Avandia was approved by the Food and Drug Administration (FDA) in 1999 to treat Type 2 diabetes, the fastest growing form of diabetes. GSK launched a multimillion-dollar ad campaign to introduce the drug to the market, which brought in $1 billion in sales last year alone with more than 2 million prescriptions filled.

A 2007 study found that Avandia could increase the risk of heart attack by as much as 43 percent, and more recent studies suggest that Avandia may be responsible for thousands of cardiovascular events such as heart attacks, strokes and other heart problems. In 2007, an FDA panel reviewed the data but voted not to pull the drug off the market.

However, concerns over a new study on the drug has led the FDA to conduct a second review the safety of Avandia. The agency is also questioning whether GSK tried to cover up the risks associated with the drug.

The panel is expected to vote soon on whether to remove the popular diabetes drug from the market.

SOURCE: Avandia Recall › GSK to pay $460 million to settle Avandia lawsuits

According to the FDA’s announcement, the “FDA previously communicated to the public about the possible association between rosiglitazone and increased cardiovascular risk in a 2007 safety alert. The agency also sought advice from external experts at the July 30, 2007, joint meeting of the FDA Endocrinologic and Metabolic Drugs and Drug Safety and Risk Management Advisory Committees. The RECORD study data represent the only new information from a completed randomized, controlled clinical trial of rosiglitazone received by FDA since the 2007 announcements.”

The RECORD study, which stands for Rosiglitazone Evaluated for Cardiovascular Outcomes and Regulation of Glycemia in Diabetes, was designed to evaluate the cardiovascular safety of rosiglitazone. This practice is consistent with the FDA’s December 2008 Guidance for Industry that recommends that manufacturers of new treatments for diabetes carefully design their clinical trials to include an evaluation of cardiovascular safety.

Once the FDA has completed its review of rosiglitazone, the agency will present its findings at a joint public meeting of the Endocrinologic and Metabolic Drugs and Drug Safety and Risk Management Advisory Committees in July 2010.

Rosiglitazone, a treatment for Type 2 diabetes, is sold as a single-ingredient product under the brand name Avandia, and is available in combination with other diabetes medications, such as metformin, under the brand name Avandament, or glimepride, under the brand name Avandaryl. The FDA advises that patients who are currently taking any form of rosiglitazone should not stop taking their medication without first talking to their healthcare professional. Any side effects with this or any other medication should be reported to the FDA MedWatch Adverse Event Reporting program at www.fda.gov/medwatch.

SOURCE: Avandia Recall › FDA announces it will review studies linking Avandia to heart attacks

Avandia was approved by the FDA for the treatment of Type 2 diabetes in 1999, and grew to become a $3 billion a year industry for GSK. In 2007, a study was published in the New England Journal of Medicine that linked Advandia to a 43 percent increased risk of heart disease. The senators contend that the London-based GSK got its hands on a copy of the report before it was published and the drug company quickly initiated a public relations push to counter any questions about Avandia’s link to increased heart risk. The drug company also urged the medical researchers who identified the risk of heart and liver problems in patients taking Avandia to stop publishing their findings.

The effort kept the drug on the market, but GSK took a near-$2 billion hit in sales in 2009. A company spokeswoman said in a statement, “the scientific evidence simply does not establish that Avandia increases ischemic cardiovascular risk or causes myocardial ischemic events … Based on the scientific evidence and a recommendation by an independent advisory committee of experts convened by the FDA, the agency has ruled that Avandia remain available to patients for the treatment of Type 2 diabetes.”

Senators Baucus and Crassley disagree. “It can be argued that GSK had a duty to warn patients and the FDA of the Company’s concerns,” wrote Baucus and Grassley in the Senate committee report. “Instead, GlaxoSmithKline executives attempted to intimidate independent physicians, focused on strategies to minimize or misrepresent findings that Avandia may increase cardiovascular risk, and sought ways to downplay findings that a competing drug might reduce cardiovascular risk.”

Sources:
Business Week
New York Times

SOURCE: Avandia Recall › Senators ask why dangerous Avandia was not pulled from market

For years, GlaxoSmithKline, the manufacturer of Avandia, enjoyed stellar sales of the diabetes drug. Avandia was GSK’s second-best seller until the results of some studies surfaced that indicated the drug poses serious risks for its users.

