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A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia

Response to Goldberg et al.

From the Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington

Address correspondence to John D. Brunzell, Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, 1959 NE Pacific St., Box 356426, Seattle, WA 98195-6426. E-mail: brunzell{at}u.washington.edu

Goldberg et al. (1) report a randomized comparison of the effects of two thiazolidinediones (TZDs), pioglitazone (Actos) and rosiglitazone (Avandia), on lipid and lipoprotein levels in individuals with diabetes treated with diet and/or oral monotherapy. Many changes in these lipids and lipoproteins seemed to be in favor of pioglitazone. Two important pieces of information were not included in the published study.

First, 80% of subjects were termed completers. Completers were defined as those who had at least one blood sample drawn on a TZD. If they quit the study, this last observation was carried forward for final analysis. It is possible that a number of subjects dropped out while on the initial dose of the respective TZD and would be a completer. By study design, this would enrich the population with subjects on two-thirds of the final dose of pioglitazone (30 of 45 mg/day) compared with one-half of the final dose (4 of 8 mg) of rosiglitazone. The authors should provide data about subjects remaining in the study at each visit to evaluate the possibility of outcome differences in lipids due to differences in relative drug dose. Perhaps it would be of interest to report the relevant data of those on each drug who actually completed all planned visits in the study.

Second, what were HDL subfraction responses as determined by nuclear magnetic resonance? Was there a similar response of big, intermediate, and small HDL particles? Some of the lipoprotein and lipid changes seen with pioglitazone appear to be those that would be expected as a peroxisome proliferator–activated receptor- effect. What was the response of big and intermediate size HDL, those that are antiathergenic (2), and the small HDL that are less antiatherogenic?

Footnotes

J.D.B. has been a member of advisory boards for and has received consulting fees from GlaxoSmithKline, Novartis, Sanofi-Aventis, and Ligand Pharm.

References

1. Goldberg RB, Kendall DM, Deeg MA, Buse JB, Zagar AJ, Pinzaire JA, Tan MH, Kahn MA, Perez AT, Jacober SJ, the GLAI Study Investigators: A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes and dyslipidemia. Diabetes Care28 :1547 –1554,2005[Abstract/Free Full Text]
   
2. Freedman DS, Otvos JD, Jeyarajah EJ, Baboriak JJ, Anderson AJ, Walker JA: Relation of lipoprotein subclasses as measured by proton nuclear magnetic spectroscopy to coronary artery disease. Arterio Thromb Vasc Biol18 :1046 –1053,1998[Abstract/Free Full Text]
   

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				R. B. Goldberg, D. M. Kendall, M. A. Deeg, J. B. Buse, A. J. Zagar, J. A. Pinaire, M. H. Tan, M. A. Khan, A. T. Perez, S. J. Jacober, et al. A Comparison of Lipid and Glycemic Effects of Pioglitazone and Rosiglitazone in Patients With Type 2 Diabetes and Dyslipidemia: Response to Bell and Brunzell Diabetes Care, December 1, 2005; 28(12): 2985 - 2986. [Full Text] [PDF]

This Article Extract Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brunzell, J. D. Search for Related Content PubMed PubMed Citation Articles by Brunzell, J. D. Social Bookmarking                What's this?