What do you think of this statement about Avandia?

Question

CBS News - 43 minutes ago
(WebMD) There's no urgent need for type 2 diabetes patients to stop taking Avandia, even if the drug really does increase the risk of heart attack, some medical experts caution.

Answer 1

I have already answered a question about rosiglitazone/Avandia. Rosiglitazone belongs to a family of drugs which reduce the body's resistance to the effects of insulin. This is a very important class of drugs for type 2 diabetics for whom insulin resistance is universally present leading to increasing production of insulin and eventually pancreatic beta cell failure and the inability to produce insulin. The first drug in this class used in the United States was troglitazone. It was withdrawn by the company for fear of lawsuits. The problem was not with the drug itself it was that physicians ignored warnings that the drug was not for everyone. The 2 remaining drugs in this class in the US are rosiglitazone and pioglitazone/Actos. It is frequently stated in the medical literature that pioglitazone increases the risk of heart failure although there is absolutely no evidence to support this claim. The study which alleges that rosiglitazone may lead to cardiovascular events such as heart attacks, strokes, and deaths has serious flaws which I will outline below. This study is of more interest to attorneys who smell money than it is to physicians. As such the Food and Drug Administration at this time has stated that they have no intention of placing warnings or restrictions on rosiglitazone. The study you are referring to was a meta-analysis. Meta-analysis are by their very definition statistically 'invalid'. They are intended to identify areas where additional study is needed - meta-analysis is never intended to generate 'hard' data, conclusions, or to become the basis for changes in medical practice. A meta-analysis sums up the results of a variety of studies. Such studies have different designs and are designed to answer different questions. It should be obvious that a summation of such data would have inherent limitations. That being said the meta-analysis was a summation of studies of short duration and studies of short duration introduce significant bias for a variety of reasons. The full effect of drugs - for benefit or harm - may take months or years and the likelihood of events is quite different in the short run as opposed to the long run. Finally - the number of events were few - too few in my opinion to lead to any conclusion. For example - 18 people on rosiglitazone as opposed to 12 people on other treatment suffered adverse events. It is true that this is a 50% increase but something which is statistically significant may not be clinically relevant. For example - a study of a drug to increase exercise tolerance in people with narrowing of the arteries in the legs found that the drug produced a statistically significant increase in exercise tolerance. In fact - however - people were able to walk only 3 additional steps. This illustrates the difference between statistics which are easily manipulated and clinically relevant data. Personally I have always preferred pioglitazone to rosiglitazone but not because I believe that the former is safer. No one on rosiglitazone should stop the drug without consulting their physician. Again - at this point this is a legal concern rather than a medical concern. Many drugs are withdrawn after such articles as companies fear lawsuits. Physicians must practice in accordance with the medical literature and not out of fear of attorneys.

Answer 2

I am diabetic ( Type 2 ), and I used to take Avandia. I am happy that the doctor switched my meds long before this warning about Avandia came out. It still worries me. I feel sorry if those who take, or are still taking Avandia, get heart problems. Web MD you are nuts!!!

Answer 3

It's a complicated world. If you're not familiar with meta-analyses, it may seem that something sinister is going on, but this is pretty well business as usual in medicine, where real take-to-the-bank answers are hard to come by. Statistical trends often are misleading, and it will take considerable study looking specifically at that question to determine if rosiglitazone really does what it appears to in terms of cardiovascular risks.
You might want to think about this: medications for type II diabetes are usually studied and marketed with an eye to how well they control blood sugar, and blood pressure medications are usually studied and marketed according to how well they control hypertension. It is generally assumed that keeping these controlled will also control cardiovascular risk, but that assumption may very well not be true. The alternative is to keep them in phase III clinical trials for thirty or forty years to get more studies of that particular question, but most of us don't want to wait that long for drugs to come on-line.

Answer 4

I think it is good advice.

If my patients ask, I am telling them to continue the avandia until they can speak with the doctor who gave them the prescription for the avandia. If they have had significant cardiovascular problems in the past, I am urging them to talk to their doctor ASAP, otherwise I advise them to make a regular appointment, or to speak with their prescribing doctor on the phone.

In other words, don't stop taking the avandia without speaking to the doctor who gave it to you.

Answer 5

The person above who said this:

"It's a complicated world. If you're not familiar with meta-analyses, it may seem that something sinister is going on"

Well that's exactly how I feel. You don't know what to do and you don't have enough information to decide yourself. Even if you did have the information, could you understand it? Look at some of the other answers to this question! I had to read them all twice to understand what they were saying. Hopefully your doctor will be informed enough to make the decision for you. It is a complicated world after all.


Here for anyone who wants to get a better idea of what meta-analasys means http://library.downstate.edu/ebm/2700.htm
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Answer 6

My sister has form 2, my mom, who's 80 3, has form a million and has because of the fact that she replaced into sixteen. mom's endocrinologist is the pinnacle of a diabetic association in Kansas city and published bulletins in the place of work that my sister introduced abode stating he does not prescribe Avandia for any of his sufferers and cautioned all and sundry one it to ask their scientific expert to alter drugs. My sister went to her usual md because of the fact she replaced into on Avandia with a replica of this bulletin and he replaced her prescription suited away because of the fact he knew the scientific expert. He pronounced he does not be prescribing Avenida to from now on of his sufferers. additionally, in the journey that your dad is form a million, he might desire to be on insulin no longer Avandia. in the journey that your dad is purely going to a usual MD even no count if that's an inner drugs scientific expert, he needs to beginning seeing an Endocrinologist for suited diabetes care.