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Analyses with a lag period are often used in pharmacoepidemiologic studies of cancer outcomes to take cancer latency and detection bias into account.13 We also conducted a modified intention-to-treat analysis, mainly to account for the possibility that a proportion of patients could have switched from DPP4 inhibitors to GLP1 receptor agonists during follow-up (a potential thyroid cancer risk with GLP1 receptor agonists could then spill over into the group classified as DPP4 inhibitors according to the intention-to-treat definition for drug use, which could lead to an underestimation of risk of thyroid cancer with GLP1 receptor agonists)
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