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Aims/hypothesis Observational studies suggest that metformin may reduce cancer risk by approximately onethird. We examined cancer outcomes and all-cause mortality in published randomised controlled trials (RCTs). Methods RCTs comparing metformin with active glucoselowering therapy or placebo/usual care, with minimum 500 participants and 1-year follow-up, were identified by systematic review. Data on cancer incidence and all-cause mortality were obtained from publications or by contacting investigators. For two trials, cancer incidence data were not The authors are writing as the Metformin Trialists' Collaboration Electronic supplementary material The online version of this article (doi:10.1007/s00125-012-2653-7) contains peer-reviewed but unedited supplementary material, which is available to authorised users. R. J. Stevens (*) :C. R. Bankhead :A. J. Farmer : S. Harrison : J. A. Hirst : J. H. McLellan :R. Perera :A. Plüddemann : N. W. Roberts : P. W. Rose Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK e-mail: richard.stevens@phc.ox.ac.uk R. Ali : B. J. Cairns : F. L. Crowe Cancer Epidemiology Unit, University of Oxford, Oxford, UK M. A. Bethel : R. R. Holman Diabetes Trials Unit, Oxford Centre for Diabetes Endocrinology and Metabolism, University of Oxford, Oxford, UK R. P. Camisasca TGRD Europe, Takeda Pharmaceutical Company, London, UK P. Home ICM–Diabetes, The Medical School, Newcastle University, Newcastle upon Tyne, UK S. E. Kahn Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, WA, USA A. Ramachandran India Diabetes Research Foundation, Dr A. Ramachandran’s Diabetes Hospitals, Egmore, Chennai, India A. Schweizer Novartis Pharma, Basel, Switzerland G. Viberti Unit for Metabolic Medicine, School of Medicine, King’s College London, London, UK Diabetologia (2012) 55:2593–2603 DOI 10.1007/s00125-012-2653-7 available; cancer mortality was used as a surrogate. Summary RRs, 95% CIs and Istatistics for heterogeneity were calculated by fixed effects meta-analysis. Results Of 4,039 abstracts identified, 94 publications described 14 eligible studies. RRs for cancer were available from 11 RCTs with 398 cancers during 51,681 person-years. RRs for all-cause mortality were available from 13 RCTs with 552 deaths during 66,447 person-years. Summary RRs for cancer outcomes in people randomised to metformin compared with any comparator were 1.02 (95% CI 0.82, 1.26) across all trials, 0.98 (95% CI 0.77, 1.23) in a subgroup analysis of active-comparator trials and 1.36 (95% CI 0.74, 2.49) in a subgroup analysis of placebo/usual care comparator trials. The summary RR for all-cause mortality was 0.94 (95% CI 0.79, 1.12) across all trials. Conclusions/interpretation Meta-analysis of currently available RCT data does not support the hypothesis that metformin lowers cancer risk by one-third. Eligible trials also showed no significant effect of metformin on all-cause mortality. However, limitations include heterogeneous comparator types, absent cancer data from two trials, and short follow-up, especially for mortality.

diabetologia

Erratum to: Cancer outcomes and all-cause mortality in adults allocated to metformin: systematic review and collaborative meta-analysis of randomised clinical trials