How safe is the use of thiazolidinediones in clinical practice?

Rizos, Christos V.; Elisaf, Moses; Mikhailidis, DP; Liberopoulos, Evangelos N.

doi:10.1517/14740330802597821

Cited by 145 publications

(85 citation statements)

References 147 publications

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“…We are aware that PPAR-g agonists cannot be easily employed in the clinical practice of PD, at least for long-term treatments, because several adverse effects have been described for these drugs. 60 This issue is particularly important in patients with end-stage renal diseases who obviously have impoverished renal clearance capacity. 61 However, RSG may be considered as a safe drug for use in uremic status because it is metabolized in the liver and thus, the accumulation of the drug and the risk of severe and prolonged hypoglycemia are minimized.…”

Section: Discussionmentioning

confidence: 99%

PPAR-γ agonist rosiglitazone protects peritoneal membrane from dialysis fluid-induced damage

Sandoval

Loureiro

González-Mateo

et al. 2010

Laboratory Investigation

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Section: Discussionmentioning

confidence: 99%

PPAR-γ agonist rosiglitazone protects peritoneal membrane from dialysis fluid-induced damage

Sandoval

Loureiro

González-Mateo

et al. 2010

Laboratory Investigation

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“…Frequently noticed side effects of TZDs include edema, weight gain, macular edema, and heart failure. Furthermore, TZDs tend to increase low-density lipoprotein cholesterol levels (37). Rosiglitazone may even be associated with a higher risk of myocardial infarction and death due to cardiovascular causes (38), but the RECORD study only confirmed the increased risk of heart failure (39).…”

Section: Discussionmentioning

confidence: 99%

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Kroese

Mooij

Hermus³

et al. 2009

European Journal of Endocrinology

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Context: Patients with congenital adrenal hyperplasia (CAH) are chronically treated with supraphysiological doses of glucocorticoids, which are known to induce insulin resistance. Thiazolidinediones might reverse this effect and improve insulin sensitivity. Objectives: To assess insulin sensitivity in CAH patients and the effect of pioglitazone treatment on insulin sensitivity in CAH patients. Secondary objectives were the effects of treatment with pioglitazone on blood pressure, body fat distribution, lipid, and steroid profiles. Design: Randomized placebo controlled crossover trial. Participants: Twelve CAH patients and 12 body mass and age-matched control subjects. Intervention: Sixteen-week treatment with pioglitazone (45 mg/day) or placebo. Main outcome measure: Insulin sensitivity measured by euglycemic clamp and oral glucose tolerance test. Further measures were 24-h blood pressure profiles, body fat distribution measured by magnetic resonance imaging, dual energy x-ray absorptiometry (DEXA) and bioimpedance procedures, liver fat by magnetic resonance spectroscopy, lipid, and steroid profiles. Results: CAH patients were insulin resistant compared with healthy controls. Treatment with pioglitazone significantly improved insulin sensitivity in CAH patients (glucose infusion rate (GIR) from 28.5G11.6 to 38.9G11.0 mmol/kg per min, PZ0.000, GIR in controls 46.2G23.4 mmol/kg per min, P!0.05 versus CAH). Treatment with pioglitazone decreased blood pressure (systolic: 124.0G13.6 vs 127.0G14.9 mmHg, P!0.001, diastolic: 72.8G11.5 vs 77.4G12.6 mmHg, P!0.001). No changes in body fat distribution, lipid, and steroid profiles were observed. Conclusions: CAH patients are insulin resistant compared with matched control subjects. Treatment with pioglitazone improves insulin sensitivity and decreases blood pressure in CAH patients.

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“…Las glitazonas (tiazolidinedionas) son antidiabéticos orales frecuentemente utilizados en el tratamiento de la diabetes tipo 2 y del ovario poliquístico; así en 2003 se estimó su facturación en 5 billones de dólares [1][2][3] . Incluyen dos fárma-cos la pioglitazona y la rosiglitazona.…”

Section: Discussionunclassified

“…La rosiglitazona actúa aumentando en los tejidos diana la sensibilidad a la insulina, así como disminuyendo la gluconeogénesis hepática 1 . Se calcula que hasta el 15% de los pacientes desarrollan retención de fluidos especialmente si se asocian con insulina, y algunos de ellos presentan alteraciones visuales secundarias a edema macular [1][2][3] . En el edema macular se produce un aumento de la permeabilidad de los vasos retinianos.…”

Section: Discussionunclassified

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Edema macular por tratamiento con rosiglitazona en diabetes mellitus

Asensio-Sánchez

Gómez-Ramírez

2010

Arch Soc Esp Oftalmol

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Caso clínico: Mujer de 61 años diabética tipo 2 de 7 años de evolución en tratamiento con insulina. Se añade rosiglitazona (4 mg al día) para conseguir un control glucémico adecuado. Un mes después, la paciente presenta edema generalizado y pérdida de visión. El estudio fundoscópico mostró edema macular bilateral. En la exploración sistémica destacaban edemas periféricos. La rosiglitazona fue suspendida y la paciente fue tratada de forma conservadora, con resolución rápida de los edemas periféricos pero no de los maculares.Discusión: Este caso nos indica la importancia de identificar los efectos secundarios de las glitazonas. El tratamiento con glitazonas puede causar edema macular que podría permanecer aun después de su supresión. Case report: A 61-year-old woman with type 2 diabetes mellitus for 7 years for which she was prescribed insulin therapy. Rosiglitazone (4 mg once daily) was introduced with adequate blood glucose control. One month later, she presented with complaints of systemic oedema and loss of vision. Fundoscopy showed bilateral macular oedema. A systemic study demonstrated peripheral oedema. Rosiglitazone was stopped and she was managed conservatively with a rapid resolution of the oedemas and at fundus examination there was no decrease in the macular oedema. Macular oedema due to rosiglitazone treatment in diabetes mellitusDiscussion: This case reminds us of the importance of identifying potential toxicities of glitazone regimens. Glitazone use appears to be a cause of macular oedema, and stopping the drug may not resolve this oedema.

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How safe is the use of thiazolidinediones in clinical practice?

Cited by 145 publications

References 147 publications

PPAR-γ agonist rosiglitazone protects peritoneal membrane from dialysis fluid-induced damage

PPAR-γ agonist rosiglitazone protects peritoneal membrane from dialysis fluid-induced damage

Pioglitazone improves insulin resistance and decreases blood pressure in adult patients with congenital adrenal hyperplasia

Edema macular por tratamiento con rosiglitazona en diabetes mellitus

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