The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. BMJ 344:e3645

Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, Quebec, Canada H3T 1E2.
BMJ (online) (Impact Factor: 16.38). 05/2012; 344:e3645. DOI: 10.1136/bmj.e3645
Source: PubMed

ABSTRACT To determine if the use of pioglitazone is associated with an increased risk of incident bladder cancer in people with type 2 diabetes.
Retrospective cohort study using a nested case-control analysis.
Over 600 general practices in the United Kingdom contributing to the general practice research database.
The cohort consisted of people with type 2 diabetes who were newly treated with oral hypoglycaemic agents between 1 January 1988 and 31 December 2009. All incident cases of bladder cancer occurring during follow-up were identified and matched to up to 20 controls on year of birth, year of cohort entry, sex, and duration of follow-up. Exposure was defined as ever use of pioglitazone, along with measures of duration and cumulative dosage.
Risk of incident bladder cancer associated with use of pioglitazone.
The cohort included 115,727 new users of oral hypoglycaemic agents, with 470 patients diagnosed as having bladder cancer during follow-up (rate 89.4 per 100,000 person years). The 376 cases of bladder cancer that were diagnosed beyond one year of follow-up were matched to 6699 controls. Overall, ever use of pioglitazone was associated with an increased rate of bladder cancer (rate ratio 1.83, 95% confidence interval 1.10 to 3.05). The rate increased as a function of duration of use, with the highest rate observed in patients exposed for more than 24 months (1.99, 1.14 to 3.45) and in those with a cumulative dosage greater than 28,000 mg (2.54, 1.05 to 6.14).
The use of pioglitazone is associated with an increased risk of incident bladder cancer among people with type 2 diabetes.

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    • "Unfortunately, treatment with Pio is associated with several side effects, such as increased body weight (Fonseca 2003), fluid retention, edema, and diurnal proximal sodium retention that may exacerbate existing congestive heart failure in diabetic and hypertensive individuals (Kavanagh et al. 2010; Zanchi et al. 2010). It has been reported that Pio treatment is associated with an up to 2-fold increase in the incidence of bladder malignancy, with the highest rate observed in type 2 diabetic patients exposed to the drug for more than 24 months (Azoulay et al. 2012). "
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    • "Meta-analysis of clinical trials studying the effects of rosiglitazone showed no statistically significant decrease in cancer risk (Monami, Lamanna, Marchionni, & Mannucci, 2008). Recent concerns over the relationship between pioglitazone and bladder cancer had been expressed (Piccinni, Motola, Marchesini, & Poluzzi, 2011) and these concerns have now been reinforced with further evidence (Azoulay et al., 2012). The European Medicines Agency [EMA] "
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    • "of some malignancies; for example, pioglitazone treatment has been associated with a higher incidence of bladder cancer [19] [20]. "
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