So, how are doctors and patients to interpret such widely divergent views on the safety of Avandia?
One possibility is that "age is playing a role in a manner we don't even understand," Garratt said. The ages of the participants in the BARI 2D study were skewed downwards compared to the other research, where volunteers were older and therefore more likely to be more frail.
Avandia, along with its pharmacological cousin Actos, are different from many other diabetes drugs in that they act directly on gene expression.
"Because genes change over time, perhaps this type of drug is going to have different outcomes in different age groups," Garratt suggested.
"What we can conclude now looking at the question from multiple different angles is that we have failed to come up with a consistent message," Garratt added. "My guess is that the marketplace will see some additional fall-off in the use of Avandia, but we know that some has already taken place. Those of us who are prescribing the medication from a cardiovascular practice perspective are already cautious. As this gets more press, that degree of caution will filter down to the internist, the family medicine physician and the diabetes expert."
The U.S. National Library of Medicine has more on thiazolidinediones.
SOURCES: Kirk Garratt, M.D., clinical director, interventional cardiovascular research, Lenox Hill Hospital, New York City; June 28, 2010, teleconference with: Richard Bach, M.D., associate professor, medicine, Washington University School of Medicine, St. Louis; American Diabetes Association annual meeting, Orlando. Fla.
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