Key result
Digoxin linked to ~99% greater cancer risk versus beta-blockers in HF and AF.
Why the study?
Previous studies neglected death as a critical competing risk when evaluating cancer risk among digoxin users.
Does digoxin increase cancer incidence in patients with HF, AF, or AFL compared to beta-blockers?
Cohort (n=1,516)
Does digoxin increase cancer incidence in patients with HF, AF, or AFL compared to beta-blockers?
Effect estimate: SHR 1.99 (95% CI 1.22-3.01)
Absolute Event Rate: 5.7% vs 4%
p-value: p=0.006
In patients with HF, AF, or AFL, digoxin use was associated with a higher risk of cancer incidence and all-cause mortality compared to beta-blockers when accounting for the competing risk of death.
Associated with higher cancer incidence versus β-blockers in HF/AF; hypothesis-generating and should not yet change practice.
Background: Previous studies neglected death as a critical competing risk while estimating the cancer risk for digoxin users. Therefore, the current study aims to assess the effectiveness of digoxin on cancer prevention by competing risk analysis. Methods: We performed a population-based retrospective cohort study using the Taiwan National Health Insurance Research database between 1998 and 2010. After one-to-one propensity score-matching from 36,160 patients with defined criteria, we enrolled 758 patients both in digoxin and β-blocker group for further analysis. Results: The results showed that the digoxin group had higher all-cause mortality than the β-blocker group in the 4- year (10.4 vs. 4.9%) and 8 years (13.6 vs. 7.0%) follow-up. The subdistribution HR of cancer incidence in the digoxin group compared to the β-blocker group was 1.99 (95% confidence interval [CI]: 1.22–3.01) and 1.46 (95% CI: 1.01–2.15) in the 4 years and 8 years follow-up, respectively. Conclusions: The result of our study showed the usage of digoxin has no benefit in cancer prevention compared with β-blocker. The possibility of β-blocker as a new drug candidate for cancer prevention needs further clinical evaluation. The current study also emphasized the necessity of competing risk analysis applying to similar clinical researches.
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Tai et al. (2021) conducted a cohort in Heart failure, atrial fibrillation, or atrial flutter (n=1,516). Digoxin vs. β-blocker was evaluated on Cancer incidence at 4 years (SHR 1.99, 95% CI 1.22-3.01, p=0.006). Digoxin use significantly increased the risk of cancer incidence compared to β-blockers in patients with heart failure, atrial fibrillation, or atrial flutter, with a subdistribution HR of 1.99.
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