An association between benzodiazepine use and occurrence of benign brain tumors

Hypnotics and Risk of Cancer: A Meta-Analysis of Observational Studies

Background and objectives: The association between hypnotic drugs and risk of cancer remains controversial. Therefore, we performed a meta-analysis to investigate this association. Materials and Methods: Pubmed and Embase were searched systematically to identify publications up to April 2020. The Newcastle-Ottawa scale for observational studies was used to assess the quality of studies. All included studies were evaluated by two reviewers independently; any discrepancies were resolved through discussion. Results: Twenty-eight studies including 22 case-control studies and 6 cohort studies with 340,614 hypnotics users and 1,828,057 non-users were included in the final analyses. Hypnotics (benzodiazepines and Z-drugs) use was significantly associated with an increased risk of cancer (odds ratio [OR] or relative risk [RR] 1.17; 95% confidence interval 1.09-1.26) in a random-effects meta-analysis of all studies. Subgroup meta-analysis by anxiolytics/sedatives effect (anxiolytics benzodiazepines vs. sedatives group (include sedatives benzodiazepines and Z-drugs)) revealed that a significant association in sedatives group (pooled OR/RR 1.26, 95% CI, 1.10-1.45), whereas no significant relationship was observed in anxiolytics benzodiazepines (pooled OR/RR 1.09, 95% CI, 0.95-1.26). Moreover, a significant dose-response relationship was observed between the use of hypnotics and the risk of cancer. Conclusions: This meta-analysis revealed association between use of hypnotics drugs and risk of cancer. However, the use of lower dose hypnotics and shorter duration exposed to hypnotics seemed to be not associated with an increased risk of cancer. Moreover, the use of anxiolytics effect benzodiazepines seemed to be lower risk than sedatives benzodiazepines. A high heterogeneity was observed among identified studies, and results were inconsistent in some subgroups. Randomized control trials are needed to confirm the findings in the future.

Increased use of benzodiazepines among older adults: Bambuí Project

BACKGROUND

Benzodiazepines are the most widely used psychoactive drugs, despite the risks associated with their prolonged use, especially among older adults.

OBJECTIVE

To investigate the use of benzodiazepines among community-dwelling people aged ≥ 75 years.

METHODS

The study was conducted among members of the baseline (in 1997) and survivors (in 2012) of the Bambuí Project cohort. The prevalence of benzodiazepine use was estimated separately for each year, and the comparison between them was performed using the Poisson regression model with robust variance.

RESULTS

The prevalence of benzodiazepine use was higher in 2012 (33.9%) compared to 1997 (24.9%). After multiple adjustments, the difference in prevalence did not remain significant in study population (PR = 1.25; 95%CI 0.99 - 1.60), unlike that observed in the female stratum (PR = 1.38; 95%CI 1.04 - 1.84). Clonazepam was the strongest-growing drug between the two years (PR = 4.94; 95%CI 2.54 - 9.62).

CONCLUSION

This study showed an important increase in benzodiazepine use in an older adult population. These results are concerning as these drugs are contraindicated for use in older adults, mainly if used chronically, and are available in the national list of essential medicines. Health professionals should be aware of the risks involved in its use regarding this population.

Association between sedative-hypnotic medication use and incidence of cancer in Korean Nation Health Insurance Service data

OBJECTIVES

We aimed to investigate the association between the use of various sedative-hypnotics and the incidence of overall and individual cancers in a large, population-based, retrospective cohort study.

METHODS

We selected a 5% random sample of individuals aged 50 years or older from data maintained by the Korean National Health Insurance Service for the years 2002-2015, excluding individuals with a prior diagnosis of cancer and with any sedative-hypnotic use in the initial two years of follow-up, leaving 236,759 participants for the final analysis. Exposure to sedative-hypnotics was defined by type of drug, standardized to a defined daily dose, and coded as a time-varying variable. Cox proportional hazard models were applied after adjusting for sex, socio-economic status, and comorbidities.

RESULTS

We observed increased risk for overall cancer among men and women who used sedative-hypnotics (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.01-1.13 for men; HR = 1.21, 95% CI = 1.09-1.25 for women) compared with non-users after full adjustment. In the fully adjusted model, women with any sedative-hypnotic use had significantly increased risk for thyroid (HR = 1.53, 95% CI = 1.24-1.87), breast (HR = 1.29, 95% CI = 1.04-1.61), ovarian (HR = 1.65, 95% CI = 1.10-2.46), and lung cancer (HR = 1.40, 95% CI = 1.17-1.69) compared with non-users. Men with sedative-hypnotic use had increased risk for prostate (HR = 1.36, 95% CI = 1.16-1.58), brain (HR = 1.67, 95% CI = 1.04-2.69), and lung cancer (HR = 1.20, 95% CI = 1.07-1.35) compared with non-users.

CONCLUSION

We found a significant increase in overall cancer incidence among participants who used sedative-hypnotics, and both male and female sedative-hypnotic users had significantly increased risk for certain types of cancer.

