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MacFarlane J, Korbonits M. Growth hormone receptor antagonist pegvisomant and its role in the medical therapy of growth hormone excess. Best Pract Res Clin Endocrinol Metab 2024; 38:101910. [PMID: 38981769 DOI: 10.1016/j.beem.2024.101910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Pegvisomant is a growth-hormone (GH) receptor antagonist that prevents the formation of the active heterotrimer of the dimerised GH receptor and the GH molecule necessary for downstream signal transduction. Over the past 20 years, it has become a key therapeutic option for physicians treating syndromes of GH/IGF-1 excess. Sufficient longitudinal follow-up data suggest that it can be deemed both safe and effective. It is the drug with the greatest potential for achieving an amelioration of the biochemical effects of GH excess with a corresponding normalisation of IGF-1 levels; however, insufficient dose titration has lessened real-world therapeutic outcomes. Theoretical concerns about stimulating tumour growth have been resolved as this has not been observed, while derangement of liver enzymes and local skin-related adverse reactions may occur in a minority of the patients. It may be a particularly impactful medication for the treatment of children, young people, and those with inherited disorders of GH excess, where other treatment modalities often fail. Combination therapy of pegvisomant with first- and second-generation somatostatin receptor ligands or with dopamine agonists remains an ongoing area of interest and research. High cost remains a barrier to the use of pegvisomant in many settings.
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Affiliation(s)
- James MacFarlane
- Cambridge Endocrine Molecular Imaging Group, Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
| | - Márta Korbonits
- Centre for Endocrinology, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
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Pirchio R, Auriemma RS, Vergura A, Pivonello R, Colao A. Investigational drugs for the treatment of acromegaly: new agents to transform therapy. Expert Opin Investig Drugs 2024; 33:509-522. [PMID: 38651260 DOI: 10.1080/13543784.2024.2343056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Disease control is essential to decrease morbidity burden and mortality in acromegaly patients. In the last decades, the availability of new drugs increased the rate of disease control. However, up to 55% of patients remain uncontrolled despite available treatment strategies in real-world data. The reasons for this finding may include poor adherence, inadequate tolerability, therapeutic inertia, and high costs. Since acromegaly is a chronic disease and medical therapy is usually life-long, patient's adherence to treatment is fundamental in both achieving and maintaining disease control. Less invasive routes of administration could improve adherence and concur to increase disease control rate. AREAS COVERED The aim of current review is to provide a detailed update about investigational drugs for acromegaly treatment currently under investigation as paltusotine, ONO-5788, AP102, GT-02037, ISIS 766720, CAM2024, Lanreotide PRF, DP1038, MTD201, solid dose injection of octreotide. EXPERT OPINION Medical therapy of acromegaly is an evolving field. Current studies are addressing patient's need for both new molecules and less invasive routes of administration for already existing drugs. It cannot be ruled out that drugs currently used for other diseases such as cancer could be considered in the future for the treatment of acromegaly.
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Affiliation(s)
- Rosa Pirchio
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - Renata S Auriemma
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - Alice Vergura
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Università Federico II di Napoli, Naples, Italy
- UNESCO Chair for Health Education and Sustainable Development, Federico II University, Naples, Italy
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Uygur MM, Villanova M, Frara S, Giustina A. Clinical Pharmacology of Oral Octreotide Capsules for the Treatment of Acromegaly. TOUCHREVIEWS IN ENDOCRINOLOGY 2024; 20:37-42. [PMID: 38812667 PMCID: PMC11132652 DOI: 10.17925/ee.2024.20.1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 05/31/2024]
Abstract
The primary goal of acromegaly treatment is to normalize biochemical parameters as it significantly reduces the risks of complications and comorbidities associated with the disease. First-line medical treatment is commonly represented by injectable somatostatin analogues (SRLs) after surgery. In June 2020, with the integration of Transient Permeation Enhancer® technology, oral octreotide capsules (OOCs) received regulatory approval from the US Food and Drug Administration for long-term maintenance treatment in patients with acromegaly who have responded to and tolerated treatment with octreotide or lanreotide. We reviewed the clinical pharmacological data on the development and clinical use of OOCs. The pharmacokinetic and pharmacodynamic data on OOCs showed a dose-dependent increase in octreotide levels and remarkable suppression of growth hormone secretion. The efficacy and safety of OOCs were investigated in four clinical trials conducted on patients with complete or partially controlled acromegaly. The trials resulted in the maintenance of biochemical control after switching from injectable SRLs to OOCs, with a comparable side-effect profile. Moreover, the acromegaly symptoms improved in patients on OOC. The data showed a patient preference to continue in the OOC arm for the extension phase of the trials. From the clinical pharmacological perspective, oral formulation of octreotide has the advantage of efficacy and safety with respect to injectable octreotide.
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Affiliation(s)
- Meliha Melin Uygur
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Endocrinology and Metabolism Disease, School of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Marta Villanova
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Frara
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Giustina
- Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
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Haberbosch L, Strasburger CJ. Efficacy and Safety of Pegvisomant in the Treatment of Acromegaly. Arch Med Res 2023; 54:102884. [PMID: 37659952 DOI: 10.1016/j.arcmed.2023.102884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/04/2023]
Abstract
Pegvisomant, the first and currently only clinically available growth hormone receptor antagonist, is an effective therapeutic option for the medical treatment of acromegaly, a rare disorder characterized by excessive growth hormone secretion. With now over 20 years of real world experience, its safety and efficacy is well-established. However, several aspects of its clinical use are still controversially discussed. The high cost of pegvisomant has limited its use in several countries, and recent studies have reported a lower efficacy than the initial clinical trials. A reported increase in tumor volume under therapy varies between studies and has been attributed to either actual growth or re-expansion after cessation of somatostatin receptor ligand therapy. Furthermore, different combinations of pegvisomant and other therapeutic agents aiming at reduction of acromegaly disease activity have been proposed to increase or retain effectiveness while lowering side effects and cost. This review aims to assess current clinical data on the safety and efficacy of pegvisomant while also addressing controversies surrounding its use.
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Affiliation(s)
- Linus Haberbosch
- Department of Endocrinology and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health at Charité Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Digital Clinician Scientist Program, Berlin, Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolism, Charité Universitätsmedizin Berlin, Berlin, Germany.
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Kwancharoen R, Deerochanawong C, Peerapatdit T, Salvatori R. Pituitary adenomas registry in Thailand. J Clin Neurosci 2023; 115:138-147. [PMID: 37572520 DOI: 10.1016/j.jocn.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Pituitary adenomas are the most common sellar tumors, and may cause adverse outcomes in terms of morbidity and mortality if left untreated or if diagnosis is delayed. No data exists on the prevalence, characteristics, and prognosis of pituitary adenomas in Thailand. The systematic registration of clinical characteristics may improve patient care and prognosis for this disease in Thailand. METHODS This was a retrospective study conducted in 11 academic referral centers. All patients diagnosed with pituitary adenomas during the 2011---2014 period were enrolled in the study. The information was correlated with two national databases. RESULTS A total of 1,283 pituitary adenoma patients were identified. The adenomas were: non-functioning 50.1%, prolactinoma 29.4%, acromegaly 14.7%, Cushing disease 3.8%, gonadotropin-producing tumor 1.0%, TSH-secreting tumor 0.6%. The mean age was 49.2±15.2 years. Sixty-three percent of patients were female. Most common complaint was visual impairment (27.7%). The average size of the tumor was 22.2±16.1 mm. Fifty-nine percent of patients underwent surgery. Median follow-up was 27.4 months (0-24 years). After treatment, 72.4% improved, and 10.4% were cured. Overall results of treatment in non-functioning adenoma, prolactinoma (medically treated), acromegaly, Cushing, TSH, gonadotropin producing adenoma were: improved/cured in 81/5.5, 86/5.7, 55.9/30, 54.2/31.2, 85.7/14.3, 69.2/15.4% respectively. CONCLUSION Pituitary adenomas in academic centers in Thailand were found predominantly in female in the 4th decade of life. After treatment 72.4% of patients improved and 10% had full recovery. A health promotion system aimed to improve patient and physician recognition and physician expertise may improve the prognosis of these diseases.
