American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Management of Acromegaly Patients: What is the Role of Pre-Operative Medical Therapy?

Fleseriu, Maria; Hoffman, Andrew R.; Katznelson, Laurence

doi:10.4158/ep14575.dscr

Cited by 46 publications

(25 citation statements)

References 46 publications

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“…The long-acting formulations circumvent the daily injections required with other agents used in the treatment of acromegaly, such as pegvisomant [6]. There is no clear benefit on surgical outcomes or perioperative morbidity/mortality with use of SSAs prior to surgery [10]. …”

Section: Introductionmentioning

confidence: 99%

Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis

Gurel

Han

Stevens

et al. 2017

BMC Pharmacol Toxicol

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BackgroundMany patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs). Long-acting SSA formulations are widely used, due in part to increased patient convenience and increased treatment adherence vs daily medications. Although medication compliance can be poor in patients with chronic conditions, adherence and persistence with these SSAs in patients with acromegaly has not been evaluated. This analysis utilized claims data to estimate treatment adherence and persistence for lanreotide depot and long-acting octreotide in this population.MethodsThis retrospective analysis used the MarketScan® database (~100 payors, 500 million claims in the US), which was searched between January 2007 and June 2012 to identify patients with acromegaly taking either lanreotide depot or long-acting octreotide. Patients switching treatments were excluded. Treatment adherence was assessed using medication possession ratio (MPR; number of doses dispensed in relation to dispensing period; ≥80% is considered adherent), injection count, and treatment time. Persistence was estimated by Kaplan-Meier analyses and Cox proportional hazards modeling. A washout period, defined as no acromegaly-related prescription activity 180 days prior to the index date, was employed to minimize effects of prior therapy and focus on patients more likely to be treatment-naïve.ResultsAltogether 1308 patients with acromegaly receiving a single SSA for treatment (1127 octreotide, 181 lanreotide) who had not switched treatments were identified. Mean MPR in patients with a 180-day washout (n = 663) was 89% for those receiving octreotide (n = 545) and 87% for those receiving lanreotide (n = 118). Median number of days on therapy was 169 (95% CI 135–232) for octreotide patients and 400 (95% CI 232–532) for lanreotide patients. The point estimate of the Cox proportional hazard ratio for stopping treatment was 1.385 for octreotide vs lanreotide (95% CI 1.079–1.777), suggesting a 38.5% increased risk for stopping octreotide before lanreotide.ConclusionsTreatment adherence was similarly good for both injectable SSA treatments studied, at 87% or greater. Persistence was greater with lanreotide than octreotide and the risk of discontinuing therapy was lower with lanreotide than octreotide. Further studies to determine factors leading to these differences in persistence or to predict discontinuation of therapy may aid in clinical management of these patients.

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Section: Introductionmentioning

confidence: 99%

Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis

Gurel

Han

Stevens

et al. 2017

BMC Pharmacol Toxicol

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“…Another possible approach to treatment is the use of SRLs as an initial approach in macroadenoma cases to reduce the tumor size and allow better surgical outcomes 22-25. Currently, some patients are receiving this treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

Borges¹,

Lara²,

Tomé³

et al. 2017

Clinics

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OBJECTIVE:To evaluate the effectiveness of the treatment of acromegaly patients at the Federal University of Triangulo Mineiro.METHODS:Cross-sectional and retrospective study of thirty cases treated over a period of two decades.RESULTS:17 men (56.7%) aged 14-67 years and 13 women aged 14-86 years were analyzed. Twenty-one patients underwent transphenoidal surgery, whichwas associated with somatostatin receptor ligands in 11 patients (39.3%), somatostatin receptor ligands + radiotherapyin 5 patients (17.8%), radiotherapy in 3 patients (10.7%), and radiotherapy + somatostatin receptorligands + cabergoline in 1 patient (3.6%). Additionally, 2 patients underwent radiotherapy and surgeryalone. Six patients received somatostatin receptor ligands before surgery, and 2 were not treated due to refusal and death. Nine patients have died, and 20 are being followed; 13 (65%) have growth hormonelevels o1 ng/mL, and 11 have normal insulin-like growth factor 1 levels.CONCLUSION:The current treatment options enable patients seen in regional reference centers to achieve strict control parameters, which allows them to be treated close to their homes.

