MTRAC reviews diabetes drugs
July 27, 2007 at 12:18 pm | In Prescribing Extra - Drugs |
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The Midlands Therapeutics Review and Advisory Committee has published reviews of pioglitazone, rosiglitazone and exenatide.
The review of pioglitazone suggests that this drug is suitable for prescribing in primary care but only after metformin and sulphonylureas.
The review of rosiglitazone suggests that this drug should not be initiated in primary care. It is also recommended that patients who are well controlled and stable on treatment can be continued until further data become available to aid decision making.
The review of exenatide suggests that this drug is suitable for initiation in secondary care and once the patient is stabilised it can be continued in primary care.
Action: Clinicians who treat diabetes in primary or secondary care will find these product reviews to be a useful summary of the currently available evidence.
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With the unwelcome attention Rosiglitazone has been getting some attention has been paid to the other glitazone Pioglitazone, that (from memory) had a non-significant drop in blood inflammatory markers in trials comparing it placebo, whereas Rosiglitazone had a small but significant increase. So if the rates of acute cardiac events in Rosiglitazone are related to these inflammatory markers and pioglitazone therefore may have safer cardiac risk factors.
Given Rosiglitazone makers GSK seem to be designing the recently published trials to encourage early (first line) or even prediabetic use of Rosiglitazone I would not be surprised to see Pioglitazone (?Takeda – In Oz Marketed by Lilly) makers pushing for it’s product to be used early instead.
So I feel this message probably really needs to be said widely and loudly before a $3 a tablet medication versus a $0.15 one gets promoted without clear evidence of any clear benefit over the older and cheaper medication.
Benedict
Comment by Benedict — July 29, 2007 #
Benedict,
As you rightly point out, the currently available evidence overwhelmingly supports using Metformin first line. It is the only antidiabetic agent proven to prevent cardiovascular events and through doing so saves lives.
In some circles here in England we call is Stormin’ Metformin!
Comment by Matthew Robinson — July 29, 2007 #