Thiazolidinedione therapy is not associated with increased colonic neoplasia risk in patients with diabetes mellitus.
Thiazolidinedione therapy is not associated with increased colonic neoplasia risk in patients with diabetes mellitus.
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DOI：
10.1053/j.gastro.2008.09.004
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发表时间：
2008-12
期刊：
影响因子：
29.4
通讯作者：
Habel LA
中科院分区：
文献类型：
--
作者：
Lewis JD;Capra AM;Achacoso NS;Ferrara A;Levin TR;Quesenberry CP Jr;Habel LA
Diabetes mellitus is associated with an increased risk of colorectal cancer. Thiazolidinediones, which are ligands for PPARγ, are widely used to treat patients with diabetes. PPARγ is highly expressed in the colon and exposure to thiazolidinediones has been proposed to affect the risk for colorectal neoplasia. Studies using in vitro models suggest that thiazolidinediones have anti-neoplastic effects, whereas in vivo studies have produced mixed results--some indicate an increased risk for intestinal tumors. This study examined the association between PPARγ-targeted therapies and the risk of colonic neoplasia in patients with diabetes. We conducted 3 retrospective case-control studies nested within the cohort of diabetic patients that were cared for within the Kaiser Permanente of Northern California system from 1994 to 2005. Case subjects were those with colonic neoplasia identified at the time of colonoscopy (study-1), sigmoidoscopy (study-2), or at follow-up lower endoscopy (study-3). Controls had no neoplasia identified at the endoscopic exam. A minimum of 1 year of therapy was used to define medication exposure. 14,086 patients were included. Among patients undergoing colonoscopy, there was an inverse association between thiazolidinedione exposure and prevalence of neoplasia (adjusted OR=0.73, 95% CI 0.57–0.92); however, this was not evident among patients without anemia (adjusted OR= 0.97, 95% CI 0.64–1.49). Significant associations between any or long-term thiazolidinedione use and colonic neoplasia were not observed among patients undergoing sigmoidoscopy or serial lower endoscopies. These results indicate that thiazolidinedione therapy is not associated with an increased risk for colonic neoplasia.
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