Divergent Risks of Endocrine and Nonendocrine Malignancies in GLP-1 Receptor Agonist Users: A Propensity-Matched Real-World Analysis of Over 140 000 Patients
Authors' conclusion
This real-world analysis demonstrates divergent oncologic risks associated with GLP-1 RA use, while the therapy offers potential protective effects against nonendocrine malignancies (particularly digestive and respiratory). The initially elevated thyroid cancer risk was no longer significant at 3 years, suggesting surveillance bias. These findings support the overall oncologic safety of GLP-1 RA in T2DM management, while warranting further long-term studies to confirm these associations.
Study context
- Population
- Adults with T2D, 2015–2023, TriNetX databasepropensity matched
- Exposure
- GLP-1 RA users vs nonusers
- GLP-1 RAn = 144,410
- Outcome
- All-cause mortality and incident malignant neoplasms
Methodological details1:1 propensity score matched, TriNetX database
- 1:1 propensity score matched
- TriNetX database
Main finding
As reported in the abstract
Hazard ratio
0.693
all-cause mortality
Hazard ratio
0.905
overall cancer incidence
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR |
|---|---|
| Thyroid gland cancerIncreased risk with GLP-1 RA | 1.411 |
Nonendocrine malignancies: digestive and respiratory cancers
- Digestive cancers, significant risk reduction (HR)
- 0.710
- Respiratory cancers, significant risk reduction (HR)
- 0.691
- Significant risk reductions also for other sites incl. oral, female genital and CNS cancers
Thyroid gland cancer
- Landmark analyses at 3 years: thyroid cancer signal attenuated to nonsignificance
Active-comparator analyses vs DPP-4i and SGLT2i
- Broadly consistent findings
Original publication
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