Real-World Treatment Patterns in Cushing's Disease Patients in Two Large US Nationwide Databases: Application of a Novel, Graphical Methodology

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-94
Michael S Broder1, Maureen P. Neary*2, Eunice Chang1, William Henry Ludlam2 and Dasha Cherepanov1
1Partnership for Health Analytic Research, Beverly Hills, CA, 2Novartis Pharmaceuticals Corporation, East Hanover, NJ
OBJECTIVES: Untreated Cushing’s disease (CD), resulting from excessive adrenocorticotropic hormone secretion by pituitary tumor, is associated with substantial morbidity and mortality. Treatment of this rare disorder includes surgery, radiotherapy, or pharmacologic therapy. Data on real-world treatment patterns for CD in US have been limited. We used a novel graphical technique to analyze treatment patterns in CD.

METHODS: Combining US claims databases (Thomson Reuters MarketScan Commercial; IMS Health PharMetrics), we identified and followed CD patients from day of first treatment until end of enrollment or 12/31/2010. CD patients were identified as those who had a claim with Cushing’s syndrome diagnosis and either benign pituitary adenomas diagnosis or hypophysectomy and newly treated in 2008 (no treatment in prior 6 months). A novel graphical methodology that displays treatment patterns for each patient, including color-coded treatment sequences and duration of each treatment in sequence, was applied and results were compared with summary statistics.

RESULTS: We identified 228 newly treated CD patients: 180 patients (78.9%) had surgery as their first observed treatment, 42 (18.4%) had pharmacologic therapy and 6 (2.6%) had radiotherapy. In those with surgery as first treatment, 172 had pituitary surgery and 8 had adrenalectomy. Dopamine agonists were used as first medical therapy in 24 patients (57.1%), ketoconazole in 17 (40.5%), and mitotane in one patient (2.4%). In 180 patients with surgery as first treatment, 15 (8.3%) had radiotherapy and 14 (7.8%) had medical treatment during follow-up. In 42 patients who had pharmacologic therapy as first treatment, 10 (23.8%) had surgery and 2 (4.8%) had radiotherapy during follow-up. Mean (median) duration of first pharmacologic therapy varied by drug: 369.5 days (245) for dopamine agonists, 157.1 (30) for ketoconazole, and 30.0 (30) for mitotane. Images revealed persistence and changes in treatment varied by initial therapy. Graphics will be presented.

CONCLUSIONS: This study addresses an unmet need for data on real-world treatment patterns for CD patients in the US. Data were provided for treatment rates and duration in a large sample of CD patients using two nationwide databases. Patient-level graphical analysis provided additional detailed information on treatment patterns.

Disclosure: MSB: Researcher, Novartis Pharmaceuticals. MPN: Employee, Novartis Pharmaceuticals. EC: Researcher, Novartis Pharmaceuticals. WHL: Employee, Novartis Pharmaceuticals. DC: Researcher, Novartis Pharmaceuticals.

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: Funding for this study was provided by Novartis Pharmaceuticals Corporation.