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Review
. 2018 Sep;14(9):552-561.
doi: 10.1038/s41574-018-0058-5.

A Consensus Statement on acromegaly therapeutic outcomes

Shlomo Melmed  1 , Marcello D Bronstein  2 , Philippe Chanson  3   4 , Anne Klibanski  5 , Felipe F Casanueva  6 , John A H Wass  7 , Christian J Strasburger  8 , Anton Luger  9 , David R Clemmons  10 , Andrea Giustina  11
Affiliations
Review

A Consensus Statement on acromegaly therapeutic outcomes

Shlomo Melmed et al. Nat Rev Endocrinol. 2018 Sep.

Abstract

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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Conflict of interest statement

S.M. is a consultant for Chiasma, Ionis, Ipsen and Strongbridge Pharma and receives research grants from Pfizer. M.D.B. is a consultant for Ipsen and Novartis, a speakers bureau member for Ipsen and has received research grants from Novartis. P.C. has received unrestricted research and educational grants from Ipsen, Novartis and Pfizer as head of the Department of Endocrinology and Reproductive Diseases, Hôpitaux Universitaires Paris-Sud,has served as investigator for clinical trials funded by Antisense, Chiasma, Ipsen, Italpharmaco, Novartis and Pfizer and is a consultant for Ipsen, Novartis and Pfizer. All fees and honoraria are paid to his institution. A.K. is a consultant for Chiasma and Crinetics and has received research grants from Ipsen. F.F.C. is a speakers bureau member for Pfizer and has received research grants from Ipsen and Pfizer. C.J.S. is an advisory board member for Pfizer and a speakers bureau member for Pfizer and Ipsen. A.L. is a consultant for Ipsen and Novartis, a speakers bureau member for Ipsen, Novartis and Pfizer and has received research grants from Pfizer. D.R.C. is a consultant for Crinetics, Ipsen and Pfizer. A.G. is a consultant for Ipsen, Novartis and Pfizer. J.A.H.W. declares no competing interests.

Figures

Fig. 1
Fig. 1. A proposed algorithm for the treatment of acromegaly in patients inadequately controlled with first-generation somatostatin receptor ligands lanreotide autogel and octreotide long-acting release.
In partial responders (≥50% decrease in growth hormone (GH) and/or insulin-like growth factor 1 (IGF1)), increase somatostatin receptor ligand (SRL) dose and/or dose frequency. If IGF1 remains modestly elevated during SRL administration, add cabergoline to SRL. If disease control is not achieved, patients should be switched to the second-generation SRL pasireotide if there is clinically relevant residual tumour on imaging and/or clinical concern of tumour growth (tumour concern). Patients with impaired glucose tolerance should be switched to the GH antagonist pegvisomant. Patients with impaired glucose tolerance and tumour concern should be treated with a combination of a first-generation SRL and pegvisomant. Those who remain uncontrolled despite second-line medical therapy should be considered for stereotactic radiosurgery (SRS) or surgical intervention.
See this image and copyright information in PMC

References

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