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      A Pituitary Society update to acromegaly management guidelines

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          Abstract

          Guidelines and consensus statements ensure that physicians managing acromegaly patients have access to current information on evidence-based treatments to optimize outcomes. Given significant novel recent advances in understanding acromegaly natural history and individualized therapies, the Pituitary Society invited acromegaly experts to critically review the current literature in the context of Endocrine Society guidelines and Acromegaly Consensus Group statements. This update focuses on how recent key advances affect treatment decision-making and outcomes, and also highlights the likely role of recently FDA-approved therapies as well as novel combination therapies within the treatment armamentarium.

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          Acromegaly: an endocrine society clinical practice guideline.

          The aim was to formulate clinical practice guidelines for acromegaly.
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            A Consensus Statement on acromegaly therapeutic outcomes

            The 11th Acromegaly Consensus Conference in April 2017 was convened to update recommendations on therapeutic outcomes for patients with acromegaly. Consensus guidelines on the medical management of acromegaly were last published in 2014; since then, new pharmacological agents have been developed and new approaches to treatment sequencing have been considered. Thirty-seven experts in the management of patients with acromegaly reviewed the current literature and assessed changes in drug approvals, clinical practice standards and clinical opinion. They considered current treatment outcome goals with a focus on the impact of current and emerging somatostatin receptor ligands, growth hormone receptor antagonists and dopamine agonists on biochemical, clinical, tumour mass and surgical outcomes. The participants discussed factors that would determine pharmacological choices as well as the proposed place of each agent in the guidelines. We present consensus recommendations highlighting how acromegaly management could be optimized in clinical practice.
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              Pasireotide Versus Octreotide in Acromegaly: A Head-to-Head Superiority Study

              Context: Biochemical control reduces morbidity and increases life expectancy in patients with acromegaly. With current medical therapies, including the gold standard octreotide long-acting-release (LAR), many patients do not achieve biochemical control. Objective: Our objective was to demonstrate the superiority of pasireotide LAR over octreotide LAR in medically naive patients with acromegaly. Design and Setting: We conducted a prospective, randomized, double-blind study at 84 sites in 27 countries. Patients: A total of 358 patients with medically naive acromegaly (GH >5 μg/L or GH nadir ≥1 μg/L after an oral glucose tolerance test (OGTT) and IGF-1 above the upper limit of normal) were enrolled. Patients either had previous pituitary surgery but no medical treatment or were de novo with a visible pituitary adenoma on magnetic resonance imaging. Interventions: Patients received pasireotide LAR 40 mg/28 days (n = 176) or octreotide LAR 20 mg/28 days (n = 182) for 12 months. At months 3 and 7, titration to pasireotide LAR 60 mg or octreotide LAR 30 mg was permitted, but not mandatory, if GH ≥2.5μg/L and/or IGF-1 was above the upper limit of normal. Main Outcome Measure: The main outcome measure was the proportion of patients in each treatment arm with biochemical control (GH <2.5 μg/L and normal IGF-1) at month 12. Results: Biochemical control was achieved by significantly more pasireotide LAR patients than octreotide LAR patients (31.3% vs 19.2%; P = .007; 35.8% vs 20.9% when including patients with IGF-1 below the lower normal limit). In pasireotide LAR and octreotide LAR patients, respectively, 38.6% and 23.6% (P = .002) achieved normal IGF-1, and 48.3% and 51.6% achieved GH <2.5 μg/L. 31.0% of pasireotide LAR and 22.2% of octreotide LAR patients who did not achieve biochemical control did not receive the recommended dose increase. Hyperglycemia-related adverse events were more common with pasireotide LAR (57.3% vs 21.7%). Conclusions: Pasireotide LAR demonstrated superior efficacy over octreotide LAR and is a viable new treatment option for acromegaly.
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                Author and article information

                Contributors
                melmed@csmc.edu
                Journal
                Pituitary
                Pituitary
                Pituitary
                Springer US (New York )
                1386-341X
                1573-7403
                20 October 2020
                20 October 2020
                2021
                : 24
                : 1
                : 1-13
                Affiliations
                [1 ]GRID grid.5288.7, ISNI 0000 0000 9758 5690, Pituitary Center, Departments of Medicine and Neurological Surgery, , Oregon Health & Science University, ; Portland, OR USA
                [2 ]Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
                [3 ]GRID grid.21729.3f, ISNI 0000000419368729, Department of Medicine, , Columbia University, Vagelos College of Physicians and Surgeons, ; New York, NY USA
                [4 ]GRID grid.8536.8, ISNI 0000 0001 2294 473X, Neuroendocrinology Research Center/Endocrinology Section, , Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, ; Rio de Janeiro, Brazil
                [5 ]GRID grid.15496.3f, Institute of Endocrine and Metabolic Sciences, , San Raffaele Vita-Salute University and IRCCS San Raffaele Hospital, ; Milan, Italy
                [6 ]GRID grid.168010.e, ISNI 0000000419368956, Departments of Medicine and Neurosurgery, , Stanford University School of Medicine, ; Stanford, CA USA
                [7 ]GRID grid.16753.36, ISNI 0000 0001 2299 3507, Division of Endocrinology, Metabolism & Molecular Medicine, , Northwestern University Feinberg School of Medicine, ; Chicago, IL USA
                [8 ]GRID grid.39382.33, ISNI 0000 0001 2160 926X, Pituitary Center, Departments of Medicine and Neurosurgery, , Baylor College of Medicine, ; Houson, TX USA
                [9 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Medicine for Endocrinology, Diabetes and Nutritional Medicine, , Charité Universitätsmedizin, ; Berlin, Germany
                [10 ]GRID grid.5645.2, ISNI 000000040459992X, Pituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                [11 ]GRID grid.50956.3f, ISNI 0000 0001 2152 9905, Pituitary Center, Cedars-Sinai Medical Center, ; 8700 Beverly Blvd., Room 2015, Los Angeles, CA 90048 USA
                Author information
                http://orcid.org/0000-0001-9284-6289
                http://orcid.org/0000-0002-2355-3447
                Article
                1091
                10.1007/s11102-020-01091-7
                7864830
                33079318
                2a9f501f-ba9d-4d49-a88a-324ddcb24feb
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 28 September 2020
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                © Springer Science+Business Media, LLC, part of Springer Nature 2021

                Medicine
                pituitary adenoma,acromegaly,growth hormone,insulin-like growth factor i,somatostatin receptor ligand,pegvisomant,oral octreotide

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