Reduced High-density Lipoprotein Cholesterol in Patients Receiving Rosiglitazone and Fenofibrate

Venero, Carmelo V.; Thompson, Paul D.; Fernández, Antonio B.

doi:10.1016/j.amjmed.2008.06.019

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…Given the prior reports of iatrogenic lowering of HDL-C with concomitant fenofibrate and TZD treatment (2,4,5,11–13), we examined the cross-sectional prevalence of low HDL-C among lipid trial participants at baseline (before initiation of fenofibrate treatment) and at postrandomization months 24 and 48, stratified by fenofibrate treatment assignment and TZD use at each time point (Table 2). At baseline, there was no difference in the prevalence of low HDL-C between the assigned lipid treatment groups (2.1% for those subsequently assigned to fenofibrate vs. 2.4% assigned to placebo) or between those receiving (1.5%) or not receiving a TZD (2.4%).…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, decreased HDL-C has also been reported with other fibrates (ciprofibrate and bezafibrate) with the sole exception being gemfibrozil (5). These case reports have shown that HDL-C returns to baseline levels after discontinuing either fibrate or TZD (11,18). Of note, HDL-C levels increased to >25 mg/dL in 73.1% of these ACCORD study participants after the site investigator received a laboratory alert containing instructions to discontinue TZD and/or fenofibrate.…”

Section: Discussionmentioning

confidence: 97%

“…This finding is concordant with the findings of a prior retrospective pharmacoepidemiologic survey of diabetic patients (17). On the other hand, although most case reports of HDL-C lowering involved combined treatment with fibrate and TZDs (5,11–13,16,18), this effect has also been observed with either TZD or fibrate treatment alone (5,16). Although rosiglitazone was the predominant TZD used in the ACCORD Lipid Trial, paradoxical HDL-C lowering has also been reported with other TZDs, including pioglitazone (5).…”

Section: Discussionmentioning

confidence: 99%

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Paradoxical Reduction in HDL-C With Fenofibrate and Thiazolidinedione Therapy in Type 2 Diabetes: The ACCORD Lipid Trial

et al. 2014

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OBJECTIVETo determine the occurrence of extremely low HDL cholesterol (HDL-C) among participants in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid Trial and to examine the relationship of this finding with treatment with fenofibrate and thiazolidinedione (TZD).RESEARCH DESIGN AND METHODSThe ACCORD Lipid Trial was a randomized, double-blind, placebo-controlled study conducted in patients with type 2 diabetes at 77 clinical centers across the U.S. and Canada in a 5,518-patient subset of the larger 10,251 ACCORD Glycemia Trial. Patients were enrolled from 11 January 2001 to 29 October 2005 and followed until the end of study visits between 1 March and 30 June 2009. Follow-up in the ACCORD Lipid Trial was 4–8 years (mean 4.7 years). Patients were treated with blinded fenofibrate or placebo on a background of simvastatin therapy. The main outcome measures for these descriptive, post hoc analyses was the occurrence of extremely low HDL-C (defined as <25 mg/dL [0.647 mmol/L]) during the trial.RESULTSAmong ACCORD Lipid Trial participants, the occurrence of extremely low HDL-C ever during study follow-up was 106% higher among those randomized to fenofibrate (10.1% fenofibrate vs. 4.9% placebo, P < 0.001). The occurrence of low HDL-C was associated with concurrent treatment with fenofibrate and TZD (7.0% for both vs. 2.2% for neither at 48 months postrandomization).CONCLUSIONSIdiosyncratic and marked reduction in HDL-C can occur in some patients treated with both fenofibrate and TZD. Practitioners should recognize this important potential idiosyncratic reaction and take appropriate corrective action.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Paradoxical Reduction in HDL-C With Fenofibrate and Thiazolidinedione Therapy in Type 2 Diabetes: The ACCORD Lipid Trial

et al. 2014

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“…Some patients had their HDL-c return to baseline values after withdrawing fibrates (2,6,8) while others after withdrawing TZDs (3,5,8), and also there were patients in which switching to pioglitazone (5-6) raised their HDL-c.…”

Section: Discussionmentioning

confidence: 99%

“…Both patients were receiving fenofibrate; one patient was prescribed troglitazone, whereas the other was prescribed rosiglitazone. Since then, several reports have been published, involving either rosiglitazone (3, 5,6,8) or pioglitazone (4,8) in combination with several fibrates, including bezafibrate (3-5), fenofibrate (3,5,6) and ciprofibrate, but not gemfibrozil.…”

Section: Discussionmentioning

confidence: 99%

Severe HDL-c reduction during rosiglitazone therapy in an obese woman with type 2 diabetes

Almeida¹,

Fedrizzi²,

Fedrizzi³

et al. 2010

Arq Bras Endocrinol Metab

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SUMMARYTreatment with rosiglitazone has been associated with severe paradoxical HDL-c reductions. To our knowledge, there are very few reports of this reaction occurring when patients are treated without the combination of a fibrate. A case of severe HDL-c lowering in a patient treated with rosiglitazone without a fibrate is presented. The patient has been treated at a private practice clinic in southern Brazil. A 64-year-old woman with a 2-year history of type 2 diabetes mellitus was referred to her endocrinologist in June 2008. Rosiglitazone 4 mg q.d. was prescribed. Nine months later, the patient experienced a 90.90% decrease of her HDL-c levels. Rosiglitazone was withdrawn and the HDL-c returned to baseline. This paradoxical HDL-c reduction is a potentially severe adverse event. Patients prescribed rosiglitazone should have their HDL-c levels measured before and during therapy. Arq Bras Endocrinol Metab. 2010;54(7):663-7 SUMÁRIOO tratamento com rosiglitazona tem sido associado a reduções paradoxais e severas no HDL-c. Há muito poucos relatos dessa reação ocorrendo em pacientes tratados com rosiglitazona sem a combinação com um fibrato. Apresentou-se um caso de diminuição severa no HDL-c em uma paciente tratada com rosiglitazona sem fibrato associado. A paciente foi tratada em uma clínica privada no Sul do Brasil. Uma mulher de 64 anos com história de diabetes melito tipo 2 há 2 anos foi encaminhada ao seu endocrinologista em junho de 2008. Prescreveu-se rosiglitazona 4 mg uma vez ao dia. Nove meses depois, a paciente teve redução de 90,90% em seus níveis de HDL-c. A rosiglitazona foi retirada e o HDL-c retornou aos níveis prévios. Essa redução paradoxal do HDL-c é um evento adverso potencialmente severo. Pacientes aos quais se prescreve rosiglitazona devem ter seus níveis de HDL-c medidos antes e durante o tratamento.

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Thiazolidinediones

2016

Meyler's Side Effects of Drugs

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Reduced High-density Lipoprotein Cholesterol in Patients Receiving Rosiglitazone and Fenofibrate

Cited by 7 publications

References 6 publications

Paradoxical Reduction in HDL-C With Fenofibrate and Thiazolidinedione Therapy in Type 2 Diabetes: The ACCORD Lipid Trial

Paradoxical Reduction in HDL-C With Fenofibrate and Thiazolidinedione Therapy in Type 2 Diabetes: The ACCORD Lipid Trial

Severe HDL-c reduction during rosiglitazone therapy in an obese woman with type 2 diabetes

Thiazolidinediones

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