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Affiliation(s)
- Ratchaneewan Kwancharoen
- Division of Endocrinology and Metabolism, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand.
| | - Chaicharn Deerochanawong
- Division of Endocrinology and Metabolism, Rajavithi Hospital, College of Medicine, Rangsit University, Thailand
| | - Thawatchai Peerapatdit
- Division of Endocrinology and Metabolism, Faculty of Medicine Siriraj Hospital, Thailand
| | - Roberto Salvatori
- Division of Endocrinology and Metabolism Department of Medicine, Pituitary Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Patierno C, Fava GA, Carrozzino D. Illness Denial in Medical Disorders: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2023; 92:211-226. [PMID: 37429268 DOI: 10.1159/000531260] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/23/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. OBJECTIVE This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. METHODS The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. RESULTS The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. CONCLUSIONS This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.
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Affiliation(s)
- Chiara Patierno
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Danilo Carrozzino
- Department of Psychology "Renzo Canestrari," University of Bologna, Bologna, Italy
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Tönjes A, Quinkler M, Knappe U, Störmann S, Schöfl C, Schopohl J, Meyhöfer SM. [Treatment of acromegaly - data from the German Acromegaly Register]. Dtsch Med Wochenschr 2023; 148:380-385. [PMID: 36940688 DOI: 10.1055/a-1847-2553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Acromegaly is a rare disease in which chronic growth hormone overproduction (usually from an anterior pituitary adenoma) leads to various systemic complications. The management of acromegaly and the comorbidities of the disease is complex and requires a multidisciplinary approach. Early diagnosis is extremely important, as then the chances of a complete cure are significantly higher. The operation is the therapy of first choice and should be performed at a specialized center with an experienced neurosurgeon. With good patient information and guidance, the drug therapy of acromegaly patients in specialized practices and clinics can usually lead to biochemical control and thereby normalization of mortality risk. As with numerous rare diseases, care in specialized centers and recording and evaluation in registry studies can contribute to better patient care and the optimization of therapy and diagnostic guidelines. We assume that with the help of the German Acromegaly Registry, which currently includes more than 2500 patients with acromegaly, we will be able to present a realistic picture of the care situation in Germany in the coming years.
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Chiloiro S, Bianchi A, Giampietro A, Pontecorvi A, Raverot G, Marinis LD. Second line treatment of acromegaly: Pasireotide or Pegvisomant? Best Pract Res Clin Endocrinol Metab 2022; 36:101684. [PMID: 35931640 DOI: 10.1016/j.beem.2022.101684] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acromegaly is a chronic disease with an increased mortality in case of persistently active disease. The treatment of acromegaly is mainly based on the surgical resection of the GH secreting pituitary tumor and, in cases with persistent disease, on the medical therapy with first generation somatostatin analogues (first gen-SSAs). Data from national registries, meta-analysis and epidemiology studies showed that 24%-65% of acromegaly patients treated with first gen-SSA did not reach the control of disease, requiring second line therapies, as the second gen-SSAs and the GH receptor antagonist. According to the high efficacy of these treatments and their molecular mechanisms of action, the choice of second line therapies should be personalized. In this review, we summarize the evidence on clinical, molecular and morphological aspects that may predict the response to second line therapies, in order to integrate and translate in the clinical practice for a patient-tailored therapeutic approach.
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Affiliation(s)
- Sabrina Chiloiro
- Pituitary Unit, Division of Endocrinology and Metabolism, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, number 8, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Bianchi
- Pituitary Unit, Division of Endocrinology and Metabolism, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, number 8, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonella Giampietro
- Pituitary Unit, Division of Endocrinology and Metabolism, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, number 8, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Pituitary Unit, Division of Endocrinology and Metabolism, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, number 8, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gérald Raverot
- Fédération d'endocrinologie, Centre de référence Maladies Rares Hypophysaires (HYPO), Hospices Civils de Lyon, Groupement hospitalier Est, Bron, France; Université Lyon 1, Lyon, France; Inserm U1052, CNRS UMR5286, Cancer Research Center of Lyon, 69372, Lyon, France
| | - Laura De Marinis
- Pituitary Unit, Division of Endocrinology and Metabolism, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, number 8, Rome, Italy; Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
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Marazuela M, Blanco C, Bernabeu I, Menendez E, Villar R, Paja M, Sampedro-Nuñez M, Samaniego ML, Díaz-Muñoz M, Sánchez-Cenizo L. Acromegaly disease activity according to ACRODAT®, a cross-sectional study in Spain: ACROVAL study. Endocrine 2022; 75:525-536. [PMID: 34668173 PMCID: PMC8816757 DOI: 10.1007/s12020-021-02900-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate disease activity status using the Acromegaly Disease Activity Tool (ACRODAT®) in a cohort of Spanish acromegaly patients, to assess the relationship between the level of disease activity according to both ACRODAT® and the physicians' clinical evaluation, and to study the potential discrepancies in the perception of symptoms between physicians and patients. DESIGN Multicenter, observational, descriptive and cross-sectional study. METHODS Disease activity was assessed in adult patients with acromegaly under pharmacological treatment during at least 6 months using ACRODAT®. RESULTS According to ACRODAT®, 48.2%, 31.8% and 20.0% of a total of 111 patients were classified as having a stable disease (S), mild disease activity (M-DA) and significant disease activity (S-DA) respectively. ACRODAT® classification of disease activity significantly correlated with physicians' opinion, with a moderate inter-rater agreement and a specificity of 92.45% (PPV = 86.21%). No correlation was found between IGF-I levels and severity of symptoms or quality of life (QoL). A decision to take clinical action was significantly more frequent in S-DA and M-DA patients than S patients but no action was taken on 5 (22.7%) and 27 (77.1%) S-DA and M-DA patients, respectively CONCLUSIONS: ACRODAT® detected disease activity in 51.8% of patients. Interestingly, although M-DA and S-DA patients were likely to be in the process of being controlled, action was not always taken on these patients. ACRODAT® is a validated and highly specific tool that may be useful to routinely monitor acromegaly and to identify patients with non-obvious disease activity by incorporating "patient-centred" parameters like symptoms and QoL to the clinical evaluation of acromegaly.
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Affiliation(s)
- Mónica Marazuela
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
| | - Concepción Blanco
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ignacio Bernabeu
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Edelmiro Menendez
- Hospital Universitario Central de Asturias (HUCA), Instituto de investigación del Principado de Asturias (ISPA), Oviedo, Asturias, Spain
| | - Rocío Villar
- Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - Miguel Paja
- Hospital Universitario de Basurto, Bilbao, Vizcaya, Spain
| | - Miguel Sampedro-Nuñez
- Hospital Universitario de La Princesa, Madrid, Universidad Autónoma de Madrid, Madrid, Spain
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Kamusheva M, Parvanova A, Rusenova Y, Vandeva S, Elenkova A. Do We Need a Specific Guideline for Assessment and Improvement of Acromegaly Patients Adherence? Front Public Health 2021; 9:693409. [PMID: 34336773 PMCID: PMC8316723 DOI: 10.3389/fpubh.2021.693409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Adherence to therapy is one of the most important elements during the therapeutic process ensuring the predefined therapeutic outcomes. The aim is to analyze the need and importance of treatment adherence guideline for acromegaly patients and the possibilities for its development and implementation in Bulgaria. Methods: A set of methods was applied: (1) a literature review in the electronic database for identification of articles and guidelines related to adherence and acromegaly; (2) analysis of Bulgarian legislative documents; (3) a pilot study for assessment of the level of treatment adherence among hospitalized Bulgarian acromegaly patients in 2018; (4) a plan for development and implementation of specific guideline was created entitled BULMEDACRO - BULgarian guideline for MEdication aDherence assessment and improvement in ACROmegaly. Results: No specific guidelines for evaluation, monitoring, reporting and/or improving adherence in acromegaly patients has been found in the literature. Requirements for regular assessment of the level of adherence, application of appropriate methods for improvement and monitoring are not sufficiently formulated and mandatory. The pilot study confirmed that therapy adherence among Bulgarian patients with acromegaly is relatively high as almost 90% of patients report that they strictly comply with their prescribed treatment regimen. It is necessary, however, a specific guideline focused on the methods for assessment and improvement of adherence, in order to ensure monitoring and follow-up of acromegaly patients. Conclusions: Patients with acromegaly should be the focus of specially designed national programs, initiatives and/or guidelines for regular evaluation and improvement of the adherence level. Despite the difficulties and the lack of an adequate legal basis, successive steps initiated by different stakeholder are needed.
