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Chen X, Wang Y, Lu T, Ao Y, Wei W, Duan W, Li H, Guo R. Antidepressants and Risk of Liver Cancer: A Systematic Review and Meta-Analysis. Ann Pharmacother 2023; 57:1398-1409. [PMID: 37016543 DOI: 10.1177/10600280221143512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Previous results regarding the association between the antidepressants use and risk of liver cancer are controversial. OBJECTIVE This study aimed to assess whether antidepressants use increases liver cancer risk. METHODS We systematically searched several English and Chinese databases, including the Cochrane Library, MEDLINE, Embase, PsycINFO, Web of Science, CNKI, CQVIP database, Wanfang database, and SinoMed, and 3 clinical trial registration platforms through May 2022. Observational studies evaluating liver cancer risk in patients on antidepressants use were included, and the quality of studies was assessed using the Newcastle-Ottawa scale. A random-effects model was used to calculate the pooled effect estimates and 95% confidence intervals (CIs). RESULTS We included 11 studies with a total of 132 396 liver cancer cases. The meta-relative risk (RR) for liver cancer associated with antidepressants use was 0.72 (95% CI 0.59-0.86). In subgroup analyses, only selective serotonin reuptake inhibitors were negatively correlated with risk of liver cancer (RR 0.64, 95% CI 0.51-0.79); both dose subgroups ≤365cDDD (RR 0.77, 95% CI 0.69-0.85) and >365cDDD (RR 0.57, 95% CI 0.40-0.81) were associated with lower liver cancer risk; only in patients with chronic viral hepatitis, the use of antidepressants reduced liver cancer risk (RR 0.70, 95% CI 0.54-0.90). CONCLUSIONS AND RELEVANCE The result of the current meta-analysis shows antidepressants use is not associated with increased risk of liver cancer and appears to be correlated with decreased risk. However, the observed association needs to be verified by more powerful evidence from prospective, methodologically rigorous studies.
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Affiliation(s)
- Xiaofeng Chen
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yifan Wang
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tiange Lu
- Department of Neurosurgery, Yuquan Hospital, Tsinghua University, Beijing, China
| | - Yutian Ao
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Wei
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenzhe Duan
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Rongjuan Guo
- Department of Neurology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
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Birck MG, Moura CS, Machado MAA, Liu JL, Abrahamowicz M, Pilote L, Bernatsky S. Skin Cancer and Hydrochlorothiazide: Novel Population-Based Analyses Considering Personal Risk Factors Including Race/Ethnicity. Hypertension 2023; 80:2218-2225. [PMID: 37489540 DOI: 10.1161/hypertensionaha.123.21274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Hydrochlorothiazide, a common antihypertensive, has photosensitive properties, potentially increasing skin cancer risk. We evaluated melanoma and nonmelanoma skin cancer among hydrochlorothiazide users with 3 different cohorts as each allows assessment of different potential cofounders/effect modifiers, including race/ethnicity. METHODS We built 3 cohorts using IBM MarketScan Research Databases: Commercial and Encounters (>3.5 million individuals, 2010-2018), a subcohort with health risk assessment respondents (415, 330), and Medicaid (509, 767, 2011-2017). Adults (aged 18+ years) entered the respective cohort with a first-filled prescription (cohort entry) for hydrochlorothiazide (the exposure of interest) or angiotensin-converting enzyme (ACE) inhibitors (the active comparator), with ≥12 months of continuous enrollment with medical/pharmacy coverage at baseline. We excluded those who used hydrochlorothiazide/ACE inhibitor (including fixed-dose combination products) 12 months before cohort entry and those with prior skin cancer, HIV, or organ transplant. We compared the risk for hydrochlorothiazide versus ACE inhibitor using multivariate proportional hazards regression. RESULTS Baseline characteristics were similar, aside from more Black individuals among hydrochlorothiazide users (43.3% [95% CI, 43.0%-43.6%]) than ACE inhibitor users (28.1% [95% CI, 27.9%-28.3%]). The hazard ratio (95% CI) for nonmelanoma skin cancer related to hydrochlorothiazide (versus ACE inhibitor) was 0.96 (0.91-1.00) in the Commercial cohort, 1.01 (0.77-1.32) for the health risk assessment subcohort, and 1.33 (0.77-2.29) for Medicaid. For melanoma, the respective hazard ratios were 1.07 (0.95-1.20), 0.85 (0.43-1.67), and 0.93 (0.51-1.67), respectively. CONCLUSIONS Our evaluation using 3 different approaches, including adjustment for race/ethnicity, did not establish a clear difference between hydrochlorothiazide and ACE inhibitor in terms of skin cancer risk.
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Affiliation(s)
- Marina G Birck
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (M.G.B., C.S.M., M.A.A.M., L.P., S.B.)
| | - Cristiano S Moura
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (M.G.B., C.S.M., M.A.A.M., L.P., S.B.)
| | - Marina A A Machado
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (M.G.B., C.S.M., M.A.A.M., L.P., S.B.)
| | - Jia Li Liu
- McGill University, Montreal, Quebec, Canada (J.L.L., M.A., S.B.)
| | | | - Louise Pilote
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (M.G.B., C.S.M., M.A.A.M., L.P., S.B.)
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada (M.G.B., C.S.M., M.A.A.M., L.P., S.B.)
- McGill University, Montreal, Quebec, Canada (J.L.L., M.A., S.B.)
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Liu T, Li Y, Wang L, Zhang X, Zhang Y, Gai X, Chen L, Liu L, Yang L, Wang B. Network pharmacology-based exploration identified the antiviral efficacy of Quercetin isolated from mulberry leaves against enterovirus 71 via the NF-κB signaling pathway. Front Pharmacol 2023; 14:1260288. [PMID: 37795035 PMCID: PMC10546324 DOI: 10.3389/fphar.2023.1260288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction: Mulberry leaf (ML) is known for its antibacterial and anti-inflammatory properties, historically documented in "Shen Nong's Materia Medica". This study aimed to investigate the effects of ML on enterovirus 71 (EV71) using network pharmacology, molecular docking, and in vitro experiments. Methods: We successfully pinpointed shared targets between mulberry leaves (ML) and the EV71 virus by leveraging online databases. Our investigation delved into the interaction among these identified targets, leading to the identification of pivotal components within ML that possess potent anti-EV71 properties. The ability of these components to bind to the targets was verified by molecular docking. Moreover, bioinformatics predictions were used to identify the signaling pathways involved. Finally, the mechanism behind its anti-EV71 action was confirmed through in vitro experiments. Results: Our investigation uncovered 25 active components in ML that targeted 231 specific genes. Of these genes, 29 correlated with the targets of EV71. Quercetin, a major ingredient in ML, was associated with 25 of these genes. According to the molecular docking results, Quercetin has a high binding affinity to the targets of ML and EV71. According to the KEGG pathway analysis, the antiviral effect of Quercetin against EV71 was found to be closely related to the NF-κB signaling pathway. The results of immunofluorescence and Western blotting showed that Quercetin significantly reduced the expression levels of VP1, TNF-α, and IL-1β in EV71-infected human rhabdomyosarcoma cells. The phosphorylation level of NF-κB p65 was reduced, and the activation of NF-κB signaling pathway was suppressed by Quercetin. Furthermore, our results showed that Quercetin downregulated the expression of JNK, ERK, and p38 and their phosphorylation levels due to EV71 infection. Conclusion: With these findings in mind, we can conclude that inhibiting the NF-κB signaling pathway is a critical mechanism through which Quercetin exerts its anti-EV71 effectiveness.
