Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion.
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Biagetti Betina, Araujo-Castro Marta, Torre Edelmiro Menéndez, Novoa-Testa Iría, Cordido Fernando, Corrales Eider Pascual, Berrocal Víctor Rodríguez, Guerrero-Pérez Fernando, Vicente Almudena, Percovich Juan Carlos, Centeno Rogelio García, González Laura, García María Dolores Ollero, Echarri Ana Irigaray, Rodríguez María Dolores Moure, Novo-Rodríguez Cristina, Calatayud María, Villar-Taibo Rocío, Bernabéu Ignacio, Alvarez-Escola Cristina, Valderrama Pamela Benítez, Tenorio-Jiménez Carmen, Galiana Pablo Abellán, Moreno Eva Venegas, Molero Inmaculada González, Iglesias Pedro, Blanco Concepción, De Lara Fernando Vidal-Ostos, de Miguel Paz, Mezquita Elena López, Hanzu Felicia, Aldecoa Iban, Aznar Silvia, Lamas Cristina, Aulinas Anna, Asla Roca Queralt, Gracia Paola, Córdova José María Recio, Aviles Mariola, Asensio-Wandosel Diego, Sampedro Miguel, Cámara Rosa, Paja Miguel, Ruz-Caracuel Ignacio, Fajardo-Montañana Carmen, Asanza Esteban Cordero, Martinez-Saez Elena, Marazuela Mónica, Puig-Domingo Manel
Аннотация
DESIGN: This is a retrospective multicentric study of acromegaly patients followed from 2003 to 2023 in 33 tertiary Spanish hospitals with at least 6 months of first-line medical treatment.
METHODS: Baseline characteristics, first-line medical treatment strategies, and outcomes were analyzed. We employed a multiple logistic regression full model to estimate the impact of some baseline characteristics on disease control after each treatment modality.
RESULTS: Of the 144 patients included, 72.9% had a GH-PA, and 27.1% had a GH&PRL-PA. Patients with GH&PRL-PA were younger (43.9 ± 15.0 vs 51.9 ± 12.7 years, P < .01) and harboring more frequently macroadenomas (89.7% vs 72.1%, P = .03). First-generation somatostatin receptor ligand (fgSRL) as monotherapy was given to 106 (73.6%) and a combination treatment with fgSRL and cabergoline in the remaining 38 (26.4%). Patients with GH&PRL-PA received more frequently a combination therapy (56.4% vs 15.2%, P < .01). After 6 months of treatment, in the group of patients under fgSRL as monotherapy, those patients with GH&PRL-PA had worse control compared to GH-PAs (29.4% vs 55.1%, P = .04). However, these differences in the rate of disease control between both groups disappeared when both received combination treatment with fgSRL and cabergoline.
CONCLUSION: In GH&PRL-PA, the biochemical control achieved with fgSRL as monotherapy is substantially worse than in patients harboring GH-PA, supporting the inclusion of cabergoline as first-line medical treatment in combination with fgSRLs in these subgroups of patients.