Doctor’s still concerned about Avandia

A new report suggests that doctors are continuing to be increasingly concerned with regard to the safety and efficacy of Avandia, with that concern increasing nine-fold since the once-popular GlaxoSmithKline diabetes drug blasted into the headlines last spring.

It has been found that nearly three-quarters of physicians surveyed, and one-third of primary care physicians and endocrinologists have switched their patients away from Avandia to other products for the treatment of Type 2 diabetes.

It’s been a year since the blockbuster report in the New England Journal of Medicine of May 2007 sounded the alarm over Avandia. From a meta-analysis of several different trials, noted cardiologist Dr. Steven Nissen determined that Avandia held potential for a whopping 43 per cent increase in myocardial infarction, among other risks. Amidst a sea of headlines, prescriptions for Avandia dropped significantly in the weeks immediately following the publication of Nissen’s findings.

One year later, that trend appears to have continued. For ‘One Year Later-A Physician and Payer Perspective’, 74 US-based primary care physicians, 70 endocrinologists and 20 managed-care pharmacy directors were surveyed as to their thoughts, positions and recent prescription history regarding Avandia.

The report finds that after one year, the full impact of the Avandia debacle has yet to be felt. Beyond decisions made by physicians and the medical community in the year immediately following the Avandia revelations, 58 percent of primary care physicians (PCP) surveyed and 52 percent of endocrinologists maintain they will reduce their reliance, and their prescriptions for Avandia over the next year.

“Cardiovascular safety concerns have significantly impacted prescriptions for Avandia and created opportunities for other antidiabetic agents,” says Donny Wong, Ph.D., principal analyst at Decision Resources, which undertook the survey. “Nearly three-quarters of physicians say they have switched patients to Januvia as a result of the Avandia meta-analysis, and one-third of PCPs and endocrinologists say they have switched patients to Byetta following publication of the Avandia meta-analysis.

“Nevertheless, Takeda’s Actos will continue to be the market share leader among oral antidiabetic agents until the drug loses patent protection in 2011.”

Specifically, 80 percent of physicians surveyed indicat they will increase the number of prescriptions for Avandia competitor Januvia, manufacturerd by Merck, over the course of the next two years. Januvia was thought by respondents to present the best overall safety profile when combined with the lowest risk for hypoglycemia, and was number two in a top three list of preferred alternatives to Avandia.

Metformin, available in generic form as well as the branded product manufactured by Bristol-Meyers Squibb, was thought to have the best overall safety amongst clinicians and and managed care organizations surveyed. While Byetta, the diabetic drug made by Amylin and Eli Lilly was on the bottom rung, respondents nonetheless praised Byetta as the drug least-likely to foster weight gain.

The survey was published in the May 11th edition of Cardiovascular Device Liability Week.

Avandia was given a black box warning for Myocardial Ischemia and Congestive Heart Failure last November. However the product has remained on the market and no recall, either mandated or voluntary, has taken place.

Thus, a product largely thought harmful to many, remains on pharmacy shelves.