Glargine and the occurrence of cancer

ABSTRACT

Technology: Glargine analogue

Indication: Glargine insulin analogue is given in single application for the treatment of pediatric or adult patients with diabetes mellitus type I or II.

Characterization of the technology: Glargine is an analogue of human insulin long duration of action produced through recombinant DNA technology.

Question: Is there evidence of increased risk of cancer in patients using insulin glargine?

Search and analysis od scientific evidence: We examined The Cochrane Library (via Bireme), Medline (via PubMed) and EMBASE databases. We sought to systematic reviews (SR), cohort studies, case-control studies and randomized clinical trials that evaluated the association between the occurrence of cancer and the use of glargine insulin analogue. We also searched for health technology assessments (HTA) on websites of international agencies and the Brazilian Network for Health Technology Assessment. We selected studies published in English, Portuguese or Spanish. The evaluation of the quality of the studies was performed according to the GRADE system for RS, Newcastle-Ottawa scale for cohort and case-control studies and Jadad scale for clinical trials.

Summary of the results of the selected studies: 11 studies were included, three RS, four cohorts, three case-control studies and a randomized clinical trial. In general, the studies had good methodological quality ratings. There were no statistically significant results for the development of cancer among patients who used glargine insulin compared to similar patients who used traditional insulin and/or oral antidiabetic therapy. The data with respect to specific types of cancer were also inconclusive. There were no HTA evaluations on the subject, only warnings about a possible association with glargine analog therapy with cancer.

Recommendations: Based on the available scientific evidence no clear relationship between the use of glargine insulin analogue and cancer development. Thus, its use is apparently as safe as the therapeutic alternatives available. Therefore, it is not recommended the discontinuation of therapy with glargine analog for security reasons related to the occurrence of cancer.

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