Troglitazone

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Troglitazone
Troglitazone svg.svg
Systematic (IUPAC) name
(RS)-5-(4-[(6-hydroxy-2,5,7,8-tetramethylchroman-2-yl)methoxy]benzyl)thiazolidine-2,4-dione
Clinical data
Legal status ?
Pharmacokinetic data
Half-life 16-34 hours
Identifiers
CAS number 97322-87-7 N
ATC code A10BG01
PubChem CID 5591
IUPHAR ligand 2693
DrugBank DB00197
ChemSpider 5389 YesY
UNII I66ZZ0ZN0E YesY
KEGG D00395 YesY
ChEBI CHEBI:9753 YesY
ChEMBL CHEMBL408 YesY
Chemical data
Formula C24H27NO5S 
Mol. mass 441.541 g/mol
 N (what is this?)  (verify)

Troglitazone (Rezulin, Resulin, Romozin, Noscal) is an antidiabetic and anti-inflammatory drug, and a member of the drug class of the thiazolidinediones. It was prescribed for patients with diabetes mellitus type 2.[1] It was developed by Daiichi Sankyo Co.(Japan). In the United States, it was introduced and manufactured by Parke-Davis in the late 1990s, but turned out to be associated with an idiosyncratic reaction leading to drug-induced hepatitis. One F.D.A. medical officer evaluating troglitazone, John Gueriguian, did not recommend its approval due to potential high liver toxicity,[2] but a full panel of experts approved it in January 1997.[3] Once the prevalence of adverse liver effects became known, troglitazone was withdrawn from the British market in December 1997, from the United States market in 2000, and from the Japanese market soon afterwards. It didn't get approval in the rest of Europe.

Approval history[edit]

Parke-Davis/Warner Lambert submitted the diabetes drug Rezulin for U.S. Food and Drug Administration (F.D.A.) review on July 31, 1996. The medical officer assigned to the review, Dr. John L. Gueriguian, cited Rezulin's potential to harm the liver and the heart and he questioned its viability in lowering blood sugar for patients with adult-onset diabetes, recommending against the drug's approval. After complaints from the drugmaker, Gueriguian was removed on November 4, 1996 and his review was purged by the F.D.A.[4][5] Parke-Davis said at the advisory committee that the risk of liver toxicity was comparable to placebo and that additional data of other studies confirmed this.[6] When the company provided these additional data one week after approval, they showed a substantial greater risk for liver toxicity.[7]

The F.D.A. approved the drug on January 29, 1997, and it appeared in pharmacies in late March. At the time Dr. Solomon Sobel, a director at the F.D.A., overseeing diabetes drugs, said in a New York Times interview that adverse effects of troglitazone appeared to be rare and relatively mild.[8]

Glaxo Wellcome P.L.C. received approval from the British Medicines Control Agency (MCA) to market troglitazone, as Romozin, in July 1997.[9] After reports of sudden liver failure in patients receiving the drug, Glaxo removed troglitazone from the market in Britain on December 1, 1997.[4] Glaxo had licensed the drug from Sankyo Company of Japan and had sold it in Britain from October 1, 1997.[10][11]

The F.D.A. and Warner-Lambert responded to the U.K. withdrawal of troglitazone by recommending that patient liver-function be monitored on a monthly basis. On May 17, 1998, a 55-year old patient named Audrey LaRue Jones died of acute liver failure after taking troglitazone. Importantly, she had been monitored closely by physicians at the National Institutes of Health as a participant in the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes prevention study.[12][13] This called into question the efficacy of the monitoring strategy. The N.I.H. responded on June 4 by dropping troglitazone from the study.[5][14] Dr. David J. Graham, an F.D.A. epidemiologist charged with evaluating the drug, warned on March 26, 1999 of the dangers of using it and concluded that patient monitoring was not effective in protecting against liver failure. He estimated that the drug could be linked to over 430 liver failures and that patients incurred 1,200 times greater risk of liver failure when taking Rezulin.[5][15] Dr. Janet B. McGill, an endocrinologist who had assisted in the Warner–Lambert's early clinical testing of Rezulin, wrote in a March 1, 2000 letter to Sen. Edward M. Kennedy (D-Mass.): "I believe that the company . . . deliberately omitted reports of liver toxicity and misrepresented serious adverse events experienced by patients in their clinical studies."[16]

On March 21, 2000, the F.D.A. withdrew the drug from the market.[17] Dr. Robert I. Misbin, an F.D.A. medical officer, wrote in a July 3, 2000 letter to the House Energy and Commerce Committee of strong evidence that Rezulin could not be used safely, after having been threatened by the FDA with dismissal in March 2000.[4][18] By that time the drug had been linked to 63 liver-failure deaths and had generated sales of more than $2.1 billion for Warner-Lambert.[15] The drug cost $1,400 a year per patient in 1998.[11] Pfizer, which had acquired Warner-Lambert in February 2000, reported the withdrawal of Rezulin cost $136 million.[19]

Lawsuits[edit]

In 2009 Pfizer Inc. resolved all but three of 35,000 claims over its withdrawn diabetes drug Rezulin for a total of about $750 million. Pfizer, which acquired rival Wyeth for almost $64 billion, paid about $500 million to settle Rezulin cases consolidated in federal court in New York, according to court filings. The company also paid as much as $250 million to resolve state-court suits. In 2004, it set aside $955 million to end Rezulin cases.[20]

Mode of action[edit]

Troglitazone, like the other thiazolidinediones (pioglitazone and rosiglitazone), works by activating peroxisome proliferator-activated receptors (PPARs).

