For all the murmur surrounding, the Oze and the similar GLP-1 drug for weight loss. There are also many concerns about serious or long-term side effects that may occur.
Among the most terrifying fear is the GLP-1 can cause certain thyroid cancer. The risk is enough that the Food and Drug Administration has to use GLP-1 for a long time to carry. Warning Providing advice to high -risk people, such as people who have a family history of certain cancer to avoid using
However, the first GLP-1 drug (for type 2 diabetes) into the market 20 years ago, since arrival, has been studied a lot, checking whether these drugs cause thyroid cancer or not, including education. Published In January, in Jama Otoloryngology – Head and neck surgery
Overall, this research is the same as many studies. But not all, it is found that there is no significant increase in thyroid cancer related to the use of GLP-1 (compared to other diabetes drugs). In addition to the results of this foundation, the clues may give important clues why some education is found.
GIZMODO GHOSTS to study the author Rozalina MCCOY, angelist at the University of Marriland, about the origin of the links that may occur between the GLP-1S and thyroid cancer. She talks about the discovery of the team and exchanges related to the start of a new drug, no matter how astonishing it is. The following dialogue has been gently resolved for clarity and grammar.
GIZMODO: Why doctors and agencies such as FDA are worried about the risks that may occur with thyroid cancer from using GLP-1S?
Rozalina McCOY: Therefore, if these drugs were developed, they were also tested. This test is made in animal models in general. In the early pre -clinic studies, before these drugs are used in humans, they are concerned about what is called C, which is a specific and rare specific thyroid cancer. And because this is observed in AGS, when the first GLP-1 is approved, they come with a warning of the Food and Drug Administration that these drugs should not be used in people with personal history or family of these tumors such as Bone Tyroid cancer–
Since then, there is concern about whether this is true in people or not. Therefore, during the two decades, this drug is surrounded by scientists. Looking to understand: Is this something that affects people? And the challenge is that in the clinic experiment, the randomly controlled trial that studies these drugs. In general, they tend to and roll thousands of patients. And may be because this type of thyroid cancer is especially rare. This risk does not occur in the experiment.
So the question is often: because of the experiments involved in patients with very low risk? Because again, because this black box warning, the experiment cannot be related to patients with knowledgeable risks, so they may choose for people with low risk. Or do we not see cancer because of the general short experiment? Most clinical experiments are only a few years old because they are very expensive to proceed. We haven't followed the patient for a long time or not? Or isn't there any risk?
Therefore, research using information in the world of sexual reality to enhance clinical experiments to detect rare events. If we just see what happens, now we have millions of people who take these drugs – can we see this signal?
GIZMODO: How is your research different from past efforts to find this signal?
MCCOY: We are creating a really strong evidence that I've watched this before. But those studies have some limitations that we really say and there are some things that we want to do.
For one, we only use the largest data set that is possible to do this. Therefore, we have insurance information for those with private insurance for those who have Medicare Advantage Insurance, which is now about half or people with Medicare and for those who have traditional Medicare, so we have different types of people with different types of insurance. We can combine nearly 400,000 patients and approximately 41,000 patients that are treated with GLP-1S, so the population is very large, using different children of the GLP-1.
Secondly, we look at the thyroid cancer rate that has been diagnosed from the first day of treatment and on Lard and focusing only on the first year, then the second and next year. When we look at the previous literature, many differences in the results – some education search for differences and others do not find the differences in the risk of cancer – from the fact that some education does what we do. But other studies do not look at the first six months or one year, and these studies are often found that there is no increase in risks, which the study that looks at the team all the time, they often encounter problems. This question: What happened here?
GIZMODO: Just to clarify one reason why this time is important because it is not possible that cancer related to the GLP-1 will occur in just six months to those who take these drugs, right?
MCCOY: Of course, because thyroid cancer often takes a long time to develop. Of course, there is a rapid developed aggressive cancer. However, those aggressive cancer are expected to hurt patients and make people go to the hospital to need treatment or even And we know that it does not happen because we have many literature, showing that GLP-1S tends to Reduce the risk of death–
GIZMODO: So what is the key point?
