The use of rosiglitazone in this database does not reflect its use
among patients in the real world.
-- Patients prescribed rosiglitazone alone suffered from more chronic
diseases compared with those prescribed pioglitazone alone;
therefore they were sicker patients. However this difference is not
corrected for in the analysis of the data and in the study
-- The TZD monotherapy patient population in the ICES analysis had a
4-fold higher rate of kidney impairment, which is indicative of
patients with more progressive type 2 diabetes.
-- The authors state that the study may have been underpowered to detect
adverse effects associated with pioglitazone because of the relatively
small number of persons prescribed pioglitazone alone. It is stated
that larger studies are needed to better determine the relative
effect of each agent on cardiovascular outcomes.
-- The ICES analysis included insulin therapy within the TZD combination
group but excluded insulin combinations within the comparison group.
Insulin is known to be associated with increased CHF and cardiovascular
risk. Therefore, this biases the TZD combination group towards
increased cardiovascular risk relative to the comparison group. This
also permits more advanced patients, with poor glycemic control and who
are at greater risk of cardiovascular complications, to be included in
the TZD population while excluding them from the control group.
Avandia(R) (rosiglitazone maleate) is a widely studied oral
anti-diabetic medicine for the treatment of type 2 diabetes, and
importantly, Avandia has been shown to control blood sugar for longer than
the most commonly used oral anti-diabetic medicines - up to five years.
When used in the a
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