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“…Thus, management of patients with acromegaly is recommended to be centralised to tertiary referral centres with special expertise applying a transdisciplinary approach and performing individualised and most often multimodal treatment (1). Transsphenoidal surgery is the only true curative treatment, however, with a disappointing low cure rate when performed as primary treatment (2,3,4,5,6), because the tumours often are large and invasive at the time of diagnosis. In order to improve therapeutic outcomes for patients and the society (cost effectiveness), new treatment algorithms have been developed during the last decades (4,6,7).…”

Section: Introductionmentioning

confidence: 99%

“…Transsphenoidal surgery is the only true curative treatment, however, with a disappointing low cure rate when performed as primary treatment (2,3,4,5,6), because the tumours often are large and invasive at the time of diagnosis. In order to improve therapeutic outcomes for patients and the society (cost effectiveness), new treatment algorithms have been developed during the last decades (4,6,7). These algorithms include a special focus on increasing the so far modest operative cure rate by stressing treatment to be performed in highly specialised multidisciplinary teams (MDTs) with a high experience in pituitary diseases (1,8), and expert surgeons with special interest for and a broad experience in pituitary surgery and thereby a documented better operative cure rate (9).…”

Section: Introductionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

Bollerslev

Heck

Olarescu

2019

European Journal of Endocrinology

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Acromegaly is a rare and challenging disease calling for management in highly specialised multidisciplinary teams (MDTs). Untreated disease has severe morbidity and a clearly increased mortality. Major attainments have been gained over the latest decades, and therefore, the aim of this review is to discuss recent achievements in modern multimodal therapy of acromegaly performed by MDTs, with an emphasis on an individualised, proactive management from the time of diagnosis to long-term outcome. Treatment by surgery is the only potential curative treatment, however, even with modern techniques still with modest cure rates, leaving the patients to often long-term medical treatment. Treatment strategies have changed dramatically in the Western world over recent years, implying a more proactive treatment algorithm often with a shorter or longer pre-surgical treatment period with somatostatin receptor ligands (SRLs). Not all patients will however respond to primary treatment with conventional SRLs and there has recently been a development of potential biomarkers for response that has been implemented in the clinical routine. By today, multimodal treatment can bring every patient in remission, but still almost a third of all patients are undertreated according to large, international registries. On the other hand, it might be a challenge not to over treat thereby bringing the patient into a state of relative or absolute growth hormone deficiency. Clinical series published during the last decade on treatment of patients with acromegaly have indicated a normalisation of mortality, most probably reflecting the proactive and individualised modern treatment. In conclusion, modern, multimodal treatment seems to have normalised mortality, but still the patients suffer from a high multi-organ morbidity and often multipharmacy. Every patient should receive an individualised, proactive treatment in order to improve long-term outcome and to reduce costs for the society.Correspondence should be addressed to J Bollerslev . His special interest is within clinical and translational endocrinology, and in particular, in classical endocrine diseases, such as acromegaly and Cushing's, often studying bone as target tissues for clinical activity. A major topic has been clinical management of acromegaly, and especially searching for biomarkers for responsiveness to medical therapy. Prospectively collected data of newly diagnosed patients with acromegaly has been the background for current studies of individualised, multimodal and transdisciplinary treatment. European Journal of Endocrinology 181:2 R60 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R61 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R63 Review J Bollerslev and others Managing acromegaly https://eje.bioscientifica.com European Journal of Endocrinology 181:2 R64 Review J Bollerslev and others Managing acromegaly https://eje.bioscie...

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American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: Management of Acromegaly Patients: What is the Role of Pre-Operative Medical Therapy?

Cited by 46 publications

References 46 publications

Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis

Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis

Treatment of acromegaly patients at the Federal University of Triângulo Mineiro (UFTM): Experience Report

MANAGEMENT OF ENDOCRINE DISEASE: Individualised management of acromegaly

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