MCCOY: First of all, we found that when we look at the overall education period, there is no increased risk of cancer, which is great. However, when we look at the first year, we will see more risks. That made us look deeply about why it happened. What is the driving?
And we look at the rate of thyroid ultrasound, which is a way you will detect these thyroid cancer. We see that patients who start in the GLP-1 they have a higher rate of Threaid ultrasound than other patients. And this is important because we know that there are a lot Overdiagnosis Or thyroid cancer– We are detecting these diseases or cubes in the thyroid gland that when the meat examination looks like cancer, so we call them cancer. And if we have never detected them and never get rid of the thyroid gland, the patient will have the best legs Therefore, these things are very low, very slow, if not growing cancer.
Returning to our education, I think what we found is that the GLP-1 patients have been diagnosed with thyroid cancer, closer to the beginning of the treatment because they get more ultrasound.
GIZMODO: Clearly, causing the question of why
MCCOY: I think it may be three times, even though our information is not especially told.
One thing that can happen is that the patient may feel something that is worried, such as a lump, or maybe they have the latest CT scan, but if you are worried about having something in the thyroid gland, and if you are using GLP-1 with this black box, people may be more worried and want to check it more detailed because the drug card.
Secondly, some doctors and patients may be worried about the start of the GLP-1 if they have no clear proof that nothing is wrong with their thyroid glands. Therefore, there may be a slight ultrasound to prevent disease, especially if the family history of the thyroid problem, which is very common and is usually not related to thyroid cancer.
And the possible explanation is when people lose weight while using GLP-1. Most weight loss occurs in the first few months of therapy. Therefore, when people come down now, they may feel the lump during the exam. And again, when combined with special caution, doctors may tend to check the meat and diagnose cancer.
The important issue in this study is that we have shown that the GLP-1S leads to the diagnosis of thyroid cancer. But they do not lead to more thyroid cancer because it is a problem. And we know that people who use GLP-1S are they Less risk of death Than the patients who have been treated with sulfonylureas and DPP-4S (two types of diabetes)
GIZMODO: Clearly, this is not the only study to see the risks and benefits of this drug. Overall, you will say where the calculation is now? For those they are determined to be more useful than the risks we know and are we looking for?
MCCOY: The way you phrase questions is a way that patients should think about this. And this is what I tell my patients every time we come to the point of deciding how they should start a new drug and the drug. Because it is an exchange between things that are useful to specific patients and what is the risk that may occur? And the calculation is unique for everyone in their situation, which is why it is important for patients to talk to their doctors and understand the balance of specific interests and risks for them.
Therefore, for GLP-1S, we know that there are many benefits in terms of reduced events and deaths for people with heart disease-the risk of heart attack and stroke decreases. People with heart failure. They have better heart failure in the hospital. Chronic kidney diseaseThe ratio of their kidney disease has decreased and the development rate of kidney failure is reduced. People with weight gain and weight loss – problems related to weight loss seem to be better. Therefore, things such as liver disease, metabolism, arthritis Drag, stop breathing whileThey tend to improve.
Therefore, in patients in this matter, which may be heart disease, kidney disease or obesity complications, then the benefits of GLP-1S are more valuable than the risk that may occur, which is generally a side effect of the digestive system. We know that they can cause – even if not always – nausea, diarrhea, bloating In people who lose weight quickly, there is a risk of gallstones if there are children of rapid weight loss. If people lose weight a lot without exercising, they will liberate muscle mass, so they can be weaker.
Key is: Will you benefit? And will you be dangerous? And your risk will be reduced through lifestyle changes such as exercise or eating for health so that you do not have nausea, flatulence or diarrhea – may eat small meals or foods that are less fat or less. Therefore there is always exchange If I have patients with bad GI side effects, then the benefits may not be worth it because they are very happy. But if they can endure, I think they are It is a person's decision for all patients.