Are angiotensin-receptor blockers (ARBs) associated with enhanced threat for cancer?

Methods: This was a meta-analysis, including all publicly available data for the development of cancers from randomized controlled trials of ARBs. From the 2,057 reports identified (1,531 from Medline, 503 from Scopus, and 23 from Cochrane databases), 1,997 reports were excluded. Exclusion criteria included duration of the trial <1 year, <100 patients, use of ARBs in all groups, nonrandomized trial design, or lack of information on cancers. A total of nine trials were included in the final analysis, of which five had data on new cancer occurrences, five had information on common types of specific solid-organ cancers, and eight had information on cancer death. The primary outcome of interest was incident cancer, with a secondary outcome of interest being occurrence of specific solid-organ cancers.

Results: Telmisartan was the study drug for 85.7% of patients (n = 30,014) who received an ARB in randomized controlled trials that had data on cancer outcomes. Patients randomized to ARBs had a significant increased risk for new cancers, as compared with patients in the control groups (7.2% vs. 6.0%; relative risk [RR], 1.08; 95% confidence interval [CI], 1.01-1.15). After limiting the analysis to trials with cancer as a prespecified endpoint, the RR was 1.11 (95% CI, 1.04-1.18). For solid organ cancers, only new lung cancer was significantly higher among patients randomized to ARBs compared to controls (0.9% vs. 0.7%; RR, 1.25; 95% CI, 1.05-1.49). No statistically significant difference in cancer deaths was observed between patients randomized to ARBs as compared to controls (1.8% vs. 1.65; RR, 1.07; 95 CI, 0.97-1.18).

Conclusions: The investigators concluded that this meta-analysis of randomized controlled trials observed a modest association between ARBs and cancer risk. Further investigation would be needed to understand the potential risk associated with particular drugs.

Perspective: This meta-analysis provides some interesting findings regarding use of ARBs and risk of cancer, which suggests a modest increase in cancer risk. Understanding the risk and benefits of ARBs in patients can be further investigated to determine if specific patients are at increased risk for cancers.

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