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Title
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Echocardiographic evidence for valvular toxicity of benfluorex : a double-blind randomised trial in patients with type 2 diabetes mellitus
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Author
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Institution/Organisation
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REGULATE Trial Investigators
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Abstract
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| Objectives: REGULATE trial was designed to compare the efficacy and safety of benfluorex versus pioglitazone in type 2 diabetes mellitus (DM) patients. Methods: Double-blind, parallel-group, international, randomised, non-inferiority trial. More than half of the 196 participating centres were primary care centres. Patients eligible had type 2 DM uncontrolled on sulfonylurea. 846 were randomised. They received study treatment for 1 year. 423 patients were allocated to benfluorex (150 to 450 mg/day) and 423 were allocated to pioglitazone (30 to 45 mg/day). Primary efficacy criterion was HbA(1c). Safety assessment included blinded echocardiographic evaluation of cardiac and valvular status. Results: At baseline, patients were 59.1+/-10.5 years old with HbA(1c) 8.3+/-0.8%, and DM duration 7.1+/-6.0 years. During the study, mean HbA(1c) significantly decreased in both groups (benfluorex: from 8.30+/-0.80 to 7.77+/-1.31 versus pioglitazone: from 8.30+/-0.80 to 7.45+/-1.30%). The last HbA(1c) value was significantly lower with pioglitazone than with benfluorex (p<0.001) and non-inferiority of benfluorex was not confirmed (p = 0.19). Among the 615 patients with assessable paired echocardiography (310 benfluorex, 305 pioglitazone), 314 (51%) had at least one morphological valvular abnormality and 515 (84%) at least one functional valvular abnormality at baseline. Emergent morphological abnormalities occurred in 8 patients with benfluorex versus 4 with pioglitazone (OR 1.99), 95% CI (0.59 to 6.69). Emergent regurgitation (new or increased by one grade or more) occurred more frequently with benfluorex (82 patients, 27%) than with pioglitazone (33 patients, 11%) (OR 2.97), 95% CI (1.91 to 4.63) and were mainly rated grade 1; grade 2 (mild) was detected in 2 patients with benfluorex and 3 with pioglitazone. There was no moderate or severe regurgitation. Conclusion: After 1 year of exposure, our results show a 2.97 fold increase in the incidence of valvular regurgitation with benfluorex and provide evidence for the valvular toxicity of this drug. |
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Language
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English
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Source (journal)
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PLoS ONE
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Publication
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2012
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ISSN
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1932-6203
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DOI
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10.1371/JOURNAL.PONE.0038273
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Volume/pages
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7
:6
(2012)
, 12 p.
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Article Reference
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e38273
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ISI
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000305652700013
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Medium
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E-only publicatie
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Full text (Publisher's DOI)
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Full text (open access)
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