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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
Summary
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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