Boniol M, et al. - The risk of pancreatic cancer was examined among patients with diabetes prescribed incretin drugs. The researchers found an association between the recent prescription of incretin therapy and an increased risk of pancreatic cancer. The reason for such an increase was likely the consequence of an occult pancreatic cancer that provoked or aggravated diabetes. For evaluating the risk of pancreatic cancer associated with long-term use of incretin drugs, additional studies were required.

Methods

• The researchers created 2 retrospective cohorts with the use of public health insurance databases of Belgium and Lombardy Region, Italy.
• They included adult patients who were first prescribed an incretin drug or another noninsulin antidiabetic drug (NIAD) from 1 July 2008 to 31 December 2013 in Belgium and from 1 January 2008 to 31 December 2012 in Lombardy Region.
• They evaluated the risk of pancreatic cancer by multivariate-adjusted Cox models that included time-dependent variables.
• By using fixed-effects meta-analyses, adjusted hazard ratios (aHRs) from Belgium and Italy were pooled.

Results

• A total of 525,733 patients with diabetes treated with NIADs and 33,292 with incretin drugs were included in this study.
• In both cohorts, results were similar.
• Among the incretin and NIAD new users, respectively, 85 and 1,589 subjects who developed pancreatic cancer were registered, which represented an aHR of pancreatic cancer of 2.14 (95% CI 1.71-2.67) among those prescribed an incretin compared with an NIAD.
• With a drug use lag exposure of 6 months, the aHR was 1.69 (1.24-2.32).
• In this study, the aHR decreased from 3.35 (2.32-4.84) in the first 3 months after the first incretin prescription to 2.12 (1.22-3.66) in months 3-5.9, 1.95 (1.20-3.16) in months 6-11.9, and 1.69 (1.12-2.55) after 12 months.
• Pancreatic cancer occurred mostly within the year after the first prescription among those prescribed an NIAD.
• Among patients subsequently prescribed insulin, the risk of pancreatic cancer was 6.89 (6.05-7.85).