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Affiliation(s)
- Tianrun Liu
- School of Medicine, Jiamusi University, Jiamusi, China
| | - Yingyu Li
- School of Medicine, Jiamusi University, Jiamusi, China
| | - Lumeng Wang
- School of Medicine, Jiamusi University, Jiamusi, China
| | | | - Yuxuan Zhang
- School of Medicine, Jiamusi University, Jiamusi, China
| | - Xuejie Gai
- The Affiliated First Hospital, Jiamusi University, Jiamusi, China
| | - Li Chen
- School of Medicine, Jiamusi University, Jiamusi, China
| | - Lei Liu
- School of Medicine, Jiamusi University, Jiamusi, China
| | - Limin Yang
- School of Medicine, Dalian University, Dalian, China
| | - Baixin Wang
- School of Medicine, Jiamusi University, Jiamusi, China
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Morais GCDF, Dantas da Silva Junior E, Bruno Silva de Oliveira C, Rodrigues-Neto JF, Laino Fulco U, Ivan Nobre Oliveira J. Modafinil: A closer look at its theoretical toxicological potential. J Psychopharmacol 2023; 37:945-947. [PMID: 37435726 DOI: 10.1177/02698811231187127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
| | | | | | | | - Umberto Laino Fulco
- Department of Biophysics and Pharmacology, Federal University of Rio Grande do Norte, Natal, Brazil
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Heisel AGU, Vuurboom MD, Daams JG, de Rie MA, Vogt L, van den Born BJH, Olde Engberink RHG. The use of specific antihypertensive medication and skin cancer risk: A systematic review of the literature and meta-analysis. Vascul Pharmacol 2023; 150:107173. [PMID: 37084802 DOI: 10.1016/j.vph.2023.107173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND The use of hydrochlorothiazide has recently been linked to skin cancer in observational studies. This may be explained by its photosensitizing properties, but photosensitivity has also been reported for other antihypertensive drugs. We conducted a systematic review and meta-analysis to compare skin cancer risk among antihypertensive drug classes and individual blood pressure lowering drugs. METHODS We searched Medline, Embase, Cochrane and the Web of Science and included studies that investigated the association between antihypertensive medication exposure and non-melanoma skin cancer (NMSC) or cutaneous malignant melanoma (CMM). We combined the extracted odds ratios (OR) using a random effects model. RESULTS We included 42 studies with a total of 16,670,045 subjects. Diuretics, in particular hydrochlorothiazide, were examined most frequently. Only 2 studies provided information about antihypertensive co-medication. Exposure to diuretics (OR 1.27 [1.09-1.47]) and CCB (OR 1.06 [1.04-1.09]) was associated with an increased risk for NMSC. The increased risk for NMSC was only observed in case control studies and studies that did not correct for sun exposure, skin phototype or smoking. Studies that did correct for covariates as well as cohort studies did not show a significantly increased risk for NMSC. Egger's test revealed a significant publication bias for the subgroup of diuretics and hydrochlorothiazide concerning NMSC (p < 0.001). CONCLUSION The available studies investigating the potential skin cancer risk that is associated with antihypertensive medication have significant shortcomings. Also, a significant publication bias is present. We found no increased skin cancer risk when analyzing cohort studies or studies that corrected for important covariates. (PROSPERO (CRD42020138908)).
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Affiliation(s)
- Annalena G U Heisel
- Department of Internal Medicine, section Nephrology, Amsterdam University Medical Centres, Amsterdam, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands
| | - Mart D Vuurboom
- Department of Internal Medicine, section Nephrology, Amsterdam University Medical Centres, Amsterdam, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands
| | - Joost G Daams
- Medical Library, Amsterdam University Centres, Amsterdam, the Netherlands
| | - Menno A de Rie
- Department of Dermatology, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Liffert Vogt
- Department of Internal Medicine, section Nephrology, Amsterdam University Medical Centres, Amsterdam, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands
| | - Bert-Jan H van den Born
- Department of Internal Medicine, section Vascular Medicine, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rik H G Olde Engberink
- Department of Internal Medicine, section Nephrology, Amsterdam University Medical Centres, Amsterdam, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands.
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Ho KMA, Rosenfeld A, Hogan Á, McBain H, Duku M, Wolfson PB, Wilson A, Cheung SM, Hennelly L, Macabodbod L, Graham DG, Sehgal V, Banerjee A, Lovat LB. Development and validation of a multivariable risk factor questionnaire to detect oesophageal cancer in 2-week wait patients. Clin Res Hepatol Gastroenterol 2023; 47:102087. [PMID: 36669752 PMCID: PMC10602932 DOI: 10.1016/j.clinre.2023.102087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/09/2023] [Accepted: 01/15/2023] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Oesophageal cancer is associated with poor health outcomes. Upper GI (UGI) endoscopy is the gold standard for diagnosis but is associated with patient discomfort and low yield for cancer. We used a machine learning approach to create a model which predicted oesophageal cancer based on questionnaire responses. METHODS We used data from 2 separate prospective cross-sectional studies: the Saliva to Predict rIsk of disease using Transcriptomics and epigenetics (SPIT) study and predicting RIsk of diSease using detailed Questionnaires (RISQ) study. We recruited patients from National Health Service (NHS) suspected cancer pathways as well as patients with known cancer. We identified patient characteristics and questionnaire responses which were most associated with the development of oesophageal cancer. Using the SPIT dataset, we trained seven different machine learning models, selecting the best area under the receiver operator curve (AUC) to create our final model. We further applied a cost function to maximise cancer detection. We then independently validated the model using the RISQ dataset. RESULTS 807 patients were included in model training and testing, split in a 70:30 ratio. 294 patients were included in model validation. The best model during training was regularised logistic regression using 17 features (median AUC: 0.81, interquartile range (IQR): 0.69-0.85). For testing and validation datasets, the model achieved an AUC of 0.71 (95% CI: 0.61-0.81) and 0.92 (95% CI: 0.88-0.96) respectively. At a set cut off, our model achieved a sensitivity of 97.6% and specificity of 59.1%. We additionally piloted the model in 12 patients with gastric cancer; 9/12 (75%) of patients were correctly classified. CONCLUSIONS We have developed and validated a risk stratification tool using a questionnaire approach. This could aid prioritising patients at high risk of having oesophageal cancer for endoscopy. Our tool could help address endoscopic backlogs caused by the COVID-19 pandemic.
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Affiliation(s)
- Kai Man Alexander Ho
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK.
| | - Avi Rosenfeld
- Department of Computer Science, Jerusalem College of Technology, Havaad Haleumi 21, Givat Mordechai 91160 Jerusalem, Israel
| | - Áine Hogan
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Hazel McBain
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Margaret Duku
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Paul Bd Wolfson
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Ashley Wilson
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Sharon My Cheung
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Laura Hennelly
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - Lester Macabodbod
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK
| | - David G Graham
- Department of Gastrointestinal Services, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - Vinay Sehgal
- Department of Gastrointestinal Services, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, UK; Department of Cardiology, St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK; Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS), University College London, Charles Bell House, 43-45 Foley Street, London W1W 7TY, UK; Department of Gastrointestinal Services, University College London Hospital, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK
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Chifiriuc MC, Filip R, Constantin M, Pircalabioru GG, Bleotu C, Burlibasa L, Ionica E, Corcionivoschi N, Mihaescu G. Common themes in antimicrobial and anticancer drug resistance. Front Microbiol 2022; 13:960693. [PMID: 36003940 PMCID: PMC9393787 DOI: 10.3389/fmicb.2022.960693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial and anticancer drug resistance represent two of the main global challenges for the public health, requiring immediate practical solutions. In line with this, we need a better understanding of the origins of drug resistance in prokaryotic and eukaryotic cells and the evolutionary processes leading to the occurrence of adaptive phenotypes in response to the selective pressure of therapeutic agents. The purpose of this paper is to present some of the analogies between the antimicrobial and anticancer drug resistance. Antimicrobial and anticancer drugs share common targets and mechanisms of action as well as similar mechanisms of resistance (e.g., increased drug efflux, drug inactivation, target alteration, persister cells’ selection, protection of bacterial communities/malignant tissue by an extracellular matrix, etc.). Both individual and collective stress responses triggered by the chemotherapeutic agent involving complex intercellular communication processes, as well as with the surrounding microenvironment, will be considered. The common themes in antimicrobial and anticancer drug resistance recommend the utility of bacterial experimental models for unraveling the mechanisms that facilitate the evolution and adaptation of malignant cells to antineoplastic drugs.
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Affiliation(s)
- Mariana Carmen Chifiriuc
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Life, Environmental and Earth Sciences Division, Research Institute of the University of Bucharest, Bucharest, Romania
- The Romanian Academy, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
| | - Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
- Suceava Emergency County Hospital, Suceava, Romania
| | | | - Gratiela Gradisteanu Pircalabioru
- Faculty of Biology, University of Bucharest, Bucharest, Romania
- Academy of Romanian Scientists, Bucharest, Romania
- *Correspondence: Gratiela Gradisteanu Pircalabioru,
| | - Coralia Bleotu
- Stefan S. Nicolau Institute of Virology, Bucharest, Romania
- Romanian Academy of Scientists, Bucharest, Romania
- Coralia Bleotu, ;
| | | | - Elena Ionica
- Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Nicolae Corcionivoschi
- Bacteriology Branch, Veterinary Sciences Division, Agri-Food and Biosciences Institute, Belfast, United Kingdom
- Faculty of Bioengineering of Animal Resources, Banat University of Agricultural Sciences and Veterinary Medicine—King Michael I of Romania, Timisoara, Romania
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Kristensen KB, Friis S, Lund LC, Hallas J, Cardwell CR, Andreassen BK, Habel LA, Pottegård A. Identification of Drug-Cancer Associations: A Nationwide Screening Study. CANCER RESEARCH COMMUNICATIONS 2022; 2:552-560. [PMID: 36923552 PMCID: PMC10010324 DOI: 10.1158/2767-9764.crc-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022]
Abstract
The main tool in drug safety monitoring, spontaneous reporting of adverse effects, is unlikely to detect delayed adverse drug effects including cancer. Hypothesis-free screening studies based on administrative data could improve ongoing drug safety monitoring. Using Danish health registries, we conducted a series of case-control studies by identifying individuals with incident cancer in Denmark from 2001 to 2018, matching each case with 10 population controls on age, sex, and calendar time. ORs were estimated using conditional logistic regression accounting for matching factors, educational level, and selected comorbidities. A total of 13,577 drug-cancer associations were examined for individual drugs and 8,996 for drug classes. We reviewed 274 drug-cancer pairs where an association with high use and a cumulative dose-response pattern was present. We classified 65 associations as not readily attributable to bias of which 20 were established as carcinogens by the International Agency for Research on Cancer and the remaining 45 associations may warrant further study. The screening program identified drugs with known carcinogenic effects and highlighted a number of drugs that were not established as carcinogens and warrant further study. The effect estimates in this study should be interpreted cautiously and will need confirmation targeted epidemiologic and translational studies. Significance This study provides a screening tool for drug carcinogenicity aimed at hypothesis generation and explorative purposes. As such, the study may help to identify drugs with unknown carcinogenic effects and, ultimately, improve drug safety as part of the ongoing safety monitoring of drugs.
