升糖素樣胜肽-1受體致效劑與其他降血糖藥物在接受雄激素剝奪治療之攝護腺癌患者中的臨床結局比較

黃聖淇¹、吳政彥^2,3、賴志政^4,5、曾文歆⁶

奇美醫院 教學部 一般科¹；奇美醫院 營養科²; 國立成功大學醫學院 公共衛生學系³

奇美醫院 加護醫學部⁴; 國立中山大學醫學院 醫學系⁵; 奇美醫院 外科部 泌尿科⁶

Glucagon-Like Peptide-1 Receptor Agonist versus Other Anti-Diabetic Agents On Patients With Prostate Cancer Undergoing Androgen-Deprivation Therapy

Sheng-Chi Huang¹, Jheng-Yan Wu^2,3, Chih-Cheng Lai^4,5, Wen-Hsin Tseng⁶

¹Department of General Medicine, Chi Mei Medical Center, Tainan, Taiwan; ²Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan; ³Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan^{; 4}Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan; ⁵School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; ⁶Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Purpose: We investigated the comparative effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) versus dipeptidyl peptidase-4 inhibitors (DPP-4is) and sodium–glucose cotransporter-2 inhibitors (SGLT2is) on mortality and cardiometabolic outcomes in patients with prostate cancer receiving androgen deprivation therapy (ADT) and concomitant type 2 diabetes mellitus.

Materials and Methods: We conducted a retrospective cohort study using the TriNetX global research network. Adult patients with type 2 diabetes and prostate cancer undergoing ADT who newly initiated GLP-1RA, DPP-4i, or SGLT2i therapy between January 2005 and December 2025 were included.

Results: After matching, 659 patients per group were included in the GLP-1RA versus DPP-4i cohort, and 1,009 patients per group in the GLP-1RA versus SGLT2i cohort. After matching, GLP-1RA use was associated with lower all-cause mortality compared with DPP-4i (HR, 0.60; 95% CI, 0.46–0.79) and SGLT2i (HR, 0.76; 95% CI, 0.59–0.99). Compared with DPP-4i, GLP-1RA also reduced MAKEs (HR, 0.63) and thrombotic events (HR, 0.53), with no difference in MACEs. No significant differences in secondary outcomes were observed versus SGLT2i.

Conclusion: GLP-1RA use was associated with a lower risk of all-cause mortality compared with both DPP-4i and SGLT2i in patients with prostate cancer receiving ADT. Additional reductions in kidney and thrombotic events were observed compared with DPP-4i. These findings suggest that GLP-1RAs may represent a favorable glucose-lowering strategy in this high-risk cardio-oncologic population.