2. Disclosure belangen NHG spreker
(Potentiële) belangenverstrengeling
Jetty A. Overbeek is a PhD student at the VUmc and is an employee of the PHARMO Institute for Drug Outcomes Research
Voor bijeenkomst mogelijk relevante relaties met bedrijven
The PHARMO Institute for Drug Outcomes Research is an independent research institute and performs financially supported studies for government and related healthcare authorities and several pharmaceutical companies
Sponsoring of onderzoeksgeld
Honorarium of andere (financiële) vergoeding
Aandeelhouder
Andere relatie, namelijk …
Not applicable

3. Risk of dipeptidyl-peptidase-4 (DPP-4) inhibitors on site-specific cancer
A systematic review and meta-analysis
Jetty A. Overbeek, Marina Bakker, Amber A.W.A. van der Heijden, Myrthe P.P. van Herk-Sukel, Ron M.C. Herings, Giel Nijpels

4. Background DPP-4 inhibitors ► Type 2 Diabetes Mellitus
DPP-4 involved in many physiological processes
Concerns about pancreatic safety, especially pancreatic cancer
In 2014, the Food and Drug Administration (FDA) & European Medicines Agency (EMA) did not yet reach a final conclusion regarding the possible relationship

5. Methods & Results Methods Results
PubMed and EMBASE, Jan Apr 2017
Inclusion criteria:
DPP-4 inhibitor vs. placebo/other oral antidiabetic drug
Original study (randomised controlled trials (RCTs) & observational)
≥1 site-specific cancer as outcome
≥52 weeks follow-up
25 studies included; 12 RCTs & 13 observational
Sample size ranged from:
29 to 71,137 (DPP-4 inhibitors)
30 to 3,934,676 (comparators)
Mean age ranged from 52 to 76 years
Follow-up ranged from:
52 to 156 weeks (RCTs)
1.1 to 6.6 years (cohort studies)
The databases PubMed and EMBASE were searched between Jan 2005 and June 2016 to identify intervention studies regarding DPP-4i and cancer risk. Studies were included if they reported on at least one cancer outcome and had a follow-up of at least one year after start drug use. Methodological quality of the studies was assessed and screening full-text assessment and data-extraction was performed. Sensitivity analyses were performed including studies with high quality.

6. Results
RCTs
Observational studies

7. Conclusion
No association between DPP-4 inhibitors and an increased short-term risk of site-specific cancer
Limitations
Low number of studies
Relatively short follow-up
Methodological quality was low
This meta-analysis shows that the use of DPP-4 inhibitors is not associated with an increased short-term risk of site-specific cancer compared to use of other non-insulin antidiabetic drugs.
The number of included studies per cancer type was low and many studies suffered from methodological limitations.
Duration of the included studies was relatively short and the effect of DPP-4 inhibitors on different cancer types remains unknown.
More sound studies with long follow-up are necessary to truly assess the impact of DPP-4 inhibitors on risk of different types of cancer.