A Potential New Use for Pioglitazone

Pioglitazone might prevent recurrent stroke, heart attack in patients with insulin resistance

(RxWiki News) Sometimes a medication used to treat one condition can also help with another. That might be the case with pioglitazone (brand name Actos).

A new study found that pioglitazone could potentially prevent recurrent stroke and heart attack in patients who have insulin resistance but not type 2 diabetes, and who have already had at least one stroke.

Insulin is a hormone that regulates blood sugar. Resistance occurs when the body's cells become less responsive to insulin. This condition typically precedes type 2 diabetes.

Insulin resistance also occurs in more than half of stroke patients without type 2 diabetes, according to the authors of this study.

Because the body is still producing insulin, treatment often includes weight loss, dietary changes and medication. Medications like pioglitazone increase insulin sensitivity.

Lead study author Walter N. Kernan, MD, said in a press release, "The IRIS trial supports the value of more research to test the vascular benefits of other interventions such as exercise, diet and medications that have similar effects on metabolism as pioglitazone." Dr. Kernan is a professor of medicine at Yale University.

Dr. Kernan and team looked at more than 3,800 patients from the Insulin Resistance Intervention after Stroke (IRIS) study. Patients in this study had insulin resistance but not type 2 diabetes. Patients also had a stroke or transient ischemic attack (TIA) within six months of the study's start.

A stroke occurs when a clot blocks a blood vessel in the brain. A TIA is a temporary stroke that resolves on its own.

These patients were divided into two groups. The first group took 45 mg of pioglitazone daily. The second group took a placebo pill.

After five years, fewer strokes and heart attacks were seen in the pioglitazone group. The medication also reduced the risk of developing type 2 diabetes by more than half.

Pioglitazone did increase the risk of bone fractures, which are a known side effect of the medication.

Pioglitazone is not currently approved by the US Food and Drug Administration (FDA) for stroke or heart attack prevention.

This study was published Feb. 17 in the New England Journal of Medicine.

The National Institute of Neurological Disorders and Stroke funded this research.

Dr. Kernan and co-author Gary Ford reported receiving fees or financial support from pharmaceutical companies such as Takeda, Pfizer and Astra Zeneca. These companies make medications used in the treatment of diabetes and stroke.

Review Date: 
February 21, 2016