The NY Times reported that "confidential reports" (isn't that a misnomer if the NY Times publishes them?) from the FDA found Avandia to be associated with an excess number of cardiovascular events:

http://www.nytimes.com/2010/02/20/health/policy/20avandia.html?scp=2&sq=avandia&st=cse

According to the NY Times, the reports demand that Avandia be taken off the market.

What do you think? Should the drug be taken off the market? Are you still using the medication in your patients, and if yes, who gets Avandia? Will the ongoing controversy influence your prescribing habits?

I think this goes back to my philosophy of telling patients their choices for medications and letting them decide what path they want to take.  If insulin resistance is the problem, as I see it, they can chose weight reduction and a beneficial level of exercise within their capabilities...but must be on a consistent basis. If they refuse the exercise/weight reduction path on a consistent basis, Actos & Avandia can be extremely beneficial...but then there is the ever present concern about side effects. That is where I think that only very conscientious physicians should prescribe Actos & Avandia. Patients on these drugs should be monitored for edema after using them. Before the thiazolidinediones are given, there should be a very thorough recent history & physical to rule out inappropriate individuals for these medications.
I know that Actos isn't included in this FDA New York Times alarm, but it is a thiazolidinedione, and we all know this class of drugs does many things to the body besides help with insulin resistance. I was a trial coordinator for Rezulin (the first thiazolidinedione) many years ago at Mt Sinai. We carefully selected our patients and monitored them carefully. When it was released to the general public,it was found to cause liver failure in several individuals and was removed from the market. Was the problem that it was given to inappropriate patients????  It was very good for the patients in our study and they had no problems. 

With all the new drugs coming out now......and their possible adverse side effects.....I am sure this will not be the last drug to have adverse effects when they are released for general use. Again, my philosophy  as a Certified Diabetes Educator and a  nurse is that the patient is a partner in the decision making regarding how best to manage their health problem. As health professionals, we are the coaches who should be very very well informed about the pros & cons of the therapeutic choices available.

The article in the NY Times is quite an eye opener.  I just want to say "where is the FDA?".  I know everyone is always hard on the FDA but come on, there was a huge red flag that came up in December 2009 and they decided that they would meet on in in the summer of 2010????  Let 7 more months go by, with 500 people or more each month suffering a heart attack?  Just doesnt make sense.  Why is a drug, that was red flagged in 2007 still left on the market so that in 2010 we find out that there have been even more deaths?  I dont get it.  The FDA's purpose is to protect the public.  Where did this one go wrong?  I agree that the patient should be an integral part of the planning for the plan of care but as health care practitioners we should guide them along the right path.  I can just hear the med mal infomercials in my head now...."Did you or a loved one suffer a heart attack while taking the drug Avandia....".

Your question is asking for our opinion based on a newspaper article.  I would much rather read those "controversial reports" before offering a yes or no.

After all, how many health professionals make clinical decisions about patient/ client care based on the media's representation of an issue?  Hopefully none.

Actually, it's pretty sad - I have to admit that the general media play a significant role in what I can and cannot prescribe to my super-concerned patients. So, independent of the merits of Dr. Nissen's article, once Avandia was in the news in 2007, most patients flat-out refused to have anything to do with it.

Definitivamente quien tiene la ultima palabra es el medico y su paciente,el criterio medico,la buena relacion medico paciente y un adecuado seguimiento redundara en un efecto beneficioso y evitara a tiempo cualquier complicacion.

Ther are 2 metanalysis: one on Avandia,and one on actos. The avandia one show clearly, increased CV mortality, the actos one, no increased mortality, and trend in reducing CV mortality.

Actualy proactive triel, is considered to be a positive trial: reducing CV mortality,with the use of actos,by 16%. If there is a concern that a medication puts patients at risk, I believe, as a physician, one should take this concern seriously ,and use it only if studies will prove that it is safe to use.

Since 2007, I stopped using Avandia, using actos instead. I had only one patient on Avandia, since he insisted to stay on it,because it improved his glycemic control, and he could not tolerate actos, due headache. He was 86 Y/O, and died from a stroke 2 weeks ago.