Clinicians do not lack for alternative therapies if patients with type 2 diabetes ask to be switched from rosiglitazone (Avandia, GlaxoSmithKline) to another glucose-lowering medication, according to the American Diabetes Association (ADA) and 2 other expert groups. The drug is again under increased scrutiny over cardiovascular risks.

Dr. Bergenstal, who also is executive director of the International Diabetes Center at Park Nicollet Health Services in St. Louis Park, Minnesota, said published clinical algorithms can guide physicians in selecting the right drug or combination of drugs. Such algorithms, he said, take into account factors such as efficacy, the risk for hypoglycemia, weight gain, and other adverse effects, as well as cost.

Regardless of the FDA’s verdict, physicians and patients alike should know that there are multiple classes of drugs, often with more than 1 agent in a class, that can be used to maintain glucose control in patients with type 2 diabetes, according to the statement by the ADA, ES, and AACE:

• sulfonylureas,
• meglitinides,
• biguanides,
• thiazolidinediones,
• alpha-glucosidase inhibitors, and
• dipeptidyl peptidase-4 inhibitors.

Switching to a New Diabetes Drug Could Pose Greater Risks

The joint statement from the ADA, AACE, and ES informs clinicians and patients that they have alternatives to rosiglitazone but does not advise physicians to automatically switch patients from this drug to something else. That advice echoes that of Daniel Einhorn, MD, the president of the AACE and medical director of the Scripps Whittier Diabetes Institute in La Jolla, California.

“So far, there is no FDA signal to discontinue the drug,” he said. “All we can say is that serious safety questions have been raised. If you’ve done well on Avandia for years, why switch to another drug that may come with more risks for you?”

At the same time, Dr. Einhorn said he is no longer writing new prescriptions for rosiglitazone while the drug is under FDA review, and he doubts that any other physicians are writing them. He acknowledged that the status of the drug is confusing for clinicians, but then, so are the safety data that the FDA advisory committee heard.

“If the data was clear,” said Dr. Einhorn, “we wouldn’t be having this discussion.”

Read more: http://www.medscape.com/viewarticle/725422?src=mp&spon=34