Chin-Hsiao Tseng1,2,3. 1. Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. 2. Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 3. Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Taiwan.
Abstract
BACKGROUND: Whether metformin may reduce hepatocellular carcinoma (HCC) risk requires confirmation. METHODS: Type 2 diabetes patients newly diagnosed during 1999-2005 and with 2 or more prescriptions of antidiabetic drugs were enrolled from the Taiwan's National Health Insurance database. A total of 173 917 ever-users and 21 900 never-users of metformin were identified (unmatched cohort). A 1:1 matched-pair cohort of 21 900 ever-users and 21 900 never-users based on a propensity score (PS) was created. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the PS. In addition, interactions with aspirin and statin were evaluated. RESULTS: In the unmatched cohort, 619 never-users and 2642 ever-users developed HCC, with a respective incidence of 668.0 and 330.7 per 100 000 person-years and an overall hazard ratio of 0.49 (95% confidence interval: 0.45-0.54). The hazard ratios for the first (<25.7 months), second (25.7-56.9 months) and third (>56.9 months) tertile of cumulative duration of metformin therapy were 0.89 (0.81-0.98), 0.50 (0.46-0.56) and 0.23 (0.21-0.26) respectively. Analyses of the matched cohort showed an overall hazard ratio of 0.76 (0.67-0.85), and the hazard ratios for the respective tertiles were 1.39 (1.19-1.62), 0.77 (0.65-0.91) and 0.37 (0.30-0.45). Aspirin and statin were observed to have a significant interaction with metformin. CONCLUSIONS: Metformin was associated with a reduced risk of HCC in a dose-response pattern. Users of both metformin and aspirin or metformin and statin had the lowest risk.
BACKGROUND: Whether metformin may reduce hepatocellular carcinoma (HCC) risk requires confirmation. METHODS: Type 2 diabetespatients newly diagnosed during 1999-2005 and with 2 or more prescriptions of antidiabetic drugs were enrolled from the Taiwan's National Health Insurance database. A total of 173 917 ever-users and 21 900 never-users of metformin were identified (unmatched cohort). A 1:1 matched-pair cohort of 21 900 ever-users and 21 900 never-users based on a propensity score (PS) was created. Hazard ratios were estimated by Cox regression incorporated with the inverse probability of treatment weighting using the PS. In addition, interactions with aspirin and statin were evaluated. RESULTS: In the unmatched cohort, 619 never-users and 2642 ever-users developed HCC, with a respective incidence of 668.0 and 330.7 per 100 000 person-years and an overall hazard ratio of 0.49 (95% confidence interval: 0.45-0.54). The hazard ratios for the first (<25.7 months), second (25.7-56.9 months) and third (>56.9 months) tertile of cumulative duration of metformin therapy were 0.89 (0.81-0.98), 0.50 (0.46-0.56) and 0.23 (0.21-0.26) respectively. Analyses of the matched cohort showed an overall hazard ratio of 0.76 (0.67-0.85), and the hazard ratios for the respective tertiles were 1.39 (1.19-1.62), 0.77 (0.65-0.91) and 0.37 (0.30-0.45). Aspirin and statin were observed to have a significant interaction with metformin. CONCLUSIONS:Metformin was associated with a reduced risk of HCC in a dose-response pattern. Users of both metformin and aspirin or metformin and statin had the lowest risk.
Authors: Mohammad Elsayed; William Wagstaff; Keywan Behbahani; Alexander Villalobos; Zachary Bercu; Bill S Majdalany; Mehmet Akce; David M Schuster; Hui Mao; Nima Kokabi Journal: Cardiovasc Intervent Radiol Date: 2021-07-26 Impact factor: 2.740
Authors: Young Youn Cho; Su Jong Yu; Hye Won Lee; Do Young Kim; Wonseok Kang; Yong-Han Paik; Pil Soo Sung; Si Hyun Bae; Su Cheol Park; Young Seok Doh; Kang Mo Kim; Eun Sun Jang; In Hee Kim; Won Kim; Yoon Jun Kim Journal: J Hepatocell Carcinoma Date: 2021-06-18