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Evaluation Video

Oral Presentation

Session: Harms of Incretin-based Therapies for Diabetes Treatment

Glucagon-like Peptide 1 Receptor Agonist Use and Risk of Thyroid Cancer: Scandinavian Cohort Study

Tuesday, August 27, 2024
9:00 AM – 9:15 AM CEST
Location: Room III
Background: Glucagon-like peptide 1 (GLP1) receptor agonists are increasingly used for type 2 diabetes and obesity but there are concerns that these drugs may increase the risk of thyroid cancer.

Objectives: We aimed to investigate if use of GLP1 receptor agonists is associated with increased risk of thyroid cancer.

Methods: We conducted a cohort study applying the active-comparator new-user study design and using nationwide register data from three Scandinavian countries, 2007-2021. Patients who initiated GLP1 receptor agonists were compared with patients who initiated dipeptidyl peptidase 4 (DPP4) inhibitors and, in an additional analysis, with patients who initiated sodium-glucose co-transporter 2 (SGLT2) inhibitors. The main outcome was thyroid cancer, captured from nationwide cancer registers. Cox regression was used to estimate hazard ratios, controlling for potential confounders using propensity score weighting.

Results: The mean follow-up time was 3.9 (standard deviation 3.5) years in the GLP1 receptor agonist group and 5.4 (standard deviation 3.5) years in the DPP4 inhibitor group. In total, 76 of 145,410 (incidence rate 1.33 events per 10,000 person-years) patients who used GLP1 receptor agonists and 184 of 291,667 (incidence rate 1.46 events per 10,000 person-years) patients who used DPP4 inhibitors developed thyroid cancer. GLP1 receptor agonist use was not associated with increased risk of thyroid cancer (hazard ratio 0.93, 95% CI 0.66-1.31; rate difference -0.13, 95% CI -0.61 to 0.36 events per 10,000 person-years). The hazard ratio for medullary thyroid cancer was 1.19 (95% CI 0.37-3.86). In the additional analysis comparing users of GLP1 receptor agonists with users of SGLT2 inhibitors, the hazard ratio for thyroid cancer was 1.16 (95% CI 0.65-2.05).

Conclusions: In this large cohort study utilizing nationwide data from three countries, GLP1 receptor agonist use was not associated with an increased risk of thyroid cancer over a mean follow-up time of 3.9 years. In the primary analysis comparing GLP1 receptor agonists vs. DPP4 inhibitors, the upper limit of the confidence interval was consistent with no more than a 31% relative risk increase.