October 20th, 2011
EMA’s CHMP Finds No Cancer Link for ARBs
Larry Husten, PHD
Following the lead of the FDA earlier this year, the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) has completed a safety review of angiotensin II receptor antagonists (ARBs) and found no evidence of any increased risk of cancer associated with the drugs. The FDA and EMA safety reviews were initially prompted by a meta-analysis in Lancet Oncology by Sipahi and colleagues.
CHMP concluded that “the evidence from the meta-analysis was weak, noting several problems with the quality of the data, specifically that patients in the trials were not followed up for long enough to clearly establish a link between ARBs and cancer, information on the risk of cancer before start of treatment was lacking, and there was a possibility of publication bias, whereby studies that showed a link with cancer were more likely to have been included in the analysis.”
Good news, I suppose.
But I have seen no comment on the possible relevance of the very high levels of angiotensin II in patients taking ARBs to the possibility of a link to cancers. Angio II is, after all, a growth factor, at least for arterial plaque and the ventricular wall. It is not specific for one receptor site. How about for one rogue cell?
It is that supposition and the focused rise in lung cancers that has led me to use aliskiren over ARBs in smokers and ex-smokers who can no longer take ACE-inhibitors because of cough.
Supposition? Yes. But a connection has not been ruled out. The statement from CHMP states that “patients in the trials were not followed up for long enough to clearly establish a link.” That is not the same as to say a link has been disproved.
A link has been suggested, it is credible, but current evidence does not support it. Since we have an alternative that does not raise angio II, why not use that until we have a definitive answer?
Competing interests pertaining specifically to this post, comment, or both:
I have no connection to either Novartis or any manufacturer of ARBs.