title: Cohort study of pioglitazone and cancer incidence in patients with diabetes.
abstract: OBJECTIVE
  To explore whether treatment with pioglitazone was associated with risk of incident cancer at the 10 most common sites (prostate, female breast, lung/bronchus, endometrial, colon, non-Hodgkin lymphoma [NHL], pancreas, kidney/renal pelvis, rectal, and melanoma).
  
  
  METHODS
  A cohort study of 252,467 patients aged ≥40 years from the Kaiser Permanente Northern California Diabetes Registry was conducted. All prescriptions for diabetes medications were identified by pharmacy records. Cox proportional hazards models were used to examine the association between risk of incident cancer and ever use, duration, dose, and time since initiation of pioglitazone (modeled as time-dependent variables).
  
  
  RESULTS
  In models adjusted for age, sex, year of cohort entry, race/ethnicity, income, smoking, glycemic control, diabetes duration, creatinine levels, congestive heart failure, and use of other diabetes medications, the hazard ratio (HR) for each cancer associated with ever use of pioglitazone ranged from 0.7 to 1.3, with all 95% CIs including 1.0. There was a suggestion of an increased risk of melanoma (HR 1.3 [95% CI 0.9-2.0]) and NHL (1.3 [1.0-1.8]) and a decreased risk of kidney/renal pelvis cancers (0.7 [0.4-1.1]) associated with ever use of pioglitazone. These associations were unaltered with increasing dose, duration, or time since first use.
  
  
  CONCLUSIONS
  We found no clear evidence of an association between use of pioglitazone and risk of the incident cancers examined. Because the maximum duration of follow-up was fewer than 6 years after the initiation of pioglitazone, longer-term studies are needed.
authors: Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. assiamira.ferrara@kp.org
authors: Assiamira
authors: A
authors: Ferrara
authors: James D
authors: JD
authors: Lewis
authors: Charles P
authors: CP
authors: Quesenberry
authors: Tiffany
authors: T
authors: Peng
authors: Brian L
authors: BL
authors: Strom
authors: Stephen K
authors: SK
authors: Van Den Eeden
authors: Samantha F
authors: SF
authors: Ehrlich
authors: Laurel A
authors: LA
authors: Habel
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D000077205:Pioglitazone; D016016:Proportional Hazards Models; D045162:Thiazolidinediones / Q000009:adverse effects* / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D000077205:Pioglitazone