For older patients with cancer and type 2 diabetes (T2D), glucagon-like peptide-1 receptor agonist (GLP-1 RA) use is associated with lower all-cause mortality than dipeptidyl peptidase-4 inhibitor (DPP4i) use, according to a study published online July 18 in JAMA Network Open.

Rotana M. Radwan, Ph.D., from the University of Florida in Gainesville, and colleagues examined whether GLP-1 RA use compared with sodium-glucose cotransporter-2 inhibitor (SGLT2i) and DPP4i use is associated with improved survival in patients with cancer and T2D in a retrospective cohort study using 2013 to 2020 Medicare data. Eligible patients were aged 66 years or older and had T2D and one of nine cancers (thyroid, pancreatic, bladder, colorectal, lung, kidney, breast, endometrial, or prostate). Propensity score matching was conducted to reduce confounding.

The GLP-1 RA versus SGLT2i cohort included 2,553 matched pairs, and the GLP-1 RA versus DPP4i cohort included 2,564 matched pairs. The researchers found no significant difference in mortality risk between GLP-1 RA and SGLT2i users. However, significantly lower mortality was seen in association with GLP-1 RA versus DPP4i use (hazard ratio, 0.60). The E-value was 1.21 and 2.73 for GLP-1 RA versus SGLT2i use and for GLP-1 RA versus DPP4i use, respectively. No significant differences were seen between GLP-1 RAs and SGLT2is in subgroup analyses; the survival benefit remained consistent across age, sex, non-Hispanic White race, and several cancer types (colorectal, lung, and breast) for GLP-1 RAs versus DPP4is.

“While causality cannot be inferred, our study adds novel evidence on the comparative effectiveness of GLP-1 RAs,” the authors write. “The observed survival differences may reflect drug class-specific systemic effects.”

Several authors disclosed ties to the biopharmaceutical industry.

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