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Pituitary

, Volume 22, Issue 4, pp 387–396 | Cite as

The effects of pre-operative somatostatin analogue therapy on treatment cost and remission in acromegaly

  • Ozge Polat Korkmaz
  • Mert Gurcan
  • Fatma Eda Nuhoglu Kantarci
  • Ozlem Haliloglu
  • Hande Mefkure Ozkaya
  • Serdar Sahin
  • Meryem Merve Oren
  • Necmettin Tanriover
  • Nurperi Gazioglu
  • Pinar KadiogluEmail author
Article

Abstract

Purpose

To investigate the effects of preoperative somatostatin analogue (SSA) treatment on the annual cost of all acromegaly treatment modalities and on remission rates.

Methods

The medical records of 135 patients with acromegaly who were followed at endocrinology clinic of Cerrahpasa Medical Faculty for at least 2 years after surgery between 2009 and 2016 were reviewed.

Results

The mean follow-up time was 50.9 ± 25.7 months. Early remission was defined according to 3rd month values in patients who didn’t achieve remission, and 6th month values in patients who achieved remission at the 3rd month after surgery. The early and late remission rates of the entire study population were 40% and 80.7%, respectively. The early remission of the preoperative SSA-treated group (61.5%) was significantly higher than SSA-untreated group (31.2%) (p = 0.002). The early remission of the preoperative SSA-treated patients with macroadenomas (52.2%) was also significantly higher than the SSA-untreated group (23.5%) (p = 0.02). In the subgroup analysis; this difference was much more pronounced in invasive macroadenomas (p = 0.002). There were no differences between the groups in terms of late remission.The median annual cost of all acromegaly treatment modalities in study population was €3788.4; the cost for macroadenomas was significantly higher than for microadenomas (€4125.0 vs. €3226.5, respectively; p = 0.03). Preoperative SSA use in both microadenomas and macroadenomas didn’t alter the cost of treatment. The increase in the duration of preoperative medical treatment had no effect on early or late remissions (p = 0.09; p = 0.8).

Conclusions

Preoperative medical treatment had no effect on the costs of acromegaly treatment. There was a benefical effect of pre-operative SSA use on early remission in patients with macroadenomas; however, this effect didn’t persist long term.

Keywords

Acromegaly Preoperative treatment Cost Somatostatin analogue 

Notes

Acknowledgments

This research did not receive any specific grant from any funding agencies in the public, commercial, or non-profit sector. We would like to thank David Chapman for his help with the proofreading this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the local ethics committee of Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty and all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human and animal participants

