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Caulley L, Whelan J, Khoury M, Mavedatnia D, Sahlollbey N, Amrani L, Eid A, Doyle MA, Malcolm J, Alkherayf F, Ramsay T, Moher D, Johnson-Obaseki S, Schramm D, Hunink MGM, Kilty SJ. Post-operative surveillance for somatotroph, lactotroph and non-functional pituitary adenomas after curative resection: a systematic review. Pituitary 2023; 26:73-93. [PMID: 36422846 DOI: 10.1007/s11102-022-01289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT Pituitary tumors are the third most common brain tumor and yet there is no standardization of the surveillance schedule and assessment modalities after transsphenoidal surgery. EVIDENCE ACQUISITION OVID, EMBASE and the Cochrane Library databases were systematically screened from database inception to March 5, 2020. Inclusion and exclusion criteria were designed to capture studies examining detection of pituitary adenoma recurrence in patients 18 years of age and older following surgical resection with curative intent. EVIDENCE SYNTHESIS A total of 7936 abstracts were screened, with 812 articles reviewed in full text and 77 meeting inclusion criteria for data extraction. A pooled analysis demonstrated recurrence rates at 1 year, 5 years and 10 years for non-functioning pituitary adenomas (NFPA; N = 3533 participants) were 1%, 17%, and 33%, for prolactin-secreting adenomas (PSPA; N = 1295) were 6%, 21%, and 28%, and for growth-hormone pituitary adenomas (GHPA; N = 1257) were 3%, 8% and 13%, respectively. Rates of recurrence prior to 1 year were 0% for NFPA, 1-2% for PSPA and 0% for GHPA. The mean time to disease recurrence for NFPA, PSPA and GHPA were 4.25, 2.52 and 4.18 years, respectively. CONCLUSIONS This comprehensive review of the literature quantified the recurrence rates for commonly observed pituitary adenomas after transsphenoidal surgical resection with curative intent. Our findings suggest that surveillance within 1 year may be of low yield. Further clinical trials and cohort studies investigating cost-effectiveness of surveillance schedules and impact on quality of life of patients under surveillance will provide further insight to optimize follow-up.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Jonathan Whelan
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Michel Khoury
- Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada
| | - Dorsa Mavedatnia
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Nick Sahlollbey
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Lisa Amrani
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Anas Eid
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Mary-Anne Doyle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Janine Malcolm
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Fahad Alkherayf
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Center for Journalology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Schramm
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G M Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shaun J Kilty
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Manosso KZB, Sampaio CL, Kasuki L, Antunes X, Gadelha MR, Boguszewski CL. GH and IGF-I levels and tumor shrinkage in response to first generation somatostatin receptor ligands in acromegaly: a comparative study between two reference centers for pituitary diseases in Brazil. Endocrine 2021; 74:146-154. [PMID: 34041695 DOI: 10.1007/s12020-021-02766-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To compare biochemical and tumor response rates between two reference centers for pituitary diseases in Brazil after primary and adjuvant therapy with somatostatin receptor ligands (SRL) in acromegaly. METHODS Patients were classified as non-responders (NR), partial responders (PR), and full responders (FR) to 12-month SRL therapy according to: [criteria A] normal IGF-I and random GH (rGH) < 1 ng/mL (FR); ≥ 50% decrease of IGF-I and/or rGH (PR); < 50% decrease of IGF-I and rGH (NR); [criteria B] normal IGF-I (FR); ≥ 50% decrease of IGF-I (PR); < 50% decrease of IGF-I (NR). Tumor shrinkage <20% defined poor responders (tPR) and ≥ 20% good responders (tGR). RESULTS We studied 219 acromegaly patients (59% women, age 43.1 ± 13.9 years; 73 from Center I and 146 from Center II). After SRL therapy, the proportion of FR, PR, and NR by criteria A and B was 30.2 vs 49.1%, 52.8 vs 21.2% and 17 vs 29.7%, respectively (p < 0.001). Considering criteria A or B separately, there was no difference in the proportion of FR, PR and NR between two centers. However, when comparing criteria A and B, the Center I showed a difference of 30.9% in classification of FR in relation to 13.2% observed in Center II (p = 0.006). tGR were 51.4% of patients, with no differences between the centers. CONCLUSIONS IGF-I alone significantly increased positive response rates to SRLs, whereas the inclusion of rGH levels into therapeutic decision might lead to a significant increment on the costs of acromegaly management.