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Affiliation(s)
- Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University – Sofia, Sofia, Bulgaria
| | - Alexina Parvanova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University – Sofia, Sofia, Bulgaria
| | - Yanitsa Rusenova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University – Sofia, Sofia, Bulgaria
| | - Silvia Vandeva
- Department of Endocrinology, University Specialized Hospital for Active Treatment of Endocrinology (USHATE) “Acad. Ivan Penchev,” Medical University – Sofia, Sofia, Bulgaria
| | - Atanaska Elenkova
- Department of Endocrinology, University Specialized Hospital for Active Treatment of Endocrinology (USHATE) “Acad. Ivan Penchev,” Medical University – Sofia, Sofia, Bulgaria
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Störmann S, Schopohl J, Bullmann C, Terkamp C, Christ-Crain M, Finke R, Flitsch J, Kreitschmann-Andermahr I, Luger A, Stalla G, Houchard A, Helbig D, Petersenn S. Multicenter, Observational Study of Lanreotide Autogel for the Treatment of Patients with Acromegaly in Routine Clinical Practice in Germany, Austria and Switzerland. Exp Clin Endocrinol Diabetes 2020; 129:224-233. [PMID: 33285601 DOI: 10.1055/a-1247-4713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Evidence from controlled trials has shown that lanreotide autogel is effective in achieving biochemical and symptom control in patients with acromegaly. However, it is important to better understand the real-world patient population receiving lanreotide autogel treatment. METHODS In this non-interventional study the long-term treatment response to lanreotide autogel in adult patients with acromegaly from office-based centers or clinics in Germany, Austria and Switzerland was studied. Assessments included growth hormone and insulin-like growth factor-I levels, symptoms, quality of life, lanreotide plasma levels and tumor somatostatin receptor subtype expression. The primary endpoint was achievement of full biochemical control, defined as growth hormone ≤2.5 µg/L and insulin-like growth factor I normalization at month 12. RESULTS 76 patients were enrolled from 21 sites. 7/51 (13.7%) patients of the efficacy population had full biochemical control at baseline, 15/33 (45.5%) at month 12 and 10/26 (38.5%) at month 24 of treatment. At 12 months of treatment higher rates of biochemical control were observed in the following subgroups: older patients (>53 years [median]), females, treatment-naïve patients, and patients with a time since diagnosis of longer than 1.4 years (median). No clinically relevant differences in acromegaly symptoms or quality of life scores were observed. Median fasting blood glucose and glycated hemoglobin levels remained unchanged throughout the study. No new safety signals were observed. Overall tolerability of treatment with lanreotide autogel was judged by 80.8% of the enrolled patients at month 12 as 'very good' or 'good'. CONCLUSION Treatment with lanreotide autogel in a real-world setting showed long-term effectiveness and good tolerability in patients with acromegaly.
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Affiliation(s)
- Sylvère Störmann
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | - Jochen Schopohl
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany
| | | | - Christoph Terkamp
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover
| | - Mirjam Christ-Crain
- Clinic of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel
| | | | - Jörg Flitsch
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg
| | - Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Anton Luger
- Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna
| | - Günter Stalla
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Germany.,MEDICOVER Neuroendocrinology MVZ, Munich
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Bernabéu I, Fajardo C, Marazuela M, Cordido F, Venegas EM, de Pablos-Velasco P, Maroto GP, Olvera MP, de Paz IP, Carvalho D, Romero C, De la Cruz G, Escolá CÁ. Effectiveness of lanreotide autogel 120 mg at extended dosing intervals for acromegaly. Endocrine 2020; 70:575-583. [PMID: 32725444 PMCID: PMC7674328 DOI: 10.1007/s12020-020-02424-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/13/2020] [Indexed: 12/03/2022]
Abstract
PURPOSE Recent data indicate that extended dosing intervals (EDIs) with lanreotide autogel 120 mg are effective and well-received among patients with acromegaly who have achieved biochemical control with monthly injections of long-acting somatostatin analogues (SSAs). We further evaluated the effectiveness of lanreotide autogel 120 mg delivered at EDIs (>4 weeks) in routine clinical practice. METHODS Cross-sectional, multicentre, observational study conducted to determine the effectiveness-measured by control of serum insulin-like growth factor 1 (IGF-1)-of lanreotide autogel 120 mg at dosing intervals >4 weeks for ≥6 months in selected patients with acromegaly treated in routine clinical practice (NCT02807233). Secondary assessments included control of growth hormone (GH) levels, treatment adherence, patient satisfaction, and quality of life (QoL) using validated questionnaires (EQ-5D, AcroQoL, and TSQM-9). Patients who received radiotherapy within the last 6 months were excluded. RESULTS Among 109 patients evaluated, mean (SD) age was 59.1 (13.2) years. IGF-1 values were normal (mean [SD]: 175.0 [74.5], 95% CI: 160.8 -189.1) in 91.7% of cases and normal in 91.4% of patients without previous radiotherapy treatment (n = 81). GH levels were ≤2.5 and ≤1 ng/mL, respectively, in 80.6% and 58.3%. Most patients were treated either every 5-6 (57.8%) or 7-8 weeks (38.5%), with 2.8% treated greater than every 8 weeks. The mean AcroQoL score was 63.0 (20.1). The mean global treatment satisfaction score (TSQM-9) was 75.1 (16.6). Treatment adherence (defined as no missed injections) was 94.5%. CONCLUSION Lanreotide autogel 120 mg at intervals of >4 weeks provided IGF-1 control in more than 90% of patients with acromegaly. Treatment satisfaction and adherence were good. These findings support use of extended dosing intervals in patients who have achieved good biochemical control with long-acting SSAs.
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Affiliation(s)
- Ignacio Bernabéu
- Endocrinology and Nutrition Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain.
| | - Carmen Fajardo
- Endocrinology and Nutrition Department, Hospital Universitario de La Ribera, Alzira (Valencia), Spain
| | - Mónica Marazuela
- Endocrinology and Nutrition Department, Hospital Universitario La Princesa, Universidad Autónoma Madrid, Instituto Princesa, Madrid, Spain
| | - Fernando Cordido
- Faculty of Health Sciences and INIBIC, University of A Coruña, and Endocrinology and Nutrition Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Eva María Venegas
- Endocrinology and Nutrition Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Pedro de Pablos-Velasco
- Endocrinology and Nutrition Department, University of Las Palmas de Gran Canaria. Spain, Las Palmas, Spain
| | - Gonzalo Piedrola Maroto
- Endocrinology and Nutrition Departament Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Pilar Olvera
- Endocrinology and Nutrition Departament, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Isabel Pavón de Paz
- Endocrinology and Nutrition Departament, Hospital Universitario de Getafe, Madrid, Spain
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário São João, Faculty of Medicine, i3S, Universidade do Porto, Porto, Portugal
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Al Dahmani K, Afandi B, Elhouni A, Dinwal D, Philip J, Bashier A, Beshyah SA, Nagelkerke N, Alkaabi JM. Clinical Presentation, Treatment, and Outcome of Acromegaly in the United Arab Emirates. Oman Med J 2020; 35:e172. [PMID: 32995046 PMCID: PMC7503193 DOI: 10.5001/omj.2020.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/04/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives We sought to ascertain the clinical characteristics and control rate of acromegaly in the UAE. Methods We conducted a multicenter retrospective analysis of all patients presenting with acromegaly to six endocrine centers in the UAE between November 2010 and December 2018. Demographic, clinical, biochemical, and radiologic data were collected. Patients were considered controlled if normal insulin-like growth factor-1 (IGF-1) level and growth hormone < 1 mcg/L were achieved at their last visit. Results A total of 75 patients were included in the study (60.0% males, 33.3% native UAE nationals). The mean age at diagnosis was 37.2 (range: 12-69) years. Common clinical features at diagnosis were headache (82.4%), coarse facial features (82.4%), acral enlargement (79.7%), and sweating (31.3%). Diabetes mellitus/prediabetes and hypertension were present in 45.2% and 35.5% of patients, respectively. About 82.2% had pituitary macroadenoma on pituitary magnetic resonance imaging. At presentation, 27.0% and 3.2% of the patients had secondary hypogonadism and diabetes insipidus, respectively. Overall, 76.7% of the patients underwent surgery, 20.8% received radiotherapy, and 50.7% received medical therapy. At their last clinic visit, only 43.7% of all patients achieved disease control. Conclusions Our study shows a high prevalence of pituitary macroadenoma in our acromegalic population, suggesting a delayed diagnosis. Also, a significant proportion of patients remained uncontrolled. Efforts to increase physician's awareness of acromegaly and to improve disease control are underway.