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Affiliation(s)
- Kasper Bruun Kristensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Søren Friis
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Lars Christian Lund
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Chris R. Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Laurel A. Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Anton Pottegård
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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9
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Wang Y, Gadalla SM. Drug-Wide Association Study (DWAS): Challenges and Opportunities. Cancer Epidemiol Biomarkers Prev 2021; 30:597-599. [PMID: 33811172 DOI: 10.1158/1055-9965.epi-20-1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/17/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
Cancer risk associations with commonly prescribed medications have been mainly evaluated in hypothesis-driven studies that focus on one drug at a time. Agnostic drug-wide association studies (DWAS) offer an alternative approach to simultaneously evaluate associations between a large number of drugs with one or more cancers using large-scale electronic health records. Although cancer DWAS approaches are promising, a number of challenges limit their applicability. This includes the high likelihood of false positivity; lack of biological considerations; and methodological shortcomings, such as inability to tightly control for confounders. As such, the value of DWAS is currently restricted to hypothesis generation with detected signals needing further evaluation. In this commentary, we discuss those challenges in more detail and summarize the approaches to overcome them by using published cancer DWAS studies, including the accompanied article by Støer and colleagues. Despite current concerns, DWAS future is filled with opportunities for developing innovative analytic methods and techniques that incorporate pharmacology, epidemiology, cancer biology, and genetics.See related article by Støer et al., p. 682.
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Affiliation(s)
- Youjin Wang
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Shahinaz M Gadalla
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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10
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Park J, Han JS, Jo HJ, Kim HY, Yoon H, Shin CM, Park YS, Kim N, Lee DH. Resting heart rate is associated with colorectal advanced adenoma. PLoS One 2021; 16:e0254505. [PMID: 34242355 PMCID: PMC8270146 DOI: 10.1371/journal.pone.0254505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background and aims Resting heart rate is an independent predictor of colorectal cancer (CRC) development and CRC-related mortality. However, little is known about the relationship between resting heart rate and colorectal adenoma development. We aimed to investigate this association in a population who underwent screening colonoscopy. Methods Among 39,021 patients who underwent both electrocardiogram and screening colonoscopy during routine health examinations at the Seoul National University Bundang Hospital, Health Promotion Center, Korea from January 2014 to July 2019, 1,344 patients had advanced adenoma. We performed 1:1 propensity score (PS) matching to establish a control group that mitigated the confounding effects of age and sex. We performed multivariate logistic regression analyses to identify the independent risk factors of advanced adenoma development. Results Resting heart rate was significantly higher in the advanced adenoma group than in the control group. The prevalence of advanced polyp increased across the quartiles of resting heart rate. Patients with higher resting heart rates were more likely to be older, smokers, and have increased blood pressure and DM and less likely to engage in active exercises than those with lower resting heart rates. Patients with higher resting heart rates had higher serum glucose, triglyceride, hemoglobin A1C, and insulin levels and lower high-density lipoprotein cholesterol levels. Patients with resting heart rate in the highest quartile (≥71 bpm) still showed significantly increased odds ratio (OR) of advanced adenoma development (OR: 1.379, 95% confidence interval: 1.099–1.731, p = 0.006). Conclusions High resting heart rate was a meaningful independent risk factor of advanced adenoma development.
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Affiliation(s)
- Jihye Park
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Soo Han
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jin Jo
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Young Kim
- Health Promotion Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Soo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Nayoung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Ho Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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11
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Antibiotic use prior to a lung cancer diagnosis: a population-based study. Cancer Causes Control 2021; 32:597-607. [PMID: 33754218 PMCID: PMC8089077 DOI: 10.1007/s10552-021-01413-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/02/2021] [Indexed: 12/25/2022]
Abstract
Aim To examine patterns of recent pre-diagnostic fillings of antibiotics as an indicator of early symptoms of lung cancer. Methods Individuals diagnosed with lung cancer (cases) in 2009–2016 were identified in the Swedish National Lung Cancer Register, a population-based register, and randomly matched with up to five individuals free of lung cancer (controls) from the general population. Conditional logistic models were used to estimate odds ratios for the association between lung cancer and a recent history of filled antibiotic prescriptions. Results The study included 27,017 cases and 129,355 controls. The likelihood of recent exposure was approximately two times higher in cases compared to controls. The magnitude of the effect size became more pronounced with proximity to the diagnosis of lung cancer and an increasing number of filled prescriptions. While the magnitude of the effect size did not differ by sex or educational level, it became attenuated with increasing age. There was no evidence supporting a trend in the magnitude of the effect size for the association between lung cancer and a history of repeated fillings by cancer stage. Conclusion Lung cancer was associated with an increased likelihood of a recent history of filled antibiotic prescriptions. However, there was no evidence of an association between repeated fillings and a diagnostic delay, as reflected by stage. Our findings underscore the importance of clinical reassessment to rule out lung cancer following pneumonia treatment, especially for patients with multiple treatment cycles. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01413-5.
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12
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McDowell RD, Hughes C, Murchie P, Cardwell C. A systematic assessment of the association between frequently prescribed medicines and the risk of common cancers: a series of nested case-control studies. BMC Med 2021; 19:22. [PMID: 33494748 PMCID: PMC7836181 DOI: 10.1186/s12916-020-01891-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Studies systematically screening medications have successfully identified prescription medicines associated with cancer risk. However, adjustment for confounding factors in these studies has been limited. We therefore investigated the association between frequently prescribed medicines and the risk of common cancers adjusting for a range of confounders. METHODS A series of nested case-control studies were undertaken using the Primary Care Clinical Informatics Unit Research (PCCIUR) database containing general practice (GP) records from Scotland. Cancer cases at 22 cancer sites, diagnosed between 1999 and 2011, were identified from GP records and matched with up to five controls (based on age, gender, GP practice and date of registration). Odds ratios (OR) and 95% confidence intervals (CI) comparing any versus no prescriptions for each of the most commonly prescribed medicines, identified from prescription records, were calculated using conditional logistic regression, adjusting for comorbidities. Additional analyses adjusted for smoking use. An association was considered a signal based upon the magnitude of its adjusted OR, p-value and evidence of an exposure-response relationship. Supplementary analyses were undertaken comparing 6 or more prescriptions versus less than 6 for each medicine. RESULTS Overall, 62,109 cases and 276,580 controls were included in the analyses and a total of 5622 medication-cancer associations were studied across the 22 cancer sites. After adjusting for comorbidities 2060 medicine-cancer associations for any prescription had adjusted ORs greater than 1.25 (or less than 0.8), 214 had a corresponding p-value less than or equal to 0.01 and 118 had evidence of an exposure-dose relationship hence meeting the criteria for a signal. Seventy-seven signals were identified after additionally adjusting for smoking. Based upon an exposure of 6 or more prescriptions, there were 118 signals after adjusting for comorbidities and 82 after additionally adjusting for smoking. CONCLUSIONS In this study a number of novel associations between medicine and cancer were identified which require further clinical and epidemiological investigation. The majority of medicines were not associated with an altered cancer risk and many identified signals reflected known associations between medicine and cancer.
