A Pituitary Society update to acromegaly management guidelines

Fleseriu, Maria; Biller, Beverly M. K.; Freda, Pamela U.; Gadelha, Mônica R.; Giustina, Andrea; Katznelson, Laurence; Molitch, Mark E.; Samson, Susan L.; Strasburger, Christian J.; Lely, Aart Jan van der; Melmed, Shlomo

doi:10.1007/s11102-020-01091-7

Cited by 175 publications

(100 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The significant limitations of this study are its retrospective design and the absence of randomization for the acromegaly treatment. Likewise, the small size of the group [21,38,42,44]. This combination is also currently included in consensus guidelines [21] for particularly resistant acromegaly, thus we think that this multicentric experience can be a useful addition to the available clinical evidence.…”

Section: Discussionmentioning

confidence: 92%

“…Likewise, the small size of the group [21,38,42,44]. This combination is also currently included in consensus guidelines [21] for particularly resistant acromegaly, thus we think that this multicentric experience can be a useful addition to the available clinical evidence. In fact, based on our data it can be hypothesized that in patients in whom residual tumor and diabetes are both clinical concerns [45] and are not sufficiently controlled by first generation SRLs, a combination of PAS-LAR and Peg-V may be a viable option.…”

Section: Discussionmentioning

confidence: 92%

See 1 more Smart Citation

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

et al. 2021

Self Cite

View full text Add to dashboard Cite

Introduction Disorders of glucose metabolism are a serious acromegaly comorbidity and may be differently impacted by medical treatments of acromegaly. In this retrospective longitudinal multicenter study, we investigated the outcome of glucose metabolism and its predictors in patients treated with Pasireotide LAR (PAS-LAR) alone or in combination with Pegvisomant (PAS-LAR + Peg-V). Subjects and methods Acromegaly patients treated continously with PAS-LAR or PAS-LAR + Peg-V for at least 6 months. Results Forty patients (25 females, 15 males) were enrolled. At last visit, 27/40 patients (67.5%) reached biochemical control of acromegaly. Overall, glucose metabolism improved in 3 (all in PAS-LAR + Peg-V; 7.5%), worsened in 26 (65%) and remained unchanged in 11 patients (27.5%). Glucose metabolism worsened in 25 patients (73.5%) treated with PAS-LAR and in a single patient (16.7%) treated with PAS-LAR + Peg-V (p < 0.001). Among patients treated with Pas-LAR alone, GH at baseline was higher in those with worsening of glucose metabolism (p = 0.04) as compared to those with stable glucose status. A significantly higher reduction of HbA1c was observed in patients treated with PAS-LAR + Peg-V, as compared with those treated with PAS-LAR alone (p = 0.005). Conclusions Our data confirmed that glucose metabolism in patients treated with PAS-LAR is often worsened, and may be predicted by entity of baseline GH hypersecretion and by the dose of PAS-LAR. Moreover, our data, although limited by small numbers, may suggest that the combination treatment PAS-LAR + Peg-V can improve glucose homeostasis in selected patients.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…For patients on long-term medical treatment when the pandemic started, some adjustments have been also helpful, for example increasing SRLs doses, which allowed for a longer injection interval (5-6 weeks or even more) (1, 2, 6, 51) for patients who could not have injections at home. In the US, oral octreotide has been Food and Drug Administration approved and available since the Fall of 2020, thus allowing some patients controlled on injectable SRLs (but requiring nurse visits for administration) to switch to an oral therapy (52).…”

Section: Acromegalymentioning

confidence: 99%

Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

Fleseriu

2021

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

“…SRLs are successful in achieving biochemical control in just over half of those treated (1). Among patients partially responsive to SRLs, higher doses, more frequent administration, or combination therapy with dopamine agonists or GH receptor antagonists, may improve biochemical control (12)(13)(14)(15). Common side effects of treatment can include injection site reactions (ISRs) and gastrointestinal (GI) symptoms (16,17).…”

Section: Introductionmentioning

confidence: 99%

Disease and Treatment-Related Burden in Patients With Acromegaly Who Are Biochemically Controlled on Injectable Somatostatin Receptor Ligands

Fleseriu

Molitch

Dreval³

et al. 2021

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

Medical treatment for acromegaly commonly involves receiving intramuscular or deep subcutaneous injections of somatostatin receptor ligands (SRLs) in most patients. In addition to side effects of treatment, acromegaly patients often still experience disease symptoms even when therapy is successful in controlling GH and IGF-1 levels. Symptoms and side effects can negatively impact patients’ health-related quality of life. In this study, we examine the disease- and treatment-related burden associated with SRL injections as reported through the use of the Acromegaly Treatment Satisfaction Questionnaire (Acro-TSQ ©) and clinician-reported symptom severity through the Acromegaly Index of Severity (AIS). Patients included in this analysis were enrolled in a randomized phase 3 study, were biochemically-controlled (an IGF-1 < 1.3 × the upper limit of normal [ULN] and average GH < 2.5 ng/ml) and receiving SRL injections for ≥6 months with a stable dose of either long-acting octreotide or lanreotide monotherapy for ≥4 months. The sample (N = 91) was 65% female, 91% Caucasian, with a mean [standard deviation (SD)] age of 53 (1) years. Two-thirds of patients reported that they still experience acromegaly symptoms; 82% of these said they experience symptoms all of the time. Three-fourths experienced gastrointestinal (GI) side effects after injections, and 77% experienced treatment-related injection site reactions (ISRs). Patients commonly reported that these interfered with their daily life, leisure, and work activities. Those with higher symptom severity, as measured by the AIS, scored significantly worse on several Acro-TSQ domains: Symptom Interference, GI Interference, Treatment Satisfaction, and Emotional Reaction. Despite being biochemically controlled with injectable SRLs, most patients reported experiencing acromegaly symptoms that interfere with daily life, leisure, and work. GI side effects and ISRs were also common. This study highlights the significant disease burden that still persists for patients with acromegaly that have achieved biochemical control with the use of injectable SRLs.

show abstract

A Pituitary Society update to acromegaly management guidelines

Cited by 175 publications

References 91 publications

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

Glucose metabolism outcomes in acromegaly patients on treatment with pasireotide-LAR or pasireotide-LAR plus Pegvisomant

Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting

Disease and Treatment-Related Burden in Patients With Acromegaly Who Are Biochemically Controlled on Injectable Somatostatin Receptor Ligands

Contact Info

Product

Resources

About