Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial.

Description

Investigators of the PERISCOPE trial compared the effects of two anti-diabetic drugs, pioglitazone and glimepiride, on change in percent atheroma volume (PAV) as measured by intravascular ultrasonography. For that purpose, they randomized 543 patients with coronary disease and type 2 diabetes to either pioglitazone (15-45 mg/day) or glimepiride (1-4 mg/day) for 18 months. The main outcome measure, PAV, increased by an average of 0.73% (95% CI, 0.33-1.12%) in patients treated with glimepiride, whereas it decreased by an average of 0.16% (95% CI, -0.57-0.25%) with pioglitazone. The latter also had a greater effect on mean HbA1c level and on fasting plasma glucose, HDL cholesterol, and C-reactive protein concentrations. As for potential side effects, glimepiride caused more hypoglycemia while pioglitazone caused more edemas and fractures. These results suggest that coronary disease progression is slower with pioglitazone compared to glimepiride in patients with both coronary artery disease and type 2 diabetes. This paper was accompanied by an editorial by Philippe Gabriel Steg and Michel Marre (JAMA 2008;299:1603-4) who placed the PERISCOPE trial in the context of similar trials performed on the topic, such as ACCORD and PROACTIVE. They briefly discussed the high rates of noncompletion and highlighted it as a potential study limitation. They also emphasized that clinical outcome trials, rather than surrogate endpoint studies such as the one presented here, are required to better evaluate the role of pioglitazone in clinical practice.