Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324 168 participants from randomised trials

Bangalore, Sripal; Kumar, Sunil; Kjeldsen, Sverre E.; Makani, Harikrishna; Grossman, Ehud; Wetterslev, Jørn; Gupta, Ajay; Sever, Peter; Gluud, Christian; Messerli, Franz H.

doi:10.1016/s1470-2045(10)70260-6

Cited by 330 publications

(329 citation statements)

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“…The authors had perceived or actual conflicts of interest with several pharmaceutical companies that manufactured ARBs. 4 Their search included PubMed, Embase, Cochrane Central Register of Controlled Trials, the grey literature, and the FDA database up to August 2010. They also searched the reference lists of included RCTs and review articles and contacted authors of RCTs for additional data as required.…”

Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%

“…For new cancer occurrence, they analyzed the same outcome data for the trials they had in common. However, data from 9 RCTs 4 Two of these trials, DIRECT and SCOPE, were identified by Bangalore and others, who tried to contact the authors of the original studies for additional data but received no response. Two other trials, I-PRESERVE and IDNT, published data only for cancer-related mortality, and their authors did not make data on cancer occurrence available to Bangalore and others.…”

Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%

“…Two other trials, I-PRESERVE and IDNT, published data only for cancer-related mortality, and their authors did not make data on cancer occurrence available to Bangalore and others. 4 One trial, Val-HeFT, was included only in the analysis of ACE inhibitor and ARB combination therapy by Bangalore and others. 4 The last 2 trials, ACTIVE-I and NAVIGATOR, were published beyond the search period used by Bangalore and others.…”

Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%

“…4 One trial, Val-HeFT, was included only in the analysis of ACE inhibitor and ARB combination therapy by Bangalore and others. 4 The last 2 trials, ACTIVE-I and NAVIGATOR, were published beyond the search period used by Bangalore and others. 4 Conversely, Bangalore and others 4 included 7 RCTs that were not included in the ATC analysis.…”

Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%

“…In April 2011, another metaanalysis, covering 15 trials with a total of 134 000 patients and published by the ARB Trialists Collaboration (ATC), reported no statistically significant difference in the incidence of cancer in the ARB treatment group (OR 1.00, 95% CI 0.95-1.04). 3 Earlier that year, in January 2011, Bangalore and others 4 published an analysis of the risk of cancer associated with all antihypertensive drug classes. That analysis included 14 RCTs with a total of 99 775 patients and concluded that there was no increased risk of cancer in the ARB treatment group (OR 0.98, 95% CI 0.93-1.03).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Does Outcome Reporting Bias “Cause” Cancer? Risks Associated with Hidden Data on Angiotensin Receptor Blockers

Egan

Lee

Minhas³

et al. 2012

CJHP

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Conflicting reports have been published regarding the influence of angiotensin receptor blockers (ARBs) on the incidence of cancer. One meta-analysis reported a 1% absolute increase in the incidence of cancer associated with ARBs over 4 years. Contrasting findings were reported in an industry-sponsored meta-analysis and in another meta-analysis, both of which showed no difference in the incidence of cancer in ARB treatment groups relative to control groups. The US Food and Drug Administration has recently asserted that evidence does not support an association between ARBs and the development of cancer. The current review compares the 3 published meta-analyses assessing the association between ARBs and cancer and shows that outcome reporting bias contributed to the conflicting results. Given the prevalence of this form of bias in the scientific literature, the processes for systematic reviews and meta-analyses are under siege, and there is an important role for health care regulators to play. If all outcome data from clinical trials were to be reported in the public domain, independent analyses could be performed and the results of industry-sponsored trials verified. Furthermore, if regulators were to mandate the publication, in the public domain, of all clinical outcomes collected in clinical trials, outcome reporting bias could be eliminated. RÉSUMÉContexte : Des rapports contradictoires ont été publiés quant à l'influence des antagonistes des récepteurs de l'angiotensine (ARA) sur l'incidence du cancer. Une méta-analyse a signalé une augmentation absolue de 1 % de l'incidence du cancer associée aux ARA sur une période de quatre ans. Des résultats très différents issus de deux méta-analyses, dont l'une a été commanditée par l'industrie, n'ont montré aucune différence dans l'incidence du cancer dans les groupes traités par les ARA comparativement aux groupes témoins. La Food and Drug Administration des États-Unis a déjà affirmé que les données probantes ne corroborent pas le lien entre les ARA et l'apparition de cancer. La présente analyse compare les trois méta-analyses publiées évaluant le lien entre les ARA et le cancer, et montre que les biais de publication des résultats ont contribué à ces conclusions contradictoires. Étant donné la prévalence de cette forme de biais dans la littérature scientifique, la démarche entourant les analyses systématiques et les méta-analyses est sur la sellette et les organismes de réglementation des soins de santé ont un important rôle à jouer dans ce contexte. Si toutes les données issues des études cliniques étaient rendues publiques, des analyses indépendantes pourraient être effectuées et les résultats des études commanditées par l'industrie pourraient être vérifiés. En outre, si les organismes de réglementation exigeaient de rendre publiques l'ensemble des données issues des études cliniques, on pourrait alors éliminer les biais de publication des résultats.Mots clés : biais de publication des résultats, méta-analyse, antagonistes des récepteurs de l'angiotensine ...

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Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%

Section: Comparison Of 3 Meta-analysesmentioning

confidence: 99%