An updated meta-analysis of pioglitazone exposure and bladder cancer and comparison to the drug's effect on cardiovascular disease and non-alcoholic steatohepatitis. (January 2018)

• Record Type: Journal Article
• Authors: Davidson, Mayer B.; Pan, Deyu
• Is Part Of: Diabetes research and clinical practice. Volume 135(2018)
• Page Start: 102
• Page End: 110
• Publication Date: 2018-01
• Subjects: Pioglitazone -- Bladder cancer -- Cardiovascular disease -- Non-alcoholic steatohepatitis; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2017.11.002
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aim: We performed a meta-analysis of epidemiological studies evaluating exposure to pioglitazone and the risk for bladder cancer and compared these results to the drug's effects on cardiovascular disease (CVD) and non-alcoholic steatohepatitis (NASH). Methods: Pubmed and Embase were searched for cohort and case control studies for all years through 2016. Results: Data from 17 papers were analyzed. In cohort studies, 822 of 357, 888 pioglitazone-exposed patients (0.23%) developed bladder cancer while 7691 of 2, 898, 682 unexposed (0.26%) did. In case control studies, 3219 of 1, 146, 916 patients (0.28%) developed bladder cancer. A random effects model showed no significant association between ever vs never use or with cumulative doses of pioglitazone. However, there was a significant association with 1–2 years (HR = 1.28 [1.08–1.55]) and >2 years (HR = 1.42 [1.14–1.77]) of exposure. The numbers needed to treat for one additional case of bladder cancer ranged from 899 to 6380 while to benefit CVD and NASH, 4–256 and 2–12, respectively. Conclusions: Given the very small prevalence of bladder cancer in diabetic patients exposed (or not) to pioglitazone (<0.3%) and the much greater beneficial effects of the drug on CVD and NASH, the use of pioglitazone should be resurrected.