Glucose-lowering drugs reduce risk for obesity-related cancers
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Key takeaways:
- Patients lost more weight after undergoing bariatric surgery than after receiving GLP-1 agonist therapy.
- GLP-1 agonist therapy lowered all-cause mortality compared with bariatric surgery.
CHICAGO — Glucagon-like peptide-1 receptor agonists lowered the risk for obesity-related cancers compared with bariatric surgery among individuals with a BMI of at least 35, according to data presented at ASCO Annual Meeting.
Treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) conferred a greater risk reduction in all-cause mortality, despite inferior weight loss results when compared with bariatric surgery, researchers noted.
“Both glucagon-like peptide-1 receptor agonist therapy and bariatric surgery reduced the risk [for] weight-related cancer as compared [with] no intervention,” Cindy Hsin-Ti Lin, MD, an internal medicine resident at Case Western Reserve University, said during a presentation.
“GLP-1 RA therapy was not inferior to bariatric surgery in terms of reducing the risk [for] weight-related cancers,” she added. “Both bariatric surgery and GLP-1 RA therapy had superior all-cause mortality compared [with] no intervention”.
Background and methodology
Prior studies have shown evidence that bariatric surgery can reduce the risk for obesity-related cancers. This prompted researchers to conduct a study to assess whether GLP-1 RAs exhibit a similar benefit for individuals with a high BMI.
Study investigators searched TriNetX, a global health care database, to identify 334,675 eligible patients; eligibility criteria included adults with a BMI of 35 or above, at least 1 year of prior health care exposure, and no prior cancer or preexisting high risk for death.
Study eligibility required 1 year of continuous GLP-1 RA therapy or follow-up, which extended to 3 and 5 years in sensitivity analyses.
Researchers conducted 1:1 propensity-score matching based on age at index date/demographics, initial BMI, prior follow-up, and mortality predictors.
They assigned patients to three comparison arms: arm 1 compared GLP-1 RA with bariatric surgery (n = 14,504), arm 2 compared GLP-1 RA with no intervention (n = 21,768) and arm 3 compared bariatric surgery with no intervention (n = 55,798).
The risk for developing 13 obesity-related cancers following intervention served as the study’s primary endpoint.
Risk for all-cause morality and precancerous lesions served as secondary endpoints.
Results, next steps
After 15 years of follow-up, researchers observed 273 patients (Kaplan Meier event rate = 8.75%) on GLP-1 RA therapy and 397 patients (Kaplan Meier event rate = 6.58%) receiving bariatric surgery who developed an obesity-related cancer (HR = 0.99; 95% CI, 0.87-1.13).
Patients who received GLP-1 RA therapy (HR = 0.61; 95% CI, 0.46-0.81) or bariatric surgery (HR = 0.78; 95% CI, 0.67-0.91) had a reduced risk for obesity-related cancer compared with no intervention at all.
Among 20,009 total patients, 40 individuals (0.353%) who received GLP-1 RA therapy and 61 (0.876%) who underwent bariatric surgery developed thyroid cancer (HR = 0.837; 95% CI, 0.558-1.254).
Researchers noted that patients lost significantly more weight after undergoing bariatric surgery than after receiving GLP-1 RA therapy over the 1- to 2-year time interval (BMI change –5.31 ± 6.05 vs. –1.57 ± 5.12 kg/m2).
Additionally, GLP-1 RA initiation appeared to lower all-cause mortality compared with no intervention (HR = 0.5; 95% CI, 0.4-0.62) and bariatric surgery (HR = 0.859; 95% CI, 0.77-0.96).
Researchers noted that neither GLP-1 RAs nor bariatric surgery appeared associated with precancerous lesions when compared with control.
Study limitations included an inability to confirm that patients stayed compliant with the treatment in each study cohort, insufficient data points to examine each individual cancer type and researchers excluding patients on both therapies due to platform limitations.
“Weight-loss medications and weight loss-surgery had similar reductions for the risk for obesity-related cancers,” Lin said. “Both treatment approaches reduced the overall risk for death compared with no interventional at all.”
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Lin CH, et al. Abstract 10508. Presented at: ASCO Annual Meeting; May 30 – June 4, 2024; Chicago.
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