Older type 2 diabetes treatments such as metformin, glipizide, and glimepiride provide the same benefits as newer drugs but at a lower cost, according to Consumer Reports Best Buy Drugs.
“The evidence shows that lower-cost, older medicines work just as well for most people,” Consumer Reports Best Buy Drugs Project Director Gail Shearer said in a statement.
The report is based primarily on an analysis of effectiveness, risks, and estimated costs of 10 diabetes drugs conducted by the Agency for Healthcare Research and Quality.
Metformin, glipizide, and glimepiride are identified as “best buy” drugs by Consumer Reports, which points out those products cost only $10 to $60 a month, less than half the cost of rosiglitazone (Avandia, $131-$262), pioglitazone (Actos, $142-$221), or sitagliptin (Januvia, approximately $200).
While Consumer Reports also lists glipizide and glimepiride as best buys, the report “recommends that most people newly diagnosed with diabetes talk to their doctor about taking metformin first.”
Similarly, an executive summary of the AHRQ report notes that “physicians and patients can feel comfortable using older medications such as metformin and second-generation sulfonylureas, as monotherapy or in combination, before newer diabetes medications such as thiazolidinediones or meglitinides, especially when cost is a factor.”
Metformin was found in the AHRQ analysis to be as effective as other medications but was not associated with weight gain. “Weight increased by 1–5 kg with most of the oral diabetes medications (thiazolidinediones, second-generation sulfonylureas, and repaglinide), but not for metformin and acarbose [Precose], which had no effect on weight in placebo-controlled trials,” according to AHRQ.
The AHRQ report, combined with the promotion of metformin by Consumer Reports, could spell trouble for the already maligned thiazolidinedione drug class.
Rosiglitazone in particular has been under scrutiny since a meta-analysis published in the New England Journal of Medicine found a statistically significant increase in the risk of myocardial infarction and an increase in the risk of death from cardiovascular cases in patients treated with the drug. The AHRQ review was completed prior to the release of the meta-analysis.
The drug's manufacturer, GlaxoSmithKline, also is looking at cardiovascular outcomes in the Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycemia in Diabetes trial. The company has reported that the Food and Drug Administration considers the interim results from RECORD to be promising and suggested that they may contradict the observed safety signal.
According to the AHRQ analysis, “these new studies substantiate our call for more vigorous postmarketing surveillance and long-term comparative assessments of major clinical outcomes.”
Brooke McManus is a staff writer for Elsevier's “The Pink Sheet.”