Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study

作者：Laurent Azoulay, Kristian B. Filion, Robert W. Platt, Matthew Dahl, Colin R. Dormuth, Kristin K Clemens, Madéleine Durand, David N. Juurlink, Laura E. Targownik, Tanvir Chowdhury Turin, J. Michael Paterson, Pierre Ernst · 发表于：BMJ · 年份：2016 · DOI：10.1136/bmj.i581 · 被引用次数：122 · 研究领域：Pancreatic and Hepatic Oncology Research、Diabetes Treatment and Management、Metabolism, Diabetes, and Cancer

OBJECTIVE: To determine whether the use of incretin based drugs compared with sulfonylureas is associated with an increased risk of incident pancreatic cancer in people with type 2 diabetes. DESIGN: Population based cohort. SETTING: Large, international, multicentre study combining the health records from six participating sites in Canada, the United States, and the United Kingdom. PARTICIPANTS: A cohort of 972,384 patients initiating antidiabetic drugs between 1 January 2007 and 30 June 2013, with follow-up until 30 June 2014. MAIN OUTCOME MEASURES: Within each cohort we conducted nested case-control analyses, where incident cases of pancreatic cancer were matched with up to 20 controls on sex, age, cohort entry date, duration of treated diabetes, and duration of follow-up. Hazard ratios and 95% confidence intervals for incident pancreatic cancer were estimated, comparing use of incretin based drugs with use of sulfonylureas, with drug use lagged by one year for latency purposes. Secondary analyses assessed whether the risk varied by class (dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists) or by duration of use (cumulative duration of use and time since treatment initiation). Site specific hazard ratios were pooled using random effects models. RESULTS: During 2,024,441 person years of follow-up (median follow-up ranging from 1.3 to 2.8 years; maximum 8 years), 1221 patients were newly diagnosed as having pancreatic cancer (incidence rate 0.60 p...