Introduction and Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have been associated with both increased (Bezin 2023) and decreased risk (Wang 2023) of certain cancers in patients with type 2 diabetes (T2DM). We investigated the risk of developing 13 obesity-associated malignancies in patients with T2DM who received GLP-1RA compared with other anti-hyperglycemic agents except insulin.
Methods: We conducted a real-world retrospective cohort study on 130 million US adults using deidentified electronic health records from Eversana Life Sciences. The study included patients with new diagnosis of T2DM and no history of malignancy who were prescribed GLP-1RA (n=30,196) within 12 months of T2DM diagnosis and propensity matched to patients on other anti-hyperglycemic agents (n=30,196) between 2010 to 2023. Outcome was incidence of 13 obesity-associated malignancies. Time-varying Cox proportional hazard model was used to compare time to event rates.
Results: In patients with T2DM (56 years, 53% female, 53% White), there was a total of 1219 malignancies after a mean follow up of 2.9 years. Most common cancers were breast (388), prostate (328), and colorectal (148). GLP-1RA users had higher risk for prostate cancer (HR 1.28, 95% CI 1.03, 1.6) compared with those on other anti-hyperglycemic agents. However, E-value was small (1.2), indicating unmeasured confounders affecting outcomes. There was no increased rate of other or overall malignancies (HR 1.04, 95% CI 0.93, 1.17).
Conclusion: Despite a noted increased risk for prostate cancer with GLP-1RA use, non-visible confounders limit the results. Other cancers showed no significant association with GLP-1RA use.
F.A. Ishola: None. C. Pike: None. S.H. Kim: Consultant; ALIGOS Therapeutics. Advisory Panel; GI Dynamics. Research Support; Fractyl Health, Inc. Consultant; Nutrisense.
