Long-term remission of acromegaly after somatostatin analogues withdrawal: a single-centre experience

Abstract

Purpose A long-lasting remission of acromegaly after somatostatin analogues (SAs) withdrawal has been described in some series. Our aim was to update the disease evolution after SAs withdrawal in a cohort of acromegalic patients. Methods We retrospectively evaluated 21 acromegalic patients previously included in a multicentre study (Ronchi et al. 2008), updating data at the last follow-up. We added further 8 patients selected for SAs withdrawal between 2008–2018. Pituitary irradiation represented an exclusion criterion. The withdrawal was suggested after at least 9 months of clinical and hormonal disease control. Clinical and biochemical data prior and after SAs withdrawal were analysed. Results In the whole cohort (29 patients) mean age was 50 ± 14.9 years and 72.4% were females. In 69% pituitary surgery was previously performed. Overall, the median time of treatment before SAs withdrawal was 53 months (IQR = 24–84). At the last follow up in 2019, 23/29 patients (79.3%) had a disease relapse after a median time of 6 months (interquartile range or IQR = 3–12) from the drug suspension, while 6/29 (20.7%) were still on remission after 120 months (IQR = 66–150). IGF-1 levels were significantly lower before withdrawal in patients with persistent remission compared to relapsing ones (IGF-1 SDS: -1.5 ± 0.6 vs -0.11 ± 1, p = 0.01). We did not observe any other difference between patients with and without relapse, including SAs formulation, dosage and treatment duration. Conclusion A successful withdrawal of SAs is possible in a subset of well-controlled acromegalic patients and it challenges the concept that medical therapy is a lifelong requirement.

Persistent remission of acromegaly in a patient with GH‐secreting pituitary adenoma: Effect of treatment with pasireotide long‐acting release and consequence of treatment withdrawal

“…Our case combined with the available literature proved that long‐term remission was expected in a subgroup of acromegalic patients, thus challenging the previous concepts. Similarly, a recent study on first‐generation SSAs indicated a similar percentage of patients (21% or 6/29) with persistent remission, identified as having constantly “safe” GH and normal IGF‐1 concentrations and stable neuroradiological imaging after the discontinuation of medication 18 . Periodic treatment discontinuation is important given that at least a subset of patients with acromegaly will achieve long‐term remission, and they will be expected to acquire an improved quality of life through elimination of medication‐related adverse effects.…”

“…Furthermore, the GH‐secreting pituitary adenoma had disappeared before the discontinuation of medication in our patient who obtained perpetual remission. Nevertheless, Sala et al 18 and Hatipoglu et al 8 reported no radiological differences between the patients achieving long‐term remission and those relapsing after treatment withdrawal. This needs to be confirmed in clinical practice, when SSAs withdrawal is possible, and in larger prospective studies.…”

“…Similarly, a recent study on first-generation SSAs indicated a similar percentage of (21% or 6/29) with persistent remission, identified as having constantly "safe" GH and normal IGF-1 concentrations and stable neuroradiological imaging after the discontinuation of medication. 18 Periodic treatment discontinuation is important given that at least a subset of patients with acromegaly will achieve long-term remission, and they will be expected to acquire an improved quality of life through elimination of medicationrelated adverse effects. In addition, the economic burden related to medication will be reduced on basis of the successful withdrawal of treatment in these patients.…”