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Rosiglitazone for type 2 diabetes mellitus
B Richter1, E Bandeira-Echtler, K Bergerhoff
1Universitaetsklinikum Duesseldorf, Heinrich-Heine University, Department of General Practice, Moorenstr. 5, Duesseldorf, Germany, 40225. richterb@uni-duesseldorf.de
The Cochrane Database of Systematic Reviews
|July 20, 2007
Summary
Rosiglitazone treatment for type 2 diabetes did not improve patient outcomes or metabolic control. This diabetes medication significantly increased edema and fracture risk, with some studies indicating higher cardiovascular risk.
Area of Science:
- Endocrinology
- Cardiology
- Pharmacology
Background:
- Diabetes mellitus is a major risk factor for cardiovascular disease, contributing to approximately 70% of all mortality in diabetic patients.
- Previous large trials in type 2 diabetes did not demonstrate reduced cardiovascular endpoints with improved metabolic control.
- Peroxisome proliferator activated receptor gamma (PPAR-gamma) activators like rosiglitazone were theoretically expected to improve endothelial function and reduce cardiovascular risk.
Purpose of the Study:
- To evaluate the efficacy and safety of rosiglitazone in managing type 2 diabetes mellitus.
- To assess the impact of rosiglitazone on patient-oriented outcomes and surrogate endpoints.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) of rosiglitazone in adult type 2 diabetes patients.
- Studies included had a minimum duration of 24 weeks.
- Data extraction and quality assessment were performed independently by two authors; meta-analysis was limited to adverse events.
Main Results:
- Eighteen RCTs involving 3888 patients treated with rosiglitazone were identified.
- No evidence was found that rosiglitazone improves patient-oriented outcomes (mortality, morbidity, quality of life) or shows clinically relevant differences in HbA1c compared to other oral antidiabetic drugs.
- Significant increases in edema (OR 2.27) and fracture rates (in women) were observed. One large RCT suggested increased cardiovascular risk.
Conclusions:
- Further research should prioritize patient-oriented outcomes to establish the benefit-risk profile of rosiglitazone.
- Public availability of all safety data and adverse events from published and unpublished investigations is recommended.
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