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Higher Cancer Prevalence Seen Among Diabetics Taking Thiazolidinediones

Posted: Thursday, July 26, 2007

Patients with diabetes, especially women, who take thiazolidinediones (TZDs) may have a 59% increased risk of developing cancer, according to a new report. 

"There is more to these drugs than first meets the eye," Dr. Maria E. Ramos-Nino from the University of Vermont, Burlington, stated.. "The long-term consequences and benefits are not understood."

Dr. Ramos-Nino and colleagues investigated the association of TZDs and cancer prevalence among nearly 9000 diabetic patients participating in the Vermont Diabetes Information System. A randomly selected sample of 1003 of these participants were interviewed about personal and clinical parameters, including any history of malignancy.

The investigators found that the use of any TZD was associated with a 59% increased risk of cancer in a logistic regression model corrected for use of sulfonylureas and biguanides, age, HbA1c, BMI, smoking, comorbidity, and other medications.

There was a significant association with rosiglitazone use with an odds ratio of 1.89 (p = 0.02) for malignancy, but not with pioglitazone use (OR = 1.09, p = 0.76).

"We are not aware of a convincing explanation or previous results to support the finding in this study of an association with cancer for rosiglitazone, but not for pioglitazone," the researchers write. "As both are thought to activate PPAR-gamma with similar potency, this finding suggests another mechanism for the association."

Women taking TZDs were more than twice as likely to have cancer as women not taking TZDs (OR = 2.07, p = 0.01), the researchers note, but the association was not significant in men (OR = 1.20, p= 0.63).

The use of sulfonylurea by women was associated with a 51% lower risk of cancer, the report indicates.

"The gender-dependent observation is difficult to explain," the team notes. "We do not know which specific tumors are increased in the TZD users in this population."

The authors acknowledge that the study has several limitations, including its cross-sectional design, lack of confirmation of cancer and absence of information on the temporal relation between TZD use and cancer.

"Our data do not provide strong evidence to change practice at this time," Dr. Ramos-Nino said. "They are disturbing, to be sure, but require further investigation before clinical decisions should be changed."

Source: Diabetes In Control: BMC Medicine June 21, 2007

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