A population-based cohort study in Taiwan––use of insulin sensitizers can decrease cancer risk in diabetic patients?

Kao, Chia Hung; Sun, Li; Chen, Pei Chun; Lin, Ming-Chia; Liang, Ji An; Muo, Chih Hsin; Chang, Shih Ni; Sung, Fung‐Chang

doi:10.1093/annonc/mds472

Cited by 28 publications

(32 citation statements)

References 30 publications

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“…They reported a lack of significant risk for bladder cancer for TZDs users versus nondiabetic controls, and versus nonusers of TZDs in the diabetic patients. The respective hazard ratios (95% CI) were 0.74 (0.27-1.99); 1.48 (0.56-3.92) [56]. It is interesting that the hazard ratio (95% CI) of 0.74 (0.27-1.99) for TZDs users versus nondiabetic controls in this study is very similar to the estimated 0.80 (0.34-1.90) in the previous study by Tseng comparing users versus nonusers of TZDs (mainly composed of non-diabetic individuals) [53].…”

Section: Taiwan: Kao and Colleagues (Matched Retrospective Cohort Study)mentioning

confidence: 99%

“…The major population-based cohorts used in these studies are derived from administrative databases, which include the Kaiser Permanente Northern California (KPNC) database in the United States [9,45], the US pharmacy claims database [46], the national health insurance in France (the CNAMTs study: Caisse Nationale d'Assurance Maladie des Travailleurs Salariés) [11], the Health Improvement Network (THIN) or General Practice Research Database (GPRD) in UK [47][48][49], and the National Health Insurance (NHI) reimbursement databases of Taiwan [50][51][52][53][54][55][56]. Hospital-based design was applied in a Japanese report [57] and in a Korean study [58].…”

Section: Observational Studiesmentioning

confidence: 99%

“…Two of them evaluated any TZDs in addition to specifying on pioglitazone and rosiglitazone [47,49] and the other three evaluated any TZDs without specifying the drugs [46,53,56]. These five studies are discussed next.…”

Section: Observational Studiesmentioning

confidence: 99%

“…For example, the UK GPRD was used in the studies by Mamtani and colleagues [47], Wei and associates [48] and Azoulay and coauthors [49]. On the other hand, Tseng [50][51][52][53], Chang and colleagues [54], Hsiao and associates [55] and Kao and coauthors [56] the Taiwanese NHI database for their studies. Some of the investigators used a retrospective cohort study design and some used a case-control design from the same databases (Table 2).…”

Section: Overlapping Populations and Contradictory Findings From The mentioning

confidence: 99%

“…A significantly lower risk of liver cancer is associated with the use of either rosiglitazone or pioglitazone in Taiwan [54,56], and a significantly lower risk of breast cancer in pioglitazone users than insulin users has been reported by using the i3 InVision Data Mart database in the United States [101]. Another recent retrospective cohort study using the UK GPRD even suggested that after failure of metformin monotherapy, addition of pioglitazone provides a better combined outcome including all-cause mortality, major adverse cardiovascular events, and cancer than other glucose-lowering agents [116].…”

Section: Balancing Risks and Benefits Is Important In Clinical Practicementioning

confidence: 99%

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A Review on Thiazolidinediones and Bladder Cancer in Human Studies

Tseng

2014

Journal of Environmental Science and Health, Part C

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There is a concern of an increased risk of bladder cancer associated with the use of thiazolidinediones, a class of oral glucose-lowering drugs commonly used in patients with type 2 diabetes with a mechanism of improving insulin resistance. Human studies on related issues are reviewed, followed by a discussion on potential concerns on the causal inference in current studies. Pioglitazone and rosiglitazone are discussed separately, and findings from different geographical regions are presented. Randomized controlled trials designed for primarily answering such a cancer link are lacking, and evidence from clinical trials with available data for evaluating the association may not be informative. Observational studies have been reported with the use of population-based administrative databases, single-hospital records, drug adverse event reporting system, and case series collection. Meta-analysis has also been performed by six different groups of investigators. These studies showed a signal of higher risk of bladder cancer associated with pioglitazone, especially at a higher cumulative dose or after prolonged exposure; however, a weaker signal or null association is observed with rosiglitazone. In addition, there are some concerns on the causal inference, which may be related to the use of secondary databases, biases in sampling, differential detection, and confounding by indications. Lack of full control of smoking and potential biases related to study designs and statistical approaches such as prevalent user bias and immortal time bias may be major limitations in some studies. Overlapping populations and opposing conclusions in studies using the same databases may be of concern and weaken the reported conclusions of the studies. Because randomized controlled trials are expensive and unethical in providing an answer to this cancer issue, observational studies are expected to be the main source in providing an answer in the future. Furthermore, international comparison studies using well-designed and uniform methodology to clarify the risk in specific sexes, ethnicities, and other subgroups and to evaluate the interaction with other environmental risk factors or medications will be helpful to identify patients at risk.

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Section: Taiwan: Kao and Colleagues (Matched Retrospective Cohort Study)mentioning

confidence: 99%

Section: Observational Studiesmentioning

confidence: 99%

Section: Observational Studiesmentioning

confidence: 99%

Section: Overlapping Populations and Contradictory Findings From The mentioning

confidence: 99%

Section: Balancing Risks and Benefits Is Important In Clinical Practicementioning

confidence: 99%

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A Review on Thiazolidinediones and Bladder Cancer in Human Studies

Tseng

2014

Journal of Environmental Science and Health, Part C

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Thiazolidinedione therapy and breast cancer risk in diabetic women: A systematic review and meta‐analysis

Lin

Cheng

et al. 2017

Diabetes Metabolism Res

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Rising experimental evidence suggests that thiazolidinediones (TZDs) exert a protective effect on breast cancer. However, studies concerning this issue were inconsistent and limited. Hence, we performed a meta-analysis with data from currently available studies to evaluate the effect of TZDs on breast cancer risk among diabetic women. We comprehensively searched for all pertinent studies addressing TZDs use and breast cancer risk published before January 1, 2016, in PubMed, Clinical Trials, and Cochrane Library. Data synthesis was performed in a random-effects model using Stata version 12.0 (Stata Corp, College Station, Texas). Fourteen independent studies were eventually selected in this meta-analysis, including 5 randomized controlled clinical trials (RCTs), 7 cohort studies, and 2 case-control studies. No significant associations of TZD use and risk of breast cancer were observed in the RCTs (pooled risk ratio [RR]: 0.77, 95% confidence interval (CI), 0.39-1.53, I = 26%) or case-control studies (pooled odds ratio, 0.99, 95% CI, 0.76-1.28, I = 31%). A 19% reduction in breast cancer risk (pooled RR: 0.81, 95% CI, 0.66-0.99, I = 72%) was found in the cohort studies. However, after removing the study with the smallest event number and the greatest effect size, the association became nonsignificant with greatly decreased heterogeneity (pooled RR: 0.94, 95% CI, 0.86-1.03, I = 16%). This meta-analysis did not find any significant association between TZDs use and risk of breast cancer among diabetic women.

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