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Affiliation(s)
- R. D. McDowell
- Centre for Public Health, Queen’s University, Grosvenor Rd., Belfast, Co. Antrim BT12 6BA UK
| | - C. Hughes
- School of Pharmacy, Queen’s University, Lisburn Rd, Belfast, Co. Antrim BT9 7BL UK
| | - P. Murchie
- Division of Applied Health Sciences Section, Section of Academic Primary Care, Foresterhill, Aberdeen, AB24 2ZD UK
| | - C. Cardwell
- Centre for Public Health, Queen’s University, Grosvenor Rd., Belfast, Co. Antrim BT12 6BA UK
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13
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Martins Lopes MS, Machado LM, Ismael Amaral Silva PA, Tome Uchiyama AA, Yen CT, Ricardo ED, Mutao TS, Pimenta JR, Shimba DS, Hanriot RM, Peixoto RD. Antibiotics, cancer risk and oncologic treatment efficacy: a practical review of the literature. Ecancermedicalscience 2020; 14:1106. [PMID: 33144874 PMCID: PMC7581329 DOI: 10.3332/ecancer.2020.1106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotics have been extensively used to treat infectious diseases over the past century and have largely contributed to increased life expectancy over time. However, antibiotic use can impose profound and protracted changes to the diversity of the microbial ecosystem, affecting the composition of up to 30% of the bacterial species in the gut microbiome. By modifying human microbiota composition, antibiotics alter the action of several oncologic drugs, potentially leading to decreased efficacy and increased toxicities. Whether antibiotics interfere with cancer therapies or even increase the risk of cancer development has been under investigation, and no randomised trials have been conducted so far. The aim of the current review is to describe the possible effects of antibiotic therapies on different oncologic treatments, especially immunotherapies, and to explore the link between previous antibiotics use and the development of cancer.
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Affiliation(s)
| | | | | | | | - Cheng T Yen
- Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | | | | | | | - Renata D Peixoto
- Centro Paulista de Oncologia (Grupo Oncoclínicas), São Paulo, Brazil
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14
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Wändell P, Carlsson AC, Li X, Sundquist J, Sundquist K. Levothyroxine treatment is associated with an increased relative risk of overall and organ specific incident cancers - a cohort study of the Swedish population. Cancer Epidemiol 2020; 66:101707. [PMID: 32222650 DOI: 10.1016/j.canep.2020.101707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 12/24/2022]
Abstract
High thyroid hormone values have been associated with an increased risk of incident cancers, especially breast cancer but also lung cancer and any solid cancers. We explored whether there is an increased risk of overall and cause-specific cancers in those receiving levothyroxine treatment. We included all individuals ≥ 18 years in Sweden (N = 8,573,313) on January 1 2009, and identified patients with two or more dispensed prescriptions of levothyroxine 2005-2006 (n = 253,193, 3.0 %). A cancer diagnosis in the Swedish Cancer Register 2009-2015 was used as outcome. We excluded patients with a cancer diagnosis before 2005. Cox regression was used (hazard ratios, HRs, and 95 % confidence intervals, CI) with adjustments for age, socioeconomic/neighborhood factors and co-morbidities. Totally 399,751 cases of incident cancer were identified, with a slight increased overall risk associated with levothyroxine treatment for both men, adjusted HR 1.06 (95 % CI 1.03-1.10), and women, adjusted HR 1.08 (95 % CI 1.07-1.10). For men, increased risks were found for cancers of the thyroid gland and other endocrine glands. For women, increased risks were found for cancers of the breast, endometrium, other female genitals (ovaries not included), stomach, colon, liver, pancreas, urinary bladder, skin, leukemia, and unspecified primary tumor. Unlike men, for women, no increased risk was found for cancer of the thyroid gland. In conclusions, levothyroxine treatment was associated with an excess cancer risk, including many different types of cancer, especially among women. Our results need confirmation by other studies, but levothyroxine is recommended to be prescribed only on approved indications.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-Based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Japan
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15
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Bao C, Wang K, Ding Y, Kong J. Association Between Anti-bacterial Drug Use and Digestive System Neoplasms: A Systematic Review and Meta-analysis. Front Oncol 2019; 9:1298. [PMID: 31828038 PMCID: PMC6890852 DOI: 10.3389/fonc.2019.01298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Anti-bacterial drugs are thought to be associated with several malignancies. Objective: We conducted a systematic review and meta-analysis to assess the association between antibacterial drug exposure and the risk of digestive system neoplasms. Methods: Relevant publications reporting a relationship between antibiotic use and the risk of cancer were identified in PubMed, EMBASE, and Cochrane Central Register through June 2018. The random-effects model was selected to pool the risk ratios (RRs) and determine 95% confidence intervals (95% CIs). We performed subgroup analyses by tumor organ site, individual antibacterial drug class, and drug dose accumulation. Results: A total of 17 eligible studies (four randomized trials and 13 observational studies) involving 77,284 cancer patients were included in our analyses. Anti-bacterial drug exposure slightly increased the risk of overall digestive system cancer (RR, 1.12; 95% CI, 1.10-1.14), stomach and small intestine (RR, 1.12; 95% CI, 1.07-1.17), anorectocolonic (RR, 1.08; 95% CI, 1.05-1.12), and hepatobiliary and pancreatic cancers (RR, 1.18; 95% CI, 1.14-1.22). For different anti-bacterial drugs classes, nitroimidazoles (RR, 1.17; 95% CI, 1.09-1.26) and quinolones (RR, 1.18; 95% CI, 1.11-1.26) showed a modest association with the risk of cancers incidence. The risks of digestive system cancers increased with the rise of drug dose accumulation: low (RR, 1.08; 95% CI, 1.05-1.11), intermediate (RR, 1.15; 95% CI, 1.12-1.18), and high (RR, 1.22; 95% CI, 1.18-1.26). Conclusions: Anti-bacterial drug exposure was associated with the risks of digestive system cancer occurrence in our analysis.
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Affiliation(s)
| | - Ke Wang
- Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Jinliang Kong
- Department of Respiratory Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, China
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16
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Xiong JQ, Jeon BH, Govindwar SP, Kurade MB, Patil SM, Park JH, Kim KH. Plant and microalgae consortium for an enhanced biodegradation of sulfamethazine. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:34552-34561. [PMID: 31650474 DOI: 10.1007/s11356-019-06506-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Pharmaceutical contamination in diverse water resources has been recognized as an emerging concern in environment because of its wide distribution and adverse effects on aquatic microorganisms and human health. Plant remediation with augmentation of microorganisms is a cost-effective and environmentally friendly approach toward an efficient treatment of pollutants, which can be easily applied in situ. (Bio)degradation of sulfamethazine (SMZ) by Iris pseudacorus, microalgal consortium, and plant-microalgal consortium was investigated. I. pseudacorus and microalgae could remove 63.5, and 25.8% of 1 mg SMZ L-1, respectively, whereas, the plant-microalgal consortium achieved 74% removal. The identified intermediates extracted after plant remediation indicated (bio)degradation of SMZ was through ring cleavage, hydroxylation, and dehydroxylation. Pigment content (total chlorophyll and carotenoid) of I. pseudacorus was significantly influenced by SMZ stress. A phytoreactor (20 L) constructed with I. pseudacorus achieved 30.0% and 71.3% removal of 1 mg SMZ L-1 from tap water and nutrient medium. This study has provided a better understanding of the metabolic mechanisms of SMZ in plants and showed the potential development of a plant-microalgal consortium as an advanced technology for treatment of these emerging contaminants. Graphical abstract.
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Affiliation(s)
- Jiu-Qiang Xiong
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
| | - Byong-Hun Jeon
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea.
| | - Sanjay P Govindwar
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
| | - Mayur B Kurade
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
| | - Swapnil M Patil
- Department of Earth Resources and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea
| | - Jung-Han Park
- Embassy of the Republic of Korea, 1-2-5 Minamiazabu Minato-ku, Tokyo, Japan
| | - Ki-Hyun Kim
- Department of Civil and Environmental Engineering, Hanyang University, Seoul, 04763, South Korea.
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17
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Crow LD, Kaizer-Salk KA, Juszczak HM, Arron ST. Medications Associated with Increased Risk of Keratinocyte Carcinoma. Dermatol Clin 2019; 37:297-305. [DOI: 10.1016/j.det.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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18
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Menne J, Schmidt BMW. Hypertonie-Update. DER NEPHROLOGE 2019; 14:227-239. [DOI: 10.1007/s11560-019-0334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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19
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Friedman GD, Achacoso N, Habel LA. Gabapentin and Cancer Risk: Updated Findings from Kaiser Permanente Northern California. Perm J 2019; 23:18-040. [PMID: 30939265 DOI: 10.7812/tpp/18-040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CONTEXT Epidemiologic analyses of gabapentin use and cancer risk in Kaiser Permanente Northern California were previously carried out in a collaborative study and independently evaluated in a UK database. OBJECTIVE To update these epidemiologic analyses with 7.5 more years of follow-up. DESIGN Case-control analyses using conditional logistic regression to estimate relative risk by odds ratios using the prior collaboration's criteria for identifying positive drug-cancer associations and our more stringent criteria requiring stronger association, lower p values, and evidence of dose response. New associations were reanalyzed with additional control for limited measures of smoking and alcohol use. MAIN OUTCOME MEASURES Gabapentin-cancer associations. RESULTS No previously found associations met our stringent criteria, but cancers of the mouth/pharynx, esophagus, liver, and vagina did. All odds ratios for 3 or more and 8 or more prescriptions were moderately reduced by control for smoking and alcohol. Substantial elevations of risk of mouth/pharynx, liver, and vaginal cancers were associated with only 1 prescription dispensed. Sensitivity analyses aimed at possible confounding and other biases did not change our conclusions but did reveal a markedly increased risk of vaginal cancer in gabapentin users with epilepsy compared with users without. CONCLUSION The reduced magnitude of relative risk with control for smoking and alcohol use suggests confounding by known risk factors. Biologically implausible elevated risk from just 1 prescription suggests confounding by indication. Either or both of these concerns applies to each of the 4 cancer sites associated with gabapentin use. Updated analyses show little if any evidence for carcinogenic effects of gabapentin.
