Pioglitazone and Rosiglitazone Have Different Effects on Lipids

Advantage goes to pioglitazone, according to the results of a large head to head comparison.

Pioglitazone and rosiglitazone – two members of the thiazolidinedione class of drugs – have markedly different effects on plasma lipids, with the advantage going to pioglitazone, according to results of a large head-to-head comparison of the two insulin-sensitizing agents.

"Pioglitazone compared with rosiglitazone is associated with significant improvements in triglycerides, HDL cholesterol, LDL particle concentration, and LDL particle size," Dr. Ronald B. Goldberg from the University of Miami School of Medicine and colleagues report in the paper.

Their 24-week study involved 802 adults with type 2 diabetes and dyslipidemia. Following a 4-week washout period during which patients discontinued their current diabetes medication and received a placebo, patients were randomized to receive either 30 mg of pioglitazone (Actos) once daily for 12 weeks followed by 45 mg once daily for the remainder of the study, or 4 mg of rosiglitazone (Avandia) once a day for 12 weeks followed by 4 mg twice daily for the remainder of the study.

"By eliminating other factors such as statins to control lipids and other medications to control blood glucose levels, we obtained a clear assessment of the blood sugar and lipid effects of both drugs," Dr. Goldberg noted in comments to Reuters Health.
Blood glucose control as measured by hemoglobin A1c improved significantly and comparably wit both pioglitazone and rosiglitazone treatment. At baseline, average HbA1c levels were 7.6% in the pioglitazone group and 7.5% in the rosiglitazone group. Following treatment, average A1C was reduced by 0.7 percent and 0.6 percent respectively, and mean A1C for both treatment groups was below the American Diabetes Association goal of less than 7%.

However, as mentioned, the two drugs differed significantly in their effects on blood lipids. Triglyceride levels fell 12.0% in the pioglitazone arm and rose 14.9% in the rosiglitazone arm (p < 0.001).

Both drugs increased HDL-C over time, but the mean changes from baseline were greater with pioglitazone than with rosiglitazone (+14.9 vs. +7.8%; p < 0.001).

Total cholesterol (TC) and LDL-C increased with both drugs, but to a lesser extent with pioglitazone. Total cholesterol and LDL-C rose 15.9% and 23.3%, respectively, in the rosiglitazone arm versus 5.7% and 15.7%, respectively, in the pioglitazone arm.

The lipid effects seen were independent of glycemic control and occurred without use of a traditional lipid-lowering statin medication.
Diabetes Care 2005;28:1547-1554

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