Glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer: Scandinavian cohort study

• Published in: BMJ (Online) 2024-04, Vol.385, p.e078225-e078225
• Main Authors: Pasternak, Björn, Wintzell, Viktor, Hviid, Anders, Eliasson, Björn, Gudbjörnsdottir, Soffia, Jonasson, Christian, Hveem, Kristian, Svanström, Henrik, Melbye, Mads, Ueda, Peter
• Format: Article
• Language: English
• Subjects: Adult; Aged; Agonists; Allmän medicin; Cohort analysis; Cohort Studies; Confidence intervals; Denmark - epidemiology; Diabetes; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Dipeptidyl-Peptidase IV Inhibitors - adverse effects; Dipeptidyl-Peptidase IV Inhibitors - therapeutic use; Drug use; Family Medicine; Female; Glucagon; Glucagon-like peptide 1; Glucagon-Like Peptide-1 Receptor - agonists; Health care policy; Humans; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Male; Medicin och hälsovetenskap; Middle Aged; Norway - epidemiology; Patients; Peptides; Pharmacovigilance; Prescription drugs; Proportional Hazards Models; Ratios; Risk Factors; Scandinavian and Nordic Countries - epidemiology; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Standard deviation; Sweden - epidemiology; Thyroid cancer; Thyroid Neoplasms - chemically induced; Thyroid Neoplasms - epidemiology
• ISSN: 1756-1833; 0959-8138; 0959-535X; 1756-1833
• DOI: 10.1136/bmj-2023-078225

AbstractObjectiveTo investigate whether use of glucagon-like peptide 1 (GLP1) receptor agonists is associated with increased risk of thyroid cancer.DesignScandinavian cohort study.SettingDenmark, Norway, and Sweden, 2007-21.ParticipantsPatients who started GLP1 receptor agonist treatment were compared with patients who started dipeptidyl peptidase 4 (DPP4) inhibitor treatment, and in an additional analysis, patients who started sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment.Main outcome measuresThyroid cancer identified from nationwide cancer registers. An active-comparator new user study design was used to minimise risks of confounding and time related biases from using real world studies of drug effects. Cox regression was used to estimate hazard ratios, controlling for potential confounders with propensity score weighting.ResultsThe mean follow-up time was 3.9 years (standard deviation 3.5 years) in the GLP1 receptor agonist group and 5.4 years (standard deviation 3.5 years) in the DPP4 inhibitor group. 76 of 145 410 patients (incidence rate 1.33 events per 10 000 person years) treated with GLP1 receptor agonists and 184 of 291 667 patients (incidence rate 1.46 events per 10 000 person years) treated with DPP4 inhibitors developed thyroid cancer. GLP1 receptor agonist use was not associated with increased risk of thyroid cancer (hazard ratio 0.93, 95% confidence interval 0.66 to 1.31; rate difference −0.13, 95% confidence interval −0.61 to 0.36 events per 10 000 person years). The hazard ratio for medullary thyroid cancer was 1.19 (0.37 to 3.86). In the additional analysis comparing the GLP1 receptor agonist group with the SGLT2 inhibitor group, the hazard ratio for thyroid cancer was 1.16 (0.65 to 2.05).ConclusionsIn this large cohort study using nationwide data from three countries, GLP1 receptor agonist use was not associated with a substantially increased risk of thyroid cancer over a mean follow-up of 3.9 years. In the main analysis comparing GLP1 receptor agonists with DPP4 inhibitors, the upper limit of the confidence interval was consistent with no more than a 31% increase in relative risk.