Characterizing the burden of uncontrolled acromegaly – a description of real-world patient characteristics in Colombia
PDF
xhtml

Keywords

Acromegaly
somatostatin analogues
Growth hormone
Colombia
insulin growth factor-1

How to Cite

Abreu, A., Román-González, A., Tovar, H., Maestre, K., Builes-Barrera, C. A. ., Nessim, E., Herrera, D., & Rojas, W. (2022). Characterizing the burden of uncontrolled acromegaly – a description of real-world patient characteristics in Colombia. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 9(2). https://doi.org/10.53853/encr.9.2.678

Abstract

Objective: To describe the epidemiology and clinical characteristics, relative to biochemical and disease control after treatment initiation, in patients with acromegaly in Colombia.

Methods: Retrospective chart review of newly diagnosed acromegaly patients who initiated medical treatment at referral health institutions in Colombia. Patients with controlled vs uncontrolled disease were analyzed, including comorbidities and treatment patterns. In addition, patients receiving somatostatin analogues (SSAs) as first-line treatment (SSA cohort) were compared with those receiving other medical therapy (non-SSA cohort).

Results: Data obtained from medical records of 53 patients showed a mean age of 49 years (SD 13.31) and a female preponderance (33 [62.26%]). After 1 year of treatment, 10 (18.9%) patients from the SSA cohort achieved complete biochemical control, showing significantly lower levels of median growth hormone (GH) and insulin-like growth factor-1 (IGF-1) vs 43 (81.1%) patients from the uncontrolled group (p=0.0010 and p=0.0001, respectively). During follow-up, acromegaly-related comorbidities were higher in patients with uncontrolled disease and in the non-SSA group vs the controlled group. Similarly, the percentage of physician visits was lower in the controlled (n=4/10, 40.0%) vs uncontrolled (n=31/43, 72.0%) group and in the SSA (n=24/38, 63.2%) vs non-SSA (n=11/15, 73.3%) cohort.

Conclusion: In patients with acromegaly receiving medical therapy, both GH and IGF-1 levels tended to decline over time with the use of SSAs. Lower frequency of comorbidities and use of healthcare resources were associated with controlled acromegaly. Optimizing disease control with adequate patient follow-up and drug treatment may improve clinical outcomes and promote efficient use of healthcare resources.

https://doi.org/10.53853/encr.9.2.678
PDF
xhtml

References

AlDallal S. Acromegaly: a challenging condition to diagnose. International journal of general medicine. 2018;11:337.

Sharma MD, Nguyen AV, Brown S, Robbins RJ. Cardiovascular disease in acromegaly. Methodist DeBakey cardiovascular journal. 2017;13:64.

Nachtigall L, Delgado A, Swearingen B, Lee H, Zerikly R, Klibanski A. Extensive clinical experience: changing patterns in diagnosis and therapy of acromegaly over two decades. The Journal of Clinical Endocrinology & Metabolism. 2008;93:2035-2041.

Schneider H, Sievers C, Saller B, Wittchen H, Stalla G. High prevalence of biochemical acromegaly in primary care patients with elevated IGF?1 levels. Clinical endocrinology. 2008;69:432-435.

Pérez AV CL, Vanegas E, et al. Efectividad y seguridad de lanreótide y octreótide en personas con diagnóstico de gigantismo o de acromegalia. Reporte N° 106. Bogotá, D.C: Instituto de Evaluación Tecnológica en Salud-IETS y Ministerio de Salud y Protección Social. 2014.

Mateus HE, Pérez AM, Mesa ML, et al. A first description of the Colombian national registry for rare diseases. BMC research notes. 2017;10:514.

Broder MS, Neary MP, Chang E, Cherepanov D, Katznelson L. Treatments, complications, and healthcare utilization associated with acromegaly: a study in two large United States databases. Pituitary. 2014;17:333-341.

Pivonello R, Auriemma RS, Grasso LF, et al. Complications of acromegaly: cardiovascular, respiratory and metabolic comorbidities. Pituitary. 2017;20:46-62.

Banerjee A PK, Wren AM. Acromegaly- clinical manifestations and diagnosis. Pharm J. 2003;13:273–278.

Alexopoulou O, Bex M, Kamenicky P, Mvoula AB, Chanson P, Maiter D. Prevalence and risk factors of impaired glucose tolerance and diabetes mellitus at diagnosis of acromegaly: a study in 148 patients. Pituitary. 2014;17:81-89.

