Résumé
Introduction: Pre-clinical studies suggested a risk of medullary thyroid C-cell cancer with GLP-1 receptor agonists (RA). The aim of this study was to determine whether the use of GLP-1 RA compared with other second-line antidiabetic drugs is associated with an increased risk of thyroid cancer.Material and methods: A nested case-control analysis was performed using the French national healthcare insurance system SNDS (“Système National des Données de Santé”) database. Patients pharmacologically treated for a type 2 diabetes between 2006 and 2018 were included in the cohort. All thyroid cancers were identified using ICD-10 codes from hospital discharge and medical procedures between 2014 and 2018. Exposure to GLP-1 RA was measured within the 6 years preceding a 6-month lag-time period and considered as cumulative duration of use based on defined daily dose (≤1, 1 to 3, >3 years). Cases were matched with up to 20 controls on age, sex, and length of diabetes, using the risk-set sampling procedure. The risk of thyroid cancer related to the use of GLP-1 RA was estimated using a conditional logistic regression adjusted on goiter, hypo and hyperthyroidism, other antidiabetic drugs and social deprivation index.Results: A total of 2,562 cases and 45,184 controls were included. Almost two thirds were female (67%), and median age was 64 [IQR: 56; 71] years. The use of GLP-1 RA for 1 to 3 years was associated with an increased risk of thyroid cancer (adjusted hazard ratio: 1.61, 95% confidence interval: 1.30 to 2.00), and medullary thyroid cancer (aHR: 1.93, 95% CI: 1.12 to 3.33). Discussion/Conclusion: Compared with the use of other second-line drugs commonly used in the treatment of type 2 diabetes, the use of GLP-1 RA was associated with an increased risk of thyroid cancer in patients with type 2 diabetes.