In February of 2007, a press release issues by GSK announced a link between female users and increased risk of bone fractures, especially of the upper arms, hands, and feet.

In June of last year, an article in The New England Journal of Medicine reported that Avandia significantly increased the likelihood of heart attacks by 43% and death by cardiovascular diseases by as much as 64% in users.

The news dealt a devastating blow to Avandia. Estimates indicate that annual Avandia profits dropped by a billion pounds (nearly $1.8 billion U.S.). A growing number of lawsuits against GSK and competition from cheaper generics also threaten GSK’s numbers. It could be argued that while additional job cuts save the company some money, those cuts are only necessary to make the company’s numbers more attractive to investors.

According to the Hertfordshire Mercury, a GSK spokeswoman explained the cuts as “part of GSK’s longer-term strategy to ensure that we invest in key areas of future growth and evolve our business to compete effectively in what is a rapidly changing and challenging environment for pharmaceutical companies.”

Translated from CEO-speak, the statement seemingly alludes to all the problems pharmaceutical companies face these days — that they must appear extra-profitable to investors while sustaining aggressive ad campaigns amidst litigation and declining sales.

SOURCE: Avandia Recall › Avandia sales drop hurting GlaxoSmithKline

Details of this strange turn of events were about to be published in the journal Nature before US Senator Charles Grassley broke its embargo and issued a letter written to GSK asking the firm what action it had taken on receiving the article from Steven Haffner of the University of Texas Health Science Center in San Antonio. The NEJM piece linked Avandia (rosiglitazone) to a 43% increased risk in heart attacks and strokes and observers were struck by the speed and detail of GSK’s rebuttal. There would now appear to be an explanation, however.

The Nature article notes that Dr Haffner faxed his copy of the article 17 days before publication in the NEJM to Alexander Cobitz, a GSK employee he knew. “Why I sent it is a mystery,” Dr Haffner is quoted as saying. “I don’t really understand it. I wasn’t feeling well. It was bad judgement.” He notes that he has worked with the UK-based drugs giant many times, principally on the Avandia ADOPT study, but refutes the notion that his motivastion for the leak was cash. “I’ve got a considerable amount of money,” he said. “I didn’t do it to raise my income or anything like that.”

GSK spokeswoman Nancy Pekarek told Nature that she was not aware of anyone at the firm informing the journal of the confidentiality breach. She added that Dr Haffner had expressed concerns regarding the methodology of the analysis, and sent the article, written by Steven Nissen of the Cleveland Clinic, for advice.

Dr Nissen has expressed his disappointment over the confidentiality breach, as has Sen Grassley, a fierce critic of the relationship of the pharmaceutical industry with doctors and regulators. He said that “the most troubling aspect of this situation is that the integrity of another aspect of the scientific process is called into question – scientific peer review”.

January 31st, 2008 by Kevin Grogan with Pharma Times

SOURCE: Avandia Recall › GSK Sent Avandia meta analysis before publication

For four years, the study followed patients over age 65, who have the highest rate of type 2 diabetes but aren’t well represented in clinical trials, says lead author Lorraine Lipscombe, a Toronto endocrinologist and researcher at the Institute for Clinical Evaluative Science, funded by the Ontario government.

Lipscombe’s team looked at how patients fared on Avandia or Actos, the only two drugs in their class, compared with those on other diabetes pills.

Since August, the U.S. labels for Avandia and Actos have carried a “black box” warning against their use in patients with advanced congestive heart failure. But the new study found Avandia raised heart failure risk even in patients with no history of the condition, suggesting the heart failure warning doesn’t go far enough, Lipscome’s team writes in The Journal of the American Medical Association.

About 8 percent of patients went to a hospital for congestive heart failure or a heart attack during the study. Compared with patients on other diabetes pills, those on only Avandia or Actos had a 60 percent higher risk of congestive heart failure and a 40 percent higher heart attack risk. They also had a 29 percent higher risk of death.

For reasons not yet clear, the increased heart risks seen in the Avandia/Actos group were predominantly in those on Avandia. That doesn’t mean Actos is safer, Lipscombe says. Her study might have had too few Actos patients – half the number on Avandia – to detect a higher risk, she says.

