Therein lies the dilemma for physicians: How should they advise the legions of patients calling with rosiglitazone questions? On one end of the spectrum, clinicians are watching and waiting. On the other end, they are taking all their patients off rosiglitazone, sometimes switching them to pioglitazone, and sometimes taking them off all TZDs. Physicians taking a middle-of-the-road position are discontinuing rosiglitazone only in patients with the highest cardiovascular disease (CVD) risk and more closely monitoring those who stay on the drug.
Some physicians are asking patients to make the decision. But how well can patients parse the evidence? How many patients can appreciate the methodological and statistical issues surrounding the meta-analysis and evaluate them in light of other evidence about TZDs and alternative treatments?
Dr. Curt Furberg of Wake Forest University seems to go a step beyond his editorial opinion in NEJM by suggesting that all patients be switched from Avandia.
"If my wife were on a TZD, I'd switch her," Furberg says. "You don't gamble when treating patients. You play it safe."