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Affiliation(s)
- Karina Zanlorenzi Basso Manosso
- SEMPR, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas, Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
| | - Carolina Labigalini Sampaio
- SEMPR, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas, Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil
| | - Leandro Kasuki
- Centro de Pesquisa em Neuroendocrinologia, Divisão de Endocrinologia, Faculdade de Medicina e Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Serviço de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, RJ, Brazil
- Serviço de Endocrinologia, Hospital Federal de Bonsucesso, Rio de Janeiro, RJ, Brazil
| | - Ximene Antunes
- Centro de Pesquisa em Neuroendocrinologia, Divisão de Endocrinologia, Faculdade de Medicina e Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Serviço de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, RJ, Brazil
| | - Monica R Gadelha
- Centro de Pesquisa em Neuroendocrinologia, Divisão de Endocrinologia, Faculdade de Medicina e Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Serviço de Neuroendocrinologia, Instituto Estadual do Cérebro Paulo Niemeyer, Secretaria Estadual de Saúde, Rio de Janeiro, RJ, Brazil
| | - Cesar Luiz Boguszewski
- SEMPR, Serviço de Endocrinologia e Metabologia do Hospital de Clínicas, Departamento de Clínica Médica, Universidade Federal do Paraná, Curitiba, Brazil.
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Campana C, Corica G, Nista F, Cocchiara F, Graziani G, Khorrami K, Franco M, Boschetti M, Ferone D, Gatto F. Emerging drugs for the treatment of acromegaly. Expert Opin Emerg Drugs 2020; 25:409-417. [PMID: 32938258 DOI: 10.1080/14728214.2020.1819983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acromegaly is a disease characterized by elevated growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels. Surgery is the only curative treatment, while medical therapies are administered life-long. To date, almost 30% of patients treated with the currently available medical therapies do not achieve biochemical control. AREAS COVERED This review focuses on new drugs in development for acromegaly. In detail, we provide an overview of the new molecules designed to improve disease control rate (such as novel somotostatin receptor ligands and antisense oligonucleotides), as well as the new formulations of existing medications aiming to improve patients' compliance (e.g. oral or long-acting subcutaneous octreotide). EXPERT OPINION The constant progresses in the medical treatment of acromegaly could lead to an individualized therapy based on tumor, as well as patient's characteristics. Besides disease control, patient's need represents a major target of medical treatment in chronic diseases such as acromegaly, in order to improve compliance to therapy and patients' quality of life.
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Affiliation(s)
- Claudia Campana
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Giuliana Corica
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Federica Nista
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Francesco Cocchiara
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Giulia Graziani
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Keyvan Khorrami
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Marta Franco
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Mara Boschetti
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Diego Ferone
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Federico Gatto
- Endocrinology Unit, Department of Internal Medicine and Medical Specialties, University of Genoa , Genoa, Italy.,Endocrinology Unit, Department of Specialist Medicine, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
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Dal J, Nielsen EH, Rasmussen UF, Andersen M, Feltoft CL, Vestergaard P, Stochholm K, Jørgensen JOL. Disease Control and Gender Predict the Socioeconomic Effects of Acromegaly: A Nationwide Cohort Study. J Clin Endocrinol Metab 2020; 105:5864154. [PMID: 32593172 DOI: 10.1210/clinem/dgaa405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Acromegaly is an insidious disease associated with severe somatic morbidity but data on socioeconomic status are scarce. OBJECTIVE To study the socioeconomic status in acromegaly in a population-based follow-up study. METHODS All incident cases of acromegaly (n = 576) during the period 1977-2010 were included. For every patient, 100 persons were sampled from the general population matched for date of birth and gender (comparison cohort). Cox regression and hazard ratios (HR), conditional logistic regression and linear regression with 95% confidence intervals (CI) were used. OUTCOME MEASURES Retirement, social security benefit, annual income, cohabitation, separation, parenthood and educational level. RESULTS The proportion of retired individuals was significantly higher in patients with acromegaly after the time of diagnosis (HR, 1.43; 95% CI, 1.26-1.62) and also during the 5-year pre-diagnostic period (HR, 1.15; 95% CI, 1.03-1.28). More individuals with acromegaly received social security benefit compared with the comparison cohort during the initial period after the time of diagnosis. Among patients who maintained a job, the annual income was similar to the comparison cohort. Compared with the background population, cohabitation was lower (HR, 0.69; 95% CI, 0.50-0.95) as was parenthood (HR, 0.56; 95% CI, 0.39-0.80), whereas neither educational level (HR, 0.61; 95% CI, 0.35-1.06) nor separation (HR, 1.13; 95% CI, 0.86-1.47) were different. Female gender and insufficient disease control were associated with a significantly worse socioeconomic status. CONCLUSIONS 1) Socioeconomic status is impaired in patients with acromegaly even before a diagnosis of acromegaly. 2) Females and patients without disease remission have worse outcomes. 3) Early diagnosis and effective treatment of acromegaly could be important factors in mitigating the negative impact on socioeconomic factors.
