In the news: metformin

La metformine, l’un des médicaments les plus couramment prescrits dans le monde, est principalement utilisée pour traiter le diabète de type 2. De nouvelles recherches sur ses effets potentiels dans d’autresologies ont fasuit jecule path de cette acté d’acte the week. While many of the methods appear promising, some results, including those of a recently published historical trial, are very disappointing (see graph).

Disappointing results in breast cancer

Results of the MA.32 clinical trial published in gamma[1] “I point out that metformin is not effective against the most common types of breast cancer and that any off-label use of this drug in this setting should be suspended,” Investigator Dr. Pamela Goodwin said in a press release. – Tannenbaum Research Institute, Toronto, Canada). The study included 3649 patients with HRT-positive or HRT-negative breast cancer who did not have diabetes. Patients were randomized to receive either placebo or metformin (850 mg twice daily) for 5 years. Among the 2533 patients with hormone receptor-positive carcinomas, the unsatisfactory survival rate was 2.78 per 100 patient-years with metformin versus 2.74 with placebo (risk ratio [HR], 1.01; p = 0.93). Among the 1116 patients with hormone receptor-negative disease, the unsatisfactory survival rate was 3.58 with metformin versus 3.60 with placebo (HR, 1.01; p = 0.92).

The only potential bright spot: Among the small subset of patients who developed HER2-positive disease (17% of the total), 1.93 disease-free survival events were associated with metformin versus 3.05 events with placebo (HR, 0.64; p = 0.03). ), and 0.78 deaths per 100 patient-years reported in the metformin group versus 1.43 in the placebo group (HR, 0.54; P=0.04). The benefit was limited to patients with the C allele of the single nucleotide variant rs11212617. The results should be confirmed by a randomized trial, but metformin could potentially be an “additional treatment option for HER2-positive breast cancer,” Dr. Goodwin said.

Diabetic cancer patients

The results of recent studies in older cancer patients with type 2 diabetes are more encouraging. An analysis of 7,725 patients with lung, breast, prostate, pancreatic, or colorectal cancer reported that 38.5% of them (2,981 patients) had been prescribed metformin. [2] Patients taking metformin had significantly better overall survival in the unadjusted (HR, 0.73; 95% CI, 0.69-0.76; p < 0.001) and adjusted (heart rate, 0.77; 95% CI) models. IC, 0.73-0.81; p < 0.001)). The hazard ratios for subjects who received metformin were 0.78 (95% CI, 0.69–0.88; p<0.001) for colorectal cancer, 0.77 (95% CI, 0.72–0.82; p<0.001) for lung cancer, 0.82 (95% CI, 0.72). -0.93; p<0.001) for pancreatic cancer and 0.74 (95% CI, 0.62-0.88; p=0.002) for prostate cancer.

Reduce weight gain caused by antipsychotics

Metformin has also shown promising results in alleviating weight gain caused by antipsychotics. New evidence-based recommendations from Ireland suggest that psychiatrists rapidly prescribe metformin for patients with starting weights greater than 7% within the first month of antipsychotic treatment. [3] They also recommend a prescription for metformin when gaining weight. Suggested starting dose is 500 mg twice daily with meals, increasing by 500 mg every 1-2 weeks until target dose of 2000 mg/day is reached. In the case of early intervention, the recommendations suggest first stabilizing the weight gained or, if possible, reversing the excess weight. When overweight is determined, the goal is to lose at least 5% of the weight in the following six months.

Neurological effects?

Other studies suggest that metformin may have neuroprotective effects. According to a preprint study, the use of antidiabetics can reduce the risk of Alzheimer’s disease in the general population.[4] Use of metformin, which equated to a 6.75 mmol/mol (1.09%) decrease in HbA1c, was associated with a 4% reduced risk of Alzheimer’s disease in people without diabetes (p = 1.06 x 10-4).

Another systematic review and meta-analysis of longitudinal data showed that metformin may be associated with a greater reduction in the risk of developing neurodegenerative disease. [5] The pooled data showed that the relative risk of developing neurodegenerative disease was 0.77 (95% CI, 0.67-0.88) in diabetic patients taking metformin. The effect was greater with prolonged use, with a relative risk of 0.29 (95% CI, 0.13-0.44) for those who had taken metformin for 4 years or longer.

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