Considering what I am about to write, I feel a little guilty about the post headline here. But these sensational headlines are just the point: the media is abuzz the last few days with the possibility that Lantus insulin "may be linked" to cancer.
The rumors started late last week, when the media got wind that a prominent diabetes researcher forecasted that an "earthquake" event was about to hit that would compromise the safety profile of Lantus. This leak came nearly two weeks before the data was actually published in the European journal Diabetologia.
For both academia and the pharma industry, a leak like this is just so irresponsible! Why? Because it kicks off just the kind of anti-Avandia media frenzy that frightens patients off their meds, without real substantiation of the potential danger. In this case, the research data wasn't even out yet, and already headlines like mine, above, using the "C-word" (cause) were appearing far and wide.
Now that the data is actually out, there are a few
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1) No cause was shown! "There was no evidence that Lantus actually causes cancer, but it might possibly cause any existing cancer cells to grow and divide more rapidly," according to Ulf Smith, president of the European Association for the Study of Diabetes (EASD).
2) Backing up for a moment, the study conducted here was not your usual kind, where one group takes the drug and another gets a placebo (unethical in a case like this, of course). Rather, researchers took recorded data (housed in databases) from 127,031 patients in the UK, Germany, Sweden and Scotland and "crunched the numbers" to look for associations with instances of cancer.
Given that it's just a bunch of numbers correlating insulin use with a handful of different types of cancer, the data is pretty inconclusive. Even the American Diabetes Association has come out with a statement that "the data within these studies and between these studies are conflicting and confusing."
3) The official recommendation to patients using Lantus now by the ADA and other expert groups is not to stop using insulin, and also to "consult your doctor" if you have concerns. I have to agree with the much-quoted diabetes analyst David Kliff that this approach is a bit lame.
That is, while I agree that it's important for PWDs not to toss aside their insulin, I'd also like to know how the many physicians across this country are supposed to be prepared to consult with their diabetes patients when they've had no time to analyze the data? And how, after reading these confusing studies, can they effectively tell their patients anything other than "there might be a link between Lantus and cancer?"
4) As eloquently pointed out by Jenny over at Diabetes Update, the population studied was most likely a very high-risk group for cancer due to a number of other factors, leading with running consistently high blood sugars for many years — most likely long before being prescribed Lantus. Many had probably also been taking "cocktails of powerful oral drugs for years before starting Lantus." Therefore, to pin the cancer correlation solely on Lantus insulin is probably misleading at best.
Nevertheless, Jenny concludes that "this latest alarm... is probably GOOD news, because it will trigger some serious research into the cancer profile of all the analog insulins and perhaps, even, of the oral diabetic drugs."
Personally, my prediction is a bit different: I'm betting that after a lot of bantering about by various researchers and industry experts, we'll end up with data illustrating a TINY risk in people who already had or are already very high-risk for cancer. Meanwhile, the damage has been done in the sense that people who really need it are afraid to take their insulin.
I say this even with the knowledge of new, more conclusive evidence that the oral drug Januvia may indeed spur pancreatic cancer.
When it comes to insulin, as long as the risk of side effects is tiny, which I'm assuming it will be, we patients will have to weigh the pros and cons: the consequences of not taking insulin when you need it are more immediately damaging, are they not?
Whether the cancer risk with Lantus proves significant or not, the scare is surely hurting drugmaker Sanofi-Aventis, which is not good for us either, in terms of rising price-points and possible curtailing of drug development.
*Sigh* In the end, it's always the patients who suffer most.