Exclusive: GPs query use of rosiglitazone

GPs have been urged to ignore ambiguous NICE guidance on rosiglitazone and advise patients to stop taking the drug.

Doubts over cardiovascular dangers of the type-2 diabetes drug were first raised in May, when researchers found the drug was associated with a 63 per cent increased risk of death from a cardiovascular cause.

But NICE draft guidelines on type-2 diabetes issued last month did not omit rosiglitazone from treatment option.

However, speaking at the Primary Care Live conference in Docklands, East London last week, Dr Azhar Faaroqi, a GP in Leicester and a member of the Primary Care Diabetes Society, said: 'GPs in the UK and everywhere else should not be initiating rosiglitazone.

'GPs should be looking to switch patients that are already on the drug,' he added.

Glitazones, which are a second or third-line treatment for type-2 diabetes, can cause heart failure and also lead to weight gain and osteoporosis, he said.

'Do not use rosiglitazone on any patient with a sniff of heart failure,' warned Dr Faaroqi.

Dr Ahmet Fuat, a Durham GP who runs a heart failure clinic and member of the Primary Care Cardiovascular Society (PCCS), said: 'We have seen a big increase in heart failure workload and a larger profile of patients with heart failure at our clinic because of the use of glitazones.'

Earlier this month, a US study of over 20,000 people with prediabetes or type-2 diabetes found that rosiglitazone or pioglitazone could increase the risk of congestive heart failure by 72 per cent. But an increased risk of cardiovascular events was not linked to use of the drugs.

Nevertheless, Dr Sarah Jarvis, West London GP and a member of the PCCS, argued that GPs should be switching patients over from rosiglitazone on to pioglitazone.

In a meta-analysis of 42 trials involving almost 18,000 patients aged an average of 56 years, rosiglitazone was linked to a 43 per cent higher risk of MI, as well as a 63 per cent higher risk of death from any cardiovascular cause than patients on drug regimens without rosiglitazone.

But Dr Allastair Benbow, European medical director for GSK, the company that manufactures rosiglitazone (Avandia), said that while the drug was not right for everybody, there was a wealth of data to back up its use including 116 trials involving over 52,000 patients.

'Rosiglitazone remains an important option for prescribing. It would be wrong for it to be withdrawn,' he said.

In its draft guideline, NICE said there was 'ongoing debate about the cardiovascular safety of rosiglitazone' and that 'concerns were raised about the short duration of the trials and the quality of the data' of the glitazone studies.

A spokesman for NICE said: 'If the European Medicine Agency (EMEA) decides on the basis of new research that the risks posed by the two glitazones outweigh their benefits they will issue updated prescribing advice to healthcare professionals.

'This will take precedence over the existing NICE guidance.'

sanjay.tanday@haymarket.com

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