C. Dureau-Pournin

Insulin glargine and risk of cancer: a cohort study in the French National Healthcare Insurance Database

Aims/hypothesisUsing the Echantillon Généraliste de Bénéficiaires: random 1/97 permanent sample of the French national healthcare insurance system database (EGB), we investigated whether, as previously suspected, the risk of cancer in insulin glargine (A21Gly,B31Arg,B32Arg human insulin) users is higher than in human insulin users. The investigation period was from 1 January 2003 to 30 June 2010.MethodsWe used Cox proportional hazards time-dependent models that were stratified on propensity score quartiles for use of insulin glargine vs human insulin, and adjusted for insulin, biguanide and sulfonylurea possession rates to assess the risk of cancer or death in all or incident exclusive or predominant (≥80% use time) users of insulin glargine compared with equivalent human insulin users.ResultsOnly type 2 diabetic patients were studied. Exposure rates varied from 2,273 and 614 patient-years for incident exclusive users of insulin glargine or human insulin, respectively, to 3125 and 2341 patient-years for all patients predominantly using insulin glargine or human insulin, respectively. All-type cancer HRs with insulin glargine vs human insulin ranged from 0.59 (95% CI 0.28, 1.25) in incident exclusive users to 0.58 (95% CI 0.34, 1.01) in all predominant users. Cancer risk increased with exposure to insulin or sulfonylureas in these patients. Adjusted HRs for death or cancer associated with insulin glargine compared with human insulin ranged from 0.58 (95% CI 0.32, 1.06) to 0.56 (95% CI 0.36, 0.87).Conclusions/interpretationThere was no excess risk of cancer in type 2 diabetic patients on insulin glargine alone compared with those on human insulin alone. The overall risk of death or cancer in patients on insulin glargine was about half that of patients on human insulin, thereby excluding a competitive risk bias.

Use of the recommended drug combination for secondary prevention after a first occurrence of acute coronary syndrome in France

PurposeThe recommended pharmacotherapy for secondary prevention of acute coronary syndrome (ACS) is long-term treatment with a combination of four therapeutic classes: beta-blockers, antiplatelet agents (including aspirin), statins or other lipid-lowering agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The aim of this study was to describe use and persistence of the recommended drug combination after the first occurrence of ACS in France.MethodsThis was a database cohort study of patients with first registration for ACS between 2004 and 2007 in a representative sample of the French healthcare insurance database (Echantillon Généraliste de Bénéficiaires, EGB). The drugs of interest were those recommended. Persistence was assessed for patients dispensed three or all four drug classes within 2 months following ACS. Discontinuation was defined by a gap of more than 6 weeks between two dispensations. The follow-up period was 24xa0months after ACS occurrence.ResultsOf 2,057 patients with incident ACS, 872 (42.4xa0%) had at least one dispensation of each of the four recommended drug classes, and 684 (33.3xa0%) had three of the four classes. Persistence to treatment at 24xa0months was 57.4xa0% (95xa0% CI [54.0-60.6]) for patients with four classes, and 55.5xa0% (95xa0% CI [51.6-59.1]) with three classes. Discontinuation of initial combination was higher in patients aged u2009≥u200965xa0years at ACS occurrence, those with associated ongoing chronic disease, and in those who did not suffer myocardial infarction.ConclusionsPost-ACS secondary prevention in France is not optimal, especially in patients who did not have myocardial infarction.