Incretin-based drugs and the risk of pancreatic cancer

Summary

Incretin-based drugs are medications prescribed to lower blood sugar levels in patients with type 2 diabetes. There have been concerns, however, that these drugs may be associated with an increased risk of developing pancreatic cancer. This CNODES project examined whether the use of incretin-based drugs increases the risk of pancreatic cancer in people with type 2 diabetes.

Administrative data from four Canadian provinces (Alberta, Manitoba, Ontario, and Quebec) and two international databases (United Kingdom Clinical Practice Research Datalink and United States MarketScan) were used to conduct this study. Using a common protocol, each site retrospectively constructed cohorts of patients with a new prescription for an anti-diabetic drug after the date that incretin based drugs became available within their jurisdiction. Patients previously diagnosed with cancer (other than non-melanoma skin cancer) were excluded. The outcome of interest was a hospitalization for pancreatic cancer. Patients prescribed incretin-based drugs were compared to patients prescribed sulfonylureas.

A nested case-control analysis, using risk-set sampling to match controls to cases, was performed on each cohort. Hazard ratios (HRs) were estimated using conditional logistic regression models, with adjustment for potential confounders. The site-specific results were meta-analyzed, using random-effects models with inverse variance weighting.

Results

The health records of 972,384 patients were included in this study; 1,221 of which were diagnosed with pancreatic cancer throughout the follow-up period. Compared to those taking sulfonylureas, the risk of pancreatic cancer was not increased in those taking incretin-based drugs [adjusted HR = 1.02; 95% CI = (0.84, 1.23)]. Similarly, there was no association with duration of use or class of incretin-based drug.

The results of this large international study indicate that the use of incretin-based drugs is not associated with an increased risk of pancreatic cancer. These findings should provide some reassurance to patients using these drugs.

Project Team

Project Co-Lead

Laurent Azoulay

Project Co-Lead

Pierre Ernst

Methods Lead

Robert Platt

Content Expert

Kristin Clemens

Lead Analyst

Matt Dahl

Liaisons

  • Tanvir Chowdhury TurinAlberta
  • Kristian FilionCPRD
  • Laura TargownikManitoba
  • Colin DormuthMarketScan
  • David JuurlinkOntario
  • Michael PatersonOntario
  • Madeleine DurandQuebec

Analysts

  • Jianguo ZhangAlberta
  • Zhihai MaAlberta
  • Hui YinCPRD
  • Matt DahlManitoba
  • Greg CarneyMarketScan
  • Simon HollandsOntario
  • Fangyun WuOntario
  • Menglan PangQuebec

Additional Collaborators

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