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JAH (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99:3933–3951CrossRefGoogle Scholar
  2. 2.
    Wilson LS, Shin JL, Ezzat S (2001) Longitudinal assessment of economic burden and clinical outcomes in acromegaly. Endocr Pract 7:170–180CrossRefGoogle Scholar
  3. 3.
    Katznelson L, Atkinson JL, Cook DM, Ezzat SZ, Hamrahian AH, Miller KK (2011) American Association of Clinical Endocrinologists medical guidelines for clinical practice forthe diagnosis and treatment of acromegaly–2011 update. Endocr Pract 4:1–44CrossRefGoogle Scholar
  4. 4.
    Ben-Shlomo A, Sheppard MC, Stephens JM, Pulgar S, Melmed S (2011) Clinical, quality of life, and economic value of acromegaly disease control. Pituitary 14:284–294CrossRefGoogle Scholar
  5. 5.
    Abu Dabrh AM, Mohammed K, Asi N, Farah WH, Wang Z, Farah MH, Prokop LJ, Katznelson L, Murad MH (2014) Surgical interventions and medical treatments in treatment-naive patients with acromegaly: systematic review and meta-analysis. J Clin Endocrinol Metab 99:4003–4014CrossRefGoogle Scholar
  6. 6.
    Melmed S, Colao A, Barkan A, Molitch M, Grossman AB, Kleinberg D, Clemmons D, Chanson P, Laws E, Schlechte J, Vance ML, Ho K, Giustina A, Acromegaly Consensus Group (2009) Guidelines for acromegaly management: an update. J Clin Endocrinol Metab 94:1509–1517CrossRefGoogle Scholar
  7. 7.
    Jane JA Jr, Starke RM, Elzoghby MA, Reames DL, Payne SC, Thorner MO, Marshall JC, Laws ER Jr, Vance ML (2011) Endoscopic transsphenoidal surgery for acromegaly: remission using modern criteria, complications, and predictors of outcome. J Clin Endocrinol Metab 96:2732–2740CrossRefGoogle Scholar
  8. 8.
    Starke RM, Raper DM, Payne SC, Vance ML, Oldfield EH, Jane JA Jr (2013) Endoscopic vs microsurgical transsphenoidal surgery for acromegaly: outcomes in a concurrent series of patients using modern criteria for remission. J Clin Endocrinol Metab 98:3190–3198CrossRefGoogle Scholar
  9. 9.
    Haliloglu O, Kuruoglu E, Ozkaya HM, Keskin FE, Gunaldi O, Oz B, Gazioglu N, Kadioglu P, Tanriover N (2016) Multidisciplinary approach for acromegaly: a single tertiary Center’s experience. World Neurosurg 88:270–276CrossRefGoogle Scholar
  10. 10.
    Nunes VS, Correa JM, Puga ME, Silva EM, Boguszewski CL (2015) Preoperative somatostatin analogues versus direct transsphenoidal surgery for newly-diagnosed acromegaly patients: a systematic review and meta-analysis using the GRADE system. Pituitary 18:500–508CrossRefGoogle Scholar
  11. 11.
    Abe T, Ludecke DK (2001) Effects of preoperative octreotide treatment on different subtypes of 90 GH-secreting pituitary adenomas and outcome in one surgical centre. Eur J Endocrinol 145:137–145CrossRefGoogle Scholar
  12. 12.
    Carlsen SM, Lund-Johansen M, Schreiner T, Aanderud S, Johannesen O, Svartberg J, Cooper JG, Hald JK, Fougner SL, Bollerslev J, Preoperative Octreotide Treatment of Acromegaly study group (2008) Preoperative octreotide treatment in newly diagnosed acromegalic patients with macroadenomas increases cure short-term postoperative rates: a prospective, randomized trial. J Clin Endocrinol Metab 93:2984–2990CrossRefGoogle Scholar
  13. 13.
    Stevenaert A, Beckers A (1993) Presurgical octreotide treatment in acromegaly. Acta Endocrinol 129:18–20Google Scholar
  14. 14.
    Kristof RA, Stoffel-Wagner B, Klingmuller D, Schramm J (1999) Does octreotide treatment improve the surgical results of macro-adenomas in acromegaly? A randomized study. Acta Neurochir 141:399–405CrossRefGoogle Scholar
  15. 15.
    Losa M, Mortini P, Urbaz L, Ribotto P, Castrignanó T, Giovanelli M (2006) Presurgical treatment with somatostatin analogs in patients with acromegaly: effects on the remission and complication rates. J Neurosurg 104:899–906CrossRefGoogle Scholar
  16. 16.
    Plockinger U, Quabbe HJ (2005) Presurgical octreotide treatment in acromegaly: no improvement of final growth hormone (GH) concentration and pituitary function. A long-term case-control study. Acta Neurochir 147:485–493CrossRefGoogle Scholar
  17. 17.
    Shen M, Shou X, Wang Y, Zhang Z, Wu J, Mao Y, Li S, Zhao Y (2010) Effect of presurgical long-acting octreotide treatment in acromegaly patients with invasive pituitary macroadenomas: a prospective randomized study. Endocr J 57:1035–1044CrossRefGoogle Scholar
  18. 18.
    Li Z-Q, Quan Z, Tian H-L, Cheng M (2012) Preoperative lanreotide treatment improves outcome in patients with acromegaly resulting from invasive pituitary macroadenoma. J IntMedRes 40:517–524Google Scholar
  19. 19.
    Mao ZG, Zhu YH, Tang HL, Wang DY, Zhou J, He DS, Lan H, Luo BN, Wang HJ (2010) Preoperative lanreotide treatment in acromegalic patients with macroadenomas increases short-term postoperative cure rates: a prospective, randomised trial. Eur J Endocrinol 162:661–666CrossRefGoogle Scholar
  20. 20.
    Colao A, Auriemma RS, Lombardi G, Pivonello R (2011) Resistance to somatostatin analogs in acromegaly. Endocrine Rev 32:247–271CrossRefGoogle Scholar
  21. 21.
