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Digoxin use is associated with pancreatic cancer risk but does not affect survival

Cancer Causes & Control volume 32, pages 41–46 (2021)Cite this article

Abstract

Purpose

Digoxin affects several cellular pathways involved in tumorigenesis. We sought to determine the association between digoxin use and pancreatic cancer risk and survival.

Methods

A nested case–control study using The Health Improvement Network (THIN), a population-representative database from the United Kingdom (UK). Cases included all individuals with incident diagnosis of pancreatic cancer. Each case was matched to up to four controls using incidence density sampling based on age, sex, practice site, calendar time, and duration of follow-up. Exposure of interest was digoxin therapy before cancer diagnosis. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between digoxin use and pancreatic cancer risk were estimated using conditional logistic regression. We further conducted a retrospective cohort study among pancreatic cancer cases using Cox regression model in order to evaluate the association between digoxin use and overall survival.

Results

We identified 4,113 cases with incident pancreatic cancer and 16,072 matched controls. The adjusted OR for diagnosis of pancreatic cancer among active digoxin users was 1.41 (95% CI 1.16–1.72). The risk did not change among active users with duration of therapy of more than 1 year (adjusted OR of 1.39, 95% CI 1.11–1.76). Digoxin was not associated with change in overall survival with an adjusted hazard ratio of 0.97 (95% CI 0.81–1.18).

Conclusions

Digoxin use was associated with modestly increased pancreatic cancer risk but did not affect overall survival.

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Data availability

The research involves using the THIN database. The University’s licensing agreement with THIN prohibits the PI to distribute this data in whole or in part to any member not explicitly listed in the proposal. Additional information on accessing THIN can be obtained at https://www.epic-uk.org/our-data/our-data.shtml.

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Funding

This study was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000003.

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Author notes

    Affiliations

    1. Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

      Ben Boursi & Yu-Xiao Yang

    2. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

      Ben Boursi, Jared S. Huber, Kevin Haynes, Ronac Mamtani & Yu-Xiao Yang

    3. Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

      Ben Boursi, Ronac Mamtani & Yu-Xiao Yang

    4. Division of Hematology/Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

      Ronac Mamtani

    5. Tel-Aviv University, Tel-Aviv, Israel

      Ben Boursi

    6. Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel

      Ben Boursi

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    1. Ben Boursi
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    Correspondence to Ben Boursi.

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    Ben Boursi and Jared S. Huber contributed equally to this manuscript.

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    Boursi, B., Huber, J.S., Haynes, K. et al. Digoxin use is associated with pancreatic cancer risk but does not affect survival. Cancer Causes Control 32, 41–46 (2021). https://doi.org/10.1007/s10552-020-01352-7

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    • DOI: https://doi.org/10.1007/s10552-020-01352-7

    Keywords

    • Pancreatic cancer
    • Digoxin
    • Cancer survival