Diabetes patients with MGUS (a pre-cancerous blood condition) who used GLP-1 receptor agonists had a 55% lower risk of progressing to multiple myeloma compared to non-users.
55% risk reductionGLP-1 receptor agonist use associated with lower progression from MGUS to multiple myeloma (HR 0.45)
What the researchers found
In a matched cohort of 3,291 veterans with diabetes and MGUS (1,097 GLP-1 RA users matched to 2,194 non-users):
- Progression to multiple myeloma: 2.6% in GLP-1 RA users vs. 5.0% in non-users
- Cumulative incidence was significantly different (P = 0.02)
- GLP-1 RA use was associated with a 55% reduction in myeloma progression (HR = 0.45, 95% CI 0.22–0.93, P = 0.03)
The analysis accounted for the competing risk of death and used a validated NLP algorithm to confirm MGUS diagnosis and progression.
Why it matters
MGUS affects about 3% of people over 50, and there are currently no approved drugs to prevent its progression to myeloma. If GLP-1 receptor agonists truly slow this progression, it could benefit thousands of people already taking these drugs for diabetes or obesity, and might change how MGUS is managed clinically.
How the study worked
Population-based cohort study of US veterans diagnosed with MGUS from 2006 to 2021 who also had diabetes. A validated natural language processing algorithm confirmed MGUS and myeloma progression. Researchers performed 1:2 matching of GLP-1 RA users to non-users and used Fine-Gray competing risk models with death as a competing event to estimate the association.
What this study cannot tell us
This is an observational study that cannot prove causation. Despite matching, residual confounding is possible — healthier patients may be more likely to receive newer, more expensive GLP-1 RAs. The study population is predominantly male veterans, limiting generalizability. The number of progression events was small (absolute numbers not detailed), making the confidence interval wide. The mechanism by which GLP-1 RAs might prevent myeloma progression is unknown.
How to read the evidence
This is a well-designed population-based cohort study using matched controls and competing risk analysis. However, it's observational, with a relatively small number of progression events and a predominantly male veteran population. The findings are hypothesis-generating and need prospective validation.
When this study was published
Published in 2024 in JNCI Cancer Spectrum, this is a recent and novel finding at the intersection of diabetes pharmacology and hematologic oncology.
The bigger picture
This adds to a growing list of unexpected benefits associated with GLP-1 receptor agonists, which already include cardiovascular protection, kidney protection, liver disease improvement, and now potentially cancer prevention. The anti-cancer mechanism is unknown but could relate to anti-inflammatory effects, metabolic improvements, or direct effects on immune surveillance.
Questions still open
- What is the biological mechanism by which GLP-1 receptor agonists could slow MGUS progression to myeloma?
- Would this effect be seen with specific GLP-1 RAs (semaglutide vs. liraglutide), or is it a class effect?
- Could GLP-1 RAs be tested prospectively as chemoprevention in high-risk MGUS patients?
Common questions
What is MGUS and why does it matter?
Should I take a GLP-1 drug to prevent myeloma?
Read the original research
Association between glucagon-like peptide-1 receptor agonist use and progression of monoclonal gammopathy of uncertain significance to multiple myeloma among patients with diabetes.
JNCI cancer spectrum, 8(6)
Citation
Grandhi, Nikhil; Liu, Lawrence; Wang, Mei; Thomas, Theodore; Schoen, Martin; Sanfilippo, Kristen; Gao, Feng; Colditz, Graham A; Carson, Kenneth R; Janakiram, Murali; Chang, Su-Hsin. (2024). Association between glucagon-like peptide-1 receptor agonist use and progression of monoclonal gammopathy of uncertain significance to multiple myeloma among patients with diabetes.. JNCI cancer spectrum, 8(6). https://doi.org/10.1093/jncics/pkae095