Association of thiazolidinediones with liver cancer and colorectal cancer in type 2 diabetes mellitus

Abstract

The objective of this nationwide case‐control study was to evaluate the risk of specific malignancy in diabetic patients who received thiazolidinediones (TZDs). A total of 606,583 type 2 diabetic patients, age 30 years and above, without a history of cancer were identified from the Taiwan National Health Insurance claims database during the period between January 1 2000 and December 31 2000. As of December 31 2007, patients with incident cancer of liver, colorectal, lung, and urinary bladder were included as cases and up to four age‐ and sex‐matched controls were selected by risk‐set sampling. Logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) between TZDs and cancer incidence. A total of 10,741 liver cancer cases, 7,200 colorectal cancer cases, and 70,559 diabetic controls were included. A significantly lower risk of liver cancer incidence was found for any use of rosiglitazone (OR: 0.73, 95% CI: 0.65‐0.81) or pioglitazone (OR: 0.83, 95% CI: 0.72‐0.95), respectively. The protective effects were stronger for higher cumulative dosage and longer duration. For colorectal cancer, rosiglitazone, but not pioglitazone, was associated with a significantly reduced risk (OR: 0.86; 95% CI: 0.76‐0.96). TZDs were not associated with lung and bladder cancer incidence, although a potential increased risk for bladder cancer with pioglitazone use ≥3 years could not be excluded (OR: 1.56; 95% CI: 0.51‐4.74). Conclusion: The use of pioglitazone and rosiglitazone is associated with a decreased liver cancer incidence in diabetic patients. The effects on occurrence of specific cancer types may be different for pioglitazone and rosiglitazone. (HEPATOLOGY 2012;)

Diabetes Mellitus, Insulin, Sulfonylurea and Advanced Fibrosis in Non-Alcoholic Fatty Liver Disease

“…Compatible with our findings, is the report that anti-diabetic medications also affect the risk of Hepatocellular Carcinoma [HCC] [7,[20][21][22]. The use of insulin and sulfonylurea was associated with a 161% and 62% increased risk of HCC respectively, while the use of metformin was associated with 50% reduction in the incidence of HCC incidence [23].…”

Antidiabetic Medications and the Risk of Colorectal Cancer in Patients with Diabetes Mellitus: A Systematic Review and Meta-analysis

“…13,14,[16][17][18][19][34][35][36][37][38][39][40][41][42]. These studies cumulatively reported 13,871 colorectal cancer cases in 840,787 patients with diabetes mellitus.…”

“…These studies cumulatively reported 13,871 colorectal cancer cases in 840,787 patients with diabetes mellitus. There were four Taiwanese studies from the same cohort (15,34,43,44), and hence, only one report was included in the main analysis (34). There were three studies that compared the association between insulin glargine (as compared with nonglargine insulin) and the risk of cancer, and these were excluded from analysis (45)(46)(47).…”

“…Three studies included only patients on monotherapy for diabetes mellitus, in which follow-up was censored when a second ADM was added (13,40,41). In six studies, the adjusted OR for the drug of interest accounted for the simultaneous use of other ADMs (14,17,19,34,35,37).…”

Decreased Risk of Liver Cancer With Thiazolidinediones Therapy in Patients With Type 2 Diabetes: Results From a Meta-Analysis

“…We read with great interest the article by Chang et al,1 who demonstrated that the use of thiazolidinediones (TZDs) is associated with a decreased liver cancer incidence in diabetic patients. Similar results were also described in other studies.…”