No risk of pancreatic cancer risk among diabetes patients receiving GLP-1RAs: JAMA

An Original Investigation on Pharmacy and Clinical Pharmacology published in JAMA Network Open concluded that In type 2 diabetes patients using GLP-1RA medication, there was no evidence supporting increased pancreatic cancer risk after seven years. However, continued monitoring beyond this period is still necessary.

In this study, adult patients with type 2 diabetes insured by Clalit Healthcare Services in Israel were followed from 2009 to 2017. The exposure was treatment with GLP-1RA compared to basal insulin.

In a Cox model, pancreatic cancer incidence was compared based on weighted cumulative exposure to GLP-1RA and basal insulin, adjusting for confounding variables with a time origin at two years after diabetes diagnosis. Sensitivity analyses were conducted using propensity score-matched and prevalent new-user designs, emphasising results from the fifth to seventh year after medication.

The results of this study are:

· During a cumulative follow-up of 3 290 439 person-years of 543 595 adults with a mean age of 59.9 years with incident diabetes, 1665 patients received pancreatic cancer diagnoses.

· 33 377 patients, constituting 6.1%, used GLP-1RA, and 106 849, constituting 19.7%, used basal insulin.

· The estimated hazard ratio (HR) for pancreatic cancer associated with incremental use of 1 defined daily dose per day of GLP-1RA in comparison to basal insulin in the fifth to seventh year previously was 0.50.

· The HR for new-user and prevalent new-user designs from the fifth year onwards after initiation of GLP-1RA vs basal insulin of 0.52 and 0.75, respectively.

Study strengths include the inclusion of a high-quality Clalit database and the high validity of the findings.

Our study did not show an increased risk of pancreatic cancer with the use of GLP-1RA in a cohort of over 500,000 adults with diabetes, they said.

Reference:

Dankner R et al. Glucagon-Like Peptide-1 Receptor Agonists and Pancreatic Cancer Risk in Patients With Type 2 Diabetes. JAMA Netw Open. 2024;7(1):e2350408. doi:10.1001/jamanetworkopen.2023.50408