Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin

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Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin

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Title: Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin
Author: Dormuth, Colin R.; Maclure, Malcolm; Carney, Greg; Bassett, Ken; Schneeweiss, Sebastian; Wright, James M.

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Citation: Dormuth, Colin R., Malcolm Maclure, Greg Carney, Sebastian Schneeweiss, Ken Bassett, and James M. Wright. 2009. Rosiglitazone and Myocardial Infarction in Patients Previously Prescribed Metformin. PLoS ONE 4(6): e6080.
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Abstract: Objective: Rosiglitazone was found associated with approximately a 43% increase in risk of acute myocardial infarction (AMI) in a two meta-analyses of clinical trials. Our objective is to estimate the magnitude of the association in real-world patients previously treated with metformin. Research Design and Methods: We conducted a nested case control study in British Columbia using health care databases on 4.3 million people. Our cohort consisted of 158,578 patients with Type 2 diabetes who used metformin as first-line drug treatment. We matched 2,244 cases of myocardial infarction (AMI) with up to 4 controls. Conditional logistic regression models were used to estimate matched odds ratios for AMI associated with treatment with rosiglitazone, pioglitazone and sulfonylureas. Results: In our cohort of prior metformin users, adding rosiglitazone for up to 6 months was not associated with an increased risk of AMI compared to adding a sulfonylurea (odds ratio [OR] 1.38; 95% confidence interval [CI], 0.91–2.10), or compared to adding pioglitazone (OR for rosi versus pio 1.41; 95% CI, 0.74–2.66). There were also no significant differences between rosiglitazone, pioglitazone and sulfonylureas for longer durations of treatment. Though not significantly different from sulfonylureas, there was a transient increase in AMI risk associated with the first 6 months of treatment with a glitazone compared to not using the treatment (OR 1.53; 95% CI, 1.13–2.07) Conclusions: In our British Columbia cohort of patients who received metformin as first-line pharmacotherapy for Type 2 diabetes mellitus, further treatment with rosiglitazone did not increase the risk of AMI compared to patients who were treated with pioglitazone or a sulfonylurea. Though not statistically significantly different compared from each other, an increased risk of AMI observed after starting rosiglitazone or sulfonylureas is a matter of concern that requires more research.
Published Version: doi:10.1371/journal.pone.0006080
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