by Dr Linda Calabresi

Hot on the heels of last week’s alert for all patients on rosiglitazone, an editorial (link) published online in Heart (27 Aug), warns that the risks associated with glitazones often outweigh the benefits and their use should be restricted.

The editorial authors from the Wake Forest University School of Medicine in the US go on to say the justification for the use of these drugs is very weak to nonexistent. And along with strongly recommending restrictions in their use, they question the rationale for leaving rosiglitazone on the market.

They claim that in the past the evaluation of oral hypoglycaemic agents has relied more on surrogate markers such as HBA1c rather than looking at clinical endpoints. The glitazones were approved on the basis they reduced glycated haemoglobin levels, they say, but evidence since then suggest the benefit-harm balance has shifted in an undesired direction.

“Today we know these drugs double the risk of congestive heart failure and fractures (in women only), cause a 40% increased risk in myocardial infarction (rosiglitazone only) and, in rare cases, increase the risk of macular oedema associated with vision loss,” the editorial authors say.