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Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus
BACKGROUND: The effect of metformin on leukemia risk remains unknown. METHODS: The Taiwan’s National Health Insurance database was used to enroll 610,089 newly diagnosed type 2 diabetes patients on at least 2 anti-diabetic prescriptions during 1999–2009. We followed-up these patients until 31 Decemb...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642096/ https://www.ncbi.nlm.nih.gov/pubmed/33193076 http://dx.doi.org/10.3389/fendo.2020.541090 |
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author | Tseng, Chin-Hsiao |
author_facet | Tseng, Chin-Hsiao |
author_sort | Tseng, Chin-Hsiao |
collection | PubMed |
description | BACKGROUND: The effect of metformin on leukemia risk remains unknown. METHODS: The Taiwan’s National Health Insurance database was used to enroll 610,089 newly diagnosed type 2 diabetes patients on at least 2 anti-diabetic prescriptions during 1999–2009. We followed-up these patients until 31 December 2011, in order to determine the incidence of leukemia. We used Cox regression model (incorporated with the inverse probability of treatment-weighting using propensity scores) to estimate hazard ratios in both intention-to-treat and per-protocol analyses. RESULTS: We enrolled 414,783 metformin initiators and 195,306 non-metformin initiators. Among them, 598 and 372 patients developed new-onset leukemia after a median follow-up period of 5.08 years and 6.79 years, respectively. The respective incidence rates were 26.52 and 28.40 per 100,000 person-years. The hazard ratio for metformin initiators versus non-metformin initiators was 0.943 (95% confidence interval 0.828–1.074) in the intention-to-treat analysis and 0.852 (95% confidence interval 0.705–1.031) in the per-protocol analysis. Sensitivity analyses after excluding patients using the exclusion criteria (a follow-up duration < 24 and < 36 months, respectively, patients with incretin-based therapies during follow-up, and patients enrolled during 2 different periods of 1999–2003 and 2004–2009) consistently showed a neutral effect. However, metformin initiators had a significantly higher risk of leukemia in the per-protocol analyses when censoring patients at a time without regular follow-up. CONCLUSION: Metformin use has an overall neutral effect on leukemia but we cannot exclude a significantly higher risk in patients who persistently use the drug. |
format | Online Article Text |
id | pubmed-7642096 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-76420962020-11-13 Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus Tseng, Chin-Hsiao Front Endocrinol (Lausanne) Endocrinology BACKGROUND: The effect of metformin on leukemia risk remains unknown. METHODS: The Taiwan’s National Health Insurance database was used to enroll 610,089 newly diagnosed type 2 diabetes patients on at least 2 anti-diabetic prescriptions during 1999–2009. We followed-up these patients until 31 December 2011, in order to determine the incidence of leukemia. We used Cox regression model (incorporated with the inverse probability of treatment-weighting using propensity scores) to estimate hazard ratios in both intention-to-treat and per-protocol analyses. RESULTS: We enrolled 414,783 metformin initiators and 195,306 non-metformin initiators. Among them, 598 and 372 patients developed new-onset leukemia after a median follow-up period of 5.08 years and 6.79 years, respectively. The respective incidence rates were 26.52 and 28.40 per 100,000 person-years. The hazard ratio for metformin initiators versus non-metformin initiators was 0.943 (95% confidence interval 0.828–1.074) in the intention-to-treat analysis and 0.852 (95% confidence interval 0.705–1.031) in the per-protocol analysis. Sensitivity analyses after excluding patients using the exclusion criteria (a follow-up duration < 24 and < 36 months, respectively, patients with incretin-based therapies during follow-up, and patients enrolled during 2 different periods of 1999–2003 and 2004–2009) consistently showed a neutral effect. However, metformin initiators had a significantly higher risk of leukemia in the per-protocol analyses when censoring patients at a time without regular follow-up. CONCLUSION: Metformin use has an overall neutral effect on leukemia but we cannot exclude a significantly higher risk in patients who persistently use the drug. Frontiers Media S.A. 2020-10-22 /pmc/articles/PMC7642096/ /pubmed/33193076 http://dx.doi.org/10.3389/fendo.2020.541090 Text en Copyright © 2020 Tseng http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Tseng, Chin-Hsiao Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title | Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title_full | Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title_fullStr | Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title_full_unstemmed | Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title_short | Metformin Use and Leukemia Risk in Patients With Type 2 Diabetes Mellitus |
title_sort | metformin use and leukemia risk in patients with type 2 diabetes mellitus |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7642096/ https://www.ncbi.nlm.nih.gov/pubmed/33193076 http://dx.doi.org/10.3389/fendo.2020.541090 |
work_keys_str_mv | AT tsengchinhsiao metforminuseandleukemiariskinpatientswithtype2diabetesmellitus |