A systematic literature review to evaluate extended dosing intervals in the pharmacological management of acromegaly

Abstract

Purpose This systematic literature review investigated whether extended dosing intervals (EDIs) of pharmacological acromegaly treatments reduce patient burden and costs compared with standard dosing, while maintaining effectiveness. Methods MEDLINE/Embase/the Cochrane Library (2001–June 2021) and key congresses (2018–2021) were searched and identified systematic literature review bibliographies reviewed. Included publications reported on efficacy/effectiveness, safety and tolerability, health-related quality of life (HRQoL), and patient-reported and economic outcomes in longitudinal/cross-sectional studies in adults with acromegaly. Interventions included EDIs of pegvisomant, cabergoline, and somatostatin receptor ligands (SRLs): lanreotide autogel/depot (LAN), octreotide long-acting release (OCT), pasireotide long-acting release (PAS), and oral octreotide; no comparator was required. Results In total, 35 publications reported on 27 studies: 3 pegvisomant monotherapy, 11 pegvisomant combination therapy with SRLs, 9 LAN, and 4 OCT; no studies reported on cabergoline, PAS, or oral octreotide at EDIs. Maintenance of normal insulin-like growth factor I (IGF-I) was observed in ≥ 70% of patients with LAN (1 study), OCT (1 study), and pegvisomant monotherapy (1 study). Achievement of normal IGF-I was observed in ≥ 70% of patients with LAN (3 studies) and pegvisomant in combination with SRLs (4 studies). Safety profiles were similar across EDI and standard regimens. Patients preferred and were satisfied with EDIs. HRQoL was maintained and cost savings were provided with EDIs versus standard regimens. Conclusions Clinical efficacy/effectiveness, safety, and HRQoL outcomes in adults with acromegaly were similar and costs lower with EDIs versus standard regimens. Physicians may consider acromegaly treatment at EDIs, especially for patients with good disease control.

Treatment Patterns, Adherence, Persistence, and Health Care Resource Utilization in Acromegaly: A Real-World Analysis

“…Furthermore, poor medication adherence has been linked to increased health care resource utilization [ 16 ]. Treatment persistence may also increase if treatment schedule is acceptable to patients [ 17 ]. These are important considerations for patients with acromegaly, as the disorder and its comorbidities may require lifelong monitoring and medical therapy across multiple specialties [ 18 ].…”

“…The majority of the cohort had acromegaly-related comorbidities, with greater prevalence of comorbidities corresponding with greater health care resource utilization. EDIs could be explored more frequently for those patients as a means to relieve the burden of treatment and health care utilization [ 23 , 24 ].…”

“…Notably, few patients had an EDI, even though EDIs are included as an option in the label for lanreotide depot [ 14 ]. EDIs can achieve clinical outcomes similar to standard treatment regiments, as well as high patient satisfaction, while presenting a lower expense [ 17 , 24 ]. EDI regimens using high doses of lanreotide depot (≥120 mg) or octreotide LAR (≥40 mg) may optimize treatment persistence, provided a well-established tolerability profile [ 4 , 23 ].…”

“…EDIs can achieve clinical outcomes similar to standard treatment regiments, as well as high patient satisfaction, while presenting a lower expense [ 17 , 24 ]. EDI regimens using high doses of lanreotide depot (≥120 mg) or octreotide LAR (≥40 mg) may optimize treatment persistence, provided a well-established tolerability profile [ 4 , 23 ]. Physicians may consider more frequent EDI use for some patients, particularly if low normal IGF-1 levels are encountered.…”

“…Physicians may consider more frequent EDI use for some patients, particularly if low normal IGF-1 levels are encountered. This approach may ameliorate both the clinical and economic burden on those patients, improve patients’ quality of life, and reduce health care resource utilization by lowering the number and frequency of injections [ 23 ].…”