Consumer Reports: Older Drugs Better For Those With Type-2 Diabetes

Consumer Reports says that older, not newer, drugs are better for those with Type-2 diabetes. New, heavily advertised drugs such as “Avandia and Actos” are more expensive but not more effective. Older drugs are also as safe “if not safer” than the new drugs.

From Consumer Reports:

Diabetes drugs received wide attention last spring when research found a possible link between rosiglitazone (Avandia) and a higher risk of heart attacks. While those risks remain unclear, the CR Best Buy Drug report cites other reasons that rosiglitazone and the related drug pioglitazone (Actos) are not wise first choices for most people with diabetes, including their higher risk of heart failure compared with other diabetes drugs. Indeed, in May 2007 the Food and Drug Administration requested that the manufacturers of Actos and Avandia put a high-profile “black-box” warning about the risk of heart failure on the labels of the two drugs.

Instead, the report recommends that most people with diabetes first talk with their doctor about taking metformin (Glucophage and generic). That medicine not only controls blood sugar as effectively as all other diabetes drugs, but also reduces the level of “bad” LDL cholesterol, doesn’t cause weight gain, and is less likely than most diabetes drugs to cause dangerously low blood sugar (hypoglycemia). Moreover, the generic version of the drug costs just $38 to $60 per month compared with $142 to $262 for Actos and Avandia, depending on the dose.

Basically, what the report says is that these new drugs Actos and Avandia are really only appropriate for the small number of patients for whom “metformin, glimepiride, or glipizide prove ineffective or intolerable.”

Remember, just because it’s new doesn’t mean it’s better!

For more information about alternatives to newer pricier drugs, you can visit Consumer Report’s Best Buy Drugs, and for more info about this report, click on over to Consumer Reports.

Older drugs are the best choice for most people with type 2 diabetes [Consumer Reports]

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  1. dbeahn says:

    So big Pham doesn’t care what’s best, just cares about recouping the cost of developing crap that isn’t as good as what we already have.

    Does this really surprise anyone?

  2. banned says:

    Its the same for everything you buy. I’m sure everybody knows somebody who owns a retro-radio from the 40′s, couches from the 60′s, etc. Companies know they can crappier products, charge more for them, and release a new version in a year.

  3. Basically same issue with Vioxx. It proved no better than Rx-dose ibuprofen and naproxen at relieving arthritis pain IN GENERAL and was only appropriate for a small number of patients who couldn’t get relief from traditional drugs. But, marketed as the new wonder drug, everybody wanted it ……

  4. rekoil says:

    Same deal with Prilosec and Nexium. Nexium didn’t come onto the market until Prilosec’s patent expired, and there’s a lot of controversy over whether or not Nexium is any better. See the Wiki for details…

  5. Sir Winston Thriller says:

    I’ve had real problems with Consumer Reports in the last two, three years. Their reports/ratings on a lot of things haven’t matched my experience. I’ll leave the decision on treatment up to my endocrinologist, Primary Care Physician, and me. Started on oen of the new diabetes drugs (Januvia) in February. Lost almost 30 pounds, HbA1C levels are low-normal. No tiredness, no highs or lows.

    Now, Januvia wasn’t mentioned in their report, but by their logic I should still be taking what stopped working well and live with it.

  6. Ncisfan says:

    @dbeahn: not really , big phrama is made up of a very corrupt group of companies. frankly I think that The FDA needs to get up off their ass before millions more die from another Vioxx (or Fen-Phen) , and purge the market like they did in 1997. But the FDA won’t !

  7. facted says:

    Eyebrows: That’s actually not true at all. Vioxx was not approved because it was a stronger pain reliever than other medications, nor was it marketed for that purpose. It was approved because there is a subset of patients (those with history of gastrointestinal bleeding, for instance), who are better off using Vioxx for pain relief over something like Aspirin because Vioxx causes less GI bleeding. In fact, the theory still holds, and believe it or not, there are Cox-2 inhibitors still on the market (Celebrex, for starters).

  8. swalve says:

    Sir Winston, I concur. CR seems to be trending away from actual independent research/testing and toward just being a clearing house for dubious press releases. They seem to have the same scientific integrity as Mythbusters these days. Very disappointing.

