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Bladder cancer with pioglitazone: A case-control study.

Bhanu Malhotra1, Priya Hiteshi1, Persis Khalkho1

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Pioglitazone use in Asian-Indian patients with type 2 diabetes did not show an increased risk of bladder cancer. However, older age and a history of hematuria are significant risk factors for malignancy.

Keywords:
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Area of Science:

  • Endocrinology
  • Oncology
  • Epidemiology

Background:

  • Conflicting reports exist regarding the association between pioglitazone and bladder cancer in type 2 diabetes patients.
  • This study investigates the prevalence and predictors of bladder malignancy in Asian-Indian type 2 diabetes patients treated with pioglitazone.

Purpose of the Study:

  • To determine the association between pioglitazone therapy and bladder cancer in Asian-Indian type 2 diabetes patients.
  • To identify predictors of bladder malignancy within this cohort.

Main Methods:

  • An observational, multicenter study evaluated 6440 type 2 diabetes patients.
  • Data collected included anti-diabetic medication history (pioglitazone use, duration, dose), physical examination, biochemical tests, and details of existing complications (neuropathy, retinopathy, nephropathy).
  • Patients were categorized into pioglitazone ever-users and never-users, and bladder cancer status, diagnosis time, risk factors, and histopathology were recorded.

Main Results:

  • Among 6440 patients, 1056 (16.3%) were pioglitazone ever-users. Prevalent bladder cancer was diagnosed in 74 patients (1.5% in pioglitazone users vs. 1.0% in non-users), with no significant difference (OR = 1.29, p=0.207).
  • History of hematuria in pioglitazone users, and older age (>58 years), smoking history, and hematuria in the overall cohort were significantly associated with bladder cancer.
  • Age was a significant predictor for any prevalent malignancy (OR = 1.036, p=0.00).

Conclusions:

  • Pioglitazone use in Asian-Indian type 2 diabetes patients is not associated with an increased risk of bladder cancer.
  • Pioglitazone should be used cautiously in patients with a history of hematuria.
  • Age over 58 years is a significant risk factor for developing malignancy, particularly bladder cancer.