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The Avandia debate

Posted by iskanbasal on June 22, 2007

Avandia or rosiglitazone is one of the Thiazolidinediones, a group of drugs used in type2 Diabetes patients to lower blood glucose levels. Troglitazone, was the first in this group of drugs, demonstrated hepatotoxicity and was removed from the market. Rosiglitazone( Avandia, brand name; Glaxo-SmithKline the company) and pioglitazone(Actos brand name;Takeda the company) are the two currently used drugs of this group.

What is the mechanism of action of thiazolidinediones?

The thiazolidinediones are agonists for peroxisome proliferator–
activated receptor γ (PPAR-γ). PPAR-γ
receptors are ligand-activated nuclear transcription
factors that modulate gene expression, lowering
blood glucose primarily by increasing insulin
sensitivity in peripheral tissues.Rosiglitazone
was introduced in 1999 and is widely used as
monotherapy or in fixed-dose combinations with
either metformin (Avandamet, GlaxoSmithKline)
or glimepiride (Avandaryl, GlaxoSmithKline).So the drug is able to reduce blood glucose and glycated hemoglobin levels.

When the debate about the increased risk of MI in patients using rosiglitazone began few weeks ago I received some articles and news headlines , and everybody I think gave interest to the subject, and some blogs. The discussion increased rapidly, and became a great dispute. A world which never sleep.

I actually read the article of Dr. Nissen at the New England Journal of medicine. It is free full text , any interested person can read it. I also read some other related articles on the subject written by another authors. The last pubblication I received on the subject was at the NewYorker. Now I think that all the commentators and conclusions from different articles agreed on the urgent necessity to make basic changes on the way the FDA do its surveillance on drugs after being approved to the market. I noticed there is some advantage in the European system over the USA in this field.

Anyhow, at my level in medical studies, my aim in reading some of the above articles is the to better understand the mechanisms of such drugs and how this kind of studies is done. To have a good example of the meta-analysis studies and statistical methods. How much complicated are all these terms in this field of knowledge!

And how it is very important to search for the goodness either for ourselves or for our neighbours.

(escuse me for English language errors)

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