Use of GIP and GLP-1 receptor agonists in prostate cancer patients.

Abstract

5024 Background: The use of glucagon-like peptide 1 receptor agonist (GLP-1 RA) and dual glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 RA (GIP/GLP-1 RA) classes has increased over the past several years. The GLP1 receptor is expressed in metastatic prostate tissue, and GLP-1 RA and GIP/GLP-1 RA medications may have an impact on prostate cancer (PCa) outcomes. However, a use analysis among patients with prostate cancer in a large, diverse, current, real-world database has not been published. Methods: This national, retrospective study analyzed adult patients in the Epic Cosmos database with an active diagnosis of PCa who initiated a GLP-1 RA or GIP/GLP-1 RA medication from January 1, 2015, to December 31, 2024. The primary endpoint was percent use and change in use over time. Secondary endpoints included factors associated with use. Data were reviewed from Epic Cosmos, a Health Insurance Portability and Accountability Act-defined limited data set using deidentified electronic health record (EHR) data from more than 293 million patients served by 1,633 hospitals and more than 37,900 clinics. Results: This study includes 1,533,762 patients with a median age of 75. 30.3% (464,477) of the patients had a concurrent diagnosis of T2DM. The percentage of PCa patients utilizing a GLP-1 RA or GIP/GLP-1 RA increased from 0.43% in 2015 to 6.1% in 2024. Odds of receiving a GLP-1 RA or GIP/GLP-1 RA in PCa patients with a T2DM diagnosis were higher among those with a low social vulnerability index (SVI) percentile (<25) compared to patients with an SVI 75 or above (OR 1.20, 95% CI 1.16, 1.24) and among obese compared to non-obese (OR 1.88, 95% CI 1.85, 1.90). Odds were lower in PCa patients with T2DM 65 years and above compared to those under 65 (OR 0.41, 95% CI 0.40, 0.42). Odds of an opioid medication were higher in T2DM PCa patients receiving a GLP-1 RA or GIP/GLP-1 RA compared to those who weren’t (OR 1.14, 95% CI 1.12, 1.16). While most PCa patients who received a GLP-1 RA or GIP/GLP-1 RA had T2DM, the percentage with neither T2DM nor obesity has increased (Table 1). Conclusions: This study showed that GLP-1 RA and GIP/GLP-1 RA use is on the rise. Use is associated with age and social vulnerability and may impact opioid receipt. Ongoing and future investigations examine the impact of GLP-1 RA and GIP/GLP-1 RA use on PCa progression. PCa patients receiving GLP-1 RA or GIP/GLP-1 RA by year. Year PCa T2DM * BMI ≥30 * No T2DM+BMI<30 * 2016 2,085 1,905 (91.37) 1,497 (71.80) 31 (1.49) 2017 3,436 3,168 (92.20) 2,448 (71.25) 50 (1.46) 2018 5,594 5,183 (92.65) 3,946 (70.54) 77 (1.38) 2019 8,594 7,975 (92.80) 5,861 (68.20) 109 (1.27) 2020 11,881 11,086 (93.31) 7,494 (63.08) 129 (1.09) 2021 18,460 17,033 (92.27) 11,820 (64.03) 298 (1.61) 2022 28,850 25,986 (90.07) 18,232 (63.20) 581 (2.01) 2023 47,596 40,638 (85.38) 31,230 (65.61) 1,393 (2.93) 2024 69,808 56,649 (81.15) 46,241 (66.24) 3,033 (4.34) * Data displayed as absolute number and as percentage of PCa population for each characteristic.