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Affiliation(s)
- Jakob Dal
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetic Center North Jutland, Aalborg, Denmark
| | - Eigil H Nielsen
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla-Feldt Rasmussen
- Department of Endocrinology and Metabolism, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Marianne Andersen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Claus L Feltoft
- Department of Endocrinology, Herlev University Hospital, Denmark
| | - Peter Vestergaard
- Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetic Center North Jutland, Aalborg, Denmark
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Guo X, Wang K, Yu S, Gao L, Wang Z, Zhu H, Xing B, Zhang S, Dong D. Patient Characteristics, Diagnostic Delays, Treatment Patterns, Treatment Outcomes, Comorbidities, and Treatment Costs of Acromegaly in China: A Nationwide Study. Front Endocrinol (Lausanne) 2020; 11:610519. [PMID: 33335513 PMCID: PMC7736552 DOI: 10.3389/fendo.2020.610519] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/02/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Acromegaly is a rare, intractable endocrine disease. We aimed to describe the patient characteristics, diagnostic delays, treatment patterns, treatment outcomes, comorbidities and treatment costs of acromegaly in China. METHODS This is a nationwide cross-sectional study. Patients diagnosed with and treated for acromegaly between 1996 and 2019 across China were surveyed via the Chinese Association of Patients with Acromegaly platform. RESULTS In total, 473 patients (58.8% females, mean age at diagnosis: 39.4±9.5 years) were included. The median disease duration was 3 years. The most common symptoms were extremity enlargement (91.8%) and facial changes (90.1%). Overall, 63.0% of patients experienced diagnostic delays within healthcare systems; 63.8% of the delays were <1 year. The most common first-line therapy was surgery with a transsphenoidal (76.1%) or transcranial approach (3.2%). Somatostatin analogues or dopamine agonists were administered in 20.5% of the patients as first-line therapies and in 41.7% as adjuvant therapies. Radiotherapy was performed in 32.1% of patients, 99.3% of whom received radiotherapy as an adjuvant therapy. After a median 5-year follow-up, 46.2% achieved biochemical control. Comorbidities were reported in 88.2% of the patients at follow-up; memory deterioration and thyroid nodules were the most common. Controlled patients had greater improvements in symptoms and comorbidities during follow-up than uncontrolled patients. The annual per-capita cost-of-treatment was $11013 in 2018, with medical treatments being the largest contributor (67%). Medical insurance covered 47.2% of all treatment costs. CONCLUSION This study provides the first comprehensive description of real-world acromegaly data in China, serving as a basis for future population-based studies.
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Affiliation(s)
- Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Kailu Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Siyue Yu
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Lu Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Zihao Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
| | - Huijuan Zhu
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bing Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Pituitary Disease Registry Center, Beijing, China
- China Pituitary Adenoma Specialist Council, Beijing, China
- China Alliance of Rare Diseases, Beijing, China
- *Correspondence: Bing Xing, ; Shuyang Zhang, ; Dong Dong,
| | - Shuyang Zhang
- China Alliance of Rare Diseases, Beijing, China
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Bing Xing, ; Shuyang Zhang, ; Dong Dong,
| | - Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China
- *Correspondence: Bing Xing, ; Shuyang Zhang, ; Dong Dong,
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Polat Korkmaz O, Gurcan M, Nuhoglu Kantarci FE, Haliloglu O, Ozkaya HM, Sahin S, Oren MM, Tanriover N, Gazioglu N, Kadioglu P. The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly. Pituitary 2019; 22:387-396. [PMID: 31098838 DOI: 10.1007/s11102-019-00968-6] [Citation(s) in RCA: 4] [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: 10/26/2022]
Abstract
PURPOSE To investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates. METHODS The medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2 years after surgery between 2009 and 2016 were reviewed. RESULTS The mean follow-up time was 50.9 ± 25.7 months. Early remission was defined according to 3rd month values in patients who didn't achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p = 0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p = 0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p = 0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was €3788.4; the cost for macroadenomas was significantly higher than for microadenomas (€4125.0 vs. €3226.5, respectively; p = 0.03). Preoperative SSA use in both microadenomas and macroadenomas didn't alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p = 0.09; p = 0.8). CONCLUSIONS Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn't persist long term.
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Affiliation(s)
- Ozge Polat Korkmaz
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Mert Gurcan
- Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | - Ozlem Haliloglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey
| | | | - Necmettin Tanriover
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurperi Gazioglu
- Department of Neurosurgery, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Kocamustafapasa Street No:53, Fatih, 34098, Istanbul, Turkey.
