The Low-Dose (7.5 Mg/day) Pioglitazone Therapy

Overview

Journal J Clin Med Res

Specialty General Medicine

Date 2017 Sep 16

PMID 28912917

Citations 12

Authors

Hidekatsu Yanai

Hiroki Adachi

Affiliations

Soon will be listed here.

Abstract

Pioglitazone is one of thiazolidinedione derivatives, which stimulates nuclear peroxisome proliferator-activated receptor gamma and improves glucose and lipid metabolism and insulin sensitivity. A recent systematic review and meta-analysis showed that pioglitazone therapy was associated with a lower risk of major adverse cardiovascular events in patients with pre-diabetes and diabetes. Further, in a cohort study of patients with type 2 diabetes, pioglitazone therapy was associated with a statistically significant decrease in the risk of all-cause mortality. Despite these beneficial effects, the meta-analysis showed that pioglitazone therapy had higher risks of heart failure, bone fractures, edema and weight gain. To find out the efficacy and safety of the low-dose (7.5 mg/day) pioglitazone therapy, we reviewed the dose-response of pioglitazone on favorable effects and adverse effects due to pioglitazone, by searching the reports on effects of daily dose of 7.5 mg and/or 15 mg and/or 30 mg of pioglitazone. The low-dose pioglitazone therapy may show the same degree of improvements in glucose and lipid metabolism, fatty liver, insulin resistance, and adiponectin as the standard- and high-dose pioglitazone therapy. Furthermore, the low-dose pioglitazone therapy may also show less adverse effects on weight gain, edema and heart failure as compared with the standard- and high-dose pioglitazone therapy.

Citing Articles

From Energy Metabolic Change to Precision Therapy: a Holistic View of Energy Metabolism in Heart Failure.

Wen J, Chen C J Cardiovasc Transl Res. 2023; 17(1):56-70.

PMID: 37450209 DOI: 10.1007/s12265-023-10412-7.

Efficacy of 3 months of additional pioglitazone treatment in type 2 diabetes patients with alcoholic fatty liver disease.

Asakawa M, Takagi N, Hamada D, Yamasaki Y, Katsuta H Diabetol Int. 2023; 14(3):243-251.

PMID: 37397908 PMC: 10307745. DOI: 10.1007/s13340-023-00619-z.

An Update on the Current and Emerging Use of Thiazolidinediones for Type 2 Diabetes.

Giglio R, Papanas N, Rizvi A, Ciaccio M, Patti A, Ilias I Medicina (Kaunas). 2022; 58(10).

PMID: 36295635 PMC: 9609741. DOI: 10.3390/medicina58101475.

Pioglitazone in diabetic kidney disease: forgotten but not gone.

Papaetis G Arch Med Sci Atheroscler Dis. 2022; 7:e78-e93.

PMID: 36158067 PMC: 9487837. DOI: 10.5114/amsad/151046.

A double-blind, Randomized controlled trial on glucose-lowering EFfects and safety of adding 0.25 or 0.5 mg lobeglitazone in type 2 diabetes patients with INadequate control on metformin and dipeptidyl peptidase-4 inhibitor therapy: REFIND study.

Ryang S, Kim S, Bae J, Han J, Kwon S, Kim Y Diabetes Obes Metab. 2022; 24(9):1800-1809.

PMID: 35581902 PMC: 9541308. DOI: 10.1111/dom.14766.

References

Loke Y, Singh S, Furberg C . Long-term use of thiazolidinediones and fractures in type 2 diabetes: a meta-analysis. CMAJ. 2008; 180(1):32-9. PMC: 2612065. DOI: 10.1503/cmaj.080486. View

Goldberg R, Kendall D, Deeg M, Buse J, Zagar A, Pinaire J . A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes and dyslipidemia. Diabetes Care. 2005; 28(7):1547-54. DOI: 10.2337/diacare.28.7.1547. View

Neumann A, Weill A, Ricordeau P, Fagot J, Alla F, Allemand H . Pioglitazone and risk of bladder cancer among diabetic patients in France: a population-based cohort study. Diabetologia. 2012; 55(7):1953-62. PMC: 3369136. DOI: 10.1007/s00125-012-2538-9. View

Roden M . Mechanisms of Disease: hepatic steatosis in type 2 diabetes--pathogenesis and clinical relevance. Nat Clin Pract Endocrinol Metab. 2006; 2(6):335-48. DOI: 10.1038/ncpendmet0190. View

