Digoxin use after diagnosis of colorectal cancer and survival: A population-based cohort study
A partir des données des registres anglais des cancers portant sur 10 357 patients atteints d'un cancer colorectal, cette étude analyse les effets d'une utilisation de digoxine après le diagnostic sur la mortalité spécifique
Background: : Digoxin has been shown to be impact on a number of pathways that are of relevance to cancer and its use has been associated with increased risks of breast and uterus cancer and, more recently, a 40% increase in colorectal cancer risk. These findings raise questions about the safety of digoxin use in colorectal cancer patients and therefore we investigated whether digoxin use after colorectal cancer diagnosis increased the risk of colorectal cancer-specific mortality. Methods: A cohort of 10,357 colorectal cancer patients newly diagnosed from 1998 to 2009 was identified from English cancer registries and linked to the UK Clinical Practice Research Datalink (to provide digoxin and other prescription records) and to the Office of National Statistics mortality data (to identify 2,724 colorectal cancer-specific deaths). Using time-dependent Cox regression models, unadjusted and adjusted hazard ratios (HR) and 95% confidence intervals (CIs) were calculated for the association between post-diagnostic exposure to digoxin and colorectal cancer-specific mortality. Results: Overall, 682 (6%) colorectal cancer patients used digoxin after diagnosis. Digoxin use was associated with a small increase in colorectal cancer-specific mortality before adjustment (HR=1.25; 95% CI 1.07-1.46), but after adjustment for confounders the association was attenuated (adjusted HR=1.10; 95% CI 0.91-1.34) and there was no evidence of a dose response. Conclusions: In this large population-based colorectal cancer cohort, there was little evidence of an increase in colorectal cancer-specific mortality with digoxin use after diagnosis. Impact: These results provide some reassurance that digoxin use is safe in colorectal cancer patients.