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Peral C, Cordido F, Gimeno-Ballester V, Mir N, Sánchez-Cenizo L, Rubio-Rodríguez D, Rubio-Terrés C. Cost-effectiveness analysis of second-line pharmacological treatment of acromegaly in Spain. Expert Rev Pharmacoecon Outcomes Res 2019; 20:105-114. [PMID: 31055976 DOI: 10.1080/14737167.2019.1610396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To estimate the cost-effectiveness of second-line pharmacological treatments in patients with acromegaly resistant to first-generation somatostatin analogues (FG SSA) from the Spanish National Health System (NHS) perspective.Methods: A Markov model was developed to analyze the cost-effectiveness of pegvisomant and pasireotide in FG SSA-resistant acromegaly, simulating a cohort of patients from the treatment beginning to death. Treatment with pegvisomant or pasireotide was compared to FG SSA retreatment. Efficacy data were obtained from clinical trials and utilities from the literature. Direct health costs were obtained from Spanish sources (€2018).Results: The Incremental Cost Effectiveness Ratio (ICER) of pegvisomant vs. FG SSA was €85,869/Quality-adjusted life years (QALY). The ICER of pasireotide vs. FG SSA was €551,405/QALY. The ICER was mainly driven by the incremental efficacy (4.41 QALY for pegvisomant vs. FG SSA and 0.71 QALY for pasireotide vs. FG SSA), with a slightly lower increase in costs with pegvisomant (€378,597 vs. FG SSA) than with pasireotide (€393,151 vs. FG SSA).Conclusion: The ICER of pasireotide compared to FG SSA was six times higher than the ICER of pegvisomant vs. FG SSA. Pegvisomant is a more cost-effective alternative for the treatment of acromegaly in FG SSA-resistant patients in the Spanish NHS.
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Affiliation(s)
- Carmen Peral
- Health Economics and Outcomes Research Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
| | - Fernando Cordido
- Endocrinology Department, Complejo Hospitalario Universitario A Coruña, and Universidad de A Coruña, A Coruña, Spain
| | | | - Nuria Mir
- Medical Affairs Department, Pfizer S.L.U, Alcobendas (Madrid), Spain
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Kamusheva M, Rusenova Y, Vandeva S, Elenkova A, Zaharieva S, Doneva M, Mitkova Z, Petrova G. Economic and pharmaco-economic analysis of acromegaly treatment: a systematic review. BIOTECHNOL BIOTEC EQ 2019. [DOI: 10.1080/13102818.2019.1680317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Maria Kamusheva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Yanitsa Rusenova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Silvia Vandeva
- Department of Endocrinology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Atanaska Elenkova
- Department of Endocrinology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Sabina Zaharieva
- Department of Endocrinology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Miglena Doneva
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Guenka Petrova
- Department of Organization and Economics of Pharmacy, Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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9
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Bernabeu I, Cámara R, Marazuela M, Puig Domingo M. Documento de expertos sobre el manejo de la acromegalia. ENDOCRINOL DIAB NUTR 2018; 65:428-437. [DOI: 10.1016/j.endinu.2018.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 11/26/2022]
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10
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Orlewska E, Stępień R, Orlewska K. Cost-effectiveness of somatostatin analogues in the treatment of acromegaly. Expert Rev Pharmacoecon Outcomes Res 2018; 19:15-25. [PMID: 30122081 DOI: 10.1080/14737167.2018.1513330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Somatostatin analogues (SSAs) are the largest contributor to the direct medical cost of acromegaly management worldwide. The aim of this review was to identify and report available evidence on the cost-effectiveness of SSAs in the treatment of acromegaly. AREAS COVERED A literature search on relevant papers published up to April 2018 was performed. A total of 22 eligible studies (10 full-text articles and 12 conference abstracts) conducted in 14 countries were included in the analysis. In majority of studies, modelling technique was the principal research method. EXPERT COMMENTARY The results of cost-effectiveness analyses: 1) support published recommendations where SSAs are indicated as first-line medical treatment for patients with persistent disease after surgery or who are not eligible for surgery; 2) suggest that preoperative medical therapy with SSAs may be highly cost-effective in acromegalic patients with macroadenoma, in centres without optimal surgical results 3) indicate that in some countries pasireotide and pegvisomant appeared to be cost-effective or even dominant strategies in comparison to first-generation SSAs. The main limitation of economic evaluations was the lack of high-quality studies designed to directly compare various treatment strategies in acromegaly.