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Affiliation(s)
- Khaled Al Dahmani
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Bachar Afandi
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Ali Elhouni
- Endocrine and Diabetes Center, Tawam Hospital, Al Ain, UAE.,Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE
| | - Denish Dinwal
- Division of Endocrinology, New Medical Center, Abu Dhabi, UAE
| | - Jim Philip
- Division of Endocrinology, New Medical Center, Al Ain, UAE
| | - Alaaeldin Bashier
- Department of Endocrinology, Dubai Hospital, Dubai Health Authority, Dubai, UAE
| | - Salem A Beshyah
- Division of Endocrinology, Mediclinic, Abu Dhabi, UAE.,Department of Medicine, Dubai Medical College, Dubai, UAE
| | | | - Juma M Alkaabi
- Department of Medicine, College of Medicine and Health Science, UAE University, Al Ain, UAE.,Division of Endocrinology, Al Ain Hospital, Al Ain, UAE
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14
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Colao A, Grasso LFS, Di Cera M, Thompson-Leduc P, Cheng WY, Cheung HC, Duh MS, Neary MP, Pedroncelli AM, Maamari R, Pivonello R. Association between biochemical control and comorbidities in patients with acromegaly: an Italian longitudinal retrospective chart review study. J Endocrinol Invest 2020; 43:529-538. [PMID: 31741320 PMCID: PMC7067716 DOI: 10.1007/s40618-019-01138-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/26/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Achieving biochemical control (normalization of insulin-like growth factor-1 [IGF-1] and growth hormone [GH]) is a key goal in acromegaly management. However, IGF-1 and GH fluctuate over time. The true potential impact of time-varying biochemical control status on comorbidities is unclear and relies on multiple, longitudinal IGF-1 and GH measurements. This study assessed the association between time-varying biochemical control status and onset of selected comorbidities in patients with acromegaly. METHODS Medical charts of adults with confirmed acromegaly and ≥ 6 months of follow-up at an Italian endocrinology center were reviewed. Patients were followed from the first diagnosis of acromegaly at the center until loss to follow-up, chart abstraction, or death. Biochemical control status was assessed annually and defined as IGF-1 ≤ the upper limit of normal, or GH ≤ 2.5 µg/L in the few cases where IGF-1 was unavailable. Time-varying Cox models were used to assess the association between biochemical control status and comorbidities. RESULTS Among 150 patients, 47% were female, average age at diagnosis was 43.1, and mean length of follow-up was 10.4 years. Biochemical control was significantly associated with a lower hazard of diabetes (HR = 0.36, 95% CI 0.15; 0.83) and cardiovascular system disorders (HR = 0.54, 95% CI 0.31; 0.93), and a higher hazard of certain types of arthropathy (HR = 1.68, 95% CI 1.04; 2.71); associations for other comorbidities did not reach statistical significance. CONCLUSION Results further support the importance of achieving biochemical control, as this may reduce the risk of high-burden conditions, including diabetes and cardiovascular system disorders. The association for arthropathy suggests irreversibility of this impairment. Due to limitations, caution is required when interpreting these results.
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Affiliation(s)
- A Colao
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy.
| | - L F S Grasso
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
| | - M Di Cera
- Dipartimento di Medicina e Scienze della Saluta di V. Tiberio, Università degli Studi del Molise, Campobasso, Italy
| | | | - W Y Cheng
- Analysis Group, Inc., Boston, MA, USA
| | | | - M S Duh
- Analysis Group, Inc., Boston, MA, USA
| | - M P Neary
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - R Maamari
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - R Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università Federico II di Napoli, Via S. Pansini 5, 80131, Naples, Italy
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15
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Giustina A, Bronstein MD, Chanson P, Petersenn S, Casanueva FF, Sert C, Houchard A, Melmed S. Staging and managing patients with acromegaly in clinical practice: baseline data from the SAGIT® validation study. Pituitary 2019; 22:476-487. [PMID: 31338660 PMCID: PMC6728296 DOI: 10.1007/s11102-019-00977-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The SAGIT® instrument, designed to assist clinicians to stage acromegaly, assess treatment response and adapt patient management, was well received by endocrinologists in a pilot study. We report an interim analysis of baseline data from the validation phase. METHODS The SAGIT® validation study (ClinicalTrials.gov NCT02539927) is an international, non-interventional study. Data collection included: demographic/disease characteristics; medical/surgical histories; concomitant acromegaly treatments; investigators' subjective evaluation of disease-control status (clinical global evaluation of disease control [CGE-DC]; controlled/not controlled/yet to be clarified) and clinical disease activity (active/not active); growth hormone (GH) and insulin-like growth factor-1 (IGF-1) levels; investigators' therapeutic decision. RESULTS Of 228 patients enrolled, investigators considered disease to be controlled in 110 (48.2%), not controlled in 105 (46.1%), and yet to be clarified in 13 (5.7%) according to CGE-DC. Thirty-three patients were treatment-naïve (not controlled, n = 31; yet to be clarified, n = 2). Investigators considered 48.2% patients in the controlled and 95.2% in the not-controlled groups to have clinically active disease. In the controlled group, 29.7% of patients did not exhibit hormonal control (GH ≤ 2.5 µg/L; normalized IGF-1) and 47.3% did not have rigorous hormonal control (GH < 1.0 µg/L; normalized IGF-1) by contemporary consensus. Current acromegaly treatment was continued with no change for 91.8% of patients in the controlled and 40.0% in the not-controlled groups. CONCLUSIONS These data highlight discrepancies between investigator-evaluated disease-control status, disease activity, hormonal control, and treatment decisions in acromegaly. Once validated, the SAGIT® instrument may assist clinicians in making active management decisions for patients with acromegaly.
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Affiliation(s)
- Andrea Giustina
- San Raffaele University Hospital Milan, 20132, Milan, Italy.
| | | | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Centre de Référence des Maladies Rares de l'Hypophyse (HYPO), Service d'Endocrinologie et des Maladies de la Reproduction and Univ Paris-Sud, University Paris-Saclay, Paris, Le Kremlin Bicêtre, France
| | | | - Felipe F Casanueva
- Instituto Salud Carlos III, Santiago de Compostela University - CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Santiago de Compostela, Spain
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16
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Ceccato F, Scaroni C. Central adrenal insufficiency: open issues regarding diagnosis and glucocorticoid treatment. ACTA ACUST UNITED AC 2019; 57:1125-1135. [DOI: 10.1515/cclm-2018-0824] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022]
Abstract
Abstract
Background
Central adrenal insufficiency (CAI) is characterized by impaired adrenocorticotropin (ACTH) secretion because of a disease or injury to the hypothalamus or the pituitary, leading to a reduced cortisol production. CAI suspicion arises more frequently in patients with pituitary tumors, cranial irradiation/surgery/injury/infections, as well as after exogenous glucocorticoid withdrawal. Nevertheless, a late diagnosis is not uncommon because CAI may present with nonspecific signs or symptoms, as fatigue or hyponatremia.
