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Study Sugests Pioglitazone May Also Have Beneficial Effect on Lipid Levels
"These data suggest that people with type 2 diabetes on a statin who switch from Avandia to ACTOS may realize incremental benefits to their lipid levels," said Robert Spanheimer, M.D., medical director for diabetes and metabolism at Takeda Pharmaceuticals North America. "Additionally, these results build on the growing body of evidence that ACTOS can confer benefits beyond blood glucose reduction: it can increase HDL and lower triglycerides. Low HDL cholesterol and elevated triglycerides represent cardiovascular risk factors for patients with type 2 diabetes."
Diabetic dyslipidemia, a risk factor for cardiovascular disease, is a profile of lipid abnormalities typically seen in people with type 2 diabetes. The pattern consists of elevated triglycerides, reduced levels of HDL cholesterol, normal or slightly-elevated levels of total and LDL cholesterol, and a shift toward smaller and denser LDL cholesterol particles. While dyslipidemia (irregularity of the lipid profile) also occurs in people who do not have diabetes, the specific abnormalities in the lipoprotein pattern characteristic of diabetic dyslipidemia appear to add excess risk for people with diabetes.
"What is unique about diabetic dyslipidemia is that lipid profiles may show normal levels of LDL, yet lower HDL and increased triglycerides that single lipid therapy alone may not address," noted Dr. Spanheimer.
Study Background and Design
Previously reported results from a head-to-head, randomized, controlled study showed that ACTOS significantly improved lipid levels to a greater extent than Avandia. COMPLEMENT was designed to determine whether these effects would remain if patients were on a statin " currently a recommended therapy for people with diabetic dyslipidemia" in addition to ACTOS or Avandia. ACTOS and Avandia are members of a class of drugs called thiazolidinediones (TZDs) that reduce blood glucose levels by targeting insulin resistance, a core metabolic dysfunction of type 2 diabetes.
The multicenter, single-arm, 17-week, open-label study enrolled 305 people with type 2 diabetes taking statins (with or without other lipid-lowering drugs) along with Avandia alone or in combination with another oral anti-diabetic drug. Patients were then switched to ACTOS (30 mg QD, titrated to 45 mg QD at investigator discretion), while maintaining their statin with or without other lipid-lowering therapy. Blood glucose and lipid levels (including fasting triglycerides, total cholesterol, LDL cholesterol and HDL cholesterol) were measured at the start of the study when patients were on Avandia, and during the time the patients were on ACTOS.
The results, which were presented in the form of several abstracts at the ADA meeting, showed ACTOS significantly lowered lipid levels when patients were switched from Avandia. Additionally, the effects were seen regardless of age or gender, or if patients took fenofibrate in addition to statin therapy. These improvements were consistent with those observed in the previous head-to-head study. Specifically:
- Triglycerides were reduced by nearly 21 percent (P
- LDL-C decreased by 1.1 percent (P=0.040),
- HDL-C: Mean HDL particle concentration increased 3.8 Î¼mol/L, and mean levels of Apo A1, a component necessary for HDL-C metabolism and biosynthesis, increased by 9.7 mg/dL.
- LDL/VLDL: Mean LDL particle size increased 0.23 nm and mean LDL particle concentration decreased 189 nmol/L, indicating there were fewer LDL particles and they were larger and more buoyant without an increase in LDL. Mean VLDL particle concentration decreased 44.9 nmol/L. Additionally, mean levels of Apo B, a component of atherogenic lipoproteins, including LDL and VLDL-C, decreased by 2.6 mg/dL.
"These changes in the particle size and composition of good and bad cholesterol particles are quite interesting," continued Dr. Spanheimer. "In patients with type 2 diabetes, a lipid profile characterized by higher levels of large, more buoyant LDL particles may provide less risk than a profile characterized by smaller, dense LDL particles. "
About ACTOS® (pioglitazone HCl)
ACTOS works by directly targeting insulin resistance, a condition in which the body does not efficiently use the insulin it produces to control blood glucose levels. ACTOS is taken once daily as an adjunct to diet and exercise, and is approved for use for type 2 diabetes as monotherapy to lower blood glucose and in combination therapy with insulin, sulfonylureas or metformin.
Source: Takeda Pharmaceuticals North America