Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Najman and Dr Parra and colleagues raise important and valid concerns about dual PPAR agonists. Both letters recommend caution in the coadministration of fibric acid derivatives and thiazolidinediones, a strategy that would activate both PPAR-α and γ receptors via 2 separate agents. Najman points out that some studies using the older PPAR-α agents gemfibrozil and bezafibrate showed nonsignificant increases in mortality. In addition, the recent Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study showed a 19% higher mortality rate in the fenofibrate treatment group (P = .22).1 In the muraglitazar analyses, we could not assess the impact of coadministration of the approved fibric acid derivatives because these agents were prohibited in the study designs.2,3
Nissen SE. Adverse Events Related to Muraglitazar Use in Diabetes—Reply. JAMA. 2006;295(17):1997-1998. doi:10.1001/jama.295.17.1998-a