Predictors for change to thiazolidinedione prescribing in the UK following the rosiglitazone cardiovascular safety warning - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue International Journal of Clinical Practice Année : 2011

Predictors for change to thiazolidinedione prescribing in the UK following the rosiglitazone cardiovascular safety warning

Gillian C Hall
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Helen Smith
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Bradley Curtis
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Alex Mcmahon
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Résumé

Objective To investigate switching from thiazolidinediones, and predictors for switching treatment, after publication of a meta-analysis reporting an increased risk of myocardial infarction associated with rosiglitazone use. Research design and methods Using THIN UK primary care database, the number of people with Type 2 diabetes prescribed either thiazolidinedione; rosiglitazone (n=10,062) or pioglitazone (n=4,454) and the rate of switching from thiazolidinediones (n=3,301 and 1,106 respectively), were computed for each month, May 2006 to January 2008. The probability of switching post-publication, May 2007 to January 2008, was modelled by logistic regression in a forward stepwise model. Variables included demographics, history of ischaemic heart disease (IHD), heart failure (HF) or stroke, risk factors for IHD, glucose-lowering and cardiovascular drug use, HbA1c and diabetes duration. Results There was a sharp increase in switching from both thiazolidinediones in summer 2007; rosiglitazone prescription numbers then decreased while pioglitazone prescribing increased. Switching from rosiglitazone was associated with IHD (adjusted odds ratio OR 1.72; 95% confidence intervals CI 1.47-2.00), insulin treatment (OR 5.10; 95% CI 3.21-8.10), HF (OR 2.26; 95% CI 1.62-3.18), recent sulphonylurea prescription (OR 1.33; 95% CI 1.17-1.51) sex (OR males v females 0.79; 95% CI 0.70, 0.90) and duration of therapy. Switching from pioglitazone was associated with HF (OR 3.05; 95% CI 1.77-5.26), duration of therapy, and number of glucose lowering treatments. Conclusions Prescribing habits for both thiazolidinediones changed immediately following the safety warning. IHD was associated with switching from rosiglitazone; otherwise reasons for change appear to be complex, not directly related to the findings of the meta-analysis.

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hal-00631704 , version 1 (13-10-2011)

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Gillian C Hall, Helen Smith, Bradley Curtis, Alex Mcmahon. Predictors for change to thiazolidinedione prescribing in the UK following the rosiglitazone cardiovascular safety warning. International Journal of Clinical Practice, 2011, 65 (5), pp.586. ⟨10.1111/j.1742-1241.2011.02648.x⟩. ⟨hal-00631704⟩

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