Spironolactone is unlikely to be associated with an increased risk of cancer

Spironolactone, a synthetic steroid, is routinely used to manage heart failure, hypertension, and edema. Off-label, the drug is also used to treat acne, hidradenitis, alopecia, and hirsutism. Despite the research available on its applications, the drug’s potential for tumorigenicity is poorly understood. Researchers at the Brigham sought to determine the rate of occurrence of several types of cancer among spironolactone ever-users, patients exposed at least once to the drug. The team conducted a systematic review and meta-analysis of seven studies reporting the occurrence of malignancies in men and women of at least 18 years of age. The authors found no significant association between spironolactone use and the individual risk of  breast, ovarian, kidney, gastric, and esophageal cancers. Treatment with the drug was associated with a decreased risk of prostate cancer. The authors note, however, that additional research in diverse populations such as younger individuals as well as patients with acne or hirsutism is needed to further examine whether these findings generalize to other populations.

“Though the U.S. Food and Drug Administration cautioned that ‘unnecessary use of this drug should be avoided,’ our data are reassuring that spironolactone is unlikely to be associated with a meaningful risk of cancer when prescribed at clinical doses,” said senior author John Barbieri, MD, MBA of the Department of Dermatology. “Now that the meta-analysis has provided us with promising data, our next steps will be to conduct future studies in more diverse populations. Understanding the relationship between spironolactone and its potential for tumorigenicity will ultimately allow us to provide our patients with answers about the risk of cancer and improve the care we can deliver.”

Read more in JAMA Dermatology.