Link between antihyperglycemic drugs and cancer is unproved, US endocrinologists say

BMJ 2013; 347 doi: (Published 27 August 2013) Cite this as: BMJ 2013;347:f5285
  1. Michael McCarthy
  1. 1Seattle

Current evidence linking the use of antihyperglycemic drugs with a raised risk of developing cancer is “limited and conflicting,” say the American Association of Clinical Oncologists and the American College of Endocrinology. Their consensus statement says that clinicians “can continue to confidently prescribe all FDA-approved antihyperglycemic medications for the management of hyperglycemia.”1

The statement was developed in response to growing concerns about the possible association between obesity, diabetes, and, in particular, the use of certain antihyperglycemic drugs and an increased risk of developing cancer.

Some studies have suggested that the use of thiazolidinediones is associated with an increased risk of cancer, especially bladder cancer.2 Preclinical carcinogenicity studies have shown an increase in thyroid C-cell carcinomas in rats given glucagon-like peptide-1 (GLP-1) receptor agonists; and adverse event reports have indicated an association between pancreatitis and use of GLP-1 receptor agonists and another class of incretin mimetics, dipeptidyl peptidase-4 inhibitors. These reports have led to speculation that inflammation associated with the drugs might promote the development of pancreatic cancer. A recent BMJ feature explored these and other concerns about the risks of incretin mimetics.3

In the new consensus statement the task force concluded that increased body mass is, indeed, associated with an increased risk of developing a number of cancers. The link between hyperglycemia and cancer is “less clear, but the association cannot be ruled out,” the task force said. But evidence indicating an association between antihyperglycemic drugs and cancer risk was insufficient, “owing to the lack of data from large-scale randomized study designs,” the task force said.

Nevertheless, although clinicians should feel confident in using these drugs, the task force recommended that they monitor their patients closely for cancer and “exercise caution when choosing medications implicated in the etiology of cancer for patients with the specific organ-related risk.”

“The research conducted to date is incomplete,” said Yehuda Handelsman, co-chairman of the task force, in a statement, “and thus insufficient to warrant withholding treatment that will result in adverse outcomes for those who have diabetes or are obese.

“Until more definitive evidence becomes available, the benefits of treatment should take precedence over any concerns for potential low-grade cancer risk,” he added.


Cite this as: BMJ 2013;347:f5285


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