To: Andrew H who wrote (11952 ) 12/2/1997 7:59:00 AM From: Henry Niman Respond to of 32384
Andy, One of the analysts also questioned the role of GLX's TZD in their decision to halt the sale of Rezulin. (From GLX thread: "Goldman Sachs' Lachman, though, said Glaxo Wellcome is developing its own glitazone drug, which is entering interim-stage trials and may have played a role in the company's decision. "We wonder what their motivation is with respect to the (suspension)," Lachman said. " Here's a comparison between Rezulin and Takeda's compound (note that patients took 400 mg of Rezulin per day, but Takeda's drug was effective at 30 mg per day): Effects of Thiazolidinediones in Diabetes Mellitus Masashi Kobayashi, MD Clinical trials of the insulin sensitizers, thiazolidinediones, have been conducted in several countries throughout the world. Ciglitazone, the first of the insulin sensitizers, was discovered by Dr Iwatsuka and his associates of Takeda Chemical Industries, Ltd., in Japan in 1979. Ciglitazone was shown to decrease insulin resistance in diabetic animals and to potentiate insulin action in vitro. A clinical trial undertaken in patients with NIDDM had to be discontinued in 1982 because of the development of cataracts in the animals that received long-term ciglitazone. Furthermore, ciglitazone was found to have insufficient potency. At that time, a more potent thiazolidinedione, pioglitazone, was prepared for evaluation by Takeda Chemical Industries. In 1983, Dr Horikoshi and his associates at Sankyo Ltd found that troglitazone was a potent insulin sensitizer; the clinical trial was finished last year in Japan. Clinical trials of both troglitazone and pioglitazone have now been completed in Japan. Troglitazone (200 mg bid) was found to decrease mean fasting glucose levels from 181.8 ñ 29.2 mg/dL to 157.2 ñ 30.6 mg/dL at 8 weeks and glycosylated hemoglobin (HbA1c) from 8.61 ñ 1.51% to 8.09 ñ 1.71% at 12 weeks, whereas placebo did not change these values. When these values were analyzed with respect to body mass index (BMI) and fasting insulin levels, patients with a BMI >24 and a fasting insulin level of 5 æU/mL responded relatively well to troglitazone. However, 28% of the NIDDM patients did not respond to troglitazone; these nonresponders did not show any characteristic clinical features. The combination of troglitazone and a sulfonylurea in patients who failed to respond to a sulfonylurea alone resulted in improved glycemic control in 72% of those patients. Side effects included slightly decreased hematocrit and hemoglobin levels. As for pioglitazone (30 mg/d), the clinical trial showed results similar to those of troglitazone. Side effects of pioglitazone also included a slight decrease in hematocrit and hemoglobin and, rarely, edema. These results suggest that troglitazone and pioglitazone are safe insulin sensitizers even for lean Japanese NIDDM patients.