Pioglitazone and the Risk of Bladder Cancer: A Meta-Analysis

Abstract

People with type 2 diabetes are at increased risk of bladder cancer. Pioglitazone is said to increase it further, although published evidence is mixed. We conducted a meta-analysis to determine if any link between the use of pioglitazone and an increased risk of bladder cancer can be found. A comprehensive literature search was conducted through electronic databases as well as registries for data of clinical trials to identify studies that investigate the effect of pioglitazone on bladder cancer in diabetic patients. We used the risk ratio (RR) and the hazard ratio (HR) provided by the studies to illustrate the risk of occurrence of bladder cancer in the experimental group compared to that in the control group. Fourteen studies using RR and 12 studies using HR were included in the analysis. The overall RR was 1.13 with 95% CI (0.96–1.33) with low heterogeneity among the studies using RR, suggesting that no connection exists between use of pioglitazone and the risk of bladder malignancy. The summary HR was 1.07 (0.96–1.18) allowing us to affirm that there is no link between long-term use of pioglitazone and bladder cancer. Our results support the hypothesis of no difference in the incidence of bladder cancer among the pioglitazone group and the nonuser group. Our conclusion is that the explanation of hypothetically increased risk of bladder malignancy should be attributed to other factors. Funding : Tchaikapharma High Quality Medicines Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0273-4) contains supplementary material, which is available to authorized users.

From NASH to diabetes and from diabetes to NASH: Mechanisms and treatment options

“…200 Finally, mixed results in the literature have been reported about the relationship between thiazolidinediones and bladder cancer, which remains uncertain, although most studies have failed to observe such an association, particularly if low quality studies are excluded. 201 In summary, many general practitioners and specialists remain unaware that pioglitazone has the potential to induce resolution of NASH in~60% of patients, as well as conferring extrahepatic benefits (i.e., reduction of new-onset diabetes or CVD). However, it is likely that its use will continue to increase in patients with NASH to prevent fibrosis progression.…”

A systematic review of observational studies of the association between pioglitazone use and bladder cancer

“…Ten previous systematic reviews or meta-analyses on the association of pioglitazone use with bladder cancer have already been published [1][2][3][4][5][6][7][8][9][10]. Nevertheless, a final word on risk associated with pioglitazone use cannot be given because these studies are flawed by factors that range from improper use of analytical procedures to scarce consideration of time-related and selection biases.…”

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

“…Another, recent meta-analysis conducted by Filipova and colleague reported no link of bladder cancer risk with pioglitazone use, Relative risk; RR = 1.13; 95% CI 0.96-1.33 and HR = 1.07; 95% CI 0.96-1.18), and suggested hypothetically increased risk of bladder malignancy should be attributed to other factors [11].…”

“…On the other hand, few studies reported no risk of bladder cancer with pioglitazone use [10,11]. For instance, a recent population based cohort study conducted in United Kingdom (UK) 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).…”