Prevalence, incidence, comorbidities, and treatment patterns among Japanese patients with acromegaly: a descriptive study using a nationwide claims database

Abstract

Epidemiological data of rare diseases are important for understanding disease burden, improving treatment, and planning healthcare systems. However, those of acromegaly in Japan are not well known. Our study aimed to describe the prevalence, incidence, prediagnostic comorbidities, and treatment patterns of patients with acromegaly in Japan. Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan, we retrospectively identified 12,713 patients with acromegaly aged ≥20 years between January 2014 and December 2017 (the prevalence cohort), 2,552 newly diagnosed patients between January 2013 and December 2017 (the incidence and comorbidity cohort), and 2,125 patients enrolled in the database at least 365 days after the diagnosis (the treatment-pattern cohort). The average annual prevalence in 2015-2017 was 9.2 cases per 100,000 in the prevalence cohort, and the average annual incidence in 2013-2017 was 0.49 cases per 100,000 in the incidence and comorbidity cohort. The most common prediagnostic comorbidities included hypertension (43%), diabetes (37%), and hyperlipidemia (27%). In the treatment-pattern cohort, 54% and 45% of patients received surgery and medical treatment as the primary treatment, respectively. Between the first surgery and 365 days after diagnosis, 15% of the patients in this cohort received medical treatment as the secondary treatment, mostly with somatostatin analogs (83%). Of the 1,569 patients who underwent surgery, 29% received medical treatment before surgery. The prevalence and incidence of acromegaly in Japan were similar to those in other countries. This epidemiological study provides the basis for better management of acromegaly nationwide.

Clinical features and complications of acromegaly at diagnosis are not all the same: data from two large referral centers

“…Comorbidities reported prior to acromegaly diagnosis in our cohort were generally lower than those reported in the international LAS database (5) at diagnosis; however, there is significant heterogeneity of data collection in different studies (e.g. based on chart review vs. diagnostic codes), which may in part be responsible for observed differences (Table 3) (5,36,37). Importantly, the frequency of most comorbidities in this study almost doubled after screening, suggesting that targeted screening can improve diagnosis of comorbidities and subsequent treatment.…”

Missed diagnosis and delayed treatment of acromegaly in a patient with severe diabetes: A case report

“…International consensus statement also recommend the use of cabergoline, a dopamine agonist (14). However, the Japanese Health Insurance System does not cover cabergoline, and therefore, bromocriptine was indicated in the present case (19). A previous report demonstrated the beneficial effects of bromocriptine in acromegaly-associated glucose abnormalities (16).…”

Bromocriptine therapy: Review of mechanism of action, safety and tolerability

“…Moreover, a significant number of patients bear invasive pituitary adenomas that are not curable surgically. In such cases, medical treatment is considered as a second‐line therapy 237,240 …”