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Affiliation(s)
- Gary D Friedman
- Division of Research, Oakland, CA.,Department of Health Research and Policy, Stanford University School of Medicine, CA
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20
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Shin D, Lee ES, Kim J, Guerra L, Naik D, Prida X. Association Between the Use of Thiazide Diuretics and the Risk of Skin Cancers: A Meta-Analysis of Observational Studies. J Clin Med Res 2019; 11:247-255. [PMID: 30937114 PMCID: PMC6436572 DOI: 10.14740/jocmr3744] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 02/19/2019] [Indexed: 12/27/2022] Open
Abstract
Background Thiazide diuretics are among the most widely prescribed antihypertensive agents. Given their photosensitizing effects, however, there are concerns that they may increase the risk of skin cancers. In this meta-analysis, we investigated an association between the use of thiazide diuretics and the risk of skin cancers. Methods We identified studies by searching three electronic databases (PubMed, EMBASE, and the Cochrane Library) from their inception to October 30, 2017. Nine relevant observational studies (seven case-control and two cohort studies) were included in this study. Since included studies were unlikely to be functionally equal, pooled estimates were calculated using random-effects meta-analysis. Results The use of thiazide diuretics was associated with an increased risk of squamous cell carcinoma (adjusted odds ratio (aOR), 1.86; 95% confidence interval (CI), 1.23 - 2.80) and marginally increased risk of basal cell carcinoma (aOR, 1.19; 95% CI, 1.02 - 1.38) and malignant melanoma (aOR, 1.14; 95% CI, 1.01 - 1.29). In the subgroup analysis, hydrochlorothiazide or hydrochlorothiazide combination medications were significantly associated with squamous cell carcinoma without significant heterogeneity among studies (aOR, 2.04; 95% CI, 1.79 - 2.33; Higgin’s I2 value = 0.0 %; Q-statistics = 2.7, P value = 0.445). Conclusions Our results suggested that the use of thiazide diuretics may be associated with an increased risk of skin cancers. This association was most prominent between the use of hydrochlorothiazide or hydrochlorothiazide combination medications and the risk of squamous cell carcinoma. Further studies are needed to confirm these findings.
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Affiliation(s)
- Doosup Shin
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Eun Sun Lee
- Department of Internal Medicine, Louise A Weiss Memorial Hospital, Chicago, IL, USA
| | - Joonseok Kim
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lucy Guerra
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Dayan Naik
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,New York Medical College, Valhalla, NY, USA.,Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Xavier Prida
- Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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21
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Ichikawa O, Glicksberg BS, Genes N, Kidd BA, Li L, Dudley JT. Lyme Disease Patient Trajectories Learned from Electronic Medical Data for Stratification of Disease Risk and Therapeutic Response. Sci Rep 2019; 9:4460. [PMID: 30872757 PMCID: PMC6418311 DOI: 10.1038/s41598-019-41128-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/27/2019] [Indexed: 02/04/2023] Open
Abstract
Lyme disease (LD) is the most common tick-borne illness in the United States. Although appropriate antibiotic treatment is effective for most cases, up to 20% of patients develop post-treatment Lyme disease syndrome (PTLDS). There is an urgent need to improve clinical management of LD using precise understanding of disease and patient stratification. We applied machine-learning to electronic medical records to better characterize the heterogeneity of LD and developed predictive models for identifying medications that are associated with risks of subsequent comorbidities. For broad disease categories, we identified 3, 16, and 17 comorbidities within 2, 5, and 10 years of diagnosis, respectively. At a higher resolution of ICD-9 codes, we identified known associations with LD including chronic pain and cognitive disorders, as well as particular comorbidities on a timescale that matched PTLDS symptomology. We identified 7, 30, and 35 medications associated with risks of these comorbidities within 2, 5, and 10 years, respectively. For instance, the first-line antibiotic doxycycline exhibited a consistently protective association for typical symptoms of LD, including backache. Our approach and findings may suggest new hypotheses for more personalized treatments regimens for LD patients.
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Affiliation(s)
- Osamu Ichikawa
- Department of Genetics and Genomic Sciences, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1498, New York, NY, 10029, USA.,Drug Research Division, Sumitomo Dainippon Pharma. Co. Ltd., 3-1-98 Kasugade-naka, Konohana-ku, Osaka, 554-0022, Japan
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1498, New York, NY, 10029, USA.,Bakar Computational Health Science Institute, University of California, 550 16th St, San Francisco, California, 94158, USA
| | - Nicholas Genes
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1190 Fifth Avenue Box 1620, New York, NY, 10029, USA
| | - Brian A Kidd
- Department of Genetics and Genomic Sciences, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1498, New York, NY, 10029, USA
| | - Li Li
- Department of Genetics and Genomic Sciences, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1498, New York, NY, 10029, USA. .,Sema4, a Mount Sinai Venture, Stamford, Connecticut, 06902, USA.
| | - Joel T Dudley
- Department of Genetics and Genomic Sciences, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1498, New York, NY, 10029, USA.
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22
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Rotshild V, Azoulay L, Zarifeh M, Masarwa R, Hirsh-Raccah B, Perlman A, Muszkat M, Matok I. The Risk for Lung Cancer Incidence with Calcium Channel Blockers: A Systematic Review and Meta-Analysis of Observational Studies. Drug Saf 2018; 41:555-564. [PMID: 29484611 DOI: 10.1007/s40264-018-0644-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION There are conflicting findings regarding the association between the use of calcium channel blockers (CCBs) and the risk of lung cancer. Considering the public health importance of lung cancer prevention, and emerging evidence of a significant biologic role of calcium channel regulation in the development of lung cancer, we conducted a meta-analysis to assess the risk of lung cancer in CCB users compared with non-CCB users. MATERIALS AND METHODS We conducted a comprehensive systematic search of leading medical databases for observational studies published up to December 2017 that examined CCB use and the risk of lung cancer. We used random-effects models to pool results. The impact of duration of CCB use on the estimated effect size was explored using random effects meta-regression. RESULTS Ten studies (six cohort and four case-control studies) that evaluated the overall cancer risk among 38,758 CCB users were included in the analysis. Overall risk ratio (RR) for CCB use and lung cancer was 1.15 (95% confidence interval [CI] 1.01-1.32). Subgroup analysis by duration of CCB use suggested that the observed increase in lung cancer risk was driven by the results of five studies with prolonged (≥ 4 years) exposure (RR 1.18; 95% CI 1.08-1.30). CONCLUSIONS Our analysis suggests exposure to CCBs is associated with an increased risk of lung cancer. Considering their widespread use, and the paucity of data on the long-term effects of chronic exposure to CCBs, these results are reason for concern and warrant further investigation. SYSTEMATIC REVIEW REGISTRATION The protocol for this study was registered at the PROSPERO registry of systematic reviews (registry number: CRD42017056362).
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Affiliation(s)
- Victoria Rotshild
- Pharmacoepidemiology Research Lab, Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, the Hebrew University of Jerusalem, P.O.B 12065, 9112001, Jerusalem, Israel
| | - Laurent Azoulay
- Department of Epidemiology, Biostatistics, and Occupational Health, Centre for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, Canada.,Gerald Bronfman Department of Oncology, McGill University, Montreal, Canada
| | - Majd Zarifeh
- Hadassah Braun School of Public and Community Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reem Masarwa
- Pharmacoepidemiology Research Lab, Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, the Hebrew University of Jerusalem, P.O.B 12065, 9112001, Jerusalem, Israel
| | - Bruria Hirsh-Raccah
- Pharmacoepidemiology Research Lab, Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, the Hebrew University of Jerusalem, P.O.B 12065, 9112001, Jerusalem, Israel
| | - Amichai Perlman
- Pharmacoepidemiology Research Lab, Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, the Hebrew University of Jerusalem, P.O.B 12065, 9112001, Jerusalem, Israel
| | - Mordechai Muszkat
- Department of Medicine, Hadassah University Hospital Mt. Scopus, Jerusalem, Israel
| | - Ilan Matok
- Pharmacoepidemiology Research Lab, Division of Clinical Pharmacy, Faculty of Medicine, School of Pharmacy, Institute for Drug Research, the Hebrew University of Jerusalem, P.O.B 12065, 9112001, Jerusalem, Israel.
