title: New use of rosiglitazone decreased following publication of a meta-analysis suggesting harm.
abstract: OBJECTIVE
  It is uncertain whether meta-analyses lead to changes in prescribing practices. We studied trends in the prescribing of glucose-lowering therapy before and after the publication of a meta-analysis suggesting harm from rosiglitazone.
  
  
  METHODS
  We examined the prescription records of all residents of Ontario, Canada, aged > or = 66 years. For each week between January and December 2007, we identified new users of five categories of glucose-lowering medications: rosiglitazone, pioglitazone, metformin, glibenclamide (glyburide) and insulin. The effect of the meta-analysis was assessed using interventional autoregressive integrated moving-average models.
  
  
  RESULTS
  Following the release of the meta-analysis, there was a sudden decline in new users of rosiglitazone (P = 0.01), mirrored by a nearly identical but transient increase in new users of pioglitazone (P < 0.001). There was also a net decline in new users of thiazolidinediones as a class (P < 0.001). The number of new users of other glucose-lowering medications did not change.
  
  
  CONCLUSIONS
  A highly-publicized meta-analysis regarding rosiglitazone's potential harms led to an abrupt decline in new users of the drug, as well as a transient surge in new use of pioglitazone.
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: B R
authors.initials: BR
authors.lastname: Shah
authors.forename: D N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: P C
authors.initials: PC
authors.lastname: Austin
authors.forename: M M
authors.initials: MM
authors.lastname: Mamdani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D015201:Meta-Analysis as Topic; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects*
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone