eoe-0605-004 alert:actos (pioglitazone)
(LOS ANGELES, POSTED JUNE 9, 2005)
this floored me.
i checked in with my chief physician yesterday (primary care provider is such an unworkable moniker. let’s try out the chief.)
dr. dale, my chief. i told him i’d met with doctor paul, the new endocrinologist the day before (i have protease-inhibitor-triggered diabetes). paul completely revised my insulin regimen in the hospital three weeks ago. the day before, he’d added a new drug to my regimen: actos (pioglitazone).
a new drug. i’d never heard of it. so i checked in with dale about it—my chief. just to make sure.
“paul told me it would reverse the migration of fat to my belly,” i said.
“what?!?” said dale.
i have protease-inhibitor-generated lipodystrophy—no subcutaneous fat. it’s wrapped around my liver and other organs and stuffed into the nooks of my abdominal cavity. facial wasting, too. and i can see the bones in the back of my hands and in my wrists as i type.
big words: hiv-associated lipodystrophy syndrome is a side effect of protease inhibitors. it is characterized by lipid redistribution—loss of subcutaneous fat and increase in fatty infiltration of the liver as well as visceral adipose tissue—and metabolic disturbances, including glucose intolerance or overt diabetes and dyslipidemia.
“that’s what i said,” i told dale. “paul’s not used to me yet, so when i asked him for brochures about it, or an internet site, he gave me this fishy look, like i’d hurt his feelings. he told me he’d been doing this for a while, and in two weeks i’d start seeing what he was talking about. so maybe it’s an off-label effect.”
“if it pulls fat out of your gut and puts it back under your skin again, i’ll take it,” my chief said. “let’s go look it up in my office.”
so we did. actos and lipid redistribution in the password-protected physician’s section of medscape: a ton of stuff. here are the two of the most recent:
first item: in the january 2005 issue of metabolism, an article titled “the effect of pioglitazone on body composition.”
the main purpose of the 24-week 48-subject randomized double-blind study was to evaluate the effect of actos “on visceral, subcutaneous, and total body fat.”
“subcutaneous fat in the trunk, arms and legs were all increased in the pioglitazone-treated group,” the report said. “visceral fat did not change significantly,” though researchers at the pennington biomedical research center in baton rouge, la, noted, “some, but not all, [prior] studies demonstrate reductions in visceral adipose tissue.”
second item: a february, 2004 case report from the journal of the medical association of thailand, titled “improvement of fat redistribution, insulin resistance and hepatic fatty infiltration in hiv-associated lipodystrophy syndrome by pioglitazone.”
subject of the report was a “50-year-old hiv-infected woman who developed hiv-associated lipodystrophy syndrome after 3 months of haart” [highly active anti-retroviral therapy].
physicians at the bamrasnaradura institute reported the woman’s “subcutaneous fat loss was restored. improvement in glycemic and lipid control was also noted. ct scan of the abdomen revealed that fatty infiltration in the liver was markedly decreased. visceral fat as assessed by ct scan had also decreased.”
so. a new drug.
a new medical adventure.
i’ll let you know what happens in two weeks.
i’ll let you know what happens with the chief, too.
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RESOURCES
“effect of pioglitazone on body composition and energy expenditure: a randomized controlled trial.”
metabolism 2005 jan;54(1):24-32 (issn: 0026-0495)
smith sr; de jonge l; volaufova j; li y; xie h; bray ga
department of molecular endocrinology, pennington biomedical research center, baton rouge, la 70808, usa. smithsr@pbrc.edu
“improvement of fat redistribution, insulin resistance and hepatic fatty infiltration in hiv-associated lipodystrophy syndrome by pioglitazone: a case report.”
j med assoc thai 2004 feb;87(2):166-72 (issn: 0125-2208)
prasithsirikul w; bunnag p
bamrasnaradura institute, nonthaburi 11000, thailand.
text of eoe5-004 alert: actos (pioglitazone) © 2005 by richard kearns
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