title: Systematic Review with Network Meta-Analysis: Antidiabetic Medication and Risk of Hepatocellular Carcinoma.
abstract: Antidiabetic medication may modify the incidence of hepatocellular carcinoma (HCC). We aimed to compare the use of different antidiabetic strategies and the incidence of HCC. PubMed, Embase.com and Cochrane Library databases were searched up to 31 October 2015 and randomized controlled trials (RCTs), cohort studies or case-control studies were included for our analyses. A total of thirteen studies enrolling 481358 participants with 240678 HCC cases who received at least two different strategies were retrieved in this analysis. Direct comparisons showed that use of metformin (risk ratio [RR] 0.49, 95% CI 0.25-0.97) was associated with a significant risk reduction of HCC, while insulin (RR = 2.44, 95% CI 1.10- 5.56) may significantly increase the risk. Indirect evidence also suggested that insulin (RR = 2.37, 95% CI 1.21-4.75) was associated with a significantly increased risk of HCC. Additionally, metformin was effective in reducing the risk of HCC when compared with sulphonylurea (RR = 0.45, 95% CI 0.27-0.74) and insulin (RR = 0.28, 95% CI 0.17-0.47). Notably, metformin was hierarchically the best when compared with other antidiabetic therapies for the prevention of HCC. In summary, available evidence suggests that metformin was the most effective strategy to reduce HCC risk when compared with other antidiabetic interventions.
authors.affiliation: Department of Cardiology, Jinhua Municipal Hospital, Jinhua 321004, China.
authors.forename: Yao-Yao
authors.initials: YY
authors.lastname: Zhou
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gui-Qi
authors.initials: GQ
authors.lastname: Zhu
authors.affiliation: Department of Ultrasonography, Jinhua Municipal Hospital, Jinhua 321004, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ji-Na
authors.initials: JN
authors.lastname: Zheng
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Cheng
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Zou
authors.affiliation: Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Braddock
authors.affiliation: Department of Cardiology, Jinhua Municipal Hospital, Jinhua 321004, China.
authors.forename: Shen-Wen
authors.initials: SW
authors.lastname: Fu
authors.affiliation: Department of Hepatology, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000517:prevention & control; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin