Predictors of Quality of Life in Acromegaly: No Consensus on Biochemical Parameters

Abstract

BackgroundQuality of life (QoL) in patients with acromegaly is reduced irrespective of disease state. The contributions of multifactorial determinants of QoL in several disease stages are presently not well known.ObjectiveTo systematically review predictors of QoL in acromegalic patients.MethodsMain databases were systematically searched using predefined search terms for potentially relevant articles up to January 2017. Inclusion criteria included separate acromegaly cohort, non-hereditary acromegaly, QoL as study parameter with clearly described method of measurement and quantitative results, N ≥ 10 patients, article in English and adult patients only. Data extraction was performed by two independent reviewers; studies were included using the PRISMA flow diagram.ResultsWe identified 1,162 studies; 51 studies met the inclusion criteria: 31 cross-sectional observational studies [mean AcroQoL score 62.7 (range 46.6–87.0, n = 1,597)], 9 had a longitudinal component [mean baseline AcroQoL score 61.4 (range 54.3–69.0, n = 386)], and 15 were intervention studies [mean baseline AcroQoL score 58.6 (range 52.2–75.3, n = 521)]. Disease-activity reflected by biochemical control measures yielded mixed, and therefore inconclusive results with respect to their effect on QoL. Addition of pegvisomant to somatostatin analogs and start of lanreotide autogel resulted in improvement in QoL. Data from intervention studies on other treatment modalities were too limited to draw conclusions on the effects of these modalities on QoL. Interestingly, higher BMI and greater degree of depression showed consistently negative associations with QoL. Hypopituitarism was not significantly correlated with QoL in acromegaly.ConclusionAt present, there is insufficient published data to support that biochemical control, or treatment of acromegaly in general, is associated with improved QoL. Studies with somatostatin receptor ligand treatment, i.e., particularly lanreotide autogel and pegvisomant have shown improved QoL, but consensus on the correlation with biochemical control is missing. Longitudinal studies investigating predictors in treatment-naive patients and their follow-up after therapeutic interventions are lacking but are urgently needed. Other factors, i.e., depression and obesity were identified from cross-sectional cohort studies as consistent factors associated with poor QoL. Perhaps treatment strategies of acromegaly patients should not only focus on normalizing biochemical markers but emphasize improvement of QoL by alternative interventions such as psychosocial or weight lowering interventions.

The real costs of acromegaly: analysis of different therapies

“…The effectiveness of both drugs is comparable and varies from 40 to 85% depending on the remission criteria adopted [18,19]. Treatment with SSA has also been shown to be connected with improved quality of life [20].…”

“…It potentially allows control of the disease in up to 90% of patients with acromegaly [18,27]. As for SSA, this treatment modality has been shown to be connected with improved quality of life [20].…”

“…In comparison with stereotactic radiosurgery, conventional radiotherapy is burdened with higher risk of developing additional complications, such as: cerebrovascular changes, radiation damages to the cranial nerves, cognitive impairments, or radiation necrosis [11]. The use of conventional radiotherapy in patients with acromegaly has also been associated with increased all-cause mortality [35] and lower quality of life [20].…”

“…Skuteczność obu leków jest porównywalna i wynosi od 40% do 85% w zależności od przyjętych kryteriów remisji [18,19]. Dowiedziono również, że leczenie z zastosowaniem SSA wpływa na poprawę jakości życia [20].…”

“…Leczenie z zastosowaniem pegwisomantu jest metodą leczenia dobrze tolerowaną i najskuteczniejszą z obecnie dostępnych, pozwala także na dobrą kontrolę choroby u ponad 90% osób dotkniętych akromegalią [18,27]. Podobnie jak w przypadku SSA wykazano, iż ten rodzaj leczenia jest związany z pozytywnym wpływem na jakość życia pacjentów [20].…”