Berg C, Petersenn S, Lahner H, et al. Cardiovascular risk factors in patients with uncontrolled and long-term acromegaly: comparison with matched data from the general population and the effect of disease control. The Journal of Clinical Endocrinology & Metabolism. 2010;95:3648-3656.

Burton T, Le Nestour E, Bancroft T, Neary M. Real-world comorbidities and treatment patterns of patients with acromegaly in two large US health plan databases. Pituitary. 2013;16:354-362.

Colao A, Ferone D, Marzullo P, Lombardi G. Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocrine reviews. 2004;25:102-152.

Rajasoorya C, Holdaway I, Wrightson P, Scott D, Ibbertson H. Determinants of clinical outcome and survival in acromegaly. Clinical endocrinology. 1994;41:95-102.

Katznelson L, Laws ER, Jr., Melmed S, et al. Acromegaly: an endocrine society clinical practice guideline. The Journal of clinical endocrinology and metabolism. 2014;99:3933-3951.

Vilar L, Vilar CF, Lyra R, Lyra R, Naves LA. Acromegaly: clinical features at diagnosis. Pituitary. 2017;20:22-32.

Cordero RA, Barkan AL. Current diagnosis of acromegaly. Reviews in Endocrine and Metabolic Disorders. 2008;9:13-19.

Lesén E, Granfeldt D, Houchard A, et al. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. European Journal of Endocrinology. 2017;176:203-212.

Lugo G, Pena L, Cordido F. Clinical manifestations and diagnosis of acromegaly. International journal of endocrinology. 2012;2012.

Ramos-Leví AM, Marazuela M. Bringing Cardiovascular Comorbidities in Acromegaly to an Update. How Should We Diagnose and Manage Them? Frontiers in Endocrinology. 2019;10.

Abreu A, Tovar AP, Castellanos R, et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016;19:448-457.

Lesen E, Granfeldt D, Houchard A, et al. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study. Eur J Endocrinol. 2017;176:203-212.

Nomikos P, Buchfelder M, Fahlbusch R. The outcome of surgery in 668 patients with acromegaly using current criteria of biochemical 'cure'. Eur J Endocrinol. 2005;152:379-387.

Abreu A, Tovar AP, Castellanos R, et al. Challenges in the diagnosis and management of acromegaly: a focus on comorbidities. Pituitary. 2016;19:448-457.

Mizera ME, Daroszewski J, Bolanowski M. Cardiovascular complications of acromegaly. Acta Endocrinologica (Bucharest). 2018;14:365.

Colao A, Bronstein MD, Freda P, et al. Pasireotide versus octreotide in acromegaly: a head-to-head superiority study. The Journal of clinical endocrinology and metabolism. 2014;99:791-799.

Gadelha MR, Bronstein MD, Brue T, et al. Pasireotide versus continued treatment with octreotide or lanreotide in patients with inadequately controlled acromegaly (PAOLA): a randomised, phase 3 trial. The lancet Diabetes & endocrinology. 2014;2:875-884.

Petersenn S, Buchfelder M, Reincke M, et al. Results of surgical and somatostatin analog therapies and their combination in acromegaly: a retrospective analysis of the German Acromegaly Register. European journal of endocrinology. 2008;159:525-532.

Dekkers O, Biermasz N, Pereira A, Romijn J, Vandenbroucke J. Mortality in acromegaly: a metaanalysis. The Journal of Clinical Endocrinology & Metabolism. 2008;93:61-67.

Holdaway IM, Bolland MJ, Gamble GD. A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly. Eur J Endocrinol. 2008;159:89-95.

Didoni G, Grottol S, Gasco V, et al. Cost-of-illness study in acromegalic patients in Italy. Journal of endocrinological investigation. 2004;27:1034-1039.

Portocarrero-Ortiz LA, Vergara-Lopez A, Vidrio-Velazquez M, et al; Mexican Acromegaly Registry Group. The Mexican Acromegaly Registry: clinical and biochemical characteristics at diagnosis and therapeutic outcomes. J Clin Endocrinol Metab. 2016;101(11):3997-4004

Castellanos-Bueno R., Abreu-Lomba A., Buitrago-Gómez N, et al (2021). Clinical and epidemiological characteristics, morbidity and treatment based on the registry of acromegalic patients in Colombia: RAPACO. Growth Hormone & IGF Research, 60-61, 101425. doi:10.1016/j.ghir.2021.101425.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Copyright (c) 2022 Revista Colombiana de Endocrinología, Diabetes & Metabolismo

Dimensions


PlumX


Downloads

Download data is not yet available.