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Affiliation(s)
- Ewa Orlewska
- a Faculty of Medicine and Health Sciences , The Jan Kochanowski University , Kielce , Poland
| | - Renata Stępień
- a Faculty of Medicine and Health Sciences , The Jan Kochanowski University , Kielce , Poland
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11
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Kaemmerer D, Schindler R, Mußbach F, Dahmen U, Altendorf-Hofmann A, Dirsch O, Sänger J, Schulz S, Lupp A. Somatostatin and CXCR4 chemokine receptor expression in hepatocellular and cholangiocellular carcinomas: tumor capillaries as promising targets. BMC Cancer 2017; 17:896. [PMID: 29282035 PMCID: PMC5745780 DOI: 10.1186/s12885-017-3911-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/13/2017] [Indexed: 12/15/2022] Open
Abstract
Background Hepatocellular (HCC) and cholangiocellular carcinomas (CCC) display an exceptionally poor prognosis. Especially for advanced disease no efficient standard therapy is currently available. Recently, somatostatin analogs have been evaluated for the treatment of HCC, however, with contradictory results. Besides, for both malignancies the chemokine receptor CXCR4 has been discussed as a possible new target structure. Methods Expression of somatostatin receptor (SSTR) subtypes 1, 2A, 3, 4, and 5, and of CXCR4 was evaluated in a total of 71 HCCs and 27 CCCs by immunohistochemistry using well-characterized novel monoclonal antibodies. Results In HCC tumor cells, frequency and intensity of expression of SSTRs and CXCR4 were only low. CXCR4 was present in about 40% of the HCCs, although at a low intensity. SSTR5, SSTR2, and SSTR3 were detected in about 15%, 8%, and 5% of the HCC tumors, respectively. SSTR and CXCR4 expression was much higher in CCC than in HCC. CXCR4 and SSTR1 were present in 60% and 67% of the CCC samples, respectively, followed by SSTR2 and SSTR5, which were detected in 30% and 11% of the tumors, respectively. Most notably, CXCR4 was intensely expressed on the tumor capillaries in about 50% of the HCCs and CCCs. CXCR4 expression on tumor vessels was associated with poor patient outcomes. Conclusions CCC, but not HCC, may be suitable for SSTR-based treatments. Because of the predominant expression of SSTR1, pan-somatostatin analogs should be preferred. In both HCC and CCC, indirect targeting of tumors via the CXCR4-positive tumor capillaries may represent a promising additional therapeutic strategy. Electronic supplementary material The online version of this article (10.1186/s12885-017-3911-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Kaemmerer
- Department of General and Visceral Surgery, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Robin Schindler
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, D-07747, Jena, Germany
| | - Franziska Mußbach
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | | | - Olaf Dirsch
- Institute of Pathology, Jena University Hospital, Jena, Germany
| | - Jörg Sänger
- Institute of Pathology and Cytology Bad Berka, Bad Berka, Germany
| | - Stefan Schulz
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, D-07747, Jena, Germany
| | - Amelie Lupp
- Institute of Pharmacology and Toxicology, Jena University Hospital, Friedrich Schiller University Jena, Drackendorfer Str. 1, D-07747, Jena, Germany.
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12
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Lesén E, Granfeldt D, Houchard A, Dinet J, Berthon A, Olsson DS, Björholt I, Johannsson G. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol 2017; 176:203-212. [PMID: 27932528 DOI: 10.1530/eje-16-0623] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 11/15/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Acromegaly is a complex endocrine disease with multiple comorbidities. Treatment to obtain biochemical remission includes surgery, medical therapy and radiation. We aimed to describe comorbidities, treatment patterns and cost-of-illness in patients with acromegaly in Sweden. DESIGN A nationwide population-based study. METHODS Patients with acromegaly were identified and followed in national registers in Sweden. Longitudinal treatment patterns were assessed in patients diagnosed between July 2005 and December 2013. The cost-of-illness during 2013 was estimated from a societal perspective among patients diagnosed between 1987 and 2013. RESULTS Among 358 patients with acromegaly (48% men, mean age at diagnosis 50.0 (s.d. 15.3) years) at least one comorbidity was reported in 81% (n = 290). The most common comorbidities were hypertension (40%, n = 142), neoplasms outside the pituitary (30%, n = 109), hypopituitarism (22%, n = 80) and diabetes mellitus (17%, n = 61). Acromegaly treatment was initiated on average 3.7 (s.d. 6.9) months after diagnosis. Among the 301 treated patients, the most common first-line treatments were surgery (60%, n = 180), somatostatin analogues (21%, n = 64) and dopamine agonists (14%, n = 41). After primary surgery, 24% (n = 44) received somatostatin analogues. The annual per-patient cost was €12 000; this was €8700 and €16 000 if diagnosed before or after July 2005, respectively. The cost-of-illness for acromegaly and its comorbidities was 77% from direct costs and 23% from production loss. CONCLUSIONS The prevalence of comorbidity is high in patients with acromegaly. The most common first-line treatment in acromegalic patients was surgery followed by somatostatin analogues. The annual per-patient cost of acromegaly and its comorbidities was €12 000.
