The Cochrane analysis reviewed randomised studies of rosiglitazone of at least 24 weeks duration with placebo or active comparators. The RECORD study was not included in this review as the trial is ongoing. The aim of the review was to assess the effects of rosiglitazone in the treatment of type 2 diabetes.
The authors of this review found that rosiglitazone did not demonstrate clinically significant differences in glycaemic controlled, measured by HbA1c, when compared to other oral hypoglycaemics. Additionally, there were no data in any of the studies for outcomes of mortality or diabetic complications and the adverse event of oedema occurred approximately twice as often in patients taking rosiglitazone.
In light of the recent safety concerns relating to the risk of fracture and myocardial infarction the authors therefore conclude that clinicians should adopt a cautious approach to rosiglitazone and "other antidiabetic medications should be employed".
Action: It would seem prudent to suspend initiation of rosiglitazone in new patients and to review the risks and benefits of continued treatment in patients on existing therapy. As previously discussed, metformin is the first line hypoglycaemic with a sulphonylurea or pioglitazone suitable second line choices.