Monday, February 22, 2010


Avandia is in the news again. On Friday, a US senate select committee was reviewing the evidence that Avandia ( Generic name : Rosiglitazone ), may be associated with an increase risk of heart attacks. This was highlighted in the Star papers today. This is actually a re-hash of the hooha that we had written earlier about the cardiac problems with avandia, way back in 2007.
Lets take a step backwards. Rosiglitazone belongs to a group of drugs called " insulin sensitisers ", that is widely used in the treatment of type 2 diabetics. The other member oif this group is Pioglitazone ( Actos ). Rosiglitazone is produced by GSK ( Glaxo Smith Kline ). When the initial clinical trial results came out in 2007, there was much media attention and also medical attention, firstly because GSK was not very forthcoming in releasing details of the trials and secondly because there seemed to be a real increase in heart attack rates and also heart failure rates in those taking rosiglitazone when compared to those taking sulphonlyureas. Of course, one of the crusaders raising this issue was Dr Steve Nissen of Cleveland Clinic fame.
Following the 2007 adverse publicity, the sales of Avandia dropped and GSK launched a promotional campaign to assure the medical community that rosiglitazones are safe but that we must exercise caution in selecting the right patient subset in the use of rosiglitazone. For some reason, FDA did approve the use of rosiglitazone in the treatment of type 2 diabetes, but did caution that it should not be used in patients with known history of heart failure.
I am not certain what spark this latest re-investigation into rosiglitazones. Looking at the problem 4 years later, it probably is true that rosiglitazone maybe assocaited with a silghtly higher risk of heart attacks and it is obviously contra-indicated in heart failure.
As clinicians, we should always play safe and where there is a choice, perhaps we should chose the safer option.

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