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Affiliation(s)
- Eva Lesén
- Nordic Health EconomicsGothenburg, Sweden
| | | | | | | | | | - Daniel S Olsson
- Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gudmundur Johannsson
- Department of Internal Medicine and Clinical NutritionInstitute of Medicine, Sahlgrenska Academy, University of Gothenburg and Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Placzek H, Xu Y, Mu Y, Begelman SM, Fisher M. Clinical and Economic Burden of Commercially Insured Patients with Acromegaly in the United States: A Retrospective Analysis. J Manag Care Spec Pharm 2016; 21:1106-12. [PMID: 26679960 PMCID: PMC10397952 DOI: 10.18553/jmcp.2015.21.12.1106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acromegaly is a chronic disorder characterized by excess growth hormone secretion and elevated insulin-like growth factor-1 levels most often caused by a pituitary adenoma. Clinical presentation of the disease includes coarsening of the facial features, soft-tissue swelling of the hands and feet, and overgrowth of the frontal skull and protrusion of the jaw, as well as joint symptoms. Acromegaly is associated with several comorbidities, including diabetes, cardiovascular disease, and arthropathy, which, if left untreated, can lead to early mortality. Surgery to remove the adenoma is the first-line treatment for many patients, but more than 50% of patients will require additional pharmacologic or radiation therapy. OBJECTIVES To (a) determine the clinical and economic burden of illness among patients with acromegaly using administrative claims data from a large, commercially insured population in the United States and (b) estimate the most frequent acromegaly-related comorbidities and health care resource utilization and costs among these patients. METHODS This retrospective, observational cohort study used administrative claims data from the HealthCore Integrated Research Database, containing a geographically diverse spectrum of longitudinal claims data from the largest database of commercially insured patients in the United States. Patients were aged ≥ 20 years and fulfilled ≥ 1 of the following criteria during the intake period (March 31, 2008-July 31, 2012): ≥ 2 independent diagnostic codes for acromegaly, ≥ 1 acromegaly diagnosis code and ≥ 1 acromegaly-related procedure code, or ≥ 1 acromegaly diagnosis code and ≥ 1 medical claim for acromegaly-related therapy. The index date was defined as the date of the first medical claim for acromegaly within the intake period. Assessed outcomes included prevalence of acromegaly diagnosis and incidence of new acromegaly diagnoses during the study period (January 1, 2008-July 31, 2013), acromegaly-related comorbidities, and pharmacotherapy use. Because 2008 and 2012 data were incomplete, incidence rates were only reported for 2009, 2010, and 2011. Total and acromegaly-related health care resource utilization and annual health care costs were analyzed during a 12-month post-index observational period. RESULTS In total, 757 patients with acromegaly met the selection criteria for this study, with a mean age of 49.3 years (53.6% female). The total prevalence of acromegaly was 41.7 cases per million. Acromegaly incidence was 15.0, 13.3, and 9.5 cases per million in 2009, 2010, and 2011, respectively. The top 5 acromegaly-related comorbidities were hypertension, diabetes, hypothyroidism, arthropathy/arthralgia/synovitis, and sleep apnea. During the study period, 51% of patients (n = 385) used acromegaly-related pharmacologic therapy, with the most common being cabergoline and octreotide (used by 12.4% and 12.2% of patients, respectively). Overall, 18.8% of patients incurred an acromegaly-related inpatient stay; 97.0% used outpatient services other than emergency room (ER) or physician visits; 74.8% had a physician office visit; and 1.8% visited the ER for acromegaly-related reasons. In the 12-month post-index period, 37.0% of patients filed claims for acromegaly-related prescription drugs, and patients with greater than 1 claim had an average of 7.6 prescriptions. The most expensive acromegaly-related costs in this study population were inpatient hospitalizations ($6,754) and prescription drugs ($6,147). CONCLUSIONS Consistent with previous studies, this study confirms that acromegaly is a rare condition associated with multiple comorbidities. Notably, 18.8% of this study population required an inpatient hospital admission during the 12-month post-index period, possibly because of severe comorbidities. Because acromegaly-related costs were driven by hospitalizations and pharmacotherapy, improved management of the disease may reduce the clinical and economic burden experienced by patients with acromegaly.
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Affiliation(s)
- Hilary Placzek
- GNS Healthcare, One Charles Park, Cambridge, MA 02142-1254.
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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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Bacigaluppi S, Gatto F, Anania P, Bragazzi NL, Rossi DC, Benvegnu G, Nazzari E, Spaziante R, Giusti M, Ferone D, Zona G. Impact of pre-treatment with somatostatin analogs on surgical management of acromegalic patients referred to a single center. Endocrine 2016; 51:524-33. [PMID: 25982150 DOI: 10.1007/s12020-015-0619-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/27/2015] [Indexed: 11/28/2022]
Abstract
First-line treatment of patients with growth hormone secreting adenomas is surgical resection. Disease control can be obtained by surgery (one or multiple steps), in case followed by medical treatment or adjuvant radiation therapy (radiosurgery or radiotherapy). The impact of pre-surgical treatment with somatostatin analogs (SSAs) on surgical outcome is still controversial. The aim of this study is to retrospectively evaluate the impact of SSA pre-treatment on biochemical outcome and post-surgical hypopituitarism in a consecutive surgical series from a single referral centre, with data covering 17 years' experience and to investigate the possible predictive value of early postoperative insulin-like factor 1 (IGF-I) on long-term biochemical control. Data from 68 acromegalic patients were revised. Endocrinological long-term follow-up (minimum 6 months) was available for 57 patients. Eighty-eight percent of patients received a single-step surgical treatment (single surgery, with or without adjuvant medical therapy). The remaining 12% underwent a multi-step strategy: redo-surgery (three macroadenomas) and/or radiation (four macro- and two microadenomas). Pre-surgical SSA treatment was performed in 77.9% and resulted in a significant lowering of basal IGF-I values (p = 0.0001). Early post-surgical IGF-I was significantly lower in patients biochemically controlled with single surgery alone (p = 0.016) and after overall treatment strategies (p = 0.005). Normalization of GH and IGF-I was obtained in 56.1%, and normalization of either one of them in 27.8% of patients. No major surgery-related complications occurred. Post-treatment hypopituitarism occurred in 11.9% and was lower in SSA pre-treated patients. Our results well compare with other recently published series. Very early post-surgical IGF-I improvement might be a useful predictor for biochemical disease control. Moreover, our results suggest that pre-surgical treatment with somatostatin analogs seems to prevent hypopituitarism.
