Increased risk of pancreatic cancer with incretin-based therapy?

Increased risk of pancreatic cancer with incretin-based therapy? Reactions 1680, p10 - 2 Dec 2017 Increased risk of pancreatic cancer with incretin-based therapy? Although there seems to be an association between incretin-based therapy in patients with diabetes and the development of pancreatic cancer, according to study results reported in Diabetes Care, "the reason for such an increase is likely the consequence of an occult pancreatic cancer that provokes or aggravates diabetes". The study used public health insurance databases in Belgium and in Lombardy, Italy, to create two cohorts of adults receiving an incident prescription for an incretin- based therapy (n=33 292) or another noninsulin antidiabetic drug (n=525 733). Patients were followed- up for a mean of 1.25–2.83 years. Pancreatic cancer was diagnosed in 885 patients from Belgium and 789 patients from Lombardy. The cancer rate for incretin recipients was 83.7 and 126.6 per 100 000 person-years, respectively, while the rate for NIAD recipients was 45.5 and 76.5 per 100 000 person- years. The risk of cancer was higher in patients who ever received an incretin drug compared to patients who only received a NIAD (adjusted hazard ratio [HR] 2.14; 95% CI 1.71, 2.67). The risk was higher when evaluated 3 months after treatment initiation (HR 3.35; 2.32, 4.84) compared to evaluation after 3–5.9 months (HR 2.12; 1.22, 3.66), 6–11.9 months (HR 1.95; 1.20, 3.16) or ≥12 months (HR 1.69; 1.12, 2.55). For the 10.6% of patients in Belgium and the 4.6% of patients in Lombardy who were prescribed an insulin therapy during follow-up, there was an increased risk of pancreatic cancer (HR 6.89; 6.05, 7.85). "These data do not support an incretin-specific effect on pancreatic cancer growth," note the authors, "whereas they do support the influence of occult pancreatic cancers on diabetes onset and aggravation". "We conclude that the protopathic bias would be an adequate hypothesis for explaining the increased risk of pancreatic cancer associated with the use of incretin drugs on the basis of spontaneous report," they add. "However, because the risk of pancreatic cancer remained slightly but significantly increased after 1 year of incretin drug use, studies that assess the risk of pancreatic cancer associated with long-term incretin drug use are needed, with examination of timing and duration while taking into account the various factors possibly involved in the occurrence of pancreatic cancer". Boniol M, et al. Incretin-Based Therapies and the Short-Term Risk of Pancreatic Cancer: Results From Two Retrospective Cohort Studies. Diabetes Care : 16 Nov 2017. Available from: URL: http://doi.org/10.2337/dc17-0280 803285328 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Increased risk of pancreatic cancer with incretin-based therapy?

Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Publisher
Springer Journals
Copyright
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-017-38941-5
Publisher site
See Article on Publisher Site

Abstract

Reactions 1680, p10 - 2 Dec 2017 Increased risk of pancreatic cancer with incretin-based therapy? Although there seems to be an association between incretin-based therapy in patients with diabetes and the development of pancreatic cancer, according to study results reported in Diabetes Care, "the reason for such an increase is likely the consequence of an occult pancreatic cancer that provokes or aggravates diabetes". The study used public health insurance databases in Belgium and in Lombardy, Italy, to create two cohorts of adults receiving an incident prescription for an incretin- based therapy (n=33 292) or another noninsulin antidiabetic drug (n=525 733). Patients were followed- up for a mean of 1.25–2.83 years. Pancreatic cancer was diagnosed in 885 patients from Belgium and 789 patients from Lombardy. The cancer rate for incretin recipients was 83.7 and 126.6 per 100 000 person-years, respectively, while the rate for NIAD recipients was 45.5 and 76.5 per 100 000 person- years. The risk of cancer was higher in patients who ever received an incretin drug compared to patients who only received a NIAD (adjusted hazard ratio [HR] 2.14; 95% CI 1.71, 2.67). The risk was higher when evaluated 3 months after treatment initiation (HR 3.35; 2.32, 4.84) compared to evaluation after 3–5.9 months (HR 2.12; 1.22, 3.66), 6–11.9 months (HR 1.95; 1.20, 3.16) or ≥12 months (HR 1.69; 1.12, 2.55). For the 10.6% of patients in Belgium and the 4.6% of patients in Lombardy who were prescribed an insulin therapy during follow-up, there was an increased risk of pancreatic cancer (HR 6.89; 6.05, 7.85). "These data do not support an incretin-specific effect on pancreatic cancer growth," note the authors, "whereas they do support the influence of occult pancreatic cancers on diabetes onset and aggravation". "We conclude that the protopathic bias would be an adequate hypothesis for explaining the increased risk of pancreatic cancer associated with the use of incretin drugs on the basis of spontaneous report," they add. "However, because the risk of pancreatic cancer remained slightly but significantly increased after 1 year of incretin drug use, studies that assess the risk of pancreatic cancer associated with long-term incretin drug use are needed, with examination of timing and duration while taking into account the various factors possibly involved in the occurrence of pancreatic cancer". Boniol M, et al. Incretin-Based Therapies and the Short-Term Risk of Pancreatic Cancer: Results From Two Retrospective Cohort Studies. Diabetes Care : 16 Nov 2017. Available from: URL: http://doi.org/10.2337/dc17-0280 803285328 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680

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Reactions WeeklySpringer Journals

Published: Dec 2, 2017

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