Use of Hypnotics and Risk of Cancer: A Meta-Analysis of Observational Studies

Background

Previous observational epidemiological studies have shown inconsistent results on the relationship between hypnotics use and risk of cancer. To determine the association between hypnotics use and risk of cancer, we conducted a meta-analysis of available literature.

METHODS

We searched databases PubMed, EMBASE, and the bibliographies of relevant articles to locate additional publications in February 2016. Three evaluators independently reviewed and selected eligible studies based on pre-determined selection criteria.

RESULTS

A total of six observational epidemiological studies including three case-control studies and three cohort studies, which involved 1,830,434 participants (202,629 hypnotics users and 1,627,805 non-users), were included in the final analyses. In a random-effects meta-analysis, compared with non-use of hypnotics, the odds ratio for overall hypnotics use was 1.29 for various cancers (95% confidence interval, 1.08-1.53). Subgroup meta-analyses by various factors such as study design, type of case-control study, study region, and methodological quality of study revealed consistent findings.

CONCLUSION

Our findings from a meta-analysis of low-biased epidemiological studies suggested evidence linking the use of hypnotics to an increased risk of cancers. The results should be cautiously interpreted because of considerable heterogeneity with a high I square value.

Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research

Various adverse events resulting from, or associated with, benzodiazepine and/or Z-drug use have been extensively reported on and discussed in great detail within the biomedical literature. It is widely accepted that motor vehicle accidents and falls leading to fractures in older adults are major adverse events that have been shown to occur more frequently in users of sedative-hypnotic medication, especially of the benzodiazepine and related Z-drug variety. However, the last few years have seen increasing reports in the literature raising the issue of benzodiazepine and Z-drug exposure in the development of other serious medical issues including dementia, infections, respiratory disease exacerbation, pancreatitis, and cancer. This article provides an overview and interpretation on the current state of evidence regarding each of these associations and proposes what gaps in the evidence for drug-exposure–harm associations need to be addressed in the future for the purpose of evaluating causality of harm as it relates to these drugs.

Benzodiazepine drug use and cancer risk: a dose-response meta analysis of prospective cohort studies

Conflicting results identifying the relationship between benzodiazepine drug use and cancer risk. Therefore, we conducted a dose-response meta-analysis of prospective cohort studies to clarify and quantitative assessed the relationship between benzodiazepine drug use and cancer risk. Up to July 2017, 22 original publications were included in current meta-analysis. Our results showed statistically significant association between benzodiazepine drug use and cancer risk (RR:1.25; 95% CI, 1.15–1.36). Subgroup analysis showed benzodiazepine using was associated with significantly a higher risk of breast cancer (RR:1.15; 95% CI, 1.05–1.26), ovarian cancer (RR:1.17; 95% CI, 1.09–1.25), colon cancer (RR:1.07; 95% CI, 1.02–1.13), renal cancer (RR:1.31; 95% CI, 1.15–1.49), malignant melanoma (RR:1.10; 95% CI, 1.03–1.17), brain cancer (RR:2.06; 95% CI, 1.76–2.43), esophagus cancer (RR:1.55; 95% CI, 1.30–1.85), prostate cancer (RR:1.26; 95% CI, 1.16–1.37), liver cancer (RR:1.22; 95% CI, 1.13–1.31), stomach cancer (RR:1.17; 95% CI, 1.03–1.32), pancreatic cancer (RR:1.39; 95% CI, 1.17–1.64) and lung cancer (RR:1.20; 95% CI, 1.12–1.28). Furthermore, a significant dose-response relationship was observed between benzodiazepine drug use and cancer risk (likelihood ratio test, P < 0.001). Our results showed per 500 mg/year, per 5 year of time since first using, per 3 prescriptions and per 3 year of duration incremental increase in benzodiazepine drug use was associated with a 17%, 4%, 16% and 5% in cancer risk increment. Considering these promising results, increasing benzodiazepine using might be harmful for health.

Association between use of short-acting benzodiazepines and migraine occurrence: a nationwide population-based case-control study

AIM

To evaluate the association between using benzodiazepines (BZDs) with short- or long-acting durations and migraine occurrence.

METHODS

The migraine group comprised 9616 subjects older than 20 years and newly diagnosed with migraine between 2005 and 2011, and the comparison group comprised 38,464 subjects without migraine. The BZDs used in the subjects were dichotomously defined as short-acting (half-life ≤24 h) and long-acting substances. A logistic regression model was used to calculate the odds ratio (OR) of migraine associated with BZD exposure and other diseases.

RESULTS

The adjusted OR of migraine associated with BZD exposure was 1.73 (95% confidence interval [CI] = 1.63-1.84). Either exposure to a short-acting BZD alone or using it combining with a long-acting BZD had significant higher risks of migraine (adjusted OR = 1.69, 95% CI = 1.59-1.80; adjusted OR = 2.06, 95% CI = 1.91-2.24, respectively), whereas only long-acting BZD use was not associated with an increase of migraine. Meanwhile, sleep disorders, anxiety, and stroke were strongly associated with migraine (adjusted OR = 2.00, 1.91, and 1.57, respectively).

