Prescribing pattern of glucose lowering drugs in the United Kingdom in the last decade: a focus on the effects of safety warnings about rosiglitazone

Abstract

Aim In the last decade, new glucose lowering drugs (GLDs) have been launched, and also several warnings regarding their safety. The cardiovascular safety of thiazolidinediones (TZD) has been questioned. We analyzed the prescription pattern of GLDs from 2000 to November 2009 in the United Kingdom (UK) using the THIN database with special focus on the effects of the safety warnings about rosiglitazone issued in May 2007 and January 2008. Methods Annual prevalence and incidence of GLD prescriptions were measured. For TZD, the monthly prevalence and incidence of prescription were calculated from May 2006 to January 2009. The switching pattern around the FDA alert and the characteristics of subjects starting treatment with TZD before and after the alerts were observed. Results The prevalence of prescriptions of GLDs increased during the 10 year period, metformin increasing more than three times. Rosiglitazone prevalence showed an increased trend until May 2007, (2.3/1000 person‐years) and decreased thereafter (January 2009: 1.1/1000 person‐years). The use of pioglitazone increased surpassing rosiglitazone from April 2008 onwards. The incidence of rosiglitazone use decreased sharply after May 2007 (0.8/1000 person‐years). The prevalence of use of other therapies remained rather stable from 2000 to 2007 but increased afterwards. After May 2007, rosiglitazone users were increasingly switched to pioglitazone. There was an increased proportion of new users of pioglitazone with cardiovascular risk after the alerts. Conclusions The prescription of GLDs in the UK has increased in the last decade. For TZDs, it changed after May 2007 as well as the characteristics of the subjects treated with them.

Pioglitazone reduces cold-induced brown fat glucose uptake despite induction of browning in cultured human adipocytes: a randomised, controlled trial in humans

“…Data from The Health Improvement Network (THIN) primary care database in the UK suggest that these drugs accounted for over 3 prescriptions per 1000 personyears, with rosiglitazone making more than double the contribution of pioglitazone [36]. Within 18 months of publication of the meta-analysis questioning the cardiovascular safety of rosiglitazone [18], the number of rosiglitazone prescriptions halved and the number of pioglitazone prescriptions doubled [36].…”

“…Data from The Health Improvement Network (THIN) primary care database in the UK suggest that these drugs accounted for over 3 prescriptions per 1000 personyears, with rosiglitazone making more than double the contribution of pioglitazone [36]. Within 18 months of publication of the meta-analysis questioning the cardiovascular safety of rosiglitazone [18], the number of rosiglitazone prescriptions halved and the number of pioglitazone prescriptions doubled [36]. Overall, while the TZD prescription rate is lower now than in 2007, currently, 10% of all prescriptions for patients with type 2 diabetes in the THIN cohort are prescribed a TZD [37] and pioglitazone retains its position at the frontline of diabetes management [19,37].…”

Matrix Metalloproteinase-9 and Augmentation Index are Reduced with an 8-Week Green-Exercise Walking Programme

“…This suggests that the improvements observed in AIx in the current study (which suggest an improvement in endothelial function) may also occur as a result of exercise-induced activation of PPARγ. Thus, while due to an association with increased risk of death from CV causes [51], the prescription of RSG has fallen dramatically in recent years [52], exercise may provide a safe alternative to RSG as a method of inducing beneficial PPARγ-dependent effects [36,37]. Therefore, with regard to the current study's findings, we propose that an exerciseinduced activation of the nuclear receptor PPARγ may cause the observed down-regulation in the expression of the elastin-degrading gene MMP-9 (and also possibly improve endothelial function), which in turn may ameliorate physical inactivity-related vascular remodelling.…”

Drug Utilization Evaluation of Antidiabetic Drugs Among Type 2 Diabetes Patients of Tamil Nadu

“…According to the statement of the American Diabetes Association and European Association for the Study of Diabetes guidelines also endorses metformin is the first-line drug for Type 2 diabetes patients and has the lowest risk of hypoglycemia, it does not cause weight gain and weight loss, has the beneficial effect of lowering the lipid levels and available at a low cost [16,17]. The study conducted by different groups reported that an increase in the use of metformin and decrease in the use of sulfonylureas [18][19][20][21]. The addon therapy of sulfonylurea to metformin is the common procedure after the metformin fails to control glycemic levels, sulfonylureas have been associated with hypoglycemia, sometimes need of hospitalizations, particularly in elderly patients [22].…”