Conversion from troglitazone to rosiglitazone or pioglitazone in the VA: a multicenter DUE.

The market withdrawal of troglitazone forced the Department of Veterans Affairs (VA) to perform a systemwide switch from troglitazone to rosiglitazone or pioglitazone. The potency, dosing equivalents, and safety of these agents had not been specifically assessed in the complex VA patient base, which includes elderly patients. The VA Pharmacy Benefits Management Strategic Healthcare Group (VA PBM) performed a national drug utilization evaluation (DUE) of the conversion from troglitazone to rosiglitazone or pioglitazone. The objectives were to: 1) assess dosing potency and equivalence of con-version doses; 2) evaluate the effects of rosiglitazone and pioglitazone on HgbA1C, lipid panel, LFTs, and Hgb/Hct; and 3) monitor adverse drug events. Nine VA facilities participated in collecting a minimum of 4 months' data for analysis by the VA PBM. A standard dose conversion table was provided. The dosing equivalent appeared less potent for pioglitazone compared to rosiglitazone as demonstrated by more frequent dosage increases (28% vs 16%). The most common ADEs detected were weight gain (27%), mild LFT elevation (23%), and CHF symptoms (9.4%). The findings of this DUE warrant close monitoring of patients placed on thiazolidinedione therapy, particularly with regards to CHF exacerbation and potential hepatotoxicity, which prompted the initiation of a VA National Thiazolidinedione Registry. [ABSTRACT FROM AUTHOR]