GLP-1s may not raise short-term pancreatic cancer risk for adults with type 2 diabetes
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Key takeaways:
- No difference in pancreatic cancer risk at 5 to 7 years was observed for adults using GLP-1 receptor agonists vs. basal insulin.
- Longer-term studies and research examining adults with obesity are needed.
Adults with type 2 diabetes who use GLP-1 receptor agonists do not have an increased short-term risk for pancreatic cancer, according to findings published in JAMA Network Open.
“Our findings provide additional reassurance to physicians prescribing GLP-1 receptor agonists to patients,” Rachel Dankner, MD, MPH, senior researcher in the Gertner Institute for Epidemiology and Health Policy Research at Sheba Medical Center In Israel, told Healio. “We were able to show that the lack of an association between GLP-1 receptor agonists and pancreatic cancer risk over 7 years is independent of important factors like sociodemographic status, ethnic background, age, sex, smoking, BMI or even history of pancreatitis before beginning treatment with these drugs. We also accounted for the history of background diabetes treatment. That means that we minimized the possibility for confounding by indication.”
Dankner and colleagues conducted a population-based cohort study with data from 543,595 adults aged 21 to 89 years diagnosed with type 2 diabetes (51% women; mean age, 59.9 years). All clinical measures were obtained from the Clalit Healthcare Services database in Israel. Pancreatic cancer diagnoses were collected from the Israel National Cancer Registry. Researchers compared pancreatic cancer risk between adults using GLP-1 receptor agonist and those receiving basal insulin. Participants were followed from 2009 until 2017.
Of the participants, 19.7% used basal insulin and 6.1% used a GLP-1 receptor agonist at some point during the study. During a mean follow-up of 6.1 years, 1,665 adults were diagnosed with pancreatic cancer.
After adjusting for covariates, one defined daily dose of a GLP-1 taken a year before a cancer diagnosis was associated with a lower risk for pancreatic cancer compared with one defined daily dose of insulin (adjusted HR = 0.22; 95% CI, 0.11-0.41). One defined daily dose of a GLP-1 taken 2 to 4 years before cancer diagnosis was also associated with a reduced pancreatic cancer risk than one defined daily dose of basal insulin (aHR = 0.32; 95% CI, 0.13-0.76). No difference in risk was observed between GLP-1 receptor agonists and basal insulin 5 to 7 years before a cancer diagnosis.
Despite the findings, Dankner said providers still need to monitor adults receiving a GLP-1 receptor agonist for pancreatic cancer.
“First, we were only able to provide safety evidence on the first 7 years of GLP-1 receptor agonist use, and there is a need for longer-term use as well, since pancreatic cancer may have a longer latency period,” Dankner said. “In addition, although our analysis emulated a randomized controlled trial and accounted for important confounding factors, we were restricted to the data we had available and there are yet additional factors like alcohol use, which were not available to us. Finally, our study was done on the Israeli population, which is relatively healthy, with low rates of alcohol abuse and relatively healthy dietary habits, so there is room for additional studies like ours on other populations.”
Additionally, Dankner said a similar study should be conducted among people receiving GLP-1 receptor agonists for obesity treatment.
For more information:
Rachel Dankner, MD, MPH, can be reached at racheld@gertner.health.gov.il.
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