Rosiglitazone, myocardial ischemic risk, and recent regulatory actions.
OBJECTIVE
To review the evidence surrounding rosiglitazone and ischemic cardiovascular risk and discuss the Food and Drug Administration (FDA) decision to revise safety information and restrict access to the drug.


METHODS
A literature search was conducted through MEDLINE (1950-January 2012), PubMed (1966-January 2012), and International Pharmaceutical Abstracts (1970-December 2011) using the search terms rosiglitazone and cardiovascular risk. Regulatory documents from the FDA and the Center for Drug Evaluation and Research, as well as reference citations from publications identified, were reviewed.


METHODS
All articles in English identified from the data sources were evaluated for inclusion.


RESULTS
Literature regarding rosiglitazone and ischemic cardiovascular risk has shown inconsistent results. Meta-analyses by the FDA, GlaxoSmithKline, and several independent research groups suggest an increased risk for myocardial infarction (MI), while others have not. Long-term, controlled trials not designed to evaluate cardiovascular outcomes did not find a significant increase in cardiovascular events and had low event rates overall. The RECORD (Rosiglitazone Evaluated for Cardiovascular Outcomes in Oral Agent Combination Therapy for Type 2 Diabetes) trial is the only prospective randomized trial to date designed to evaluate cardiovascular outcomes of rosiglitazone; the results were limited because of issues with study design and event adjudication. The only direct comparisons between rosiglitazone and pioglitazone are observational studies in which pioglitazone had a more favorable MI risk profile.


CONCLUSIONS
Data involving rosiglitazone and an association with ischemic cardiovascular risk have yielded variable results. The FDA made the decision to restrict access to rosiglitazone in September 2010 by requiring GlaxoSmithKline to submit a risk evaluation and mitigation strategy (REMS). Drug labeling was revised in February 2011, and the rosiglitazone REMS program took full effect in November 2011.
PGY2 Ambulatory Care Resident, University of Georgia, Athens, USA. bourgc@uga.edu
Catherine A
CA
Bourg
Beth Bryles
BB
Phillips
D004348:Drug Labeling; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects*; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000453:epidemiology; D012306:Risk; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000009:adverse effects*; D014481:United States; D014486:United States Food and Drug Administration
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077154:Rosiglitazone