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Affiliation(s)
- Susanna Bacigaluppi
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Federico Gatto
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Pasquale Anania
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Nicola Luigi Bragazzi
- School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
| | - Diego Criminelli Rossi
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy
| | - Giulia Benvegnu
- Anaesthesiology, Department of Emergency (DEA), IRCCS San Martino-IST, Genova, Italy
| | - Elena Nazzari
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
| | - Renato Spaziante
- Department of Neurosurgery, University of Salerno, Salerno, Italy
| | - Massimo Giusti
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Diego Ferone
- Endocrinology, Department of Internal Medicine and Medical Specialties (DIMI), IRCCS San Martino-IST, University of Genoa, Genova, Italy
- Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genova, Italy
| | - Gianluigi Zona
- Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS San Martino-IST, University of Genoa, Largo Rosanna Benzi 10, 16132, Genova, Italy.
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16
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Margusino-Framiñán L, Pertega-Diaz S, Pena-Bello L, Sangiao-Alvarellos S, Outeiriño-Blanco E, Pita-Gutierrez F, Pita-Fernandez S, Cordido F. Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome. Eur J Intern Med 2015; 26:736-41. [PMID: 26300269 DOI: 10.1016/j.ejim.2015.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/19/2015] [Accepted: 07/29/2015] [Indexed: 01/28/2023]
Abstract
CONTEXT There is no uniform standard of care for acromegaly. Due to the high costs involved, steps must be taken to ensure the cost-effective delivery of treatment. OBJECTIVE Taking the results of an earlier meta-analysis as a starting point, this study aims to determine whether treatment with long-acting somatostatin analogue (SSA) prior to surgery improves the cost-effectiveness of the treatment of acromegaly. METHODS The results are presented as an Incremental Cost Effectiveness Ratio (ICER) immediately after surgery, for the following year and over the next four decades. The cure rates percentage (95% CI) for the three randomized prospective controlled trials were 44.4% (34.2-54.7) and 18.2% (10.1-26.3) for preoperative treated and untreated patients respectively. The cost of pharmacological treatments was based on the number of units prescribed, dose and length of treatment. RESULTS The mean (95% CI) ICER immediately after surgery was €17,548 (12,007-33,250). In terms of the postoperative SSA treatment, the ICER changes from positive to negative before two years after surgery. One decade after surgery the ICER per patient/year was €-9973 (-18,798; -6752) for postoperative SSA treatment and €-31,733 (-59,812; -21,483) in the case of postoperative pegvisomant treatment. CONCLUSIONS In centres without optimal surgical results, preoperative treatment of GH-secreting pituitary macroadenomas with SSA not only shows a significant improvement in the surgical results, but is also highly cost-effective, with an ICER per patient/year one decade after surgery, of between €-9973 (-18,798; -6752) and €-31,733 (-59,812; -21,483) for SSA and pegvisomant respectively.
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Affiliation(s)
| | - Sonia Pertega-Diaz
- Clinical Epidemiology and Biostatistics Unit, University Hospital A Coruña, A Coruña, Spain
| | - Lara Pena-Bello
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain
| | - Susana Sangiao-Alvarellos
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain
| | | | | | | | - Fernando Cordido
- Instituto de Investigación Biomedica (INIBIC), University Hospital A Coruña, A Coruña, Spain; Department of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain; Department of Endocrinology, University Hospital A Coruña, A Coruña, Spain.
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17
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Rudmik L, Starreveld YP, Vandergrift WA, Banglawala SM, Soler ZM. Cost-effectiveness of the endoscopic versus microscopic approach for pituitary adenoma resection. Laryngoscope 2014; 125:16-24. [DOI: 10.1002/lary.24780] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 04/29/2014] [Accepted: 05/27/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Luke Rudmik
- Rhinology and Endoscopic Sinus Surgery; Division of Otolaryngology-Head and Neck Surgery; Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Yves P. Starreveld
- Division of Neurosurgery; Department of Clinical Neurological Sciences; University of Calgary; Calgary Alberta Canada
| | - William A. Vandergrift
- Department of Neurosurgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Sarfaraz M. Banglawala
- Division of Rhinology and Sinus Surgery; Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
| | - Zachary M. Soler
- Division of Rhinology and Sinus Surgery; Department of Otolaryngology-Head and Neck Surgery; Medical University of South Carolina; Charleston South Carolina U.S.A
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Giustina A, Chanson P, Kleinberg D, Bronstein MD, Clemmons DR, Klibanski A, van der Lely AJ, Strasburger CJ, Lamberts SW, Ho KKY, Casanueva FF, Melmed S. Expert consensus document: A consensus on the medical treatment of acromegaly. Nat Rev Endocrinol 2014; 10:243-8. [PMID: 24566817 DOI: 10.1038/nrendo.2014.21] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In March 2013, the Acromegaly Consensus Group met to revise and update guidelines for the medical treatment of acromegaly. The meeting comprised experts skilled in the medical management of acromegaly. The group considered treatment goals covering biochemical, clinical and tumour volume outcomes, and the place in guidelines of somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists, and alternative modalities for treatment including combination therapy and novel treatments. This document represents the conclusions of the workshop consensus.
