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Prescriber Update Articles

Lantus (insulin glargine) and cancer - no conclusive evidence of higher risk

Web site: November 2009
Prescriber Update 2009;30(14):23

 

Four epidemiological studies were recently published in Diabetologia suggesting a possible association between insulin glargine (Lantus) use and an increased risk of cancer.

Medsafe and the Medicines Adverse Reactions Committee (MARC) have closely reviewed these studies in conjunction with data provided by the sponsor of Lantus.

The results of the studies are summarised in the table below:

Study Any malignancy,
hazard ratio (95% CI)
Hemkens et al1 1.18 (1.08-1.28)
Currie et al2 0.81 (0.59-1.11)¤
Jonasson et al3 1.06 (0.90-1.25)§
Colhoun et al
(incident cohort)4		 0.87 (0.63-1.21)§


Comparators: Human insulin alone. ¤ Long acting insulin - derived data § Non glargine insulin.

The MARC considered that these studies have methodological problems including: potential exposure misclassification, selection bias, differing comparator groups, lack of adjustment for confounding factors, short duration, and incomplete information on risk factors.

As a result of the issues and the inconsistency of the study results, the MARC could not determine if there was an increased risk of cancer in patients taking insulin glargine.

The MARC has advised that until further information is available, newer insulins such as Lantus should only be used when there is additional benefit to the patient, compared with other treatments.

Medsafe’s media release and “Dear Healthcare Professional letter” can be found at:

http://www.medsafe.govt.nz/hot/MediaContents.asp

References

  1. Hemkins LG, Grouven U, Bender R, et al. Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort study. Diabetologia 2009;52(9):1732-44.
  2. Currie CJ, Poole CD, Gale AM. The influence of glucose lowering therapies on cancer risk in type 2 diabetes. Diabetologia 2009;52(9):1766-77.
  3. Jonasson JM, Ljung R, Talback M, et al. Insulin glargine use and short-term incidence of malignancies – a population based follow-up study in Sweden. Diabetologia 2009;52(9):1745- 54.
  4. Colhoun HM, SDRN Epidemiology Group. Use of insulin glargine and cancer incidence in Scotland: a study from the Scottish Diabetes Research Network Epidemiology Group. Diabetologia 2009;52(9):1755-65.