Changes in acromegaly treatment over four decades in Spain: analysis of the Spanish Acromegaly Registry (REA)

Abstract

Since 1997 there is an online National Registry of acromegalic patients in Spain (REA). We aimed to study changes in acromegaly treatment and outcomes over the last four decades in Spain. In REA clinical and biochemical data are collected at diagnosis and updated every one to 2 years. We analyzed the first treatment received and the different treatments administered according to decade of diagnosis of acromegaly: prior to 1980, 1980-1989, 1990-1999 and 2000-2009. Surgical cure rates according to pretreatment with long-acting somatostatin receptor ligands (SRLs) were also analyzed. 1,658 patients were included of which 698 had accurate follow-up data. Treatment of acromegaly changed over time. Surgery was the main treatment option (83.8 %) and medical treatment was widely used (74.7 %) both maintained over decades, while radiation therapy declined (62.8, 61.6, 42.2 and 11.9 % over decades, p < 0.001). First treatment type also changed: surgery was the first line option up until the last decade in which medical treatment was preferred (p < 0.001). Radiotherapy was barely used as first treatment. Treatment combinations changed over time (p < 0.001). The most common treatment combination (surgery plus medical therapy), was received by 24.4, 16.4, 25.3 and 56.5 % of patients over decades. Medical treatment alone was performed in 7.3, 6, 7.2 and 14.7 % over decades. Type of medical treatment also changed, SRLs becoming the first medical treatment modality in the last decades, whereas dopamine agonist use declined (p < 0.001). Surgical cure rates improved over decades (21, 21, 36 and 38 %, p = 0.002) and were not influenced by SRL pre-surgical use. Acromegaly treatment has changed in Spain in the last four decades. Surgery has been the main treatment option for decades; however, medical therapy has replaced surgery as first line in the last decade and radiotherapy rates have clearly declined. SRLs are the most used medical treatment.

Dawkowanie i koszt lanreotydu Autogel 120 mg stosowanego w leczeniu akromegalii w Polsce — wyniki 2-letniego badania Lanro-Study

“…Third, the study population, from 35 centres in different Polish regions, represents a wide cross-section of acromegalic patients in our country. About 80% of patients with a documented tumour size had a macroadenoma at diagnosis indicating that the analysed cohort was representative for the disease [13][14][15][16][17][18][19][20][21][22][23]. In the current analysis the prevalence of acromegaly in women is higher than in other registries [13][14][15][16][17][18][19][20][21][22][23], but the female predominance is in accordance with literature.…”

“…This is less than the numbers in the Belgian register (34%) [16] and about half of those published from the UK or Spain (48% and 45%, respectively) [13,14]. A very recent publication from the Spanish Acromegaly Registry, however, documented a decline in the use of radiotherapy to 11.9% in patients diagnosed after 2000 [19].…”

Expert consensus document: A consensus on the medical treatment of acromegaly

“…The expertise of the pituitary surgeon influences cost-effectiveness by optimizing surgical outcomes (MQ), and the potential of radiation therapy as a means of controlling drug ex penditure could also be considered (DR). [50][51][52] Tumour volume and medical therapy…”

Characteristics and outcome of surgically treated acromegaly patients attending an endocrinology clinic at a tertiary referral centre in Durban, South Africa over a period of 10 years

“…13 Results from the Spanish Acromegaly Register were similar, with 76% of 698 subjects regarded as controlled, as defined by a normal IGF-1 level. 14 Whilst acromegaly is well characterised in the developed world, there is a paucity of information from Africa and South Africa. The available literature from South Africa is limited to a single publication.…”

“…16,20 In the German and Spanish Register studies, disease control, defined as a normal IGF-1, was substantially higher than in the current study (71.9% and 76% respectively). 13,14 The strict definition of cure, however, includes retention of normal pituitary function after surgery or radiotherapy. If the criteria of normal age-matched and gender-matched IGF-1 together with random GH < 1.0 μg/l and normal pituitary function are used; only 2 of 27 (7.4%) subjects would be regarded as cured.…”