Lower Incidence of Leukemia in Sodium Glucose Cotransporter-2 Inhibitor-Treated Patients with Type 2 Diabetes Mellitus: Result from Large Real-World Cohorts
Authors: Lee Gin Yi , Huang Clare , Ma Kevin Sheng-Kai 
Published: December 2023

Objective: Leukemia is the among the top ten most common cancer in the United States of America, with incidence of 14.0 per 100,000 people. While the incidence of non-Hodgkin lymphoma has significantly decreased, the incidence of leukemia has been stable during 2014-2018 [1]. In the meantime, sodium-glucose cotransporter-2 inhibitors (SGLT-2i), a comparatively new class of anti-diabetic medication, has gained significant popularity among clinician due to its cardioprotective and renoprotective properties. Several observational studies and meta-analyses explored the relationship between SGLT-2i and solid tumor, including bladder cancer and breast cancer [2, 3]. Nevertheless, contemporary data for SGLT-2i and leukemia are limited. This large cohort study was aimed to investigate the association between SGLT-2i and the risk of leukemia.
Methods: This was a retrospective cohort study including patients with T2DM from 92 hospitals across the United States between 2015 and 2023. Inclusion criteria were patients with T2DM aged 18 years or older who newly initiated treatment with SGLT-2i or DPP-4i. Patients with a history of type 1 diabetes or malignancies were excluded. Propensity score matching was applied to each group to account for confounding factors, including demographic characteristics, comorbidities, laboratory data, and medication history. The primary outcome of interest was the occurrence of incident leukemia, including lymphoid leukemia, myeloid leukemia and monocytic leukemia. Kaplan-Meier analysis and log-rank tests were used to compare the outcomes across the cohorts, while hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were calculated using the Cox proportional hazard regression model.
Results: A total of 718,276 SGLT-2i initiators were matched to 1,159,112 DPP4i initiators diagnosed with T2DM. Among these, 3,429 incidents of leukemia were identified, with 1,148 occurring in the SGLT2i groups and 2,281 in the DPP-4i group after matching.The baseline characteristics, including ethnicity, comorbidities and medication history, were well-balanced between the two cohorts. SGLT-2i initiators demonstrated a significantly reduced risk of new-onset leukemia compared to those using DPP-4i, including myeloid leukemia (HR, 0.676; 95% CI, 0.589 to 0.776, p &lt; 0.001) and lymphoid leukemia (HR, 0.846; 95% CI, 0.753-0.950, p = 0.005). There was no significant difference in the occurrence of monocytic leukemia (aHR 0.836; 95% CI, 0.556 to 1.257, p = 0.388).
Conclusion: This population-based propensity-score matched cohort study showed that SGLT-2i is associated with lower in the risk of developing leukemia when compared to those treated with DPP-4i. These findings highlight the potential therapeutic value of SGLT-2i in the prevention of hematological malignancies in patients with T2DM. Further clinical trials are necessary to explore and validate the potential applications.
Reference
1. Cronin, K.A., et al., Annual report to the nation on the status of cancer, part 1: National cancer statistics. Cancer, 2022. 128(24): p. 4251-4284.
2. Garcia, M., et al., SGLT2 Inhibitors and Bladder Cancer: Analysis of Cases Reported in the European Pharmacovigilance Database. J Clin Pharmacol, 2021. 61(2): p. 187-192.
3. Tang, H., et al., SGLT2 inhibitors and risk of cancer in type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Diabetologia, 2017. 60(10): p. 1862-1872.