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Multicenter Study
. 2024 Jun 5;190(6):458-466.
doi: 10.1093/ejendo/lvae053.

Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion

Betina Biagetti  1 , Marta Araujo-Castro  2 , Edelmiro Menéndez Torre  3 , Iría Novoa-Testa  4 , Fernando Cordido  4 , Eider Pascual Corrales  1 , Víctor Rodríguez Berrocal  5 , Fernando Guerrero-Pérez  6 , Almudena Vicente  7 , Juan Carlos Percovich  8 , Rogelio García Centeno  8 , Laura González  8 , María Dolores Ollero García  9 , Ana Irigaray Echarri  9 , María Dolores Moure Rodríguez  10 , Cristina Novo-Rodríguez  11 , María Calatayud  12 , Rocío Villar-Taibo  13 , Ignacio Bernabéu  13 , Cristina Alvarez-Escola  14 , Pamela Benítez Valderrama  14 , Carmen Tenorio-Jiménez  11 , Pablo Abellán Galiana  15 , Eva Venegas Moreno  16 , Inmaculada González Molero  17 , Pedro Iglesias  18 , Concepción Blanco  19 , Fernando Vidal-Ostos De Lara  19 , Paz de Miguel  20 , Elena López Mezquita  21 , Felicia Hanzu  22 , Iban Aldecoa  23 , Silvia Aznar  24 , Cristina Lamas  24 , Anna Aulinas  25   26 , Queralt Asla Roca  26   27 , Paola Gracia  28 , José María Recio Córdova  29 , Mariola Aviles  21 , Diego Asensio-Wandosel  30 , Miguel Sampedro  31 , Rosa Cámara  32 , Miguel Paja  33 , Ignacio Ruz-Caracuel  34 , Carmen Fajardo-Montañana  35 , Esteban Cordero Asanza  36 , Elena Martinez-Saez  37 , Mónica Marazuela  31 , Manel Puig-Domingo  30
Affiliations
Multicenter Study

Effectiveness of combined first-line medical treatment in acromegaly with prolactin cosecretion

Betina Biagetti et al. Eur J Endocrinol. .

Abstract

Objective: The aim of this study is to compare the response to first-line medical treatment in treatment-naive acromegaly patients with pure growth hormone (GH)-secreting pituitary adenoma (GH-PA) and those with GH and prolactin cosecreting PA (GH&PRL-PA).

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.

Keywords: acromegaly; cabergoline; dopamine agonist; first-line treatment; prolactin; somatostatin receptor ligand.

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Conflict of interest statement

Conflict of interest: The authors declare no conflict of interest.

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