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Oral Presentation

Session: Harms of Incretin-based Therapies for Diabetes Treatment

Glucagon-Like Peptide 1 Receptor Agonists and Risk of Thyroid Cancer: An International Multisite Cohort Study in Canada, Denmark, Norway, Sweden, South Korea and Taiwan

Tuesday, August 27, 2024
8:15 AM – 8:30 AM CEST
Location: Room III

    Presenting Author(s)

  • Sarah M. Baxter, MPharm, PhD (she/her/hers)

    Postdoctoral Research Fellow
    Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
    Belfast, United Kingdom

    Slides

    • Co-Author(s)

  • Lars Christian Lund, PhD (he/him/his)

    Postdoctoral researcher
    Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
    Odense C, Denmark

  • JH

    Jacob Harbo Andersen

    Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark, Denmark

  • Thomas Heiberg Brix

    Department of Endocrinology, Odense University Hospital, Odense, Denmark, Denmark

  • Laszlo Hegedüs

    Department of Endocrinology, Odense University Hospital, Odense, Denmark, Denmark

  • Miyuki Hsing-Chun Hsieh, PhD

    Immediate Past Chair of the ISPE Student Council
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
    Chiayi City, Taiwan (Republic of China)

  • CT

    Chris Tzu-Ting Su

    School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

  • Michael Chun-Yuan Cheng, MA (he/him/his)

    Research Associate
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

  • ZC

    Zoe Chi-Jui Chang

    School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

  • Edward Chia-Cheng Lai, PhD (he/him/his)

    Professor
    Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Taiwan
    National Cheng Kung University
    Tainan City, Taiwan (Republic of China)

  • SH

    Swaleh Hussain

    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, Canada

  • Cherry Chu, MSc

    Women's College Hospital Research Institute, Toronto, Toronto, Ontario, Canada
    Toronto, Canada

  • TG

    Tara Gomes, PhD

    Scientist
    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
    Toronto, Canada

  • TA

    Tony Antoniou

    Scientist
    Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Canada

  • AE

    Antoine Eskander

    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, Canada

  • ZB

    Zachary Bouck

    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada, Canada

  • Mina Tadrous, PharmD PhD

    Assistant Professor
    Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
    University of Toronto
    Toronto, Canada

  • Sungho Bea, PharmD, PhD

    Postdoctoral fellow
    Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States

  • EC

    Eun-Young Choi, PharmD

    PhD student
    School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
    Suwon, Republic of Korea

  • Ju-Young Shin, PhD

    Associate Professor
    School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
    Suwon, Republic of Korea

  • KM

    Karin Modig, MSc, PhD

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Sweden

  • MT

    Mats Talbäck, BSc, PhD

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Sweden

  • Rickard Ljung, MD, PhD, MPH

    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, Sweden

  • HL

    Hanne L. Løvdal Gulseth

    Norwegian Institute of Public Health
    Oslo, Norway

  • Øystein Karlstad, MscPharm, PhD

    Senior researcher
    Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway.
    Oslo, Norway

  • Blanaid Hicks, PhD

    Senior Lecturer
    Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom

  • Anton Pottegård, PhD, DMSc

    Professor
    University of Southern Denmark
    Odense M, Denmark

Background: Glucagon-like peptide 1 receptor agonists (GLP1-RAs) are commonly prescribed glucose-lowering medications due to their favourable outcomes on blood glucose control, weight loss and reduction in cardiovascular events. However, concerns have been raised that use of GLP1-RAs may increase the risk of thyroid cancer.

Objectives: To investigate if GLP1-RA use compared to use of dipeptidyl peptidase-4 inhibitors (DPP-4is), was associated with increased risk of thyroid cancer in patients with type 2 diabetes.

Methods: We conducted a multisite cohort study using the Danish, Swedish and Norwegian registries, the ICES data repository in Ontario (Canada), the Korean National Health Insurance Service-National Health Insurance Database, and the National Health Insurance Research Database in Taiwan. Study populations comprised patients with type 2 diabetes between 2007 and 2023 (dependent on data availability). For primary analysis, an active comparator new-user cohort was identified in each site where initiators of GLP1-RA were compared to initiators of DPP-4i. We followed patients from one year after the date of treatment initiation until incident thyroid cancer or death, ten years after treatment initiation or end of follow-up. Cox regression models were fit to estimate hazard ratios (HR) and 95% CIs. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores. We also estimated adjusted rate ratios for cumulative GLP1-RAs dose. Several subgroup and supplementary analyses were conducted, including by sex, age, and cancer subtype. Site-specific HRs were pooled using fixed-effects models.

Results: We included 92,497 patients initiating GLP1-RA and 2,484,408 patients initiating DPP-4i. Among users of GLP1-RA and DPP-4i, we identified 62 and 6,206 events of incident thyroid cancer, respectively. Overall, GLP1-RAs, relative to DPP-4is, were not associated with an increased risk of thyroid cancer (HR 0.72, 95% CI 0.52-1.00). Further, we observed no increased risk in thyroid cancer with increasing cumulative dose of GLP1-RA among GLP1-RA ever-users. In subgroup analysis, no effect modifications were observed. Analyses restricting to medullary thyroid cancer was prohibited by low number of outcomes. Results remained generally consistent across a range of supplementary analyses.

Conclusions: We found no evidence of increased risks of thyroid cancer with use of GLP1-RA as compared to DPP-4i in this international multisite study. However, we cannot rule out excess risk for medullary thyroid cancer and ongoing monitoring of this safety outcome is required.