Rosiglitazone (Avandia) should be used only by people who can’t control their diabetes other ways, the FDA said today. Across the Atlantic, the European Medicines Agency ordered rosiglitazone off the market until its maker, GlaxoSmithKline, can supply “convincing data” that there exists a group of people with diabetes for whom the blood-sugar-lowering benefit of taking rosiglitazone outweighs the risks. The announcements come in the wake of mounting evidence that rosiglitazone increases the chance of having a heart attack or developing heart failure. (Rosiglitazone is also combined with metformin under the brand name Avandamet, and with glimepiride under the brand name Avandaryl.)
It’s quite a turnabout for a drug that experts once thought might decrease the risk of heart attack in people with diabetes as it helped them control their blood sugar. In the United States, rosiglitazone became available in 1999, and quickly became the top-selling diabetes drug in the world. That changed in 2007 with the publication in JAMA of a meta-analysis of four large randomized, controlled trials showing that people with diabetes who took rosiglitazone were 42% more likely to have a heart attack than those who didn’t take the drug, and were twice as likely to develop heart failure.
The Avandia story offers an important lesson for doctors and the rest of us: Don’t be too eager to try a brand-new drug when you can use an equally effective alternative that has been around a while. There are many diabetes drugs on the market. Older ones, such as metformin, have an excellent track record for safety and there is some evidence that metformin may help protect against cardiovascular disease.
If you have been taking Avandia, don’t stop it on your own. If you do that without having an alternative in place, the prolonged increase in blood sugar and insulin would be worse for you than the small cardiovascular risk from the drug.
Instead, talk with your doctor about alternatives that would work you. Everyone is different. Some people do fine with metformin or another oral diabetes medication to control their blood sugar; others need two or three drugs, or insulin injections. Whatever you and your doctor decide to do, don’t overlook exercise, the most potent anti-diabetes therapy around.
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