Original Title: Tiazolidinedionas en diabetes mellitus tipo 2

Authors' recommendations: CONCLUSIONS High-quality evidence shows that the use of pioglitazone in second line therapy or subsequently as monotherapy, or as dual therapy with metformin and triple therapy with metformin and sulfonylureas, does not show differences in mortality due to any cause, of cardiovascular origin or serious adverse events versus the rest of the oral hypoglycemic drugs, glucagon-like peptide-1 receptor agonists (GLP-1) and insulin in type 2 diabetes mellitus. High-quality evidence shows that the use of pioglitazone in first line as monotherapy does not reduce the concentration of glycated hemoglobin when compared with metformin. As second line, the use of pioglitazone with metformin slightly reduces the concentration of glycated hemoglobin when compared with metformin alone or in combination with dipeptidyl peptidase-4 [DPP-4] inhibitors but not versus metformin with sulfonylureas. High-quality evidence shows that the use of pioglitazone is associated to an increased risk of bladder cancer when compared with other oral hypoglycemic drugs. High-quality evidence shows that the use of rosiglitazone increases the risk of acute myocardial infarction and stroke when compared with pioglitazone or metformin. High-quality evidence shows that the use of rosiglitazone in second line therapy or subsequently as monotherapy, or as dual therapy with metformin and in triple therapy with metformin and sulfonylureas, does not show differences in mortality due to any cause, of cardiovascular origin or of serious adverse events when compared with the rest of the oral hypoglycemic drugs, glucagon-like peptide-1 receptor agonists (GLP-1) and insulin in type 2 diabetes mellitus. High-quality evidence shows that the use of rosiglitazone in first line as monotherapy does not reduce the concentration of glycated hemoglobin when compared with metformin. As second line, the use of rosiglitazone with metformin reduces the concentration of glycated hemoglobin when compared with metformin alone or in combination with dipeptidyl peptidase-4 [DPP-4] inhibitors but not versus metformin with sulfonylureas. The clinical practice guidelines identified mention thiazolidinediones in monotherapy when there is a contraindication to receive metformin, or in combination with other oral hypoglycemic drugs when the treatment goals have not been achieved with patients with type 2 diabetes mellitus. Health sponsors from high-income countries cover thiazolidinediones in type 2 diabetes mellitus for all lines of treatment. Rosiglitazone is not approved to be commercially available in Europe due to its safety profile. No cost-effectiveness studies have been found in Argentina although its retail price is similar to that of metformin and sulfonylureas.

Project Status: Completed

Year Published: 2019

URL for published report: https://www.iecs.org.ar/home-ets/

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)