Grimsdyke House, London, UK.
Int J Clin Pract. 2011 May;65(5):586-91. doi: 10.1111/j.1742-1241.2011.02648.x.
To investigate switching from thiazolidinediones, and predictors for switching treatment, after publication of a meta-analysis reporting an increased risk of myocardial infarction associated with rosiglitazone use.
Using the Health Information Network (THIN) UK primary care database, the number of people with type 2 diabetes prescribed either thiazolidinedione, rosiglitazone (n = 10,062) or pioglitazone (n = 4454), and the rate of switching from thiazolidinediones (n = 3301 and 1106, respectively), were computed for each month, May 2006 to January 2008. The probability of switching post-publication, May 2007 to January 2008, was modelled by logistic regression in a forward stepwise model. Variables included demographics, history of ischaemic heart disease (IHD), heart failure (HF) or stroke, risk factors for IHD, glucose-lowering and cardiovascular drug use, HbA(1c) and diabetes duration.
There was a sharp increase in switching from both thiazolidinediones in summer 2007; rosiglitazone prescription numbers then decreased while pioglitazone prescribing increased. Switching from rosiglitazone was associated with IHD [adjusted odds ratio (OR) 1.72; 95% confidence intervals (CI) 1.47-2.00], insulin treatment (OR 5.10; 95% CI 3.21-8.10), HF (OR 2.26; 95% CI 1.62-3.18), a recent sulphonylurea prescription (OR 1.33; 95% CI 1.17-1.51) gender (OR men vs. women 0.79; 95% CI 0.70, 0.90) and duration of therapy. Switching from pioglitazone was associated with HF (OR 3.05; 95% CI 1.77-5.26), duration of therapy, and number of glucose-lowering treatments.
Prescribing habits for both thiazolidinediones changed immediately following the safety warning. IHD was associated with switching from rosiglitazone; otherwise reasons for change appear to be complex, not directly related to the findings of the meta-analysis.
在发表荟萃分析报告罗格列酮使用与心肌梗死风险增加后，研究噻唑烷二酮类药物的转换及其转换治疗的预测因素。
使用英国健康信息网（THIN）初级保健数据库，计算了 2006 年 5 月至 2008 年 1 月期间，分别接受噻唑烷二酮类、罗格列酮（n = 10062）或吡格列酮（n = 4454）治疗的 2 型糖尿病患者人数（n = 3301 和 1106），以及噻唑烷二酮类药物的转换率（分别为每月和每月）。2007 年 5 月至 2008 年 1 月期间，使用向前逐步模型的逻辑回归对发布后的转换概率进行建模。变量包括人口统计学、缺血性心脏病（IHD）、心力衰竭（HF）或中风病史、IHD 危险因素、降血糖和心血管药物使用、HbA1c 和糖尿病病程。
2007 年夏季，两种噻唑烷二酮类药物的转换率均急剧上升；罗格列酮的处方数量随后下降，而吡格列酮的处方数量增加。与罗格列酮转换相关的因素包括 IHD[调整后的优势比（OR）1.72；95%置信区间（CI）1.47-2.00]、胰岛素治疗（OR 5.10；95%CI 3.21-8.10）、HF（OR 2.26；95%CI 1.62-3.18）、最近使用磺脲类药物（OR 1.33；95%CI 1.17-1.51）、性别（OR 男性与女性 0.79；95%CI 0.70，0.90）和治疗持续时间。与吡格列酮转换相关的因素包括 HF（OR 3.05；95%CI 1.77-5.26）、治疗持续时间和降血糖治疗次数。
安全性警告发布后，两种噻唑烷二酮类药物的处方习惯立即发生变化。IHD 与罗格列酮的转换有关；否则，转换的原因似乎很复杂，与荟萃分析的结果没有直接关系。
