SGLT2 Inhibitors and Cancer: What's the Risk?

The 3 FDA-approved sodium glucose co-transporter 2 inhibitors remain under close post-marketing scrutiny. These 7 slides distill for you all the cancer risk information to date.

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:

Lin HW, Tseng CH. A review of the relationship between SGLT2 inhibitors and cancer. Internat J Endocrinol. 2014;719578. Published online Aug. 31, 2014. doi: 1155/2014/719578.
Ishikawa T, Oguri T, Isobe K, Fujitaka, Koh N. SGLT gene expression in primary lung cancers and their metastatic lesions. Jpn J Cancer Res. 2001;92:874–879.
Pelucchi C, Bosetti C, Negri E, Malvezzi M, LaVecch C. Mechanisms of disease: the epidemiology of bladder cancer. Nat Clin Pract Urol. 2006;3:327–340.
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