DOC News March 1, 2007
Volume 4 Number 3 p. 9
© 2007 American Diabetes Association
DREAM Washout's Results Revealed
Bruce Goldfarb
Hopes that rosiglitazone (Avandia, GlaxoSmithKline) has a long-term effect
on the progression to diabetes were dashed by the reporting of the DREAM
(Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication)
study washout results at the International Diabetes Federation (IDF) 19th
World Diabetes Congress, held December 3–7, 2006, in Cape Town, South
Africa.
At the end of the washout period, those taking rosiglitazone progressed to
diabetes at the same rate as participants receiving placebo, according to
researchers.
The DREAM trial revealed that therapy with rosiglitazone, when combined
with a healthful diet and physical activity, reduced the risk of developing
type 2 diabetes by 62% in people with pre-diabetes, compared with placebo.
(DOC News, November 2006, page 1).
The results suggest that rosiglitazone delays progression to full-blown
diabetes during treatment, but the effects do not persist when therapy is
discontinued.
"The practical implication is that you can't stop the drug. If you
stop the drug, you lose the benefit," says David Nathan, MD, director of
the diabetes center at Massachusetts General Hospital in Boston and chairman
of the Diabetes Prevention Program.
"I haven't been a big fan of rosiglitazone as a prevention owing to
its expense, the edema, and heart failure. [DREAM washout results] don't
surprise me, and it doesn't make me more or less a fan of rosiglitazone than I
was before," Nathan says.
How the results of the DREAM washout phase will affect plans for changing
the labeling or indications of the drug is unclear. GlaxoSmithKline did not
respond to several requests for comment. 
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