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Indian Heart J. 2016 Jul-Aug;68(4):564-71. doi: 10.1016/j.ihj.2016.02.017. Epub 2016 Apr 11.

Cardiovascular outcome trials for anti-diabetes medication: A holy grail of drug development?

Author information

1
Consultant Endocrinologist, Department of Endocrinology and Diabetes, Providence Endocrine and Diabetes Specialty Centre, TC 1/2138, Murinjapalam, Trivandrum 695011, India. Electronic address: drmathewjohn@yahoo.com.
2
Chief Executive Officer and Endocrinologist, Chellaram Diabetes Institute, Pune, Maharashtra, India. Electronic address: unnikrishnanag@gmail.com.
3
Endocrinologist, Bharti Hospital and B.R.I.D.E., Karnal, Haryana 132001, India. Electronic address: brideknl@gmail.com.
4
Head, Department of Cardiology, PRS Hospital, Trivandrum, Kerala 695012, India. Electronic address: tinynair@gmail.com.

Abstract

Since the time questions arose on cardiovascular safety of Rosiglitazone, FDA has suggested guidelines on conduct of studies on anti-diabetic drugs so as to prove that the cardiovascular risk is acceptable. Based on the cardiovascular risks of pre-approval clinical trials, guidelines have been made to conduct cardiovascular safety outcome trials (CVSOTs) prior to the drug approval or after the drug has been approved. Unlike the trials comparing the efficacy of antidiabetic agents, the CVSOTs examine the cardiovascular safety of a drug in comparison to standard of care. These trials are expensive aspects of drug development and are associated with various technical and operational challenges. More cost effective models of assessing cardiovascular safety like use of biomarkers, electronic medical records, pragmatic and factorial designs can be adopted. This article critically looks at the antidiabetic drug approval from a cardiovascular perspective by asking a few questions and arriving at answers.

KEYWORDS:

Anti diabetic drugs; Cardiovascular; Trials

PMID:
27543483
PMCID:
PMC4990725
DOI:
10.1016/j.ihj.2016.02.017
[Indexed for MEDLINE]
Free PMC Article

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