    Caron PJ, Bevan JS, Petersenn S, Flanagan D, Tabarin A, Prévost G, Maisonobe P, Clermont A (2014) Tumor shrinkage with lanreotide Autogel 120 mg as primary therapy in acromegaly: results of a prospective multicenter clinical trial. J Clin Endocrinol Metab 99:1282–1290CrossRefGoogle Scholar
  22. 22.
    Melmed S, Sternberg R, Cook D, Klibanski A, Chanson P, Bonert V, Vance ML, Rhew D, Kleinberg D, Barkan A (2005) A critical analysis of pituitary tumor shrinkage during primary medical therapy in acromegaly. J Clin Endocrinol Metab 90:4405–4410CrossRefGoogle Scholar
  23. 23.
    Jacob JJ, Bevan JS (2014) Should all patients with acromegaly receive somatostatin analogue therapy before surgery and if so, for how long? Clin Endocrinol 81:812–817CrossRefGoogle Scholar
  24. 24.
    Fleseriu M, Hoffman AR, Katznelson L (2015) AACE neuroendocrine and pituitary Scientific Committee. American Association of Clinical Endocrinologists and Amerıcan College of Endocrınology Disease State Clinical Review: management of acromegaly patients: what is the role of pre-operative medical therapy? Endocr Pract 21:668–673CrossRefGoogle Scholar
  25. 25.
    Zhang L, Wu X, Yan Y, Qian J, Lu Y, Luo C (2015) Preoperative somatostatin analogs treatment in acromegalic patients with macroadenomas. A meta-analysis. Brain Dev 37:181–190CrossRefGoogle Scholar
  26. 26.
    Beckers A (2008) Does preoperative somatostatin analog treatment improve surgical cure rates in acromegaly? A new look at an old question. J Clin Endocrinol Metab 93:2975–2977CrossRefGoogle Scholar
  27. 27.
    Fougner SL, Bollerslev J, Svartberg J, Oksnes M, Cooper J, Carlsen SM (2014) Preoperative octreotide treatment of acromegaly: long-term results of a randomised controlled trial. Eur J Endocrinol 171:229–235CrossRefGoogle Scholar
  28. 28.
    Margusino-Framinan L, Pertega-Diaz S, Pena-Bello L, Sangiao-Alvarellos S, Outeirino-Blanco E, Pita-Gutierrez F, Cordido F (2015) Cost-effectivenes analysis of preoperative treatment of acromegalywith somatostatin analogue on surgical outcome. Eur J Int Med 26:736–741CrossRefGoogle Scholar
  29. 29.
    Duan L, Huang M, Yan H, Zhang Y, Gu F (2015) Cost-effectiveness analysis of two therapeutic schemes in the treatment of acromegaly: a retrospective study of 168 cases. J Endocrinol Invest 38:717–723CrossRefGoogle Scholar
  30. 30.
    Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–617Google Scholar
  31. 31.
    Duan L, Zhu H, Xing B, Gu F (2017) Prolonged preoperativetreatment of acromegaly with Somatostatin analogs may improve surgical outcome in patients with invasive pituitary macroadenoma (Knosp grades 1-3): a retrospective cohort study conducted at a single center. BMC Endocr Disord 17:55CrossRefGoogle Scholar
  32. 32.
    Fleseriu M (2011) Clinical efficacy and safety results for dose escalation of somatostatin receptor ligands in patients with acromegaly: a literature review. Pituitary 14:184–193CrossRefGoogle Scholar
  33. 33.
    Losa M, Ciccarelli E, Mortini P, Barzaghi R, Gaia D, Faccani G, Papotti M, Mangili F, Terreni MR, Camanni F, Giovanelli M (2001) Effects of octreotide treatment on the proliferation and apoptotic index of GH-secreting pituitary adenomas. J Clin Endocrinol Metab 86:5194–5200CrossRefGoogle Scholar
  34. 34.
    Cap J, Cerman J, Nemecek S, Marekova M, Hana V, Frysak Z (2003) The influence of treatment with somatostatin analogues on morphology, proliferative and apoptotic activity in GH-secreting pituitary adenomas. J Clin Neurosci 10(4):444–448CrossRefGoogle Scholar
  35. 35.
    Roset M, Merino-Montero S, Luque-Ramírez M, Webb SM, López-Mondéjar P, Salinas I, Soto A, Bernal C, Villabona C, De Luis D, Donnay S, Pascual H, Pérez-Luis J, Spanish group of the OASIS study (2012) Cost of clinical management of acromegaly in Spain. Clin Drug Investig 32:235–245CrossRefGoogle Scholar
  36. 36.
    Didoni G, Grottol S, Gasco V, Battistini M, Ferone D, Giusti M, Ragazzoni F, Ruffo P, Ghigo E, Minuto F (2004) Cost-of-illness study in acromegalic patients in Italy. J Endocrinol Invest 27:1034–1039CrossRefGoogle Scholar
  37. 37.
    Moore DJ, Adi Y, Connock MJ, Bayliss S (2009) Clinical effectiveness and cost effectiveness of pegvisomant for the treatment of acromegaly: a systematic review and economic evaluation. BMC Endocr Disord 8:9–20Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ozge Polat Korkmaz
    • 1
  • Mert Gurcan
    • 2
  • Fatma Eda Nuhoglu Kantarci
    • 3
  • Ozlem Haliloglu
    • 1
  • Hande Mefkure Ozkaya
    • 1
  • Serdar Sahin
    • 1
  • Meryem Merve Oren
    • 4
  • Necmettin Tanriover
    • 5
  • Nurperi Gazioglu
    • 5
  • Pinar Kadioglu
    • 1
    Email author
  1. 1.Division of Endocrinology, Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of MedicineIstanbul University-CerrahpasaIstanbulTurkey
  2. 2.Cerrahpasa Faculty of MedicineIstanbul University-CerrahpasaIstanbulTurkey
  3. 3.Department of Internal MedicineIstanbul Training and Research HospitalIstanbulTurkey
  4. 4.Department of Public HealthIstanbul UniversityIstanbulTurkey
  5. 5.Department of Neurosurgery, Cerrahpasa Faculty of MedicineIstanbul University-CerrahpasaIstanbulTurkey

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