Louis Jacob1, Karel Kostev2, Wolfgang Rathmann3, Matthias Kalder4. 1. Department of Biology, École Normale Supérieure de Lyon, Lyon, France. Electronic address: louis.jacob.contacts@gmail.com. 2. Department of Epidemiology, IMS HEALTH, Frankfurt, Germany. Electronic address: kkostev@de.imshealth.com. 3. Department of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany. Electronic address: wolfgang.rathmann@ddz.uni-duesseldorf.de. 4. Department of Gynecology and Obstetrics, Philipps-Universität Marburg, Marburg, Germany. Electronic address: kalder@med.uni-marburg.de.
Abstract
AIM: To analyze the impact of glucose-lowering drugs on metastases in women living in Germany who have been diagnosed with breast cancer (BC) and type 2 diabetes mellitus (T2DM). METHODS: Women initially diagnosed with BC (2004-2013) were identified in the IMS Disease Analyzer database. Patients with a documentation of metastases at index date or during the following six months were excluded. We selected T2DM women between 40 and 90years of age who received glucose-lowering therapy (metformin, sulfonylureas, incretins, insulins, other medications). The primary outcome was the diagnosis of metastases recorded in the database between the index date and the end of follow-up. A multivariate Cox regression model was used to predict BC metastases on the basis of patient characteristics and glucose-lowering medication. RESULTS: A total of 4,953 women with BC and diabetes were included in the study. The mean age was 71.4years and 4.7% of patients had private health insurance coverage. Mean HbA1C was 7.1% and mean BMI was 30.6kg/m(2). After 5years follow-up, 9.2% of patients with metformin and 12.3% of patients without exhibited metastases (log-rank p-value=0.011), whereas 6.2% of patients with incretins and 11.0% of patients without incretins exhibited metastases (both log-rank p-values <0.001). Metformin (HR=0.73, 95% CI: 0.58-0.92) and incretins (HR=0.62, 95% CI: 0.45-0.84) both significantly decreased the risk of metastases. None of the other variables were significantly associated with diagnosis of metastases. CONCLUSION: The use of metformin and incretins in women with T2DM and BC may reduce the risk of metastases.
AIM: To analyze the impact of glucose-lowering drugs on metastases in women living in Germany who have been diagnosed with breast cancer (BC) and type 2 diabetes mellitus (T2DM). METHODS:Women initially diagnosed with BC (2004-2013) were identified in the IMS Disease Analyzer database. Patients with a documentation of metastases at index date or during the following six months were excluded. We selected T2DM women between 40 and 90years of age who received glucose-lowering therapy (metformin, sulfonylureas, incretins, insulins, other medications). The primary outcome was the diagnosis of metastases recorded in the database between the index date and the end of follow-up. A multivariate Cox regression model was used to predict BC metastases on the basis of patient characteristics and glucose-lowering medication. RESULTS: A total of 4,953 women with BC and diabetes were included in the study. The mean age was 71.4years and 4.7% of patients had private health insurance coverage. Mean HbA1C was 7.1% and mean BMI was 30.6kg/m(2). After 5years follow-up, 9.2% of patients with metformin and 12.3% of patients without exhibited metastases (log-rank p-value=0.011), whereas 6.2% of patients with incretins and 11.0% of patients without incretins exhibited metastases (both log-rank p-values <0.001). Metformin (HR=0.73, 95% CI: 0.58-0.92) and incretins (HR=0.62, 95% CI: 0.45-0.84) both significantly decreased the risk of metastases. None of the other variables were significantly associated with diagnosis of metastases. CONCLUSION: The use of metformin and incretins in women with T2DM and BC may reduce the risk of metastases.
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