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Affiliation(s)
- Andrea Giustina
- Chair of Endocrinology, University of Brescia, via Biseo 17, 25100 Brescia, Italy
| | - Philippe Chanson
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie et des Maladies de la Reproduction, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Paris, F 94275, France
| | - David Kleinberg
- Neuroendocrine Unit, New York University School of Medicine, Department of Veterans Affairs Medical Centre, 423 East 23rd Street, Room 16043W, New York, NY 10010, USA
| | - Marcello D Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Avenue Dr. Eneas de Carvalho, 255, 7° Andar, Sala 7037, São Paulo, CEP 05403 000, Brazil
| | - David R Clemmons
- Department of Medicine, University of North Carolina, CB# 7170, 8024 Burnett-Womack, Chapel Hill, NC 27599, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | | | - Steven W Lamberts
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands
| | - Ken K Y Ho
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, QLD 4102, Australia
| | - Felipe F Casanueva
- Santiago de Compostela University and CIBERobn, Santiago de Compostela, E-15780, Spain
| | - Shlomo Melmed
- Department of Medicine, Cedars-Sinai Medical Center, Room 2015, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
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Abstract
INTRODUCTION Acromegaly is a rare disease that severely impacts patients' health all the while, being a slowly progressing illness. In the past decades, advancements in treatment modalities, especially development of new drugs, as well as focused guidelines has improved management of acromegaly. Still, many patients are considered not sufficiently treated and there remains an ongoing need for further development. AREAS COVERED This article reviews new medical treatments currently under clinical investigation (such as pasireotide, oral octreotide and somatoprim) and under experimental development (such as octreotide implants, CAM2029 and ATL-1103). EXPERT OPINION As it seems unlikely that one single agent may achieve cure in 100% of cases, there is an urgent need for new agents that help patients where current medication fails. Imperatively, this means we have to improve our understanding of the underlying pathogenetic and molecular mechanisms.
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Affiliation(s)
- Sylvère Störmann
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV , Ziemssenstr. 1, 80336 München , Germany +49 0 89 5160 2111 ; +49 0 89 5160 2194 ;
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[Practical guidelines for diagnosis and treatment of acromegaly. Grupo de Neuroendocrinología de la Sociedad Española de Endocrinología y Nutrición]. ACTA ACUST UNITED AC 2013; 60:457.e1-457.e15. [PMID: 23660006 DOI: 10.1016/j.endonu.2013.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/04/2013] [Accepted: 01/09/2013] [Indexed: 12/14/2022]
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Sesmilo G. [Epidemiology of acromegaly in Spain]. ACTA ACUST UNITED AC 2012; 60:470-4. [PMID: 23246411 DOI: 10.1016/j.endonu.2012.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/09/2012] [Accepted: 09/12/2012] [Indexed: 11/25/2022]
Abstract
Epidemiology of acromegaly in Spain does not differ from that reported in other published series. Prevalence rate is approximately 60 cases per million, peak incidence occurs in middle age, more women are affected (61%), and there is a substantial delay between occurrence of the first symptoms and diagnosis. Studies REA (Spanish Acromegaly Registry) and OASIS analyzed the epidemiology, clinical characteristics, and management of the disease in Spain. Surgery, performed in more than 80% of patients, has been (and continues to be) the main treatment for the past four decades. In the past decade, however, more patients have received somatostatin analogs (SSAs) as first-line treatment. Use of radiation therapy has significantly decreased in recent decades. Somatostatin analogs (SSAs) are the most commonly used drugs, administered to 85% of patients; however, only 12%-15% continue on drug treatment alone. The surgical remission rate was 38.4% in the last decade, with a significant improvement over decades. Preoperative treatment with SSAs has no influence on surgical cure rates. Second-line therapies used after surgical failure in the past decade included SSAs in 49% of patients, repeat surgery in 27%, radiotherapy in 11%, pegvisomant in 15%, and dopamine agonists in 5%. Mean cost of acromegaly treatment was 9.668€ (data estimated in 2009 and adjusted in 2010), of which 71% was due to the cost of SSAs. Patients treated with pegvisomant have a more aggressive form of the disease and higher comorbidity rates.
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Affiliation(s)
- Gemma Sesmilo
- Servicio de Endocrinología, Institut Universitari Dexeus, Barcelona, España.
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