Actos, released this summer by Lilly and Co. in collaboration with Takeada Pharmaceuticals, is the latest of the oral agents for treatment of diabetes. Actos whose chemical name is pioglitazone, is part of the new class of diabetes fighting drugs called “glitazones”. Other drugs in this class are Rezulin(Parke Davis/Sankyo) and Avandia (Bristol Myers Squibb). Glitazones work by making the body more sensitive to insulin. This is important because diabetes develops in up to 92% of Type 2 Diabetics (adult onset variety) due to an impairment of the body’s ability to utilize the insulin already in the blood. This defect is called insulin resistance and is a genetically determined (inherited) characteristic. Certain drugs such as steroids (Prednisone, cortisone) can make insulin resistance worse as can obesity.
Use alone or in combination
Actos can be used alone or in combination with a variety of other diabetes treatments. Many diabetics are already taking pills of a type known as sulfonylureas, including Glucotrol, Amaryl, Prandin, Micronase and Diabeta. Glitazones such as Actos can be combined with these to create an enhancement of the blood sugar lowering effect. What’s more Actos can be combined with the other classes of anti-diabetes drugs including Glucophage (metformin) and even insulin itself. Some Type 2 diabetics who are taking insulin can have their insulin doses reduced or even eliminated after starting Actos.
Generally safe to use
The first glitazone released over 2 years ago, Rezulin, received a lot of negative attention due to its association with a rare but potentially lethal side effect of liver failure. Fortunately there is no indication so far that the two newest glitazones, Actos and Avandia, produce this complication. Both new glitazones can cause fluid retention and should be used with great caution in individuals with heart failure.
Can improve cholesterol levels
An additional benefit to Actos is its ability to improve the abnormal cholesterol (lipid) profile usually seen with Type 2 diabetes. High triglyceride levels with low HDL (good cholesterol) and high LDL (bad cholesterol) is a common combination of lipid abnormalities in diabetics. Actos has been shown to lower triglyceride levels by about 10%, raise HDL by about 20% and have a neutral effect on LDL. Only Rezulin has shown similar beneficial effects among the glitazones.
Actos is a great addition to the available drugs for treatment of diabetes. As always, consult with your health care provider before embarking on any changes in your treatment regime.
We gratefully acknowledge that this page is supported in part by a grant from the Eli Lilly company
For more information about Actos, visit the Actos web site at http://www.actos.com/
Today’s NY Times carries a front page article about the dangers of Actos and Avandia, two popular diabetes medications. The reason behind the news story is that the FDA has finally required the two companies that make these diabetes drugs to carry a “black box” warning (the strongest labeling warning that can be applied) about the potential for congestive heart failure (overload of fluid in the heart and lungs) in diabetics using these drugs. Is this warning really news? Not to doctors.
I have been to numerous seminars on the use of these two diabetes drugs and have been paid by the companies that manufacture these drugs to educate other health care professionals about the use and hazards of these drugs. Both companies gave all representatives and speakers the strictest instructions regarding their obligation to carefully mention the potential for fluid overload and congestive heart failure associated with the use of these drugs. I know that my colleagues, particularly the cardiologists (heart doctors) and endocrinologists (diabetes doctors), have been acutely aware of this information for years.
Did you know that the type of drugs known as sulfonylureas that have been used to treat diabetes since the 1960’s and remain popular today carry a “black box” warning since the 1970’s about the potential for causing heart disease? This class of drug include Diabinese, Orinase, DiaBeta, Micronase, glyburide, and glipizide. Why are these drugs still in widespread use, and where are the stories notifying the public about this? What’s the big deal about the black box warning on Actos and Avandia?
I think I smell some politics going on. The Commissioner of the FDA, Dr. von Eschenback, was appointed by President Bush in 2005. The harshest critics of the FDA on this issue are the Democrats on the House Panel. Coming out of the woodwork are various “injured” parties who were criticised by company representatives for speaking out against these drugs in 1999. These stories warrant a separate column in The Times today.
Are there real risks to taking Actos and Avandia in the treatment of diabetes. Of course there are, just as there is a real risk of treating diabetes with just about any drug. It is up to the medical profession to remain vigilant and educated about these risks and to balance them with the benefits. Inflammatory front page news stories which create an atmosphere of mistrust and hysteria may serve only narrow political purposes.
This blogged comment at metabolism.com is not intended to convey medical advice. Diabetics are encouraged to contact their own healthcare professional about advice about what to do at this time. Most authorities encourage the public not to panic and to wait instructions from their physician before altering their medical treatment.