In observational studies such as this, factors other than the drugs in question might skew results, so clinical trials that randomly assign patients to treatments are considered the gold standard.

“The problems with the study become obvious with regard to the CHF (congestive heart failure) findings,” Nancy Pekarek, spokeswoman for Avandia maker Glaxo-SmithKline, said in an e-mail. “We know (Avandia and Actos) have well-documented and similar CHF events, yet this study somehow finds an increase in these events with Avandia versus Actos.”

But Steven Nissen, the Cleveland Clinic’s chief of cardiovascular surgery, says Lipscombe’s study “has a lot of appeal. It’s independent, it’s not funded by industry, and it’s huge.” And, “it’s real-life data.”

Nissen reported in The New England Journal of Medicine in May the pooled results of 42 short-term clinical trials showed Avandia patients were 43 percent more likely to have a heart attack or be hospitalized for blocked coronary arteries than others in the trials.

Based on Nissen’s study and others, the Food and Drug Administration last month added information to Avandia’s black box about a potential increased heart attack risk. The FDA has asked Glaxo to compare Avandia’s heart attack risk with those of other diabetes pills. That clinical trial is not expected to be done until March 2014.

January 8th, 2008 by RITA RUBIN with APP.com

SOURCE: Avandia Recall › Avandia study shows increased heart risks or death

“I was having severe chest pains and I was hospitalized and told at a later time that taking Avandia could cause the severe pain I was having,” Joyce says. “I thought that I was having a heart attack, but they did a stress test and said that the pain was not a heart attack. But it was something strenuous under the heart.”

Joyce says she was put on Avandia in 2002 or 2003 and was only taken off it after she was hospitalized in 2007. “The pain just got worse and worse through the years,” Joyce says. “I’m still having some small chest pains, but it’s not as serious as it was. Sometimes, I still get little ‘catches’ under my heart that haven’t completely gone away. I’m trying to take it easy, watch my weight and watch what I eat. I also had swelling in my ankles and feet. I still get that sometimes, too. But that’s not as bad as it was.

“Walking distances would cause my chest to tighten up a little bit. But, I could just be lying in bed and my chest would tighten up. Not just walking makes it tight. I was scared to do strenuous stuff because of my chest tightening up. After the last time I was in the hospital, I saw my new doctor and told him I was taking Avandia. He said, “We’re taking you off that today.’ And since then I’ve been somewhat better but I still have some pains. It hasn’t even been a good two months since I stopped taking it.

“I’m really scared of Avandia now. It’s scary when it’s messing with your heart. I think Avandia is a big risk to your health and a big risk to your heart.”

Fortunately for Joyce, she did not suffer any heart attacks while taking Avandia. Hopefully, she will make a full recovery and stop experiencing chest pains and swelling in her ankles. Other patients have allegedly suffered life-threatening heart problems while taking Avandia. Some are filing lawsuits against the maker of Avandia, alleging GlaxoSmithKline knew about the problems associated with Avandia but did not properly warn patients about those risks.

January 8th, 2008 by Heidi Turner with LawyersandSettlements.com

SOURCE: Avandia Recall › Avandia a big risk to your heart

Avandia’s heart attack link came to light when an analysis of 42 clinical trails published by the Cleveland Clinic in May showed that patients taking the drug had a 43% higher risk of having a heart attack. Just last month, the Food & Drug Administration (FDA) announced the addition of a long-awaited black box warning for Avandia’s increased risk of heart attacks. However, many patient advocates and FDA critics thought the black box warning was a weak response to Avandia’s safety issues, and have called on GlaxoSmithKline, the maker of Avandia, and the FDA to pull the drug from the market.

Now, it seems that Avandia side effects have reached the general public. That is made clear in a study conducted by scientists at the Institute for Clinical Evaluative Sciences in Toronto, Canada. Researchers there analyzed data for 159,026 older adults who were treated with at least one oral diabetes drug between 2002 and 2005 and were entered in an Ontario healthcare database.

The subjects were followed through March 2006. During an average follow-up period of 3.8 years, 7.9 percent of the patients were hospitalized for congestive heart failure, 7.9 percent were hospitalized for a heart attack, and 19 percent died, according to the researchers’ report in Journal of the American Medical Association. Further analysis revealed that the risks were largely confined to patients who were using Avandia, known generically as rosiglitazone.

