Pioglitazone use and risk of bladder cancer: population based cohort study

Abstract

Objective To determine whether pioglitazone compared with other antidiabetic drugs is associated with an increased risk of bladder cancer in people with type 2 diabetes.Design Population based cohort study.Setting General practices contributing data to the United Kingdom Clinical Practice Research Datalink.Participants A cohort of 145 806 patients newly treated with antidiabetic drugs between 1 January 2000 and 31 July 2013, with follow-up until 31 July 2014.Main outcome measures The use of pioglitazone was treated as a time varying variable, with use lagged by one year for latency purposes. Cox proportional hazards models were used to estimate adjusted hazard ratios with 95% confidence intervals of incident bladder cancer associated with pioglitazone overall and by both cumulative duration of use and cumulative dose. Similar analyses were conducted for rosiglitazone, a thiazolidinedione not previously associated with an increased risk of bladder cancer.Results The cohort generated 689 616 person years of follow-up, during which 622 patients were newly diagnosed as having bladder cancer (crude incidence 90.2 per 100 000 person years). Compared with other antidiabetic drugs, pioglitazone was associated with an increased risk of bladder cancer (121.0 v 88.9 per 100 000 person years; hazard ratio 1.63, 95% confidence interval 1.22 to 2.19). Conversely, rosiglitazone was not associated with an increased risk of bladder cancer (86.2 v 88.9 per 100 000 person years; 1.10, 0.83 to 1.47). Duration-response and dose-response relations were observed for pioglitazone but not for rosiglitazone.Conclusion The results of this large population based study indicate that pioglitazone is associated with an increased risk of bladder cancer. The absence of an association with rosiglitazone suggests that the increased risk is drug specific and not a class effect.

Prescribing pattern of anti diabetic drugs in patients suffering from type 2 diabetes mellitus with co-existing hypertension in a tertiary care teaching hospital

“…Pioglitazone is associated with bladder cancer, however no direct causal relation has been proved yet. 16 Only four prescriptions included four anti diabetic drugs. Poly therapy, as in this study, is particularly useful in patients, in whom there is persistent hyperglycaemia despite of adequate lifestyle modifications and pharmacological measures.…”

Do We Still Need Pioglitazone for The Management of Type 2 Diabetes Mellitus? A Peep In To Risk of Bladder Cancer in Diabetic Population

“…When compared with other anti-diabetic medications, pioglitazone use was associated with an increased risk of bladder cancer (121.0 versus 88.9 per 100,000 person years) with hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.22-2.19. This study also reported that risk of bladder cancer with pioglitazone may vary in a dose and duration dependent manner [8]. In addition, an epidemiological study identified 1,161,443 prevalent and 320,090 incident diabetics with mean age = 75.1 years, mean follow-up time = 38.0 months, and 20.2% filled a prescription for pioglitazone.…”

“…The ongoing results from the several studies suggested that pioglitazone use was associated with increased risk of bladder cancer [8,9]. On the other hand, few studies reported no risk of bladder cancer with pioglitazone use [10,11].…”

Type 2 diabetes therapeutic strategies: why don't we see the «ELEPHANT» in the room?

“…Интересно от-метить, что результаты последних исследований еще раз окончательно подтвердили влияние пиоглитазона на раз-витие рака мочевого пузыря [20,21].…”