No Bladder Cancer Risk with Pioglitazone Use

July 23, 2015

No Bladder Cancer Risk with Pioglitazone Use

  1. Thomas L. Schwenk, MD

But possible excess risk for prostate cancer and pancreatic cancer requires further study.

  1. Thomas L. Schwenk, MD

Animal models and some postmarketing studies have suggested elevated risk for bladder cancer in pioglitazone users. Now, researchers present three studies in which pioglitazone use was assessed in patients who developed bladder cancer (in two studies) and other cancers (in the third study). All studies were conducted at a large integrated healthcare system in California.

In a cohort analysis of 193,099 patients with diabetes (18% treated with pioglitazone for a median 3 years), unadjusted bladder cancer incidence did not differ significantly between those who did and did not use pioglitazone (90 and 76 per 100,000 person-years, respectively). In a case-control analysis that involved 464 patients with incident bladder cancer and 464 matched controls, pioglitazone use did not differ significantly between those with bladder cancer and controls.

Finally, to assess risk for 10 other cancers (e.g., prostate, pancreatic, breast, colon) in pioglitazone users versus nonusers, researchers performed a cohort analysis of 236,507 patients with diabetes (16% treated with pioglitazone). During mean follow-up of about 6 years, risks for prostate cancer and pancreatic cancer were elevated significantly in pioglitazone users (adjusted hazard ratios, 1.13 and 1.41, respectively).

Comment

The authors note that the excess risk found for pancreatic cancer might be explained by pioglitazone treatment for hyperglycemia that often precedes discovery of pancreatic cancer. However, the excess risk found for both prostate cancer and pancreatic cancer requires further study. The results for bladder cancer are more reassuring, although a small elevation in bladder cancer risk with pioglitazone use could not be excluded entirely.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

Citation(s):

Reader Comments (1)

Victor Kantariya Physician, Family Medicine/General Practice

Diabetes Drugs and Cancer Risk. that is the problem
There are some controversies. Previous observational studies have linked metformin use with a reduction in cancer of breast, colon, liver, lung and pancreas compared with other diabetes drugs. "No Bladder-Cancer Protection with Metformin. New Study Finds" (Diabetes Care,2014).However, Metformin might prevent progression of Bladder Cancer via inhibition of AMP-activated protein kinase and downstream inhibition of the mTOR. Dr. Victor Kantariya MD

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