Content
The PubMed database was searched (years 1980–2018), using “central adrenal insufficiency” and “ACTH deficiency” as keywords. Subsequently, reference sections of the retrieved articles were searched.
Summary
Dynamic tests are needed when morning basal cortisol levels are not sufficient to exclude or to confirm CAI. Short Synacthen Test (SST) is the most used, and Endocrine Society’s guidelines recommend a cortisol peak >500 nmol/L to exclude CAI. Despite thresholds, understanding the pretest probability of ACTH deficiency (the clinical background of the patient) is essential because the diagnostic accuracy of SST in case of a negative result is suboptimal. Glucocorticoid replacement therapy, able to replicate cortisol circadian rhythm, is required in patients with CAI; fludrocortisone treatment is not necessary. Short-acting glucocorticoid drugs (hydrocortisone or cortisone acetate) are the most used; lower doses than previously used are nowadays recommended to reduce cortisol-related comorbidities. Promising results have been obtained with modified-release hydrocortisone, especially regarding glucose metabolism in patients with primary adrenal insufficiency.
Outlook
An accurate clinical diagnosis and a careful individualized therapy are mandatory in patients with CAI.
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18
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Cámara R, Venegas E, García-Arnés JA, Cordido F, Aller J, Samaniego ML, Mir N, Sánchez-Cenizo L. Treatment adherence to pegvisomant in patients with acromegaly in Spain: PEGASO study. Pituitary 2019; 22:137-145. [PMID: 30756345 DOI: 10.1007/s11102-019-00943-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The burden of chronic daily subcutaneous administration of pegvisomant on adherence has not been previously studied. This study was aimed to determine the adherence to pegvisomant treatment in acromegaly patients in the real-world clinical practice setting in Spain. METHODS Multicenter, observational, descriptive, cross-sectional study in patients with acromegaly treated with pegvisomant for at least 12 months. Patient adherence was indirectly determined by Batalla and Haynes-Sackett questionnaires and directly by prescription record review. Additionally, treatment satisfaction was assessed by the Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) and treatment convenience by an ad-hoc Pegvisomant questionnaire. Errors in reconstitution and administration process were determined by direct observation. RESULTS 108 patients were included in the analysis. Rates of adherence varied from 60.7 to 92.1% and did not correlate with disease control. Older patient age and alternative schedules other than daily pegvisomant dosing were associated with lower adherence. Treatment satisfaction and convenience was high, with a mean (SD) total SATMED-Q score of 74.6 ± 15.4 over 100 and a total ad-hoc Pegvisomant questionnaire score of 71.2 ± 15.2 over 100. 34.3% of patients made mistakes during the reconstitution /administration process. CONCLUSIONS Patient adherence to pegvisomant was high (60.7-92.1%), but more than a third of the patients in the study made mistakes during the administration process, with a potential impact on disease control. Besides dosing compliance, correct administration of medication should be carefully assessed in these patients.
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Affiliation(s)
- Rosa Cámara
- Hospital Universitario y Politécnico La Fe, Avenida de Fernando Abril Martorell, 106, 46026, Valencia, Spain
| | - Eva Venegas
- Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot, s/n, 41013, Sevilla, Spain
| | | | - Fernando Cordido
- Complejo Hospitalario Universitario A Coruña, As Xubias, 84, 15006, La Coruña, Spain
| | - Javier Aller
- Hospital Universitario Puerta de Hierro-Majadahonda, Calle Manuel de Falla, 1, 28222, Majadahonda, Madrid, Spain
| | - M Luz Samaniego
- TFS Statistical Services, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Nuria Mir
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain
| | - Laura Sánchez-Cenizo
- Pfizer S.L.U, Avda. Europa, 20B. Parque Empresarial La Moraleja, 28108, Alcobendas, Madrid, Spain.
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19
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Tseng FY, Huang TS, Lin JD, Chen ST, Wang PW, Chen JF, Huey-Herng Sheu W, Chang TC. A registry of acromegaly patients and one year following up in Taiwan. J Formos Med Assoc 2019; 118:1430-1437. [PMID: 30612883 DOI: 10.1016/j.jfma.2018.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/21/2018] [Accepted: 12/19/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/PURPOSE The objectives of this study were to describe epidemiological data, treatment outcomes, and quality of life (QOL) of patients with acromegaly in Taiwan. METHODS From 2013 to 2015, subjects with acromegaly were recruited through five medical centers. After enrollment, each patient was kept on observation for 1 year. RESULTS The analyzed cohort included 272 acromegalic subjects (117 males, 155 females) with a mean age of 51.4 ± 12.9 years. Their mean age at diagnosis was 41.8 ± 12.1 years. About 83.8% patients presented symptoms of facial changes. Galactorrhea was noted at the earliest age of 32.7 ± 9.1 years. The duration between the onset of symptoms/signs and diagnosis was 6.9 ± 8.1 years. Around 70.3% patients harbored a macroadenoma. At enrollment, percentages of patients ever received surgical intervention, radiotherapy, somatostatin analogs, and dopamine agonists were 94.8%, 27.9%, 64%, and 30%, respectively. At the final following-up visit, the random growth hormone (GH), nadir GH after oral glucose tolerance test, and the insulin-like growth factor 1 levels were 2.7 ± 4.9 μg/L, 2.4 ± 6.1 μg/L, and 291.5 ± 162.4 ng/mL, respectively. The remission rate assessed by random GH level (≦2 μg/L) was 63.8%. The mean AcroQoL scores for the total 22 items were 64.0 ± 19.7. About 42.8% patients never sensed or felt discomfort about their changes in appearance. CONCLUSION This study described the profiles of acromegaly in Taiwan. It is important to enhance early diagnosis and timely commencement of treatment to prevent serious complications of acromegaly.
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Affiliation(s)
- Fen-Yu Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tien-Shang Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Der Lin
- Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Department of Internal Medicine, Linkuo Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Wen Wang
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jung-Fu Chen
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wayne Huey-Herng Sheu
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tien-Chun Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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20
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Park HH, Kim EH, Ku CR, Lee EJ, Kim SH. Outcomes of Aggressive Surgical Resection in Growth Hormone–Secreting Pituitary Adenomas with Cavernous Sinus Invasion. World Neurosurg 2018; 117:e280-e289. [DOI: 10.1016/j.wneu.2018.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/01/2018] [Accepted: 06/02/2018] [Indexed: 12/19/2022]
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Kasuki L, Wildemberg LE, Gadelha MR. MANAGEMENT OF ENDOCRINE DISEASE: Personalized medicine in the treatment of acromegaly. Eur J Endocrinol 2018; 178:R89-R100. [PMID: 29339530 DOI: 10.1530/eje-17-1006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
Acromegaly is associated with high morbidity and elevated mortality when not adequately treated. Surgery is the first-line treatment for most patients as it is the only one that can lead to immediate cure. In patients who are not cured by surgery, treatment is currently based on a trial-and-error approach. First-generation somatostatin receptor ligands (fg-SRL) are initiated for most patients, although approximately 25% of patients present resistance to this drug class. Some biomarkers of treatment outcome are described in the literature, with the aim of categorizing patients into different groups to individualize their treatments using a personalized approach. In this review, we will discuss the current status of precision medicine for the treatment of acromegaly and future perspectives on the use of personalized medicine for this purpose.