The Canadian researchers wrote that their findings “provide evidence from a real-world setting and support data from clinical trials that the harms of thiazolidinediones may outweigh their benefits, even in patients without obvious…cardiovascular disease”.

This latest research does not bode well for Avandia. Earlier this month, pharmacy benefit managers HealthTrans and Prime Therapeutics announced that they would be dropping the controversial diabetes drug from their value-based prescription drug formularies as of January 1, 2008 because of safety concerns.

In October, the Department of Veterans Affairs (VA) announced that it was removing Avandia from its prescription drug formulary because of its heart attack risks. The VA said that it would still make Avandia available for patients who were already taking it and wanted to continue. But the decision means that patients not currently prescribed Avandia will not be able to get it through the VA in the future. Prior to its announcement, the VA accounted for about 8 percent of Avandia sales.

Avandia was once GlaxoSmithKline’s second-biggest selling drug, with worldwide revenue of $3.2 billion in 2006, but sales have plunged since May, with US sales down 48 percent in the third quarter from a year ago.

December 17th, 2007 by Staff with NewsInferno.com

SOURCE: Avandia Recall › Avandia heart attacks seen in general patient population

For four years, the study followed patients over age 65, who have the highest rate of type 2 diabetes but aren’t well-represented in clinical trials, says lead author Lorraine Lipscombe, a Toronto endocrinologist and researcher at the Institute for Clinical Evaluative Science, funded by the Ontario government.

Lipscombe’s team looked at how patients fared on Avandia or Actos, the only two drugs in their class, compared with those on other diabetes pills.

Since August, the U.S. labels for Avandia and Actos have carried a “black box” warning against their use in patients with advanced congestive heart failure. However, the new study found Avandia raised heart failure risk even in patients with no history of the condition, suggesting the heart failure warning doesn’t go far enough, Lipscome’s team writes in The Journal of the American Medical Association.

About 8% of patients went to a hospital for congestive heart failure or a heart attack during the study. Compared with patients on other diabetes pills, those on only Avandia or Actos had a 60% higher risk of congestive heart failure and a 40% higher heart attack risk. They also had a 29% higher risk of death.

For reasons not yet clear, the increased heart risks seen in the Avandia/Actos group were predominantly in those on Avandia. That doesn’t mean Actos is safer, Lipscombe says. Her study might have had too few Actos patients – half the number on Avandia – to detect a higher risk, she says.

In observational studies such as this, factors other than the drugs in question might skew results, so clinical trials that randomly assign patients to treatments are considered the gold standard.

“The problems with the study become obvious with regard to the CHF (congestive heart failure) findings,” Nancy Pekarek, spokeswoman for Avandia maker Glaxo-SmithKline, said in an e-mail. “We know (Avandia and Actos) have well-documented and similar CHF events, yet this study somehow finds an increase in these events with Avandia vs. Actos.”

But Steven Nissen, the Cleveland Clinic’s chief of cardiovascular surgery, says Lipscombe’s study “has a lot of appeal. It’s independent, it’s not funded by industry, and it’s huge.” And, “it’s real-life data.”

Nissen reported in The New England Journal of Medicine in May the pooled results of 42 short-term clinical trials showed Avandia patients were 43% more likely to have a heart attack or be hospitalized for blocked coronary arteries than others in the trials.

Based on Nissen’s study and others, the Food and Drug Administration last month added information to Avandia’s black box about a potential increased heart attack risk. The FDA has asked Glaxo to compare Avandia’s heart attack risk with those of other diabetes pills. That clinical trial is not expected to be done until March 2014.

December 11th, 2007 by Rita Rubin USA TODAY with USA Today

SOURCE: Avandia Recall › New Avandia study reaffirms heart risk

The moves by Prime Therapeutics and HealthTrans mark the latest example of U.S. healthcare providers deciding to limit access to the drug, following an earlier decision by the U.S. Department of Veterans Affairs to severely restrict use.

Such actions, particularly if followed by others, may further undermine sales of the once-popular medicine, which have been hit hard recently by a report linking it to heart attacks.

Prime and HealthTrans said in separate statements they had made their decisions after a thorough analysis of the clinical literature examining the safety and efficacy of Avandia.

