Pharmacoepidemiology
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Initiation and Pancreatic Cancer Prognosis Juhua Luo* Juhua Luo Fengge Wang Yu Du Michael Hendryx
INTRODUCTION: Emerging findings from laboratory studies indicate that sodium-glucose cotransporter 2 inhibitors (SGLT2i), a relatively new class of antidiabetic drugs, may offer therapeutic benefits in cancer treatment. Pancreatic cancer is a devastating disease with a 5-year survival rate of only around 12%. The aim of this study was to test the hypothesis that initiation of SGLT2i may improve pancreatic cancer prognosis.
METHODS: We conducted a study using the National Surveillance, Epidemiology, and End Results (SEER) and Medicare linked data in the United States to assess the impact of initiating SGLT2i on the survival of patients diagnosed with pancreatic cancer. The study included 6373 individuals aged 66 years or older, newly diagnosed with pancreatic cancer between 2014 and 2017, and with pre-existing type 2 diabetes. Participants were followed until the end of 2019. Data regarding the initiation of SGLT2i were obtained from the Medicare Part D file. Among the study sample, 309 (5%) used SGLT2i. Propensity score matching was used to control for potential confounding.
RESULTS: SGLT2i was marginally associated with lower mortality among patients with pancreatic cancer and type 2 diabetes (HR=0.85, 95% CI=0.71-1.01). The association was more pronounced with duration of drug use more than one year (HR=0.67, 95% CI=0.49-0.90). By using Dipeptidyl peptidase 4 inhibitors (DPP4i) as an active comparator in a sensitivity analysis, SGLT2i initiation was not significant overall but longer duration of SGLT2i use remained significant (HR=0.79, 95%CI=0.63-0.98).
CONCLUSION: Our large study utilizing SEER-Medicare linked data suggests that SGLT2i use is linked to improved overall survival among pancreatic cancer patients with pre-existing type 2 diabetes when compared to those not using SGLT2i or to those using DPP4i. Further research is needed to validate these findings and explore the potential mechanisms underlying this association.