From the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Epidemiology. 2020 Jul;31(4):559-566. doi: 10.1097/EDE.0000000000001196.
It has been proposed that the weight loss associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may improve detection of breast cancer in patients undergoing this treatment. We aimed to determine whether the weight-lowering effects of GLP-1 RAs are associated with an increased detection of breast cancer among obese women with type 2 diabetes.
Using the UK Clinical Practice Research Datalink, we conducted a propensity score-matched cohort study among female obese patients with type 2 diabetes newly treated with antidiabetic drugs between 1 January 2007 and 31 January 2018. New users of GLP-1 RAs (n = 5,510) were matched to new users of second- to third-line noninsulin antidiabetic drugs (n = 5,510). We used time-dependent Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of breast cancer associated with different GLP-1 RA maximal weight loss categories (<5%, 5%-10%, >10%).
Breast cancer incidence gradually increased with GLP-1 RA maximal weight loss categories, with the highest HR observed for patients achieving at least 10% weight loss (HR = 1.8, 95% CI = 1.1, 2.8). In secondary analyses, the HR for >10% weight loss was highest in the 2-3 years since treatment initiation (HR = 2.9, 95% CI = 1.2, 6.9).
In this population-based study, the detection of breast cancer gradually increased with GLP-1 RA weight loss categories, particularly among those achieving >10% weight loss. These results are consistent with the hypothesis that substantial weight loss with GLP-1 RAs may improve detection of breast cancer among obese patients with type 2 diabetes.
有人提出，胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）引起的体重减轻可能会改善接受此类治疗的患者的乳腺癌检出率。我们旨在确定 GLP-1 RAs 的减重效果是否与肥胖 2 型糖尿病女性中乳腺癌的检出率增加有关。
我们使用英国临床实践研究数据链接，在 2007 年 1 月 1 日至 2018 年 1 月 31 日期间，对新接受抗糖尿病药物治疗的肥胖 2 型糖尿病女性患者进行了倾向评分匹配的队列研究。新使用 GLP-1 RAs（n=5510）的患者与新使用二线至三线非胰岛素抗糖尿病药物（n=5510）的患者相匹配。我们使用时间依赖性 Cox 比例风险模型来估计与不同 GLP-1 RA 最大体重减轻类别（<5%、5%-10%、>10%）相关的乳腺癌的风险比（HR）和 95%置信区间（CI）。
乳腺癌的发病率随着 GLP-1 RA 最大体重减轻类别的增加而逐渐增加，体重减轻至少 10%的患者观察到最高的 HR（HR=1.8，95%CI=1.1，2.8）。在二次分析中，治疗开始后 2-3 年内>10%体重减轻的 HR 最高（HR=2.9，95%CI=1.2，6.9）。
在这项基于人群的研究中，随着 GLP-1 RA 体重减轻类别，乳腺癌的检出率逐渐增加，尤其是在体重减轻>10%的患者中。这些结果与以下假设一致，即 GLP-1 RAs 引起的大量体重减轻可能会改善肥胖 2 型糖尿病患者乳腺癌的检出率。