Troglitazone is a ligand to both PPARα and – more strongly – PPARγ. Troglitazone also contains an α-tocopheroyl moiety, potentially giving it vitamin E-like activity in addition to its PPAR activation. It has been shown to reduce inflammation:[21] troglitazone use was associated with a decrease of nuclear factor kappa-B (NF-κB) and a concomitant increase in its inhibitor (IκB). NFκB is an important cellular transcription regulator for the immune response.

References[edit]

  1. ^ Fisher, Lawrence (4 November 1997). "Adverse Diabetes Drug News Sends Warner-Lambert Down". The New York Times. Retrieved 12 December 2012. 
  2. ^ Retired Drugs: Failed Blockbusters, Homicidal Tampering, Fatal Oversights, wired.com
  3. ^ Cohen, J. S. (2006). "Risks of troglitazone apparent before approval in USA". Diabetologia 49 (6): 1454–5. doi:10.1007/s00125-006-0245-0. PMID 16601971. 
  4. ^ a b c Willman, David (20 December 2000). "NEW FDA: Rezulin Fast-Track Approval and a Slow Withdrawal". The Los Angeles Times. Retrieved 12 December 2012. 
  5. ^ a b c Willman, David (4 June 2000). "The Rise and Fall of the Killer Drug Rezulin". The Los Angeles Times. Retrieved 12 December 2012. 
  6. ^ Avorn, J (2005). Powerful medicines. New York: Vintage books. 
  7. ^ Gøtzsche, Peter; Rennie, Drummond (2013). Deadly medicines and organised crime : how big pharma has corrupted healthcare. London [u.a.]: Radcliffe Publ. p. 185. ISBN 9781846198847. 
  8. ^ Leary, Warren (31 January 1997). "New Class of Diabetes Drug Is Approved". The New York Times. Retrieved 12 December 2012. 
  9. ^ Sinclair, Neil (31 July 1997). "Glaxo Wellcome gets approval for Romozin". ICIS News. Retrieved 12 December 2012. 
  10. ^ British Broadcasting Corporation (1 December 1997). "Diabetes drug withdrawn from sale". BBC. Retrieved 12 December 2012. 
  11. ^ a b Fisher, Lawrence (17 January 1998). "Drug Makers at Threshold of a New Therapy; With a Dose of Biotechnology, Big Change Is Ahead in the Treatment of Diabetes". The New York Times. Retrieved 12 December 2012. 
  12. ^ Diabetes Prevention Research Group (April 1999). "Design and methods for a clinical trial in the prevention of type 2 diabetes". Diabetes Care 22 (4): 623–634. doi:10.2337/diacare.22.4.623. Retrieved 12 December 2012. 
  13. ^ Diabetes Prevention Program Research Group (7 February 2002). "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin". The New England Journal of Medicine 346 (6): 393–403. doi:10.1056/NEJMoa012512. PMC 1370926. PMID 11832527. Retrieved 12 December 2012. 
  14. ^ Gale, Edwin (January 2006). "Troglitazone: the lesson that nobody learned?". Diabetologia 49 (1): 1–6. doi:10.1007/s00125-005-0074-6. 
  15. ^ a b Willman, David (16 August 2000). "FDA's Approval and Delay in Withdrawing Rezulin Probed". The Los Angeles Times. Retrieved 12 December 2012. 
  16. ^ Willman, David (10 March 2000). "Fears Grow Over Delay in Removing Rezulin". The Los Angeles Times. Retrieved 12 December 2012. 
  17. ^ U.S. Food and Drug Administration. "2000 Safety Alerts for Human Medical Products". U.S. Food and Drug Administration. Retrieved 12 December 2012. 
  18. ^ Willman, David (March 17, 2000). "Physician Who Opposes Rezulin Is Threatened by FDA With Dismissal". Los Angeles Times. 
  19. ^ Pfizer. "Pfizer Annual Report 2001". Pfizer. Retrieved 12 December 2012. 
  20. ^ Feeley, Jef (March 31, 2009). "Pfizer Ends Rezulin Cases With $205 Million to Spare". Bloomberg. Retrieved 6 April 2014. 
  21. ^ Aljada A, Garg R, Ghanim H, et al. (2001). "Nuclear factor-kappaB suppressive and inhibitor-kappaB stimulatory effects of troglitazone in obese patients with type 2 diabetes: evidence of an antiinflammatory action?". J. Clin. Endocrinol. Metab. 86 (7): 3250–6. doi:10.1210/jc.86.7.3250. PMID 11443197. 

External links[edit]