, including heart failure and heart attack. A black box

warning was recently added to both drugs cautioning against their use in

patients with existing heart failure.

Recent meta-analyses have suggested that the risks associated with

rosiglitazone may be higher than those associated with pioglitazone. To

compare cardiovascular outcomes and death rates between the two

therapies, Wolfgang C. Winkelmayer, M.D., Sc.D., and colleagues at

Brigham and Women's Hospital and Harvard Medical School, Boston, used

medical claims data to study 28,361 patients older than 65 years who

began taking either rosiglitazone or pioglitazone between 2000 and 2005.

Of these, 14,260 (50.3 percent) began treatment with pioglitazone and

14,101 (49.7 percent) with rosiglitazone.

After an average of 380 days taking pioglitazone or 369 taking

rosiglitazone, 1,869 patients died. After adjusting for other factors,

individuals taking rosiglitazone had a 15 percent higher rate of death

and a 13 percent greater risk of heart failure compared with those

taking pioglitazone. However, there were no differences in heart attack

or stroke risk between the two groups.

" This study confirms the safety concerns that have been raised for

rosiglitazone compared with pioglitazone, which, in turn, also cannot be

considered a very safe drug given its well-documented effect on the risk

of congestive heart failure, " the authors write. " Although previous

studies have indicated that the increased risk with rosiglitazone use

resides predominantly in cardiovascular outcomes, the present study

suggests that differences in all-cause mortality [death] risk may be

even more important to consider in elderly patients. "

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(Arch Intern Med. 2008;168[21]:2368-2375. Available pre-embargo to the

media at www.jamamedia.org.)

Editor's Note: This study was supported by a Scientist Development Grant

from the American Heart Association; a Norman S. Coplon Extramural

Research Program Award from Satellite Healthcare Inc.; and

investigator-initiated grants from Amgen, Fresenius Medical Care and

GlaxoKline. Please see the article for additional information,

including other authors, author contributions and affiliations,

financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives Media Relations at

312/464-JAMA (5262) or e-mail mediarelations@....

--

ne Holden, MS, RD

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