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Diabetes drug pioglitazone could get personal: Neither panacea, nor peril

When I was in training, one of my beloved mentors declared, “I never use a drug until it’s been on the market for 20 years.” I was young enough then that I couldn’t fathom being a doctor for 20 years, let alone waiting two decades to use a new drug. As my career has progressed, I’ve seen many new drugs released to the market. Some of them are truly miraculous, bringing people longer, healthier, and more productive lives. Many of them have not withstood the test of time. More than a few have even been taken off the market. Even though the Food and Drug Administration diligently reviews each new medicine before it’s approved for use, we often learn much more about a drug after its release into…

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  The Rise and Fall of the Glitazones

At the peak of their popularity, rosiglitazone and pioglitazone grossed something like 20% of the global revenue for diabetes therapy. Yet the bubbles burst, one by one, and the residual debate centers on the question of whether pioglitazone, the sole survivor, is worth using at all. Who was to blame – the regulators, the companies, or the medical community?

Articles of Interest

Diabetes Drug Linked to Higher Risk of Death

“The big attraction of these drugs is that they are insulin-sensitizing drugs and forestall the time when someone would have to go on to insulin,” Dr. Wolfe added. “But with a 15 percent excess mortality over even pioglitazone, which itself is dangerous, that doesn’t seem like a very good tradeoff.”

Do We Still Need Pioglitazone for the Treatment of Type 2 Diabetes?

It is our belief that pioglitazone represents an important therapeutic option in people with T2DM and that more commonly used regimens are both less effective and more likely to result in worse safety outcomes.

Efficacy and Safety of Pioglitazone Monotherapy in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Based on the findings of this meta-analysis, we concluded that pioglitazone monotherapy showed overall favourable risk-benefit balance. Specifically, pioglitazone is an effective treatment option in managing T2DM patients due to its potential of ameliorating hyperglycaemia, adverse lipid metabolism and BP. Improvement of these CV risk factors is crucial in terms of CV protection and stroke prevention in T2DM patients.

Gliptins and Glitazones Aren't Associated with Adverse Cardiovascular Outcomes in Type 2 Diabetics

In this large cohort study, gliptin and glitazone use was not associated with excess risk for all-cause death, HF, or CV disease in type 2 diabetic patients. Further, when combined with metformin, gliptins and glitazones were associated with lower risk for all three outcomes. Although subject to confounding by indication, these results are relevant to clinicians who prescribe these drugs when metformin monotherapy no longer achieves glycemic control.

Have glitazones lost their sparkle?

Now the thiazolidinediones, better known as 'glitazones', are under suspicion of causing serious, previously unsuspected adverse effects. Given these concerns, what can be said about the role of thiazolidinediones in third-line therapy of poorly controlled type 2 diabetes?

The glitazones

A new class of drugs, the glitazones, offers the first therapeutic option specifically targeting insulin resistance. The drugs act on tissues such as liver and skeletal muscle, sensitizing them to insulin action, and thereby increasing glucose uptake and decreasing its hepatic output.

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GoodRx

Glitazones are used to treat diabetes type 2 and PCOS. They work by making the body more sensitive to insulin at a cellular level to lower blood sugar levels. They also work to regulate menstrual cycles.