Charbonnel B, Matthews D, Schernthaner G, Hanefeld M, Brunetti P . A long-term comparison of pioglitazone and gliclazide in patients with Type 2 diabetes mellitus: a randomized, double-blind, parallel-group comparison trial. Diabet Med. 2005; 22(4):399-405. DOI: 10.1111/j.1464-5491.2004.01426.x. View

Yki-Jarvinen H . Thiazolidinediones. N Engl J Med. 2004; 351(11):1106-18. DOI: 10.1056/NEJMra041001. View

Vu A, Kosmiski L, Beitelshees A, Prigeon R, Sidhom M, Bredbeck B . Pharmacodynamic Effects of Low-Dose Pioglitazone in Patients with the Metabolic Syndrome without Diabetes Mellitus. Pharmacotherapy. 2016; 36(3):252-62. DOI: 10.1002/phar.1713. View

Liao H, Saver J, Wu Y, Chen T, Lee M, Ovbiagele B . Pioglitazone and cardiovascular outcomes in patients with insulin resistance, pre-diabetes and type 2 diabetes: a systematic review and meta-analysis. BMJ Open. 2017; 7(1):e013927. PMC: 5223642. DOI: 10.1136/bmjopen-2016-013927. View

Schondorf T, Maiworm A, Emmison N, Forst T, Pfutzner A . Biological background and role of adiponectin as marker for insulin resistance and cardiovascular risk. Clin Lab. 2005; 51(9-10):489-94. View

10.

Majima T, Komatsu Y, Doi K, Shigemoto M, Takagi C, Fukao A . Safety and efficacy of low-dose pioglitazone (7.5 mg/day) vs. standard-dose pioglitazone (15 mg/day) in Japanese women with type 2 diabetes mellitus. Endocr J. 2006; 53(3):325-30. DOI: 10.1507/endocrj.k05-067. View

11.

Meier C, Kraenzlin M, Bodmer M, Jick S, Jick H, Meier C . Use of thiazolidinediones and fracture risk. Arch Intern Med. 2008; 168(8):820-5. DOI: 10.1001/archinte.168.8.820. View

12.

Rajagopalan S, Dutta P, Hota D, Bhansali A, Srinivasan A, Chakrabarti A . Effect of low dose pioglitazone on glycemic control and insulin resistance in Type 2 diabetes: A randomized, double blind, clinical trial. Diabetes Res Clin Pract. 2015; 109(3):e32-5. DOI: 10.1016/j.diabres.2015.05.030. View

13.

Aso Y, Hara K, Ozeki N, Yatsuka C, Nakano T, Matsumoto S . Low-dose pioglitazone increases serum high molecular weight adiponectin and improves glycemic control in Japanese patients with poorly controlled type 2 diabetes. Diabetes Res Clin Pract. 2009; 85(2):147-52. DOI: 10.1016/j.diabres.2009.05.015. View

14.

Panikar V, Kale N, Hoskote S, Deogaonkar N, Joshi S . Effect of Low (7.5 mg/day), Standard (15 mg/ day) and High (30 mg/day) Dose Pioglitazone Therapy on Glycemic Control and Weight Gain in Recently-Diagnosed Type 2 Diabetes Patients. J Assoc Physicians India. 2018; 63(11):36-9. View

15.

Lee M, Saver J, Liao H, Lin C, Ovbiagele B . Pioglitazone for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis. Stroke. 2016; 48(2):388-393. DOI: 10.1161/STROKEAHA.116.013977. View

16.

Karter A, Ahmed A, Liu J, Moffet H, Parker M . Pioglitazone initiation and subsequent hospitalization for congestive heart failure. Diabet Med. 2005; 22(8):986-93. PMC: 3557913. DOI: 10.1111/j.1464-5491.2005.01704.x. View

17.

Guan Y, Hao C, Cha D, Rao R, Lu W, Kohan D . Thiazolidinediones expand body fluid volume through PPARgamma stimulation of ENaC-mediated renal salt absorption. Nat Med. 2005; 11(8):861-6. DOI: 10.1038/nm1278. View

18.

Belfort R, Harrison S, Brown K, Darland C, Finch J, Hardies J . A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 2006; 355(22):2297-307. DOI: 10.1056/NEJMoa060326. View

19.

Ogawa S, Takeuchi K, Ito S . Plasma BNP levels in the treatment of type 2 diabetes with pioglitazone. J Clin Endocrinol Metab. 2003; 88(8):3993-6. DOI: 10.1210/jc.2002-021765. View

20.

Kadowaki T, Yamauchi T, Kubota N, Hara K, Ueki K, Tobe K . Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. J Clin Invest. 2006; 116(7):1784-92. PMC: 1483172. DOI: 10.1172/JCI29126. View