A research team led by Professor Ju-Young Shin from the School of Pharmacy has found that glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) are not associated with the risk of thyroid cancer in patients with type 2 diabetes.

“Incretin-based therapies, including GLP-1RAs and DPP-4 inhibitors are commonly included in combination therapies to achieve glycaemic goals, reduce body weight, minimize weight gain, or prevent cardiorenal events in patients with type 2 diabetes. However, issues related to the increased risk of thyroid cancer with incretin-based therapies have not yet been settled.”, said Professor Shin.

Using nationwide healthcare insurance data of South Korea from 2014 to 2020, two distinct cohorts were established to compare each drug with sodium-glucose cotransporter-2 (SGLT2) inhibitors, chosen as active comparators because of their previous non-association with thyroid cancer. Weighted Cox proportional models were used to estimate hazard ratios of thyroid cancer incidence associated with incretin-based drugs of interest.

The team found that the use of GLP-1RAs was not associated with an increased risk of thyroid cancer (weighted hazard ratio 0.98, 95% confidence interval 0.62-1.53) compared with that of SGLT2 inhibitors. Using DPP-4 inhibitors was also not associated with an increased risk of thyroid cancer (0.95, 0.79-1.14) compared with that of SGLT2 inhibitors.

"These findings provide insights that the use of GLP-1RAs and DPP-4 inhibitors do not increase the risk of thyroid cancer in patients with type 2 diabetes. Therefore, when considering the risk-benefit balance of incretin-based drugs in patients with type 2 diabetes, the potential for an elevated risk of thyroid cancer would be negligible.", concluded Dr Shin.

The study was co-led by Professor Ju-Young Shin (School of Pharmacy, Sungkyunkwan University), and Professor Young Min Cho (Division of Endocrinology, Department of Internal Medicine, Seoul National University Hospital), with Professor HeeJun Son (Division of Endocrinology, Department of Internal Medicine, Seoul National University Hospital) as co-first authors, and Professor Jae Hyun Bae (Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine), and Sun Wook Cho (Division of Endocrinology, Department of Internal Medicine, Seoul National University Hospital) as co-investigators.