Katsuyama Hisayuki, Fukunaga Takayuki, Hamasaki Hidetaka, Adachi Hiroki, Moriyama Sumie, Kawaguchi Akiko, Mishima Shuichi, Sako Akahito, Yanai Hidekatsu
Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine Kohnodai Hospital, Chiba, Japan.
J Clin Med Res. 2016 Aug;8(8):585-90. doi: 10.14740/jocmr2611w. Epub 2016 Jul 1.
The aim of the study was to understand the influences of withdrawal or dose reduction of pioglitazone in patients with type 2 diabetes.
We retrospectively picked up patients who had undergone withdrawal or daily dose reduction of pioglitazone after a continuous prescription for 3 months or longer between January 2010 and March 2014. We compared the data before the withdrawal or dose reduction of pioglitazone with the data at 3 or 6 months after those by a chart-based analysis.
Among 713 patients taking pioglitazone at least once during the studied period, 20 patients had undergone withdrawal of pioglitazone (group A) and 51 patients had undergone daily dose reduction (group B). The mean pioglitazone dose at baseline was 23 mg in subjects of group A, and 30 mg in group B. The number of subjects who had taken high-dose metformin (≥ 1,000 mg) and dipeptidyl peptidase-4 (DPP-4) inhibitors increased after the withdrawal or dose reduction of pioglitazone in both groups. Although no significant change was observed in plasma glucose and HbA1c levels, body weight significantly decreased at 3 and 6 months after the dose reduction in group B. The same tendency was observed in group A. Serum high-density lipoprotein-cholesterol (HDL-C) levels significantly decreased at 3 and 6 months after the withdrawal in group A. The serum alanine aminotransferase levels significantly increased 3 months after the withdrawal in group A.
Present study demonstrated that the withdrawal of pioglitazone exacerbated serum HDL-C and liver function in patients with type 2 diabetes, although glycemic control could be maintained by using high-dose metformin or DPP-4 inhibitors.
本研究旨在了解2型糖尿病患者停用或减少吡格列酮剂量的影响。
我们回顾性选取了2010年1月至2014年3月期间连续服用吡格列酮3个月或更长时间后停药或每日减少剂量的患者。通过图表分析比较了吡格列酮停药或减药前的数据与停药或减药后3个月或6个月的数据。
在研究期间至少服用过一次吡格列酮的713例患者中，20例患者停用了吡格列酮（A组），51例患者进行了每日剂量减少（B组）。A组受试者基线时吡格列酮的平均剂量为23 mg，B组为30 mg。两组在停用或减少吡格列酮剂量后，服用高剂量二甲双胍（≥1000 mg）和二肽基肽酶-4（DPP-4）抑制剂的受试者数量增加。虽然血浆葡萄糖和糖化血红蛋白水平未观察到显著变化，但B组在减药后3个月和6个月时体重显著下降。A组也观察到相同趋势。A组在停药后3个月和6个月时血清高密度脂蛋白胆固醇（HDL-C）水平显著下降。A组在停药后3个月时血清丙氨酸氨基转移酶水平显著升高。
本研究表明，尽管使用高剂量二甲双胍或DPP-4抑制剂可维持血糖控制，但停用吡格列酮会加重2型糖尿病患者的血清HDL-C和肝功能。
