Sartans, or Angiotensin-receptor blockers, are a class of blood-pressure-lowering drug that is also used for the treatment of heart failure and diabetic nephropathy.
A significant excess of fatal tumors was observed in the CHARM trial with Candesartan ( Atacand ), published in 2003, but that the Researchers concluded this finding was likely due to chance.
Investigators at Case Western Reserve University School of Medicine, Cleveland, have decided to perform a meta-analysis of clinical trials.
New cancer data were available for 61,950 patients from five trials, including only three of the seven FDA-approved sartans; most patients in this meta-analysis ( 85.7% ) received Telmisartan ( Micardis ) as study drug; the other patients received Losartan or Candesartan. The five trials with new cancer data were ONTARGET, PROFESS, LIFE, TRANSCEND, and CHARM-Overall. In addition, data were available for cancer deaths in LIFE, TRANSCEND, VALIANT, and Val-HeFT.
It is unknown whether other sartans, as Irbesartan ( Avapro ), Valsartan ( Diovan ), Olmesartan ( Benicar ), and Eprosartan ( Teveten ), are linked to a higher risk of new cancer incidence.
Given the limited data, it is not possible to draw conclusions about the exact risk of cancer associated with each Angiotensin-receptor blocker.
In the meta-analysis, patients randomly assigned to receive sartans had a significantly increased risk of new cancer occurrence, compared with those in the control groups ( 7.2% vs 6%; risk ratio [RR] 1.08; p=0.016 ).
When analysis was limited to trials where cancer was a prespecified end point, the RR was 1.11 ( p=0.001 ).
Among the malignancies examined ( lung, breast, and prostate ) only new lung-cancer occurrence was significantly higher in those randomly assigned to sartans than in control subjects ( 0.9% vs 0.7%; RR 1.25; p=0.01 ).
It has been seen a weak trend for an increased risk of prostate cancer with Angiotensin-receptor antagonists use.
There was no significant difference in cancer deaths observed in the meta-analysis between those who took Angiotensin-receptor blockers and control subjects ( 1.8% vs 1.6%; RR 1.07; p=0.183 ). But the Researchers noted that tumor death is typically a slow process and, with the present trials, it is not possible to make conclusions regarding the effect of sartans on cancer-related deaths.
Source: Lancet Oncology, 2010
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