A new international, multicenter study has found that incretin-based drugs, used to treat type 2 diabetes, are not associated with an increased risk of pancreatic cancer. Findings from this study, published in the BMJ, might help allay some of the concerns initially brought to the forefront by the U.S. Food and Drug Administration (FDA) in response to increased reporting of pancreatic cancer in patients taking incretin-based drugs vs. other oral antidiabetic agents (2.9 times higher with exenatide, 2.7 times higher with sitagliptin).
Incretin-based drugs include dipeptidyl peptidase-4 (DPP-4) inhibitors (eg, linagliptin, sitagliptin, vildagliptin, saxagliptin) and glucagon-like peptide-1 receptor agonists (eg, exenatide, liraglutide). Previous studies which noted the pancreatic cancer risk (but which didn’t specifically investigate it) were limited in a number of ways including, small sample sizes, low duration time follow-ups and a low number of specific incretin-based drugs. The findings of this new study suggests that when compared to sulfonylureas, incretin-based drugs are not associated with an increased risk of pancreatic cancer.
In total, 972,384 patients from 6 participating sites in Canada, the U.S., and the United Kingdom, were included. In follow-ups, with the median follow-up time ranging from 1.3 to 2.8 years, 1221 out of the 972,384 were newly diagnosed as having pancreatic cancer (incidence rate 0.60 per 1000 person years). Compared with use of sulfonylureas, incretin-based drugs were not associated with an increased risk of incident pancreatic cancer (pooled adjusted hazard ratio 1.02, 95% confidence interval 0.84 to 1.23).
Researchers used a nested case-control analyses methodology for each participating site. Cases of pancreatic cancer were matched with up to 20 randomly selected controls matched on sex, age, cohort entry data, duration of treated diabetes, and duration follow-up. Calculations on the crude incidence rate of pancreatic cancer were based on the Poisson distribution with 95% confidence intervals.