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May 3, 2006

Adverse Events Related to Muraglitazar Use in Diabetes—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(17):1997-1998. doi:10.1001/jama.295.17.1998-a

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

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