Session: SUN 281-290-Comparative Effectiveness/Health Outcomes/Quality Improvement/Patient or Provider Education/Endocrine Emergencies
Poster Board SUN-283
Methods: A retrospective chart audit was conducted in US, France, Italy, and Brazil (September 2012). 97 endocrinologists completed structured case report forms for the 4 most recently-seen patients (2 with somatostatin analogues [SSAs], 2 with pegvisomant [PegV] or PegV+SSAs), N=380; those on the last choice of medical therapy ≥6 months were included in the analysis (N=335). Patient demographics, comorbidities, treatment history, insulin-like growth factor type 1 (IGF-1) and symptoms were recorded. Control of IGF-1 was defined as IGF-1≤1ULN,
Results: Of the 335 medically treated patients (mean age 51 yrs; 52% men), 193 (57.6%) were treated with SSAs, 116 (34.6%) with PegV, and 26 (7.8%) with PegV+SSAs. 208 of 335 patients (62%) were treated with surgery prior to medical therapy (74% US, 63% Brazil, 54% France, 51% Italy), 127 (38%) received medical therapy with (n=6) or without (n=121) radiation. 124 (37%) of all study patients had IGF-1>ULN (44% US, 48% Brazil, 31% France, 41% Italy); 67 (20%) had IGF-1>1.5xULN (19% US, 28% Brazil, 21% France, 15% Italy) despite treatments. 63 of 208 (30%) patients treated with surgery prior to medical therapy and 61 of 127 (48%) treated with medical therapy had IGF-1>ULN. 59% of SSA-treated patients had IGF-1≤ULN vs. 67% of patients on PegV, and 73% of patients on PegV+SSAs. The rates of acromegaly symptoms and comorbidities were similar among patients treated with SSAs and PegV (overall 65% hypertension, 31% type 2 diabetes, 23% arthritis, 48% headache, 51% fatigue, 43% joint pain, 15% paresthesia and 24% perspiration). The rates of acromegaly symptoms were higher in patients with IGF-1>ULN: 50% vs.46% headache, 53% vs. 49% fatigue, 47% vs. 41% joint pain, 23% vs. 10% paresthesia* and 32% vs. 19% perspiration (*p<0.05).
Conclusions: Medical therapy remains an integral component of acromegaly management. Despite the different therapeutic strategies, including treatment with different drugs with stable dose for at least 6 months, 37% of all medically treated patients remain with IGF-1>ULN.
Disclosure: DF: Medical Advisory Board Member, Novartis Pharmaceuticals, Medical Advisory Board Member, Eli Lilly & Company, Speaker, Novartis Nutrition, Inc., Speaker, Ipsen. AF: Employee, Novartis Pharmaceuticals. WHL: Employee, Novartis Pharmaceuticals. RR: Employee, Novartis Pharmaceuticals. CTT: Employee, Novartis Pharmaceuticals. MG: Medical Advisory Board Member, Novartis Pharmaceuticals, , Novartis Pharmaceuticals, Investigator, Novartis Pharmaceuticals, Investigator, Pfizer, Inc., Speaker, Pfizer, Inc., Speaker, Ipsen.
*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm
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