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Affiliation(s)
- Leandro Kasuki
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
- Endocrine Unit, Hospital Federal de Bonsucesso, Rio de Janeiro, Brazil
| | - Luiz Eduardo Wildemberg
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica R Gadelha
- Neuroendocrinology Research Center/Endocrine Section and Medical School, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuroendocrine Section, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
- Neuropathology and Molecular Genetics Laboratory, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
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22
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van der Lely AJ, Gomez R, Pleil A, Badia X, Brue T, Buchfelder M, Burman P, Clemmons D, Ghigo E, Jørgensen JOL, Luger A, van der Lans-Bussemaker J, Webb SM, Strasburger CJ. Development of ACRODAT ®, a new software medical device to assess disease activity in patients with acromegaly. Pituitary 2017; 20:692-701. [PMID: 28887782 PMCID: PMC5655576 DOI: 10.1007/s11102-017-0835-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE Despite availability of multimodal treatment options for acromegaly, achievement of long-term disease control is suboptimal in a significant number of patients. Furthermore, disease control as defined by biochemical normalization may not always show concordance with disease-related symptoms or patient's perceived quality of life. We developed and validated a tool to measure disease activity in acromegaly to support decision-making in clinical practice. METHODS An international expert panel (n = 10) convened to define the most critical indicators of disease activity. Patient scenarios were constructed based on these chosen parameters. Subsequently, a panel of 21 renowned endocrinologists at pituitary centers (Europe and Canada) categorized each scenario as stable, mild, or significant disease activity in an online validation study. RESULTS From expert opinion, five parameters emerged as the best overall indicators to evaluate disease activity: insulin-like growth factor I (IGF-I) level, tumor status, presence of comorbidities (cardiovascular disease, diabetes, sleep apnea), symptoms, and health-related quality of life. In the validation study, IGF-I and tumor status became the predominant parameters selected for classification of patients with moderate or severe disease activity. If IGF-I level was ≤1.2x upper limit of normal and tumor size not significantly increased, the remaining three parameters contributed to the decision in a compensatory manner. CONCLUSION The validation study underlined IGF-I and tumor status for routine clinical decision-making, whereas patient-oriented outcome measures received less medical attention. An Acromegaly Disease Activity Tool (ACRODAT) is in development that might assist clinicians towards a more holistic approach to patient management in acromegaly.
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Affiliation(s)
- Aart J van der Lely
- Erasmus University Medical Center, Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Roy Gomez
- Pfizer Medical Affairs, 17 Boulevard de la Plaine, 1050, Brussels, Belgium.
| | - Andreas Pleil
- Pfizer Inc, 10555 Science Center Drive, San Diego, CA, 92121, USA
| | - Xavier Badia
- University of Barcelona and Omakase Consulting, Gran Via de les Corts Catalanes, 585, 08007, Barcelona, Spain
| | - Thierry Brue
- Aix-Marseille Université, APHM, Hôpital Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares de l'hypophyse HYPO, 13385 Cedex 15, Marseille, France
| | - Michael Buchfelder
- Neurochirurgische Klinik, Universitatsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Pia Burman
- Skane University Hospital, University of Lund, Jan Waldenströms gata 24, Malmö, Sweden
| | - David Clemmons
- UNC Hospitals Diabetes and Endocrinology Clinic, 300 Meadowmont Village Cir #202, Chapel Hill, NC, 27517, USA
| | - Ezio Ghigo
- University Hospital Città Salute e Scienza, Via Gianfranco Zuretti, 29, 10126, Turin, Italy
| | - Jens Otto Lunde Jørgensen
- Aarhus University, Institut for Klinisk Medicin - Medicinsk Endokrinologisk afdeling MEA, NBG, Nørrebrogade 44, 8000, Aarhus, Denmark
| | - Anton Luger
- Medizinische Universität und Allgemeines Krankenhaus Wien, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Susan M Webb
- Hospital and IIB-S Pau Barcelona, UAB and CIBERER Unit 747, Padre Claret 167, 08025, Barcelona, Spain
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Maione L, Brue T, Beckers A, Delemer B, Petrossians P, Borson-Chazot F, Chabre O, François P, Bertherat J, Cortet-Rudelli C, Chanson P. Changes in the management and comorbidities of acromegaly over three decades: the French Acromegaly Registry. Eur J Endocrinol 2017; 176:645-655. [PMID: 28246150 DOI: 10.1530/eje-16-1064] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/14/2017] [Accepted: 02/27/2017] [Indexed: 01/25/2023]
Abstract
CONTEXT Acromegaly is a rare disease associated with chronic multisystem complications. National registries have been created in several countries. DESIGN The French Registry contains data on acromegaly epidemiology, management and comorbidities recorded over more than three decades, retrospectively until 1999 and prospectively from 1999 to 2012. RESULTS Data could be analyzed for 999 of the 1034 patients included in the registry (46% males). Disease control, defined as IGF-I normalization (adjusted for age and sex), was achieved in 75% of patients at the last follow-up visit. Half the patients with uncontrolled disease had IGF-I levels below 1.5 times the upper limit of normal (ULN). The proportion of patients with surgically cured disease did not change markedly over time, whereas the proportion of patients with uncontrolled disease fell and the proportion of patients with medically controlled disease rose. Cardiovascular, metabolic, respiratory and rheumatologic comorbidities and their outcomes were recorded for most patients, and no noteworthy overall deterioration was noted over time. Cancer occurred in 10% of patients, for a standardized incidence ratio of 1.34 (95% CI: 0.94-1.87) in men and 1.24 (0.77-1.73) in women. Forty-one patients died during follow-up, for a standardized mortality ratio of 1.05 (0.70-1.42). Most deaths were due to cancer. CONCLUSIONS The majority of patients with acromegaly now have successful disease control thanks to the multistep management. The incidence of comorbidities following diagnosis of acromegaly is very low. Life expectancy is now close to that of the general population, probably owing to better management of the GH/IGF-I excess and comorbidities.
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Affiliation(s)
- Luigi Maione
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France
| | - Thierry Brue
- Université Aix-Marseille and Assistance Publique-Hôpitaux de MarseillePôle ENDO (Endocrinologie, Diabète, Obésité Nutrition), Hôpital de la Conception, Marseille, France
| | - Albert Beckers
- Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Brigitte Delemer
- Service d'EndocrinologieDiabète et Nutrition, Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Patrick Petrossians
- Département de Médecine InterneService d'Endocrinologie, Centre Hospitalier Universitaire de Liège, Université de Liège, Domaine Universitaire du Sart-Tilman, Liège, Belgium
| | - Françoise Borson-Chazot
- Université Lyon 1Lyon, France
- Hospices Civils de LyonFédération d'Endocrinologie du pôle Est, Lyon, France
- INSERM U1052UMR CNRS 5286, Centre de Recherche en Cancérologie de Lyon, Equipe Tumeurs Endocrines, Lyon, France
| | - Olivier Chabre
- Service d'Endocrinologie-Diabétologie-NutritionPôle Digidune, Centre Hospitalier Universitaire de Grenoble and Université Grenoble Alpes, Grenoble, France
| | - Patrick François
- Service de NeurochirurgieCHRU de Tours; and Université François-Rabelais de Tours, Tours, France
| | - Jérôme Bertherat
- Assistance Publique Hôpitaux de ParisService d'Endocrinologie, Hôpital Cochin, and Université Paris Descartes, Sorbonne Paris Cité, and INSERM U1016, CNRS UM8104, Institut Cochin, Paris, France
| | - Christine Cortet-Rudelli
- Service de DiabétologieEndocrinologie et des Maladies Métaboliques, Hôpital Huriez, CHU de Lille, Lille, France
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de ParisHôpital de Bicêtre, Service d'Endocrinologie et des Maladies de la Reproduction, Le Kremlin Bicêtre, France
- Univ Paris-SudFaculté de Médecine Paris-Sud, Unité Mixte de Recherche-S1185, Le Kremlin Bicêtre, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1185Le Kremlin Bicêtre, France
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Varadhan L, Reulen RC, Brown M, Clayton RN. The role of cumulative growth hormone exposure in determining mortality and morbidity in acromegaly: a single centre study. Pituitary 2016; 19:251-61. [PMID: 26724807 DOI: 10.1007/s11102-015-0700-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Acromegaly has traditionally been associated with significant mortality and cardiovascular morbidity. The aim of this study was to assess the overall mortality and improvement in mortality and morbidity in acromegaly and correlate these with cumulative growth hormone exposure. METHODS All patients treated for acromegaly at our centre until 2012 were analysed in this retrospective observational study. Baseline demographic details such as age at diagnoses, radiological features and pituitary status were obtained on these 167 patients. Cumulative GH levels (GHy) were calculated as a sum of average of GH readings in consecutive years. Mortality rates and development of new diabetes, hypertension and cardiovascular events (stroke, congestive cardiac failure and ischaemic heart disease) were assessed. RESULTS The SMR for overall cohort was 1.6. There has been a significant improvement in SMR over the past two decades (SMR until 1992 2.5; SMR since 1992 1.0). Cumulative GH exposure was significantly high in patients who died (35.2 vs 24.1, p < 0.01) and in those with incident metabolic or vascular events during follow up (51.6 vs 24.4, p = 0.0001). The cardiovascular event rate of the 'new' cohort was significantly better than the 'old' cohort (8.0 vs. 29.1 %, p < 0.001). CONCLUSION There has been significant improvement in mortality and morbidity associated with acromegaly, in the setting of routine care in a specialized endocrine unit. Early and effective treatment to 'control' acromegaly could reduce GH exposure and hence vascular comorbidities.
