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Concerns have been raised that the use of glucagon-like peptide-1 receptor agonists (GLP-1) may increase the incidence of pancreatitis or pancreatic cancer, but a large-scale cohort analysis found that this was unfounded.

The results of a study on the risk association of pancreatic cancer with the use of GLP-1 agents conducted by Dr. Rachel Dankner and others at the Gertner Institute for Epidemiology and Health Policy in Israel were published in the international journal JAMA Network on the 4th (doi:10.1001/jamanetworkopen.2023.50408).

A large-scale cohort analysis involving 540,000 people showed that the use of GLP-1 agents did not increase the risk of pancreatic cancer.

As the use of GLP-1, which is widely used as a treatment for diabetes and obesity, increases, studies to confirm its safety, including the increase in pancreatitis and pancreatic cancer, are continuing.

A review of short-term in vivo studies and case reports conducted at the request of the U.S. Food and Drug Administration (FDA) left open the possibility of increased acute pancreatitis with GLP-1 agents, but a recent meta-analysis found conflicting results, finding no problems with the pancreas-related safety profile.

Dr. Dankner took note of the existence of bias in previous studies, such as the short average follow-up period and limited sample size, and began a cohort analysis of 540,000 people followed for an average of 7 years.

The study looked at the incidence of pancreatic cancer among adult patients (ages 21 to 89 years) with type 2 diabetes insured by Clalit Healthcare Services, an Israeli national compulsory health care institution, from 2009 to 2017, when GLP-1 agents became available, compared to basal insulin users. It was designed in a way that compares with .

During the follow-up period of 543,595 patients with type 2 diabetes, a total of 1,665 patients were diagnosed with pancreatic cancer, of which 33,377 (6.1%) patients took GLP-1 agents and 106,849 (19.7%) patients took GLP-1 agents. Basal insulin was used.

As a result of the analysis, in the Cox proportional hazards model that reflected characteristics such as age, gender, race, sociodemographic status, body mass index, and smoking history, the estimated hazard ratio (HR) of pancreatic cancer for GLP-1 agents compared to basal insulin was 0.50, which was only half. The HR for pancreatic cancer in the GLP-1 agent use group during the entire follow-up period was 0.67.

“In a cohort of more than 500,000 adults with diabetes, we tracked more than 30,000 GLP-1 drug users and assessed their risk of developing pancreatic cancer up to 7 years after starting treatment,” said Dr. Dankner. “We found no evidence that use of the agent increases the risk of pancreatic cancer,” he said.

“Through the Cox model, we were able to explore the risk of pancreatic cancer associated with the use of GLP-1 agents compared to basal insulin, but the follow-up period is limited to 7 years,” he said. “As for the risk of pancreatic cancer more than 7 years after starting treatment, “Monitoring is still needed,” he added.

2024-01-23 02:52:05

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