CONCLUSIONS

We observed a significant increase of migraine occurrence in subjects using short-acting BZDs, either alone or in combination with long-acting ones.

Use of benzodiazepine and risk of cancer: A meta-analysis of observational studies

Several observational epidemiological studies have reported inconsistent results on the association between the use of benzodiazepine and the risk of cancer. We investigated the association by using a meta-analysis. We searched PubMed, EMBASE, and the bibliographies of relevant articles to locate additional publications in January 2016. Three evaluators independently reviewed and selected eligible studies based on predetermined selection criteria. Of 796 articles meeting our initial criteria, a total of 22 observational epidemiological studies with 18 case-control studies and 4 cohort studies were included in the final analysis. Benzodiazepine use was significantly associated with an increased risk of cancer (odds ratio [OR] or relative risk [RR] 1.19; 95% confidence interval 1.16-1.21) in a random-effects meta-analysis of all studies. Subgroup meta-analyses by various factors such as study design, type of case-control study, study region, and methodological quality of study showed consistent findings. Also, a significant dose-response relationship was observed between the use of benzodiazepine and the risk of cancer (p for trend <0.01). The current meta-analysis of observational epidemiological studies suggests that benzodiazepine use is associated with an increased risk of cancer.

Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management

Benzodiazepine (BZD) inappropriate use (i.e., misuse and overuse) is a worldwide public health problem. Despite current knowledge about increased sensitivity to side effects in the elderly, that should lead to more caution, only a third of BZD prescriptions in this age group are considered appropriate. The most frequent inadequate situations are excessive duration and/or dosage of a medical prescription or self-medication, especially in a context where it would be contraindicated, e.g., long-acting BZD in the elderly. Polypharmacy and comorbidities are major risk factors. Consequences of BZD inappropriate use are falls, delirium and other cognitive dysfunction, acute respiratory failure, car accidents, dependence, and withdrawal symptoms. An emerging concern is a potentially increased risk of dementia. Contrary to most clinicians' belief, discontinuation of chronic BZD use in elderly patients is feasible, with adequate psychotherapeutic or pharmacological strategies, and can lead to long-term abstinence. Brief cognitive therapy mostly relies on psychoeducation and motivational enhancement and is particularly useful in this context. Further research is needed, notably in three areas: (1) assessing the impact of public health programs to prevent BZD inappropriate use in the elderly, (2) developing alternative strategies to treat anxiety and insomnia in elderly patients, and (3) exploring the association between chronic BZD use and dementia.

Long-term use of benzodiazepines: Definitions, prevalence and usage patterns – a systematic review of register-based studies

Background

Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD.

Methods

Systematic review of register-based studies on long-term BZD use published in 1994–2014.

Results

Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as “long-term” varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13–36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31–64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.

Conclusions

Long-term BZD use is common and a clinical reality. Uniform definitions for “long-term”, which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.

Association Between Benzodiazepine Use and Epilepsy Occurrence: A Nationwide Population-Based Case-Control Study

We conducted a retrospective case-control study to evaluate the association between the risk of benzodiazepine (BZD) use and epilepsy occurrence by using data from the Taiwan National Health Insurance Research Database. We recruited 1065 participants who ages 20 years or older and newly diagnosed with epilepsy (International Classification of Diseases, Ninth Revision, Clinical Modification 345) between 2004 and 2011 and assigned them to the epilepsy group. We subsequently frequency-matched them with participants in a control group (n = 4260) according to sex, age, and index year at a 1:4 ratio. A logistic regression model was employed to calculate the odds ratio (OR) for association of epilepsy with BZD exposure. Multivariate logistic regression was conducted to estimate the dose-response relationship between BZD levels and epilepsy risk. The adjusted OR (aOR) for the association of epilepsy with BZD exposure was 2.02 (95% confidence interval [CI] = 1.68-2.42). The aOR for an average BZD dose increased to 1.26 for the participants on <0.01 defined daily dose (DDD), and increased to 4.32 for those on ≥1.50 DDD. On average, when the DDD of BZD exposure increased by 100 units, the epilepsy risk increase by 1.03-fold (95% CI = 1.01-1.04, P = 0.003). The annual BZD exposure day ranges were significantly associated with epilepsy (2-7 days: aOR = 1.67; 8-35 days: aOR = 3.16; and ≥35 days: aOR = 5.60). Whenever the annual BZD exposure increased by 30 days, the risk of epilepsy notably increased by 1.03-fold (95% CI = 1.01-1.04, P < 0.001). In addition, users who quit BZD for more than 6 months still exhibited a higher risk of epilepsy than did the non-BZD users. A considerable increase in epilepsy occurrence was observed in ones with BZD use, particularly in those with prolonged use, multiple exposure, and high-dose consumption.