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Affiliation(s)
- Lakshminarayanan Varadhan
- Department of Diabetes and Endocrinology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK.
| | - Raoul C Reulen
- Department of Public Health and Epidemiology, Centre for Childhood Cancer Survivor Studies, University of Birmingham, Birmingham, UK
| | - Maureen Brown
- Department of Diabetes and Endocrinology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
| | - Richard N Clayton
- Department of Diabetes and Endocrinology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, ST4 6QG, UK
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Kreitschmann-Andermahr I, Siegel S, Kleist B, Kohlmann J, Starz D, Buslei R, Koltowska-Häggström M, Strasburger CJ, Buchfelder M. Diagnosis and management of acromegaly: the patient's perspective. Pituitary 2016; 19:268-76. [PMID: 26742496 DOI: 10.1007/s11102-015-0702-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Early diagnosis is a success factor for the prevention of long-term comorbidity and premature death in patients with acromegaly, but large-scale data on the diagnostic process and disease management are scarce. Therefore, we aimed to evaluate the diagnostic process, implementation of treatment and changes in life situation in patients with acromegaly, focusing on sex-specific differences. METHODS Non-interventional patient-reported outcome study. 165 patients with clinically and biochemically proven acromegaly were questioned about the diagnostic process and utilization of health care by means of a self-developed standardized postal survey including questions on acromegaly symptoms experienced before diagnosis, number and specialty of consulted doctors, time to diagnosis and aftercare. RESULTS The diagnostic process took 2.9 (SD 4.53) years, during which 3.4 (SD 2.99) physicians were consulted. Women waited longer [4.1 (SD 5.53) years] than men [1.6 (SD 2.69) years; p = 0.001] for the correct diagnosis, and consulted more doctors in the process [4.0 (SD 2.99) vs. 2.7 (SD 2.84) doctors, p < 0.001, respectively]. In 48.5 % of patients, acromegaly was diagnosed by an endocrinologist (men: 45.1 %; women: 52.4 %). Overall disease duration from symptom onset until last surgery was 5.5 (SD 6.85) years, with no sex differences. A change in employment status was the most commonly reported event after diagnosis and a quarter of the patients stated that the illness had changed their lives. CONCLUSIONS Our findings confirm the urgent need to increase awareness of the clinical manifestation of acromegaly to facilitate an earlier diagnosis of the disease and to provide diagnostic equality across the sexes.
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Affiliation(s)
- Ilonka Kreitschmann-Andermahr
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany.
| | - Sonja Siegel
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany
| | - Bernadette Kleist
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Johannes Kohlmann
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany
| | - Daniel Starz
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany
| | - Rolf Buslei
- Institute of Neuropathology, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany
| | - Maria Koltowska-Häggström
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
| | - Christian J Strasburger
- Department of Endocrinology, Diabetes and Nutritional Medicine, Charité Universitaetsmedizin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nuremberg, Schwabachanlage 6, 91031, Erlangen, Germany
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Broder MS, Chang E, Ludlam WH, Neary MP, Carmichael JD. Patterns of pharmacologic treatment in US patients with acromegaly. Curr Med Res Opin 2016; 32:799-805. [PMID: 26609770 DOI: 10.1185/03007995.2015.1125870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To establish a baseline pattern of care across academic and community settings, it is important to examine the contemporary treatment of acromegaly. We characterized medical treatment patterns for acromegaly in the US to develop a basis for tracking concordance with guidelines. RESEARCH DESIGN AND METHODS Acromegaly patients were identified in two commercial claims databases for this retrospective analysis. Study subjects had ≥2 medical claims with acromegaly (ICD-9-CM code 253.0) and ≥1 claim for pharmacotherapy (bromocriptine, cabergoline, octreotide SA, octreotide LAR, lanreotide, or pegvisomant) in the study timeframe (1 January 2002-31 December 2013). Patients were considered newly treated if they were continuously enrolled for ≥6 months before first observed treatment and had no claim for pharmacologic treatment during that time. Outcomes included various pharmacotherapies, including combination treatments, and differences between lines of therapy. RESULTS A total of 3150 patients had ≥1 pharmacotherapy (mean age: 46.5 years; 50.1% were female); 1471 were newly treated. Somatostatin receptor ligands (SRLs) were the most common drug class used first line (57.2%); cabergoline (27.8%) was the most common treatment, followed by octreotide LAR (22.3%) and lanreotide (19.7%). SRLs were also the most commonly used second-line (42.8%) and third-line pharmacotherapies (43.9%), with combination therapy (23.2%) and octreotide LAR (19.8%) as the most commonly used treatments, respectively. CONCLUSIONS This study, representing the largest claims-based analysis of acromegaly to date, used two databases across a 12 year period to examine complex treatment patterns in a difficult-to-study disease. Although wide variation in acromegaly treatment patterns exists in US clinical practice, in first-line, second-line, and third-line therapy, SRL was the most commonly used drug class. Drug combinations also varied considerably across lines of therapy. The switching between different monotherapies and varied use of drugs in combination may suggest an unmet need for alternative treatment options. Our claims-based technique of examining treatment patterns may be used for other rare diseases, although high censoring rates may be a challenge.
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Affiliation(s)
- Michael S Broder
- a a Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA
| | - Eunice Chang
- a a Partnership for Health Analytic Research LLC , Beverly Hills , CA , USA
| | - William H Ludlam
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Maureen P Neary
- b b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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27
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Bernabeu I, Pico A, Venegas E, Aller J, Alvarez-Escolá C, García-Arnés JA, Marazuela M, Jonsson P, Mir N, García Vargas M. Safety of long-term treatment with Pegvisomant: analysis of Spanish patients included in global ACROSTUDY. Pituitary 2016; 19:127-37. [PMID: 26553421 DOI: 10.1007/s11102-015-0691-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To evaluate the long-term safety of Pegvisomant (PEG) in the Spanish cohort of ACROSTUDY. METHODS As of July 2013, 199 Spanish patients were included in ACROSTUDY, a global non interventional safety PEG surveillance study. Patients were observed for safety, biochemical outcome and magnetic resonance imaging evaluations. RESULTS PEG was administered during an average period of 6.7 ± 2.1 years and a mean daily dose of 15.5 ± 7.5 mg. 48.2% of patients received PEG monotherapy. 90.9% of patients had received other medical treatment before PEG start. 195 adverse events (AEs) were reported in 88 patients (44.2%), and serious AEs were described in 31 patients (15.6%). There were no cases of liver tests >10 ULN, or permanent liver damage. Tumor size changes were locally reported in 61 cases (33.5%), with increases observed in 11 patients (6%). In acromegalic patients with diabetes mellitus a decrease in fasting serum glucose value was reported, reaching statistical significance after 1 and 4 years of treatment (-24.6 and -25.9 mg/dl, p = 0.04). After 60 months, normal or lower limit of normal (LLN) IGF-I levels were found in 67.9% of patients. 85.5% of patients showed an IGF-I normal or <LLN at any time after PEG start. Most patients with uncontrolled IGF-I levels were on submaximal PEG doses. CONCLUSIONS ACROSTUDY carried out with the Spanish cohort confirmed that PEG has a favorable safety and efficacy profile. The percentage of patients considered under control was similar to data reported globally and in other local ACROSTUDY results.