  9. stavs says:

    When the brehaha came out about Avandia I spoke to my doctor about it. Right now he has me on Avandia, Glipzide, and Januvia. I can not tolerate Metformin (I get Joanne Fabrics style diarreah) so he has me those. My sugar levels dropped. I went from an A1C of 12.5 down to 7.5 in 3 months. I also dropped my 2+ liter a day Pepsi habit, so I plan on trying to get off some of the meds.

    I say talk to your doc…he will do whats best for you.

  10. @facted: I think you missed my point, which was more or less the same as yours. Vioxx, because of a different mechanism, is appropriate for a small number of patients for whom existing medicine did not work or were not indicated. Here’s where my point is different:

    It absolutely WAS marketed as “better” than older medicine at relieving arthritis pain. The Cox-2 inhibitors generally have marketed themselves as miracle drugs for arthritis, both to consumers and to doctors. You’re hard-pressed to find consumers with arthritis who don’t know what a Cox-2 inhibitor does and why it’s “better” than older medicines.

    Most arthritis medicine is NOT prescribed by rheumatologists, and stunning numbers of general practicioners prescribed Cox-2 inhibitors to patients with minor osteoarthritis BEFORE using more traditional drugs in cases were OTC doses of Advil were more than enough to relieve the pain. Which, regardless of whether the class of drugs AS A WHOLE turns out to be more dangerous, is seriously ethically questionable merely because of cost and safety issues — the ibuprofin has been available to the general public since 1969 (in the UK) and so has decades of wide use to back up its safety in a large variety of populations. It also costs pennies per dose. Cox-2 inhibitors were introduced in 1999, a mere year after initial discovery of the enzyme involved, have less than a decade of safety data, and cost a great deal per dose.

    Yet drug company advertising, both to physicians who are NOT specialists in rheumatology and direct-to-consumer, ensured overprescription of these largely untested drugs.

    “believe it or not, there are Cox-2 inhibitors still on the market”

    I can’t imagine why anyone WOULDN’T believe it, since they’re excellent drugs for people who need them. Vioxx really didn’t need to be pulled except that it was being used widely in inappropriate populations — BECAUSE OF OVERMARKETING.

    You also seem to be assuming I don’t know anything about arthritis or prescription drugs. You would in fact be wrong. It’s part of my job.

  11. @Sir Winston Thriller: “Now, Januvia wasn’t mentioned in their report, but by their logic I should still be taking what stopped working well and live with it.”

    What the report actually says is that you should FIRST talk to your doctor about traditional or older medicines. Ethically, when a doctor is starting from scratch seeking the most effective drug therapy, all other things being equal, doctors should start their patients on older drugs with the widest possible use in the general population, because these drugs have the largest amount of safety data. There is also a cost issue in the ethics of prescribing medicine, and lower-cost drugs or drugs with generic equivalents are generally preferred when available.

    Obviously, if the new drug is drastically better or safer (“no more gaping flesh wound side effects!”) or if it is CLEARLY indicated for a particular population (“this new one seems to be far more effective in teenagers than other drugs that were only limitedly effective in teens”), the doctor should consider starting the patient on the newer drug first.

    And quite obviously, if the old drug DOESN’T WORK for the patient, attempting the new drug is clearly indicated. But then we’re not STARTING the therapy from scratch, we’re continuing a therapy in which we already have data in that particular patient, which is that Drug X doesn’t work so we need to try something else.

  12. Antiskeptic says:

    Consumer Reports does consumers a disservice by basically publishing a summary of a marginally useful study without talking to doctors or doing anything to add value.

    Yes, taking metformin is the best first option for most patients (basically, anyone who can tolerate it), But many people don’t get their blood sugar low enough on metformin. And since diabetes worsens over time for nearly all people, even those who do okay taking metformin at first may need something else over time. The newer drugs can be added to metformin to get blood sugar down further. This is what nearly all doctors do — prescribe metformin first, and add something else (like Actos or Januvia) if/when metformin isn’t working enough on its own. Some insurance companies are even beginning to require this approach.

    Way to go, Consumer Reports. You’ve basically just told patients to ask their doctor to do what 95% of doctors do anyway.