RISK OF DIPEPTIDYL-PEPTIDASE-4 (DPP-4) INHIBITORS ON SITE-SPECIFIC CANCER- A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Overbeek JA1, Bakker M2, van der Heijden AA1, van Herk-Sukel MP3, Herings RM2, Nijpels G1
1VU University Medical Centre, Amsterdam, The Netherlands, 2PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands, 3University Medical Center Utrecht, Utrecht, The Netherlands
OBJECTIVES: The long-term impact of DPP-4 inhibition is unknown and there are concerns about the influence of DPP-4 inhibition on carcinogenesis of the pancreas and thyroid. The aim was to identify and summarise all publications on the risk of DPP-4 inhibitor use on specific cancer types. METHODS: The databases PubMed and EMBASE were searched between January 2005 and April 2017 to identify studies comparing DPP-4 inhibitors with either placebo or anti-diabetic drugs on cancer risk. Studies were included if they reported on at least 1 specific cancer outcome and had a follow-up of at least one year after start drug use. Methodological quality of the studies was assessed by the Cochrane Collaboration’s tool and the Newcastle-Ottawa Scale. Screening of full-text and data-extraction was performed independently by two reviewers. Random effects model meta-analysis was used for quantitative data synthesis. Sensitivity analyses were performed including studies with high quality. RESULTS: Twenty-five studies met the inclusion criteria. Sample sizes of the DPP-4 inhibitor groups ranged from 29 to 8,212 patients for RCTs and from 2,422 to 71,137 patients for observational studies, mean age at the start of the study ranged from 51 to 76 years; median follow-up was 1.0 year for RCTs and 2.0 years for cohort studies. None of the pooled (sensitivity) analyses, except the observational studies regarding breast cancer (pooled HR (95% CI) = 0.76 (0.60-0.96), showed evidence for an association between DPP-4 inhibitors and cancer. Also for pancreatic and thyroid cancer no statistically significant risk was found. Most of the included studies suffered from serious biases CONCLUSIONS: Our meta-analysis does not support the hypothesis that DPP-4 inhibitor use is associated with an increased risk of site-specific cancer. Future studies should address the methodological limitations and follow patients for a longer period in order to determine the long-term cancer risk of DPP-4 inhibitors.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PDB12
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
Diabetes/Endocrine/Metabolic Disorders, Oncology