A BMJ investigation into the top-selling diabetes drug rosiglitazone (Avandia) raises concerns about its safety and the whole system by which drugs are evaluated, regulated, and promoted around the
world.
BMJ Editor in Chief, Dr Fiona Godlee,
believes that the drug should not have been licensed and should now be
withdrawn. She also calls for more robust regulatory processes and better
access to the raw data used to license drugs to allow scrutiny by the
scientific community.
The investigation reveals that in July the
Commission on Human Medicines advised the MHRA to withdraw the drug as the
“risks of rosiglitazone outweigh its benefits and that it no longer has a place
on the UK market”.
In light of these concerns, doctors are also
advising that no new patients should be started on rosiglitazone, and patients
already taking it should be reviewed and alternative treatments considered.
Those at higher risk of heart disease should be advised to stop taking the
drug.
Rosiglitazone, manufactured by Glaxo
SmithKline (GSK) was approved by the US Food and Drug Administration (FDA) in
1999 and by the European Medicines Agency (EMA) in 2000 to help lower blood
sugar levels in patients with type 2 diabetes.
Since its approval, several studies have
suggested that rosiglitazone may lead to a small overall increase in the risk
of heart attacks, but in July an FDA scientific advisory panel recommended that
it was safe enough to stay on the market.
In her report, Dr Deborah Cohen
investigations editor of the BMJ, obtained documents under the Freedom of
Information Act that note a paucity of evidence during the European approval
process and outline concerns from some panel members about the long term risks
and benefits of rosiglitazone. Other experts have since remarked on the poor
evidence base and lack of long term data on cardiovascular safety.