A new-user retrospective cohort in the TriNetX electronic health record network compared adults with type 2 diabetes starting a GLP-1 receptor agonist with initiators of six other antidiabetic classes, in six separate propensity-score-matched analyses on 39 covariates, for incident pancreatic cancer between one and twenty years after the index prescription. Relative to insulin the hazard for GLP-1 users was 0.43 (95% CI 0.35-0.53); relative to metformin, sulfonylureas, thiazolidinediones and DPP-4 inhibitors the hazards ran the other way (HRs 1.30-1.39), and no difference was seen against SGLT2 inhibitors. Absolute risk differences were 0.04 to 0.15 percentage points, and the reported absolute risks against insulin sit awkwardly with the hazard ratio.
Why it is interesting: The pancreatic cancer signal for the incretin drugs flips direction depending on the comparator chosen, which is itself the finding about how these EHR analyses are read.