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Despite FDA Warning, Avandia Use Varies Across U.S.
Date:11/18/2010

By Steven Reinberg
HealthDay Reporter

WEDNESDAY, Nov. 17 (HealthDay News) -- Using the controversial diabetes drug Avandia as an example, new research finds that doctors' prescribing patterns vary across the country in response to warnings about medications from the U.S. Food and Drug Administration.

The result is that patients may be exposed to different levels of risk depending on where they live, the researchers said.

"We were looking at the impact black-box warnings for drugs have at a national level, and, more specifically, at a geographical level, and how these warnings are incorporated into practice," said study lead researcher Nilay D. Shah, an assistant professor of health services research at the Mayo Clinic in Rochester, Minn.

In 2007, the FDA required that Avandia come with a "black-box warning" -- the strongest warning possible -- alerting consumers that the drug was associated with an increased risk of heart attack.

Before the warning, Avandia was widely prescribed throughout the United States, although regional differences existed. "There was about a two-fold difference in use before the warning -- around 15.5 percent use in Oklahoma versus about 8 percent in North Dakota," Shah said.

Right after the warning, the use of Avandia dropped dramatically, from a nationwide high of 1.3 million monthly prescriptions in January 2007 to roughly 317,000 monthly prescriptions in June 2009.

"There was a huge decrease in use across the country," Shah said. "But there was quite a bit of residual use."

After the FDA warning, the researchers still found as much as a three-fold difference in use across the nation. In Oklahoma, Avandia use dropped to about 5.6 percent, but in North Dakota it tumbled to 1.9 percent, Shah said.

The reasons for the differences aren't clear. Some factors might include how doctors are made aware of FDA warnings and how they react. Another factor could be t
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