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23
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Friedman GD, Habel LA, Achacoso N, Sanders CM, Oyer HM, Fireman B, Van Den Eeden SK, Kim FJ. Haloperidol and Prostate Cancer Prevention: More Epidemiologic Research Needed. Perm J 2018; 24:18.313. [PMID: 31852040 DOI: 10.7812/tpp/18.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT The antipsychotic drug haloperidol has antiproliferative and growth-inhibiting properties on prostate cancer cell lines in vitro by binding the sigma 1 protein. Evidence is needed regarding a possible preventive association in men. OBJECTIVE To examine whether our epidemiologic data support an inverse association of haloperidol use with risk of prostate cancer. DESIGN These case-control analyses used conditional logistic regression to estimate relative risk by odds ratios (ORs) adjusting for race/ethnicity and aspects of medical care related to detection of prostate cancer. We tested 3 other commonly used antipsychotic drugs, risperidone, quetiapine, and olanzapine, for sigma 1 protein binding and inhibition of clonogenic growth of prostate cancer cells. Use of any of these by men was considered use of a comparator drug. MAIN OUTCOME MEASURES 1) association of haloperidol with prostate cancer; 2) sigma 1 binding and clonogenic growth. RESULTS Probably owing to small numbers of haloperidol recipients, evidence of a preventive association was inconsistent, depending on the definition of long-term use. If duration of use was greater than 1 year, the odds ratio (OR) was 0.38 (95% confidence interval (CI) = 0.14-1.01) for haloperidol and 0.80 (95% CI = 0.66-0.98) for the comparator drug; if the duration of use was greater than 2 years, the OR was 0.66 (95% CI = 0.24-1.76) for haloperidol and 0.84 (95% CI = 0.66-1.08) for the comparator drug. Unlike haloperidol, risperidone, quetiapine, and olanzapine did not bind sigma 1 or inhibit clonogenic growth. CONCLUSION Given the laboratory evidence, our ambiguous epidemiologic findings should encourage more epidemiologic evaluation of haloperidol use and risk of prostate cancer. Finding a negative association could be a scientific advance in prostate cancer prevention but would not be sufficient basis for recommending the prescription of haloperidol for that purpose.
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Affiliation(s)
- Gary D Friedman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Research and Policy, Stanford University School of Medicine, CA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Christina M Sanders
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Halley M Oyer
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Bruce Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Felix J Kim
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Pottegård A, Hallas J, Olesen M, Svendsen MT, Habel LA, Friedman GD, Friis S. Hydrochlorothiazide use is strongly associated with risk of lip cancer. J Intern Med 2017; 282:322-331. [PMID: 28480532 DOI: 10.1111/joim.12629] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The diuretic hydrochlorothiazide is amongst the most frequently prescribed drugs in the United States and Western Europe, but there is suggestive evidence that hydrochlorothiazide use increases the risk of lip cancer. OBJECTIVES To study the association between use of hydrochlorothiazide and squamous cell carcinoma of the lip. METHODS We conducted a case-control study using Danish nationwide registry data. From the Cancer Registry (2004-2012), we identified 633 case patients with squamous cell carcinoma (SCC) of the lip and matched them to 63 067 population controls using a risk-set sampling strategy. Hydrochlorothiazide use (1995-2012) was obtained from the Prescription Registry and defined according to cumulative use. Applying conditional logistic regression, we calculated odds ratios (ORs) for SCC lip cancer associated with hydrochlorothiazide use, adjusting for predefined potential confounders obtained from demographic, prescription and patient registries. RESULTS Ever-use of hydrochlorothiazide was associated with an adjusted OR for SCC lip cancer of 2.1 (95% confidence interval (CI): 1.7-2.6), increasing to 3.9 (95%CI: 3.0-4.9) for high use (≥25 000 mg). There was a clear dose-response effect (P < 0.001), with the highest cumulative dose category of hydrochlorothiazide (≥100 000 mg) presenting an OR of 7.7 (95%CI: 5.7-10.5). No association with lip cancer was seen with use of other diuretics or nondiuretic antihypertensives. Assuming causality, we estimated that 11% of the SCC lip cancer cases could be attributed to hydrochlorothiazide use. CONCLUSIONS Hydrochlorothiazide use is strongly associated with an increased risk of lip cancer.
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Affiliation(s)
- A Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - J Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M Olesen
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - M T Svendsen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - L A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - G D Friedman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - S Friis
- Danish Cancer Society, Danish Cancer Society Research Center, Copenhagen, Denmark
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Zhang L, Ai H, Chen W, Yin Z, Hu H, Zhu J, Zhao J, Zhao Q, Liu H. CarcinoPred-EL: Novel models for predicting the carcinogenicity of chemicals using molecular fingerprints and ensemble learning methods. Sci Rep 2017; 7:2118. [PMID: 28522849 PMCID: PMC5437031 DOI: 10.1038/s41598-017-02365-0] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/10/2017] [Indexed: 01/11/2023] Open
Abstract
Carcinogenicity refers to a highly toxic end point of certain chemicals, and has become an important issue in the drug development process. In this study, three novel ensemble classification models, namely Ensemble SVM, Ensemble RF, and Ensemble XGBoost, were developed to predict carcinogenicity of chemicals using seven types of molecular fingerprints and three machine learning methods based on a dataset containing 1003 diverse compounds with rat carcinogenicity. Among these three models, Ensemble XGBoost is found to be the best, giving an average accuracy of 70.1 ± 2.9%, sensitivity of 67.0 ± 5.0%, and specificity of 73.1 ± 4.4% in five-fold cross-validation and an accuracy of 70.0%, sensitivity of 65.2%, and specificity of 76.5% in external validation. In comparison with some recent methods, the ensemble models outperform some machine learning-based approaches and yield equal accuracy and higher specificity but lower sensitivity than rule-based expert systems. It is also found that the ensemble models could be further improved if more data were available. As an application, the ensemble models are employed to discover potential carcinogens in the DrugBank database. The results indicate that the proposed models are helpful in predicting the carcinogenicity of chemicals. A web server called CarcinoPred-EL has been built for these models (http://ccsipb.lnu.edu.cn/toxicity/CarcinoPred-EL/).
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Affiliation(s)
- Li Zhang
- School of Life Science, Liaoning University, Shenyang, 110036, China.,Research Center for Computer Simulating and Information Processing of Bio-macromolecules of Liaoning Province, Shenyang, 110036, China
| | - Haixin Ai
- School of Life Science, Liaoning University, Shenyang, 110036, China.,Research Center for Computer Simulating and Information Processing of Bio-macromolecules of Liaoning Province, Shenyang, 110036, China.,Engineering Laboratory for Molecular Simulation and Designing of Drug Molecules of Liaoning, Shenyang, 110036, China
| | - Wen Chen
- School of Information, Liaoning University, Shenyang, 110036, China
| | - Zimo Yin
- School of Information, Liaoning University, Shenyang, 110036, China
| | - Huan Hu
- School of Life Science, Liaoning University, Shenyang, 110036, China
| | - Junfeng Zhu
- School of Life Science, Liaoning University, Shenyang, 110036, China
| | - Jian Zhao
- School of Life Science, Liaoning University, Shenyang, 110036, China
| | - Qi Zhao
- Research Center for Computer Simulating and Information Processing of Bio-macromolecules of Liaoning Province, Shenyang, 110036, China.,School of Mathematics, Liaoning University, Shenyang, 110036, China
| | - Hongsheng Liu
- School of Life Science, Liaoning University, Shenyang, 110036, China. .,Research Center for Computer Simulating and Information Processing of Bio-macromolecules of Liaoning Province, Shenyang, 110036, China. .,Engineering Laboratory for Molecular Simulation and Designing of Drug Molecules of Liaoning, Shenyang, 110036, China.
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Friedman GD, Achacoso N, Habel LA. Research Letter: Anticholinergic Drugs and the Gallbladder -A Neglected Effect? Perm J 2017; 21:16-133. [PMID: 28488984 DOI: 10.7812/tpp/16-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gary D Friedman
- Director Emeritus for the Division of Research in Oakland, CA.
| | - Ninah Achacoso
- Data Consultant for the Division of Research in Oakland, CA.
| | - Laurel A Habel
- Senior Investigator and Section Chief for the Division of Research in Oakland, CA.
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Emerce E, Cok I, Sari S, Bostanci O. An investigation of the mutagenic activity of salamide - a major impurity of hydrochlorothiazide. Toxicol Mech Methods 2016; 26:644-649. [PMID: 27790927 DOI: 10.1080/15376516.2016.1222642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hydrochlorothiazide is a widely used antihypertensive agent and one of its major impurities, salamide (4-amino-6-chlorobenzene-1,3-disulphonamide), has a chemical structure containing a primary amino group, a functional group that has previously been reported to be associated with carcinogenic activity. It is known that hydrochlorothiazide purity is a challenging problem for the pharmaceutical industry. As there were no prior mutagenicity data for the impurity salamide, the aim was to investigate its mutagenicity in this study. Salamide was tested for mutagenic potential in Salmonella typhimurium TA98, TA100, TA 1535, TA 1537, and E. coli WP2 uvrA + E. coli WP2 [pKM101] strains at six different concentrations, the highest concentration being the 5000 μg/plate. In both the presence and absence of the metabolic activation system, no mutagenic activity was observed. Results indicated that salamide should be classified as an ordinary impurity and controlled according to Q3A(R2) and Q3B(R2) guidelines.
