POEMs

Pioglitazone After Stroke or TIA Reduces Stroke and MI, but Also Has Significant Harms

 


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Am Fam Physician. 2016 Aug 15;94(4):319.

Clinical Question

In patients with evidence of insulin resistance and a recent stroke or transient ischemic attack (TIA), does pioglitazone (Actos) improve outcomes?

Bottom Line

In patients with a recent stroke or TIA and evidence of insulin resistance, pioglitazone reduces the likelihood of myocardial infarction (MI) or stroke (number needed to treat [NNT] = 36 over five years) but increases the risk of significant weight gain (number needed to treat to harm [NNTH] =14), edema (NNTH = 9), and fracture (NNTH = 53). The risk of receiving a diagnosis of diabetes mellitus is lowered, but that is predictable when you give someone a medicine that lowers blood sugar. (Level of Evidence = 1b)

Synopsis

The researchers in this trial hypothesized that because

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



 

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