medwireNews: Initiating treatment with a glucagon-like peptide (GLP)-1 receptor agonist does not raise the risk for thyroid cancer 'substantially' compared with beginning dipeptidyl peptidase (DPP)-4 inhibitor treatment, suggest the researchers of a Scandinavian cohort study.
“Although small risk increases cannot be excluded, in the main analysis comparing GLP1 receptor agonists with DPP4 inhibitors, the upper limit of the confidence interval was consistent with no more than a 31% increase in relative risk,” say Björn Pasternak (Karolinska Institutet, Stockholm, Sweden) and colleagues.
The Scandinavian study was performed using data from Denmark, Norway, and Sweden healthcare and administrative registers and included a total of 437,077 participants after propensity score estimation.
The cohorts comprised 145,410 new GLP-1 receptor agonist users with a mean age of 57.5 years and 291,667 new DPP-4 inhibitor users with a mean age of 58.0 years. The majority (53.2–54.0%) of participants in both groups were men.
The GLP-1 receptor agonist and DPP-4 inhibitor users were followed-up for an average of 3.9 and 5.4 years, respectively. During this time, the thyroid cancer incidence rates were a corresponding 1.33 and 1.46 per 10,000 person–years, with 76 incident thyroid cases in the GLP-1 receptor agonist group and 184 cases in the DPP-4 inhibitor group. This gave a nonsignificant hazard ratio for thyroid cancer with GLP-1 receptor agonist treatment versus DPP-4 inhibitor treatment of 0.93.
“In absolute terms, this translates to no more than 0.36 excess events per 10,000 person years, which should be interpreted against the background incidence of 1.46 per 10,000 person years in the comparator group in the study population,” note Pasternak et al.
The team emphasizes that despite GLP-1 receptor agonists being contraindicated for use in patients with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2, there was not a significantly increased risk for medullary thyroid cancer with GLP-1 receptor treatment versus DPP-4 inhibitor treatment, with a risk difference of 19%.
The authors conclude in The BMJ: “[T]his study adds to the available evidence about GLP1 receptor agonist use and risk of thyroid cancer, and supports the conclusion of a recent European Medicines Agency investigation that the available evidence does not support a causal association between GLP1 receptor agonist use and thyroid cancer.”
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