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Affiliation(s)
- Esra Emerce
- a Department of Toxicology, Faculty of Pharmacy , Gazi University , Ankara , Turkey
| | - Ismet Cok
- a Department of Toxicology, Faculty of Pharmacy , Gazi University , Ankara , Turkey
| | - Sibel Sari
- b Department of Molecular Biology, Division of Biology, Faculty of Science , Hacettepe University , Ankara , Turkey
| | - Omur Bostanci
- b Department of Molecular Biology, Division of Biology, Faculty of Science , Hacettepe University , Ankara , Turkey
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Yang LB, Wang JH, Qiao L, Xie N, Bu X, Song YH, An M. Correlation between reproductive factors and pancreatic cancer in northwest China. Shijie Huaren Xiaohua Zazhi 2016; 24:2571-2576. [DOI: 10.11569/wcjd.v24.i16.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To assess the correlation between reproductive factors and pancreatic cancer in Chinese female Hans from northwest China, in order to find a new strategy for the prevention and treatment of pancreatic cancer.
METHODS: A total of 154 female pancreatic cancer patients treated at the Second Affiliated Hospital of Xi'an Jiaotong University from 2008 to 2014 were included in a case group, and 251 gender and age matched hospitalized patients without gynecological and endocrine disease were included in a control group. A case-control study was carried out, and odds ratio (OR) and its 95% confidence interval (95%CI) estimating the relative risk of each factor (including parity, age at menarche and age at menopause) to pancreatic cancer were calculated to assess their correlation.
RESULTS: In the female Han population, compared with the hospitalized patients without gynecological and endocrine disease, multiple births (≥3) was a risk factor for pancreatic cancer (OR = 2.42, 95%CI: 1.43-4.10). In univariate analysis, compared with non-menopausal women, menopausal woman had a higher risk to develop pancreatic cancer (OR = 4.65), and menarche at age less than or equal to 14 years was associated with a lower risk to develop pancreatic cancer. In multivariate analysis, age at menarche and age at menopause were not associated with the incidence of pancreatic cancer. When distribution characteristics of parity in patients with pancreatic cancer were studied, compared with the control group of patients, patients with pancreatic cancer had a significantly higher proportion of multiple births (≥3) compared with the control group (P < 0.05).
CONCLUSION: In the female Han population, multiple births may be a risk factor for pancreatic cancer. Age at menarche and age at menopause are not significantly associated with the incidence of pancreatic cancer. Compared with hospitalized patients without gynecological and endocrine disease, patients with pancreatic cancer have a higher proportion of multiple births.
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 09/02/2023] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Abstract
This is a review of hypnotic drug risks and benefits. Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality (especially overdose deaths, quiet deaths at night, and suicides), infections, cancer, depression, automobile crashes, falls, other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with even greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse (not better) and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics' mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Friedman GD, Achacoso N, Habel LA. Confounding by alcohol use: benzodiazepines and risk of liver cancer. Br J Clin Pharmacol 2016; 79:872-3. [PMID: 25387597 DOI: 10.1111/bcp.12549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 12/30/2022] Open
Affiliation(s)
- Gary D Friedman
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA; Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
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Bugan I, Karagoz Z, Altun S, Djamgoz MBA. Gabapentin, an Analgesic Used Against Cancer-Associated Neuropathic Pain: Effects on Prostate Cancer Progression in anIn VivoRat Model. Basic Clin Pharmacol Toxicol 2015; 118:200-7. [DOI: 10.1111/bcpt.12484] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/27/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Ilknur Bugan
- Department of Biology; Faculty of Science; Istanbul University; Vezneciler Istanbul Turkey
| | - Zeynep Karagoz
- Department of Biology; Faculty of Science; Istanbul University; Vezneciler Istanbul Turkey
| | - Seyhan Altun
- Department of Biology; Faculty of Science; Istanbul University; Vezneciler Istanbul Turkey
| | - Mustafa B. A. Djamgoz
- Department of Life Sciences; Sir Alexander Fleming Building; Imperial College London; South Kensington Campus; London UK
- Biotechnology Research Centre; Cyprus International University; Haspolat North Cyprus
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Chan HL, Hsieh YH, Lin CF, Liang HY, Huang KY, Chiu WC, Lee Y, McIntyre RS, Chen VCH. Invasive Cervical Cancer and Antidepressants: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1866. [PMID: 26496343 PMCID: PMC4620823 DOI: 10.1097/md.0000000000001866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To our knowledge, no prior population-based study has been published wherein the primary aim was to evaluate whether an association between psychotropic drug prescription and cervical cancer exists. Herein we have conducted the first study that primarily aimed to determine the association between antidepressants use and risk of invasive cervical cancer in the general population.This is a population-based study utilizing Taiwan's National Health Insurance Research Database. We identified 26,262 cases with invasive cervical cancer and 129,490 controls. We adopted the conditional logistic regression model as the statistical method and adjusted for potential confounding factors.The prescription of selective serotonin reuptake inhibitors (SSRIs) (adjusted OR = 0.93, 95% CI = 0.84-1.04), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), serotonin norepinephrine reuptake inhibitors (SNRIs), mirtazapine and bupropion, adjusting for cumulative dose, was not associated with an increased, or decreased, risk for invasive cervical cancer. An association between trazodone prescription and invasive cervical cancer was observed (adjusted OR = 1.22, 95% CI = 1.03-1.43).An association between the major classes of antidepressants and invasive cervical cancer was not observed herein. Our preliminary finding regarding a possible association between trazodone and cervical cancer requires replication.
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Affiliation(s)
- Hsiang-Lin Chan
- From the Department of Child Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan (HLC, YHH, CFL, HYL); Department of Psychiatry, Chang Gung University, Taoyuan, Taiwan (HLC, YHH, CFL, HYL, VCHC); Department of Speech, Language Pathology and Audiology, Chung Shan Medical University, Taichung, Taiwan (KYH); Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan (WCC); School of Medicine, Fu Jen Catholic University, Taipei, Taiwan (WCC); Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, Canada (YL, RSM); Department of Psychiatry, University of Toronto, Toronto, Canada (RSM); and Department of Psychiatry, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan (VCHC)
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Lee SK, Dawson J, Lee JA, Osman G, Levitin MO, Guzel RM, Djamgoz MB. Management of cancer pain: 1. Wider implications of orthodox analgesics. Int J Gen Med 2014; 7:49-58. [PMID: 24470767 PMCID: PMC3891517 DOI: 10.2147/ijgm.s42187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In this review, the first of two parts, we first provide an overview of the orthodox analgesics used commonly against cancer pain. Then, we examine in more detail the emerging evidence for the potential impact of analgesic use on cancer risk and disease progression. Increasing findings suggest that long-term use of nonsteroidal anti-inflammatory drugs, particularly aspirin, may reduce cancer occurrence. However, acetaminophen may raise the risk of some hematological malignancies. Drugs acting upon receptors of gamma-aminobutyric acid (GABA) and GABA “mimetics” (eg, gabapentin) appear generally safe for cancer patients, but there is some evidence of potential carcinogenicity. Some barbiturates appear to slightly raise cancer risks and can affect cancer cell behavior in vitro. For cannabis, studies suggest an increased risk of squamous cell carcinoma of the tongue, larynx, and possibly lung. Morphine may stimulate human microvascular endothelial cell proliferation and angiogenesis; it is not clear whether this might cause harm or produce benefit. The opioid, fentanyl, may promote growth in some tumor cell lines. Opium itself is an emerging risk factor for gastric adenocarcinoma and possibly cancers of the esophagus, bladder, larynx, and lung. It is concluded that analgesics currently prescribed for cancer pain can significantly affect the cancer process itself. More futuristically, several ion channels are being targeted with novel analgesics, but many of these are also involved in primary and/or secondary tumorigenesis. Further studies are needed to elucidate possible cellular and molecular effects of orthodox analgesics and their possible long-term impact, both positive and negative, and thus enable the best possible clinical gain for cancer patients.