“Prime takes drug safety warnings very seriously and our primary concern is the safety of our members,” said Craig Mattson, senior director of drug technology assessment and formulary development.

Britain-based Glaxo, Europe’s biggest drugmaker, said it was surprised and disappointed.

“It limits options for treatment and could be detrimental for patients. The FDA (Food and Drug Administration) has said the data remains inconclusive and therefore to limit patients’ options in this is disappointing,” a spokeswoman said.

Concerns about the safety of Avandia were triggered in May by a U.S. analysis linking it to a 43 percent higher risk of heart attack. Avandia was Glaxo’s second-biggest drug in 2006, with worldwide revenue of 1.6 billion pounds ($3.2 billion), but sales have plunged since May, with revenue in the United States down 48 percent in the third quarter from the year-ago period.

SOURCE: Avandia Recall › Two U.S. healthcare providers drop Glaxo’s Avandia

The Association announced on Tuesday that it was updating its “consensus statement” on the use of oral diabetes medications in light of the increased heart attack risks linked to some diabetes medicines, such as Avandia.

Avandia’s heart attack link came to light in May, when an analysis of 42 clinical trails published by the Cleveland Clinic showed that patients taking the drug had a 43% higher risk of having a heart attack. Earlier this month, the Food & Drug Administration (FDA) announced the addition of a long-awaited black box warning for Avandia’s increased risk of heart attacks.

However, many patient advocates and FDA critics thought the black box warning was a weak response to Avandia’s safety issues, and have called on both GlaxoSmithKline, the maker of Avandia, and the FDA to pull the drug from the market.

The American Diabetes Association’s revised consensus statement was formulated in cooperation with European Association for the Study of Diabetes. The statement reads in part: “New information suggests additional hazards associated with the use of either thiazolidedione, and rosiglitazone (Avandia) in particular may result in an increased frequency of myocardial infarctions. . .

We therefore recommend greater caution in using thiazolidediones, especially in patients at risk of, or with, congestive heart failure.”

The American Diabetes Association’s new Avandia stance is only the latest development that could hurt the drug’s sagging sales. In October, the United States Department of Veterans Affairs (VA) announced that it was dropping Avandia from its prescription drug formulary. In a statement announcing the move, the VA said that it had conducted its own review and concluded that, for some patients, Avandia did not afford the same margin of safety as other diabetes medications.

Prior to its announcement, the VA accounted for about 8% of Avandia’s sales in the United States. And in November, Health Canada sent a letter to Canadian health professionals informing them that Avandia could no longer be prescribed as monotherapy for type 2 diabetes, except when metformin use is contraindicated or not tolerated. Health Canada also withdrew its approval for Avandia to be used in combination with a sulfonylurea, except when metformin is contraindicated or not tolerated.

Last week, Glaxo got more bad news on the Avandia front when a Congressional Committee Report found that company executives made a concerted effort to intimidate Dr. John Buse, a diabetes expert, into keeping quiet about some of the Avandia’s safety problems. The report alleged that Glaxo Chief Executive Jean-Pierre Garnier and former research chief Tachi Yamada were involved in the intimidation.

November 27th, 2007

SOURCE: Avandia Recall › Avandia side effects prompt new caution from American Diabetes Association

Avandia has been a subject of debate since May 21, when an analysis of 42 clinical trails published by the Cleveland Clinic showed that patients taking the drug had a 43-percent higher risk of having a heart attack. Since the Cleveland Clinic study was published, a great deal of controversy has swirled around Avandia. In June, Congress held hearings to discuss Avandia and the FDA’s handling of its safety issues. At those hearings, it was revealed that GlaxoSmithKline, Avandia’s manufacturer, had informed the FDA of a study it had conducted that produced similar results. However, both the agency and the manufacturer felt that more investigation was needed before conclusions could be made about Avandia’s possible safety issues. Since those revelations were made public, the FDA has been under a great deal of pressure to take action on Avandia.

In July, the FDA convened a panel to discuss the issues surrounding Avandia’s heart attack risk. The panel voted 20-3 that the drug did in fact raise the chance of heart attacks, yet the panel still voted 22-1 to allow it to remain on the market. They recommended that Avandia be given a warning label about the cardiac problems. The FDA did finally add that black box warning to the Avandia label this month.

