Which Patients With Ischemic Stroke and Insulin Resistance May Benefit From Pioglitazone?

The Insulin Resistance Intervention After Stroke (IRIS) trial has reported that treating insulin resistance with the peroxisome proliferator –activated receptor γ agonist pioglitazone hydrochloride reduced recurrent stroke or myocardial infarction (MI) by about one-fourth compared with placebo (pioglitazone, 9.0% vs placebo, 11.8%; hazard ratio [HR], 0.76; 95% CI, 0.62-0.93) in 3876 patients with recent (<6 months) ischemic stroke or transient ischemic attack and insulin resistance but without diabetes, heart failure, or bladder cancer. Pioglitazone was also associated with less incident diabetes vs placebo (3.8% vs 7.7%; HR, 0.48 [95% CI, 0.33-0.69]) but more weight gain above 4.5 kg (52.2% vs 33.7%), more peripheral edema (35.6% vs 24.9%), and more bone fracture requiring surgery or hospitalization (5.1% vs 3.2%). The weight gain reflects an increase in adipose tissue and fluid due to renal sodium retention. As the latter may predispose to heart failure, patients with a history of heart failure were excluded from the IRIS trial. Patients with a history of bladder cancer were also excluded because pioglitazone may increase the risk of bladder cancer.
Source: JAMA Neurology - Category: Neurology Source Type: research