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Clopidogrel and other stories . . .

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f2051 (Published 02 April 2013) Cite this as: BMJ 2013;346:f2051

Clopidogrel has brought great wealth to its manufacturers, but envious competitors have sought to stain its reputation by using data from in vitro studies to argue for an interaction with commonly prescribed drugs, such as proton pump inhibitors. In this way, more than 8000 academic papers have been generated, and companies have developed platelet testing kits, genotyping products, and competing thienopyridine antiplatelet drugs. But when these have been brought to trial against simple fixed dose clopidogrel they don’t affect outcomes. And as prospective trials have tested the interaction with proton pump inhibitors, its clinical significance has disappeared, as shown in a new systematic review (Heart 2013;99:520-7; doi:10.1136/heartjnl-2012-302371). So, beware of mechanistic reasoning.

The only oral hypoglycaemic agent that doesn’t make outcomes worse is metformin, and even that hasn’t been proved. Yet it may have true benefits. In a nationwide case-control study from Taiwan, this drug seems to decrease the risk of hepatocellular carcinoma in a dose dependent manner (Gut 2013:62:606-5; doi:10.1136/gutjnl-2011-301708). As for the latest class of antidiabetes drugs, the incretin mimetics, a post mortem study in Diabetes …

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