To the Editor: The study by Dr Nissen and colleagues1 evaluating the incidence of death, myocardial infarction, stroke, congestive heart failure, and transient ischemic attack in patients with diabetes treated with muraglitazar underscores the need for inclusion of hard clinical end points in the evaluation of new drugs, as well as a thorough review of all available data in a peer-reviewed format. At times the presumed safety of a drug is not realized when used in higher-risk populations (eg, cyclooxygenase 2 inhibitors), and at times unexpected events may be observed in populations thought to potentially derive the most benefit from a drug. Such was the case when clopidogrel was compared with aspirin plus esomeprazole in patients at high risk for vascular events who had presented with ulcer bleeding.2
Parra D, Beckey C, Thomas T. Adverse Events Related to Muraglitazar Use in Diabetes. JAMA. 2006;295(17):1997–1998. doi:10.1001/jama.295.17.1997-b
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