SGLT2 Inhibitors and Cancer: What's the Risk?

There are 3 sodium glucose co-transporter 2 inhibitors approved for use in the US in patients with type 2 diabetes. Dapagliflozin, canagliflozin, and empagliflozin have all come under increased FDA scrutiny for potential carcinogenicity and manufacturers are engaged in mandatory post-marketing studies to further current understanding.The brief slide show above distills the clinical data on cancer risk for the 3 SGLT2 inhibitors. References for all slides are provided below.

References:

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• Zhu Z, Zhang X, Shen Z, et al. Diabetes mellitus and risk of bladder cancer: a meta-analysis of cohort studies. PLoS One. 2013;8(2):e56662. doi: 10.1371/journal.pone.0056662.
• Azoulay H, Yin K, Filion B, et al. The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. BMJ. 2012;344:ArticleIDe3645.
• Tseng CH. Metformin may reduce bladder cancer risk in Taiwanese patients with type 2 diabetes. PLoS One. 2014;9(10):e109852.
• Nauck M.  Update on developments with SGLT2 inhibitors in the management of type 2 diabetes. Drug Des Devel Ther. 2014;8:1335-1380.
• FDA Briefing Document. NDA 204042. Invokana (Canagliflozin) tablets.  Janssen Pharmaceuticals.  Jan. 10, 2013.  Accessed Jan. 28, 2015 at: http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryCommittee/UCM334550.pdf
• U.S. Food and Drug Administration. Final Risk Evaluation and Mitigation Strategy Review. Nov. 12, 2013.  Accessed Jan. 28, 2015 at: http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/204629Orig1s000RiskR.pdf
• U.S. Food and Drug Administration. FDA background document, BMS-512148 NDA 202293 dapagliflozin. in Proceedings of the Endocrinologic & Metabolic Drug Advisory Committee Meeting,2013, http://www.fda.gov/downloads/drugs/endocrinolog-icandmetabolicdrugsadvisorycommittee/ucm378079.pdf