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Eur J Clin Invest. 2016 Jan;46(1):70-9. doi: 10.1111/eci.12570. Epub 2015 Dec 17.

Sitagliptin and pancreatic cancer risk in patients with type 2 diabetes.

Tseng CH1,2,3.

Author information

1
Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
2
Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
3
Division of Environmental Health and Occupational Medicine of the National Health Research Institutes, Zhunan, Taiwan.

Abstract

BACKGROUND:

The risk of pancreatic cancer associated with incretin-based therapies is controversial.

METHODS:

This study retrospectively analysed the National Health Insurance database including patients with newly diagnosed type 2 diabetes mellitus at an age ≥ 25 years between 1999 and 2010. A total of 71 137 ever users of sitagliptin and 933 046 never users were followed for pancreatic cancer until 31 December 2011. A time-dependent approach was used to calculate incidence and estimate hazard ratios adjusted for propensity score using Cox regression.

RESULTS:

During follow-up, 83 ever users and 3658 never users developed pancreatic cancer, representing an incidence of 73·6 and 55·0 per 100 000 person-years, respectively. The adjusted hazard ratio (95% confidence intervals) for ever versus never users was 1·40 (1·13-1·75). The respective adjusted hazard ratio for the first, second and third tertile of cumulative dose < 14 700, 14 700-33 700 and > 33 700 mg was 1·83 (1·28-2·62), 1·97 (1·41-2·76) and 0·72 (0·45-1·15). For average daily dose of < 50, 50-99·9 and ≥ 100 mg, the respective hazard ratio was 3·10 (1·17-8·26), 1·01 (0·63-1·61) and 1·53 (1·18-1·97).

CONCLUSIONS:

Sitagliptin is significantly associated with a higher risk of pancreatic cancer, especially when the cumulative dose is < 33 700 mg. The risk diminished in users with a higher cumulative dose. The daily dose of sitagliptin should better be kept < 100 mg, and its use should be reconsidered in patients who suffer from severe renal impairment and thus a daily dose of < 50 mg is always recommended. Future studies are required to confirm the findings with more appropriate adjustment for smoking.

KEYWORDS:

Incretin; National Health Insurance; Taiwan; pancreatic cancer; sitagliptin

PMID:
26584246
DOI:
10.1111/eci.12570
[Indexed for MEDLINE]

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