{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:58:02Z","timestamp":1791406682301,"version":"4.3.3"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2013,8,18]],"date-time":"2013-08-18T00:00:00Z","timestamp":1376784000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet. Med."],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Pioglitazone, a thiazolidinedione, was approved for treatment of Type\u00a02 diabetes. However, several observational studies suggest an association of pioglitazone with an increased risk of bladder cancer in patients with diabetes. Therefore, we sought to perform a systematic review and meta\u2010analysis to evaluate the magnitude of this association and the quality of the supporting evidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Electronic databases were queried to identify controlled studies of pioglitazone that measured the risk of bladder cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six studies involving 215\u00a0142 patients using pioglitazone were included, with a median period of follow\u2010up of 44\u00a0months. The hazard of developing bladder cancer was significantly higher in patients using pioglitazone (hazard ratio\u00a01.23; 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.09\u20131.39; <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00%) compared with control groups. The risk of bias was moderate across the six studies. Considering an incidence rate of 20.8 per 100\u00a0000 person years, the number needed to harm was five additional cases of bladder cancer per 100\u00a0000 person years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients treated with pioglitazone have a slight increased risk of bladder cancer compared to general population. Patient involvement and weighing treatment benefits versus risks should be discussed with patient toward shared decision. Patients with type 2 diabetes with risk factors, such as family history, smoking, or exposure to certain forms of chemotherapy may need to consider other anti\u2010hyperglycemic agents. Also, pioglitazone should be discontinued in type 2 diabetes patients with newly diagnosed bladder cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/dme.12144","type":"journal-article","created":{"date-parts":[[2013,1,28]],"date-time":"2013-01-28T09:00:01Z","timestamp":1359363601000},"page":"1026-1032","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":135,"title":["Pioglitazone and risk of bladder cancer: a meta\u2010analysis of controlled studies"],"prefix":"10.1111","volume":"30","author":[{"given":"M.","family":"Ferwana","sequence":"first","affiliation":[{"name":"National and Gulf Center for Evidence Based Health Practice King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia"},{"name":"Family Medicine and Primary Care Department King Abdulaziz Medical City Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Firwana","sequence":"additional","affiliation":[{"name":"National and Gulf Center for Evidence Based Health Practice King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia"},{"name":"Department of Internal Medicine University of Missouri Columbia MO"},{"name":"Knowledge and Evaluation Research Unit Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Hasan","sequence":"additional","affiliation":[{"name":"National and Gulf Center for Evidence Based Health Practice King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia"},{"name":"Department of Internal Medicine University of Missouri Columbia MO"},{"name":"Knowledge and Evaluation Research Unit Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. H.","family":"Al\u2010Mallah","sequence":"additional","affiliation":[{"name":"National and Gulf Center for Evidence Based Health Practice King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia"},{"name":"King Abdul\u2010Aziz Cardiac Center Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Kim","sequence":"additional","affiliation":[{"name":"Knowledge and Evaluation Research Unit Mayo Clinic Rochester MN USA"},{"name":"Department of Urology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. M.","family":"Montori","sequence":"additional","affiliation":[{"name":"Knowledge and Evaluation Research Unit Mayo Clinic Rochester MN USA"},{"name":"Division of Diabetes and Endocrinology Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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