Pioglitazone is a forgotten hypoglycemic drug with proven cardioprotective and nephroprotective properties

Pesheva, Ekaterina D.; Фадеев, В. В.

doi:10.26442/20751753.2021.4.200892

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…Механизм действия метформина направлен на повышение скорости утилизации глюкозы мышцами за счет активации анаэробного гликолиза, а также угнетение глюконеогенеза, а пиоглизатон улучшает чувствительность к инсулину непосредственно за счет активации рецепторов PPARγ (peroxisome proliferator-activated receptor (рецепторы, активируемые пероксисомными пролифераторами)), которые экспрессируются в адипоцитах, печени и скелетных мышцах. Их активация обуславливает повышение экспрессии транспортеров глюкозы GLUT-1 и GLUT-4 на мембранах клеток печени и скелетной мускулатуры, что приводит к увеличению поглощения свободных жирных кислот и отложению их в подкожной жировой ткани [ 14 ].…”

Section: Discussionunclassified

Toxic manifestations of alpelisib in endocrinology. Description of the clinical case

Kudaeva,

Kozhedub,

Kupryshina

et al. 2023

Probl Endokrinol (Mosk)

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Breast cancer (BC) is a serious disease and is considered an important health problem worldwide. The prevalence of the disease in women according to Rosstat was 64,951 cases in the Russian Federation in 2020 (21.7% among all types of cancer). Hormone-dependent estrogen receptor-positive (HR+), human epidermal growth factor receptor type 2 negative (HER2-) metastatic breast cancer (mBC) accounts for 70% of all cases. About 40% of patients with ER+/HER2- mBC have mutations in the PIK3CA gene, leading to hyperactivation of the alpha isoform (p110α) of phosphatidylinositol 3-kinase (PI3K). Hormonal therapy with or without cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitor is considered the standard treatment for patients with ER+/HER2- mBC. However, acquired resistance to this therapy remains a problem. Innovative methods for the treatment of breast cancer are the use of targeted therapeutic agents aimed at direct inhibition of the PI3K pathway in combination with hormone therapy. Alpelisib is a PI3Kα-specific inhibitor. Hyperglycemia is the most common side effect of alpelisib treatment. Currently, there is a consensus on the prevention and correction of hyperglycemia in patients receiving therapy with alpelisib, which recommends that before starting therapy, in order to diagnose carbohydrate metabolism disorders and assess the risk of developing hyperglycemia, determine in all patients: the level of glycated hemoglobin (HbA1c), glucose fasting plasma (FPG), body mass index (BMI). And also to evaluate such risk factors as the presence of a family history of type 2 diabetes mellitus (DM 2), the presence of gestational diabetes in the patient’s history, or the fact of the birth of children weighing more than 4 kilograms.Recently, new combinations of drugs have been actively used to treat disorders of carbohydrate metabolism, such as pioglitazone + metformin. This paper discusses the mechanism of action of PI3K inhibitors, new therapeutic combinations and their undesirable effects, and presents therapeutic experience.

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Section: Discussionunclassified

Toxic manifestations of alpelisib in endocrinology. Description of the clinical case

Kudaeva,

Kozhedub,

Kupryshina

et al. 2023

Probl Endokrinol (Mosk)

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Long-term results of transferring the patient from therapy with glucagon-like peptide-1 receptor agonists in combination with metformin to a dipeptidyl peptidase-4 inhibitor in combination with pioglitazone and inhibitor of type 2 sodium-glucose cotransporter in type 2 diabetes

Salukhov,

Shipilova,

Minakov

2024

Diabetes mellitus

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The pioglitazone belongs to the class of antidiabetic medications and has various pleiotropic effects. The evidence base for this medication, based on the results of randomized clinical trials, demonstrates convincing cardio- and cerebroprotective efficacy of pioglitazone, comparable to innovative glucose-lowering drugs from the classes of GLP-1 agonists and SGLT-2 inhibitors. Currently, in Russia, a fixed combination of pioglitazone and alogliptin is available. However, it should be noted that there has been a recent lack of GLP-1 agonists on the domestic pharmaceutical market, which raises questions about the choice of further tactics for patients who have been taking them until recently.This clinical case presents an example of the transformation of glucose-lowering therapy from a combined treatment regimen with semaglutide and metformin to the combined use of a fixed combination of alogliptin and pioglitazone with empagliflozin. Against the background of therapy change, a stable and pronounced glucose-lowering effect was obtained and confirmed after six months, comparable to GLP-1 receptor agonists without the effect of escape and hypoglycemia. No edema or weight gain was observed, and no other adverse events were detected, which allowed continuing the chosen glucose-lowering therapy. Strategic perspectives of the prescribed therapy were determined — reducing cardio- and cerebrovascular risk and improving the patient’s prognosis.

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Rethinking the role of pioglitazone in modern diabetology as a cardiorenoprotective agent

Салухов

Kovalevskaya

2022

Medicinskij sovet

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Thiazolidinediones are insulin sensitizers – a class of antidiabetic drugs that reducing insulin resistance, convincingly improve glycemic control in patients with type 2 diabetes. In addition to glucose-reducing action, a representative of this class – pioglitazone in studies demonstrates other pleiotropic effects associated with a decrease in blood pressure, a decrease in the level of pro-inflammatory cytokines and prothrombotic factors, correction of dyslipidemia and improving the state of the vascular wall. In accordance with these anti-atherogenic and metabolic effects of pioglitazone in patients with confirmed cardiovascular diseases, he reduced the frequency of development of large atherosclerotic events in prospective randomized clinical studies (studies of PROactive and IRIS), as well as in meta-analyses of all published studies of pioglitazone. Pioglitazone reduces albuminuria and proteinuria, mortality from all causes and cardiovascular events in patients with diabetes and chronic kidney disease. In other studies, the intake of pioglitazone was associated with mobilization of fat from liver in patients with non-alcoholic fatty liver disease with an improvement in its function and a positive effect on fibrosis. This article also provides an analysis of unwanted phenomena that were noted during the study of pioglitazone. The identified weight increase, swelling, bone fractures of the limbs, have a rare frequency of occurrence and dose-dependent nature. Indeed, when using low doses of pioglitazone (7.5–30 mg/day), the ratio of benefit/risk for the drug seems very favorable. At the same time, the benefits of pioglitazone with a significant improvement in cardiovascular and cerebrovascular outcomes are higher with secondary than with primary prevention in patients with both 2TDM and prediabetes/insulin resistance, most likely due to positive effects on atherosclerosis

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Pioglitazone is a forgotten hypoglycemic drug with proven cardioprotective and nephroprotective properties

Cited by 4 publications

References 22 publications

Toxic manifestations of alpelisib in endocrinology. Description of the clinical case

Toxic manifestations of alpelisib in endocrinology. Description of the clinical case

Long-term results of transferring the patient from therapy with glucagon-like peptide-1 receptor agonists in combination with metformin to a dipeptidyl peptidase-4 inhibitor in combination with pioglitazone and inhibitor of type 2 sodium-glucose cotransporter in type 2 diabetes

Rethinking the role of pioglitazone in modern diabetology as a cardiorenoprotective agent

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