The Archives of Internal Medicine has published the results of a retrospective observational study that aimed to compare cardiovascular and mortality outcomes in patients initiating pioglitazone and rosiglitazone therapy.
The study analysed data from the Medicare database for a five year period between January 2000 and December 2005. 28,361 individuals aged 65 years and older were identified who were treated with rosiglitazone or pioglitazone. The treatment split was even with 50.3% of patients receiving pioglitazone and 49.7% receiving rosiglitazone. There were 1,869 deaths during the time period analysed. The study outcomes were all-cause mortality, myocardial infarction, stroke and hospital admission for heart failure.
After adjustment for potential confounding factors the authors found a 15% increase in the risk of death in users of rosiglitazone (95% CI 5% - 26%) and a 13% increase in the risk of hospital admission for heart failure. No differences were found for myocardial infarction or stroke.
The authors conclude that these results "are compatible with an increased risk of all-cause mortality and congestive heart failure in patients initiating therapy with rosiglitazone" although they concede that due to the nature of the analysis, residual confounding may have an influence on the results.
Action: Glitazones continue to be a third line option after metformin and sulphonylureas. The use of rosiglitazone should be avoided where alternative options are available.
Original story found on Pharmagossip