Efficacy and Safety of Novel Thiazolidinedione Rivoglitazone in Type-2 Diabetes a Meta-Analysis

Deep Dutta; Jyoti Kadian; Indira Maisnam; Ashok Kumar; Saptarshi Bhattacharya; Meha Sharma

doi:10.4103/ijem.ijem_17_23

Efficacy and Safety of Novel Thiazolidinedione Rivoglitazone in Type-2 Diabetes a Meta-Analysis

Indian J Endocrinol Metab. 2023 Jul-Aug;27(4):286-295. doi: 10.4103/ijem.ijem_17_23. Epub 2023 Aug 28.

Authors

Deep Dutta¹, Jyoti Kadian², Indira Maisnam³, Ashok Kumar⁴, Saptarshi Bhattacharya⁵, Meha Sharma⁶

Affiliations

¹ Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.
² Department of Medicine, Kalpana Chawla Government Medical College, Karnal, Haryana, India.
³ Department of Endocrinology, Institute of Post-graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India.
⁴ Department of Endocrinology, CEDAR Superspeciality Healthcare, Panipat, Haryana, India.
⁵ Department of Endocrinology, Apollo Hospitals, New Delhi, India.
⁶ Department of Rheumatology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.

Abstract

No meta-analysis has analyzed the safety and efficacy of rivoglitazone in type-2 diabetes (T2DM). We undertook this meta-analysis to address this knowledge gap. Electronic databases were searched for RCTs involving T2DM patients receiving rivoglitazone in the intervention arm, and placebo/active comparator in the control arm. The primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in glucose, lipids, and adverse events. From initially screened 24 articles, data from 3 RCTs (3591 patients) that fulfilled all criteria was analzsed. HbA1c was significantly lower with standard-dose (1 mg/d) [MD-0.86% (95%CI:-1.11--0.61); P < 0.01; I² = 87%] and high-dose (1.5-2 mg/d) [MD-0.97%(95%CI:-1.03--0.90); P < 0.01; I² = 19%] rivoglitazone compared to placebo. When compared to pioglitazone (30-45 mg/d), HbA1c lowering was comparable with standard-dose [MD 0.05%(95%CI:-0.01 - 0.11); P = 0.08; I² = 11%], but superior with high-dose [MD -0.11%(95%CI:-0.18- -0.04); P < 0.01; I² = 0%] rivoglitazone. Triglycerides were significantly lower with standard-dose [MD-17.95 mg/dl (95%CI:-34.23--1.66); P = 0.03; I² = 0%] and high-dose [MD-40.41 mg/dl (95%CI:-72.90- -7.93);P = 0.01;I² = 71%] rivoglitazone compared to placebo. Adiponectin significantly improved with standard-dose [MD 7.94 ng/ml (95%CI: 5.48-10.39); P < 0.01;I² = 98%] and high-dose [MD 13.82 ng/ml (95%CI: 8.16-19.48); P < 0.01; I² = 100%] rivoglitazone compared to placebo. hsCRP was significantly lower with standard-dose [MD -1.00 mg/L (95% CI: -1.20 - -0.80); P < 0.01; I² = 6%] and high-dose [MD -1.50 mg/L (95%CI:-1.59- -1.40); P < 0.01; I² = 0%] rivoglitazone compared to placebo. Treatment-emergent adverse events with standard-dose [Risk ratio (RR) 1.16 (95%CI: 0.84 -1.60); P = 0.38; I² = 0%] and high-dose [RR1.34 (95%CI: 0.99-1.83); P = 0.06; I² = 0%] rivoglitazone was comparable to placebo. Severe adverse events with standard-dose [RR1.88 (95%CI: 0.69-5.12);P = 0.22;I² = 0%] and high-dose [RR 1.27 (95% CI: 0.45 - 3.59); P = 0.68; I² = 0%] rivoglitazone was comparable to placebo. This meta-analysis highlights the good glycaemic efficacy and safety of both standard and high-dose rivoglitazone, and appears to be better than lobeglitazone in T2DM.

Keywords: Lobeglitazone; meta-analysis; rivoglitazone; type-2 diabetes.