J Stroke.  2019 May;21(2):139-150. 10.5853/jos.2019.00038.

Effects of Thiazolidinedione and New Antidiabetic Agents on Stroke

• Ahn CH
• Lim S

• KMID: 2449891
• DOI: http://doi.org/10.5853/jos.2019.00038

Abstract

Patients with hyperglycemia are at a high risk of cardio- and cerebrovascular diseases. Diabetes patients also have poor outcomes after cerebrovascular disease development. Several classes of drugs are used for diabetes management in clinical practice. Thiazolidinedione (TZD) was introduced in the late 1990s, and new antidiabetic agents have been introduced since 2000. After issues with rosiglitazone in 2007, the U.S. Food and Drug Administration strongly recommended that trials investigating cardiovascular risk associated with new antidiabetic medications should be conducted before drug approval in the United States, to prove the safety of these new drugs and to determine their superiority to previous medications. Currently, results are available from two studies with TZD focusing on cardiovascular diseases, including stroke, and from 12 cardiovascular outcome trials focusing on major adverse cardiovascular events associated with new antidiabetic agents (four with dipeptidyl peptidase-4 inhibitors, three with sodium-glucose cotransporter-2 inhibitors, and five with glucagon-like peptide-1 analogues). These studies showed different results for primary cardiovascular outcomes and stroke prevention. It is important to determine whether prescription of TZD or new antidiabetic medications compared to conventional treatment, such as sulfonylurea or insulin, is better for stroke management. Furthermore, it is unclear whether drugs in the same class show greater safety and efficacy than other drugs for stroke management.

Keyword

Stroke; Diabetes mellitus; Thiazolidinediones; Dipeptidyl-peptidase IV inhibitors; Sodiumglucose transporter 2; Glucagon-like peptide 1

MeSH Terms

Cardiovascular Diseases
Cerebrovascular Disorders
Diabetes Mellitus
Dipeptidyl-Peptidase IV Inhibitors
Drug Approval
Glucagon-Like Peptide 1
Humans
Hyperglycemia
Hypoglycemic Agents*
Insulin
Prescriptions
Stroke*
Thiazolidinediones
United States
United States Food and Drug Administration
Dipeptidyl-Peptidase IV Inhibitors
Glucagon-Like Peptide 1
Hypoglycemic Agents
Insulin
Thiazolidinediones