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Affiliation(s)
- I Bernabeu
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - A Pico
- Hospital General Universitario de Alicante, Alicante, Spain.
| | - E Venegas
- Hospital Universitario Virgen del Rocío, Seville, Spain
| | - J Aller
- Hospital Universitario Puerta de Hierro - Majadahonda, Madrid, Spain
| | | | | | - M Marazuela
- Hospital Universitario de La Princesa, Madrid, Spain
| | - P Jonsson
- Pfizer Endocrine Care, Sollentuna, Sweden
| | - N Mir
- Pfizer Medical Department, Madrid, Spain
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28
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Araujo KM, da Silva FT, Bestane GC, Soares MM, Denadai R. Delayed Diagnosis of Acromegaly in an Elderly Adult that Initially Presented as Cutis Verticis Gyrata. J Am Geriatr Soc 2016; 64:685-7. [PMID: 27000365 DOI: 10.1111/jgs.13990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Karin M Araujo
- Department of Internal Medicine, Municipal Hospital Walter Ferrari, Campinas, São Paulo, Brazil
| | - Flavia T da Silva
- Department of Internal Medicine, Municipal Hospital Walter Ferrari, Campinas, São Paulo, Brazil
| | - Gabriela C Bestane
- Department of Internal Medicine, Municipal Hospital Walter Ferrari, Campinas, São Paulo, Brazil
| | - Marcella M Soares
- Department of Internal Medicine, Municipal Hospital Walter Ferrari, Campinas, São Paulo, Brazil
| | - Rafael Denadai
- Institute of Plastic and Craniofacial Surgery, SOBRAPAR Hospital, Campinas, São Paulo, Brazil
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29
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Strasburger CJ, Karavitaki N, Störmann S, Trainer PJ, Kreitschmann-Andermahr I, Droste M, Korbonits M, Feldmann B, Zopf K, Sanderson VF, Schwicker D, Gelbaum D, Haviv A, Bidlingmaier M, Biermasz NR. Patient-reported outcomes of parenteral somatostatin analogue injections in 195 patients with acromegaly. Eur J Endocrinol 2016; 174:355-62. [PMID: 26744896 PMCID: PMC4722610 DOI: 10.1530/eje-15-1042] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/17/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Long-acting somatostatin analogues delivered parenterally are the most widely used medical treatment in acromegaly. This patient-reported outcomes survey was designed to assess the impact of chronic injections on subjects with acromegaly. METHODS The survey was conducted in nine pituitary centres in Germany, UK and The Netherlands. The questionnaire was developed by endocrinologists and covered aspects of acromegaly symptoms, injection-related manifestations, emotional and daily life impact, treatment satisfaction and unmet medical needs. RESULTS In total, 195 patients participated, of which 112 (57%) were on octreotide (Sandostatin LAR) and 83 (43%) on lanreotide (Somatuline Depot). The majority (>70%) of patients reported acromegaly symptoms despite treatment. A total of 52% of patients reported that their symptoms worsen towards the end of the dosing interval. Administration site pain lasting up to a week following injection was the most frequently reported injection-related symptom (70% of patients). Other injection site reactions included nodules (38%), swelling (28%), bruising (16%), scar tissue (8%) and inflammation (7%). Injection burden was similar between octreotide and lanreotide. Only a minority of patients received injections at home (17%) and 5% were self-injecting. Over a third of patients indicated a feeling of loss of independence due to the injections, and 16% reported repeated work loss days. Despite the physical, emotional and daily life impact of injections, patients were satisfied with their treatment, yet reported that modifications that would offer major improvement over current care would be 'avoiding injections' and 'better symptom control'. CONCLUSION Lifelong injections of long-acting somatostatin analogues have significant burden on the functioning, well-being and daily lives of patients with acromegaly.
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Affiliation(s)
- Christian J Strasburger
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Niki Karavitaki
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Sylvère Störmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Peter J Trainer
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Ilonka Kreitschmann-Andermahr
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Michael Droste
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Márta Korbonits
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Berit Feldmann
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Kathrin Zopf
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Violet Fazal Sanderson
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - David Schwicker
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Dana Gelbaum
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Asi Haviv
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Martin Bidlingmaier
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine for EndocrinologyDiabetes and Nutritional Medicine, Charité Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, GermanyOxford Centre for DiabetesEndocrinology and Metabolism, Oxford, UKMedizinische Klinik und Poliklinik IVKlinikum der Universität München, Munich, GermanyDepartment of EndocrinologyThe Christie, Manchester, UKDepartment of NeurosurgeryUniversity of Erlangen Nuremberg, Erlangen, GermanyDepartment of NeurosurgeryUniversity of Duisburg-Essen, Essen, GermanyPractice for EndocrinologyOldenburg, GermanyEndocrinologyBarts and the London School of Medicine, Queen Mary University, London, UKEndokrinologie and Diabetologie im ZentrumStuttgart, GermanyPhase IV ProgramsBasle, SwitzerlandChiasmaNewton, Massachusetts, USAEndocrine Research LaboratoriesMedizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, GermanyLeiden University Medical CentreLeiden, The Netherlands
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Polanco-Briceno S, Glass D, Plunkett C. Communication practices and awareness of resources for acromegaly patients among endocrinologists. Patient Prefer Adherence 2016; 10:2531-2541. [PMID: 28008238 PMCID: PMC5167300 DOI: 10.2147/ppa.s119570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study was designed to assess the awareness and utilization of resources to improve patients' treatment experiences among endocrinologists who currently treat patients with acromegaly. METHODS A total of 4,280 US endocrinologists were randomly selected from the CMS National Plan and Provider Enumeration System and were invited by mail to participate in a 20-minute online survey. In order to qualify, respondents had to be the primary physician making treatment decisions for at least one patient for their acromegaly. RESULTS Results are based on responses from 126 physicians from primarily urban and suburban practices, with a median of five acromegaly patients. A total of 70% of patients are currently receiving drug therapy; among these, 91% are on octreotide (51%), lanreotide (29%), or pasireotide (11%), alone or in combination with another therapy. Nearly half of the respondents thought that the impact of patient adherence on therapy outcome for acromegaly was either not very (40%) or not at all (7%) significant. Respondents who believe patient adherence significantly impacts treatment outcome were significantly more likely to discuss automated adherence reminders (50% vs 26%; P=0.015), mobile administration programs (57% vs 35%; P=0.029), and symptom tracking (72% vs 42%; P=0.002). Overall, 44% of respondents routinely recommend education/emotional support programs, and 25% routinely recommend financial assistance programs. Respondents who believe patient adherence significantly impacts treatment outcome generally were more familiar with individual education and emotional support programs compared to those who do not, although they were not more likely to routinely refer patients to any of these resources. CONCLUSION There are unmet needs with respect to increasing awareness among physicians of the importance of patient adherence to therapy, resources available to patients, and how collaboration among patients, nurses, and physicians can improve adherence and overall treatment experiences.
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Affiliation(s)
- Susan Polanco-Briceno
- Deerfield Institute, New York, NY, USA
- Correspondence: Susan Polanco-Briceno, Deerfield Institute, 780 Third Avenue, 37th floor, New York, NY 10017, USA, Tel +1 212 551 1600, Email
| | | | - Cindy Plunkett
- Department of Internal Medicine, Metabolism Endocrinology & Diabetes (MEND), University of Michigan, Ann Arbor, MI, USA
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Bernabeu I, Marazuela M. Pegvisomant: Balance after 10 years. ACTA ACUST UNITED AC 2015; 62:363-5. [PMID: 26242927 DOI: 10.1016/j.endonu.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ignacio Bernabeu
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España.
| | - Mónica Marazuela
- Servicio de Endocrinología y Nutrición, Hospital Universitario de La Princesa, Madrid, España
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