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GLP-1RA Use and Thyroid Cancer Risk

Juan P Brito1,2, Jeph Herrin3, Kavya Sindhu Swarna4,5

  • 1Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota.

JAMA Otolaryngology-- Head & Neck Surgery
|January 23, 2025
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1RA) showed no overall increased thyroid cancer risk in type 2 diabetes patients. However, a higher risk was observed within the first year of GLP-1RA use, possibly due to early detection.

Area of Science:

  • Endocrinology
  • Oncology
  • Pharmacovigilance

Background:

  • The widespread use of glucagon-like peptide-1 receptor agonists (GLP-1RA) necessitates a thorough understanding of their potential association with thyroid cancer.
  • Existing research has yielded conflicting results regarding the link between GLP-1RA and thyroid malignancies.

Purpose of the Study:

  • To investigate the risk of incident thyroid cancer in adults with type 2 diabetes treated with GLP-1RA compared to other common glucose-lowering medications.
  • To analyze the association between GLP-1RA use and thyroid cancer risk across different time intervals post-treatment initiation.

Main Methods:

  • A secondary analysis using a target trial emulation approach with US claims data from January 1, 2014, to December 31, 2021.
  • Included adults with type 2 diabetes initiating treatment with GLP-1RA, SGLT2 inhibitors, DPP4 inhibitors, or sulfonylureas.
  • Inverse propensity score weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) for thyroid cancer.

Main Results:

  • The study included 351,913 patients; 41,112 initiated GLP-1RA therapy.
  • GLP-1RA initiation was not significantly associated with an increased overall risk of thyroid cancer compared to other drug classes (HR, 1.24; 95% CI, 0.88-1.76).
  • A significantly higher risk of thyroid cancer was observed within the first year of GLP-1RA initiation (HR, 1.85; 95% CI, 1.11-3.08), amplified in as-treated analyses.

Conclusions:

  • While the absolute risk of thyroid cancer remains low, GLP-1RA therapy may be associated with an increased risk of new thyroid cancer diagnoses within the first year of use.
  • This early increased risk might be attributed to enhanced detection of pre-existing or early-stage thyroid cancers.
  • Further research is warranted to elucidate the mechanisms behind this observed association and its clinical implications.

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