Now, Dr. Robert Misbin, an FDA safety reviewer who worked on the original Avandia approval, has called for changes in the way such drugs are handled by the FDA. Currently, an experimental drug is tested against a placebo. But Dr. Misbin now feels that diabetes drugs like Avandia, should be tested against other drugs currently on the market. In his interview with the Journal of Diabetic Care, Dr. Misbin likened comparing a drug’s effectiveness to a placebo to evaluating it in a vacuum. Dr. Misbin argued that putting an experimental medication up against a tried and true existing drug would give medical reviewers a better idea of the new medication’s efficacy and safety.

Dr. Misbin focused his comments on diabetes drugs, because he was part of the Avandia approval process, and because the subsequent safety issues surrounding Avandia highlighted weaknesses in the FDA approval system. Misbin also said because there are so many safe and effective diabetes medications on the market now, experimental diabetes drugs should have to pass more hurdles to be approved by the FDA.

November 27th, 2007 by Staff with NewsInferno.com

SOURCE: Avandia Recall › Avandia reviewer calls for changes in FDA drug approval process

In a floor statement placed in the Senate record, Sen. Charles Grassley also said that safety watchdogs within the federal Food and Drug Administration “several months ago” recommended a “black box” on the drug’s label, the strongest possible warning.It is the first confirmation that the FDA’s own analysis of Avandia shows a similar magnitude of heart attack risks, dangers that were first publicly raised in a medical journal report published earlier this week.

Grassley complained that FDA higher-ups have said they want to wait for results of an ongoing study that will not be available for two more years before making a decision.

“That’s a long time from now when you have millions of Americans taking this drug,” said the statement by the Iowa Republican. “Those numbers seem like a high enough threshold to me for the FDA to warn the American people of the possibility of a problem.”

The FDA has been under fire since Monday’s report came out, attacked by consumer advocates for dropping the ball on drug safety and for taking no stronger action in light of the new warning signs.

Avandia, sold by the British company GlaxoSmithKline PLC, is a blockbuster medication used to treat Type 2 diabetes, the most common form of the disease. More than 6 million people worldwide have taken the drug, whose U.S. sales topped $2.2 billion last year.

On Monday, an analysis led by Cleveland Clinic cardiology chief Dr. Steven Nissen of 42 separate studies on Avandia concluded that it raised the risk of heart attacks by 43 percent, compared to the rates among people taking no or other diabetes drugs. The analysis also indicated that Avandia might increase the risk of heart-related deaths.

GlaxoSmithKline strongly disputes the conclusions. Company officials said that while their own similar analysis suggested a 31 percent greater risk _ information it shared with the FDA as early as 2005 _ more rigorous, albeit smaller, individual studies did not show that.

Critics have accused the FDA of being lax in monitoring drug safety, and some members of Congress scheduled hearings and have subpoenaed key people to appear.

Grassley’s staff has been meeting with FDA staffers and others and gathering documents all week to investigate the issue, said Jill Kozeny, press officer for the Senate Finance Committee, of which Grassley is ranking member.

FDA spokeswoman Julie Zawisza confirmed Thursday the internal analysis that Grassley’s statement revealed, but added, “we have conflicting data” from individual studies, and therefore “are continuing to review the results of GSK’s ongoing trial to determine the actual risk.”

She said she could not discuss “ongoing regulatory matters” like the black box warning that Grassley’s statement says was urged months ago by the FDA’s Division of Drug Risk Evaluation.

As for the number of heart attacks possibly linked to the drug _ as many as 20 a day, Grassley contends _ Zawisza said: “A relationship between the drug and these deaths has not been established. We don’t have data to support such a conclusion.”

Any increase in heart attack risk is especially worrisome for diabetics because two-thirds of them die of heart problems.

About 1 million Americans are currently taking Avandia, which costs from $90 to $170 for a one-month supply. The FDA and diabetes experts are advising users of the medication to talk to their doctors and not to immediately discontinue the drug, which helps keep blood-sugar levels under control.

May 24th, 2007 by Marilynn Marchione with The Associated Press

SOURCE: Avandia Recall › FDA study said to show Avandia risk