What question did this study set out to answer?

To compare cardiovascular outcomes and all-cause mortality between older patients with diabetes initiating rosiglitazone versus pioglitazone therapy.

November 24, 2008Archives of Internal Medicine

Comparison of Cardiovascular Outcomes in Elderly Patients With Diabetes Who Initiated Rosiglitazone vs Pioglitazone Therapy

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Why the study?

Does rosiglitazone increase mortality and cardiovascular events compared to pioglitazone in elderly patients with diabetes?

Population

28,361 Medicare beneficiaries older than 65 years with diabetes mellitus, US-based.

Comparison

Rosiglitazone vs Pioglitazone

Design

Cohort

Follow-up

29,060 person-years of follow-up

Authors

WWWolfgang C. WinkelmayerBaylor College of Medicine SSSoko SetoguchiGeneral Cardiology RLRaisa LevinHeart Failure & Transplant

Discussion

Member takes

Implication

Supports caution favoring pioglitazone over rosiglitazone in elderly diabetic patients; leaves open causal confirmation in randomized trials.

Key Points

To compare cardiovascular outcomes and all-cause mortality between older patients with diabetes initiating rosiglitazone versus pioglitazone therapy.
Assembled an inception cohort of 28,361 Medicare beneficiaries older than 65 years with diabetes who initiated rosiglitazone (49.7%) or pioglitazone (50.3%) between 2000 and 2005.
Evaluated all-cause mortality, myocardial infarction, stroke, and heart failure hospitalizations over 29,060 person-years of follow-up, censoring at drug crossover or 60 days after discontinuation using multivariable Cox regression models.
Initiation of rosiglitazone was associated with a 15% higher risk of all-cause mortality compared with pioglitazone (95% CI, 5%-26%), with 1,869 total deaths observed.
Patients starting rosiglitazone had a 13% greater risk of hospitalization for congestive heart failure compared to those starting pioglitazone (95% CI, 1%-26%).
No significant differences were observed between rosiglitazone and pioglitazone in the rates of myocardial infarction or stroke.

Structured PICO

Does rosiglitazone increase mortality and cardiovascular events compared to pioglitazone in elderly patients with diabetes?

Population

28,361 Medicare beneficiaries older than 65 years with diabetes mellitus, US-based.

Intervention

Rosiglitazone

Comparator

Pioglitazone

Outcome

All-cause mortality, myocardial infarction, stroke, and hospitalization for congestive heart failurehard clinical

In elderly patients with diabetes, initiating rosiglitazone is associated with an increased risk of all-cause mortality and heart failure compared to pioglitazone.

Limitations

residual confounding due to its nonrandomized nature

Cite This Study

Winkelmayer et al. (2008) studied this question.

synapsesocial.com/papers/6a7019d978a11c550e09e8b4 https://doi.org/10.1001/archinte.168.21.2368

Topics

Heart failure HFrEF treatment SGLT2 inhibitors in heart failure

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Implication

Supports caution favoring pioglitazone over rosiglitazone in elderly diabetic patients; leaves open causal confirmation in randomized trials.

Comparison of Cardiovascular Outcomes in Elderly Patients With Diabetes Who Initiated Rosiglitazone vs Pioglitazone Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Comparison of Cardiovascular Outcomes in Elderly Patients With Diabetes Who Initiated Rosiglitazone vs Pioglitazone Therapy

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

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Topics

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