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Affiliation(s)
| | - Jill Dawson
- Healthcare Communications Consultancy, Danville, CA, USA
| | - Jack A Lee
- College of Arts and Sciences, Vanderbilt University, Nashville, TN, USA
| | - Gizem Osman
- Department of Chemical Engineering, Loughborough University, Loughborough, UK
| | - Maria O Levitin
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK
| | - Refika Mine Guzel
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK
| | - Mustafa Ba Djamgoz
- Division of Cell and Molecular Biology, Neuroscience Solutions to Cancer Research Group, South Kensington Campus, Imperial College London, London, UK ; Cyprus International University, Biotechnology Research Centre, Haspolat, North Cyprus, Mersin, Turkey
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Antidepressants and testicular cancer. Cancer Causes Control 2013; 25:251-8. [PMID: 24276357 DOI: 10.1007/s10552-013-0327-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 11/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Re-examine association of fluoxetine and paroxetine with risk of testicular cancer noted in drug screening, with 4 years more follow-up and expanded study of these and other antidepressant drugs. METHODS In the Kaiser Permanente Medical Care Program in Northern California, 906 men with testicular cancer diagnosed August 1996-December 2010 were compared with 38,253 matched controls with race/ethnicity recorded regarding receipt of antidepressant drugs at least 2 years before diagnosis or control index date. Analyses emphasized duration of use and histological subgroups. RESULTS With control for race/ethnicity and use of other antidepressant drugs, odds ratios (OR) and 95 % confidence intervals (CI) for associations with testicular cancer were as follows: fluoxetine 1.22 (0.88-1.71), paroxetine 1.19 (0.78-1.83), and 1.21 (0.92-1.58) for all serotonin reuptake inhibitors. There was no statistically significant association with risk of all testicular cancers or their histological subtypes for any individual drug or for tricyclics or all antidepressants combined except for citalopram with all testicular cancers 2.55 (1.43-4.52) and those of mixed histology 4.36 (1.50-12.68) and nefazodone with embryonal cancers 9.79 (1.85-51.81). These could readily be chance findings in the context of the many analyses that were performed. Duration of use was not associated with risk of the drugs and drug groups with sufficient numbers of exposed cases for analysis. CONCLUSIONS We found little evidence to support a testicular carcinogenic effect of fluoxetine, paroxetine, or other antidepressant drugs, but a weakly positive association is not ruled out. The signals in prior screening may have been due to chance and/or uncontrolled confounding.
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Monami M, Filippi L, Ungar A, Sgrilli F, Antenore A, Dicembrini I, Bagnoli P, Marchionni N, Rotella CM, Mannucci E. Further data on beta-blockers and cancer risk: observational study and meta-analysis of randomized clinical trials. Curr Med Res Opin 2013; 29:369-78. [PMID: 23368896 DOI: 10.1185/03007995.2013.772505] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aim of the present paper is to provide some further data on the relationship between β-blocker treatment and the incidence of cancer, using two different approaches (epidemiological study and meta-analysis of clinical trials). METHODS In a consecutive series of 1340 diabetic patients starting insulin therapy, 112 cases of cancer during a mean follow-up of 75.9 months were identified as first hospital admission or death. For each case, the controls were chosen randomly from those members of the cohort matched for age, sex and BMI. The main predefined analysis was the comparison of cases and controls for length of exposure to β-blockers and proportion of patients exposed using a conditional logistic regression which takes into account the matching structure. For the meta-analytic sub-study, an extensive search of Medline and the Cochrane Library (any date up to December 31st, 2011) was performed for all trials in which a β-blocker was used. Mantel-Haenszel Odds Ratios (MH-OR) with 95% confidence intervals for incident malignancies were calculated using a random effect model. RESULTS After adjusting for mean daily dose of glargine and metformin, and ischemic heart disease, exposure to β-blockers was associated with a reduced overall risk of cancer (HR 0.33 [0.13; 0.83], p = 0.019; HR for each month of exposure 0.87 [0.77; 0.98], p = 0.025). In the meta-analysis sub-study, performed on nine trials, β-blockers were associated with a non-significant trend toward lower risk of cancer (MH-OR 0.93 [0.86; 1.01], p = 0.070). STUDY LIMITATION Limitations of the observational study are the small sample size that limits the statistical power of analyses, that it was performed on diabetic patients only, and that diagnoses of malignancies were derived from administrative data. CONCLUSIONS In conclusion, this research seem to confirm a possible beneficial effect of β-blockers against the risk of cancer development.
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Affiliation(s)
- Matteo Monami
- Section of Geriatric Cardiology and Medicine, Department of Cardiovascular Medicine, University of Florence and Careggi Teaching Hospital, Florence, Italy
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Friedman GD, Asgari MM, Warton EM, Chan J, Habel LA. Antihypertensive drugs and lip cancer in non-Hispanic whites. ARCHIVES OF INTERNAL MEDICINE 2012; 172:1246-51. [PMID: 22869299 PMCID: PMC3809130 DOI: 10.1001/archinternmed.2012.2754] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In screening pharmaceuticals for possible carcinogenic effects we noted an association between lip cancer risk and the photosensitizing antihypertensive drugs hydrochlorothiazide and nifedipine. In this study, we further characterized the risk of lip cancer associated with these and other commonly used antihypertensive drugs. METHODS In a comprehensive medical care program, we evaluated prescriptions dispensed and cancer occurrence from August 1, 1994, to February 29, 2008. We identified 712 patients with lip cancer (cases) and 22,904 comparison individuals (controls) matched for age, sex, and cohort year of entry in the susceptible group, non-Hispanic whites. We determined use, at least 2 years before diagnosis or control index date, of the commonly prescribed diuretics hydrochlorothiazide and hydrochlorothiazide combined with triamterene, the angiotensin-converting enzyme inhibitor lisinopril, the calcium channel blocker nifedipine, and the β-adrenergic blocker atenolol, the only nonphotosensitizer agent studied. We analyzed the use of each drug exclusively and regardless of use of the others, and focused on duration of use. Conditional logistic regression was used for analysis of matched case-control sets, with control for cigarette smoking. RESULTS At least a 5-year supply of a drug yielded the following odds ratios (95% CIs), respectively, compared with no use: hydrochlorothiazide, 4.22 (2.82-6.31); hydrochlorothiazide-triamterene, 2.82 (1.74-4.55); lisinopril, 1.42 (0.95-2.13); nifedipine, 2.50 (1.29-4.84); and atenolol, 1.93 (1.29-2.91). When the other drugs were excluded, the odds ratio for atenolol was reduced to 0.54 (0.07-4.08). CONCLUSION These data support an increased risk of lip cancer in non-Hispanic whites receiving treatment for hypertension with long-term use of photosensitizing drugs.
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Affiliation(s)
- Gary D Friedman
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California, USA
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Jansen L, Below J, Chang-Claude J, Brenner H, Hoffmeister M. Beta blocker use and colorectal cancer risk. Cancer 2012; 118:3911-9. [DOI: 10.1002/cncr.26727] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 10/11/2011] [Accepted: 11/07/2011] [Indexed: 12/31/2022]
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Irizarry MC, Webb DJ, Boudiaf N, Logie J, Habel LA, Udaltsova N, Friedman GD. Risk of cancer in patients exposed to gabapentin in two electronic medical record systems. Pharmacoepidemiol Drug Saf 2011; 21:214-25. [PMID: 22144034 DOI: 10.1002/pds.2266] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 09/11/2011] [Accepted: 09/12/2011] [Indexed: 01/14/2023]
Abstract
PURPOSE High doses of gabapentin were associated with pancreatic acinar cell tumors in male Wistar rats, but there is little published epidemiological data regarding gabapentin and carcinogenicity. We explored the association between gabapentin and cancer in a US medical care program and followed up nominally significant associations in a UK primary care database. METHODS In the US Kaiser Permanente Northern California (KPNC) health system, we performed nested case-control analyses of gabapentin and 55 cancer sites and all cancers combined using conditional logistic regression. Up to 10 controls were matched to each case on year of birth, sex, and year of cohort entry. No other covariates were included in models. Only dispensings for gabapentin 2 years or more before index date were considered. Nominally significant associations with an OR > 1.00 and p < 0.05 for three or more dispensings versus no dispensings were followed up by similar nested case-control analyses in the UK General Practice Research Database (GPRD), adjusting for potential indications for gabapentin and risk factors for the specific cancers. RESULTS The following analyses had OR > 1.00 and p < 0.05 for three or more dispensings of gabapentin versus no dispensing (2-year lag) in KPNC and were also examined in the GPRD: all cancers, breast, lung and bronchus, urinary bladder, kidney/renal pelvis, stomach, anus/anal canal/anorectum, penis, and other nervous system. These cancers were not statistically significantly associated with gabapentin in the GPRD case-control studies (2-year lag). The GPRD and KPNC studies did not identify a statistically significant increased risk of pancreatic cancer with more than two prescriptions of gabapentin in the 2-year lagged analyses. CONCLUSIONS The epidemiological data in a US cohort with up to 12 years of follow-up and a UK cohort with up to 15 years of follow-up do not support a carcinogenic effect of gabapentin use. However, the confidence intervals for some analyses were wide, and an important effect cannot be confidently excluded.
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Friedman GD, Schwalbe JS, Habel LA. Re: a case-control study of levothyroxine and the risk of colorectal cancer. J Natl Cancer Inst 2011; 103:1637-9. [PMID: 22010174 DOI: 10.1093/jnci/djr374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Friedman GD, Udaltsova N, Habel LA. Norepinephrine antagonists and cancer risk. Int J Cancer 2011; 128:737-8; author reply 739. [PMID: 20333678 DOI: 10.1002/ijc.25351] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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