NPS RADAR: Rosiglitazone is a third-line choice in diabetes type 2 treatment
Summary of the review of the NPS RADAR on rosiglitazone (Avandia)
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Rosiglitazone improves glycaemic control but there is a lack of evidence that it improves diabetes–related clinical complications and mortality. Prescribers should consider this —along with recently emerging safety information — when assessing the ratio of potential harms and benefits for each patient.
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Rosiglitazone is no longer indicated in combination with insulin or for triple oral therapy in combination with metformin and a sulfonylurea.
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Rosiglitazone is a third-line choice. It may still be considered as part of dual therapy when either metformin or a sulfonylurea is contraindicated or not tolerated.
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Insulin should also be considered instead of rosiglitazone in these scenarios.
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Do not use rosiglitazone in people with heart failure or a history of heart failure.
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Avoid using rosiglitazone in people with ischaemic heart disease. Take particular care when prescribing the drug to people with a high risk of cardiovascular events.
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Bear in mind the possibility that rosiglitazone may increase the risk of a myocardial infarction.
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A large clinical trial found an increased rate of fractures of the upper arm (humerus), hand and foot among women using rosiglitazone.
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Wait 8 weeks before increasing the dose, as the full effect of the drug may not be seen before this time. In clinical trials of glitazone treatment, 25% to 30% of patients had no improvement in glycaemic control.
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Establish the effective and tolerated dose of each component as single drugs before considering the rosiglitazone with metformin combination tablet. Do not use combination tablets for patients taking more than 2 g/day of metformin because the maximum recommended daily dose of rosiglitazone will be exceeded.